It’s that time of year again-the time where we all consider making positive changes in our lives for the coming calendar year. And, what better than to make a diabetes-related new year’s resolution? We’ve curated a list of tips to help improve your diabetes self-management based on the last year of research articles reviewed by the CWD Team.
1. Get a CGM if You Can
All signs point to Time-In-Range as the new standard of care for diabetes management, and it’s quite difficult to get an accurate measurement of your glucose’s time in range (TIR) without the use of a continuous glucose monitor (CGM).1 The good news is that there is more than one option available for many people living with diabetes, so there are some options. The bad news is that there are still many barriers to using CGM, most notably cost2 as well as things such as provider bias.3
The current CGM’s available in the U.S. market are:
- Medtronic Guardian (available with OR without their insulin pump)
- Dexcom G6 (Dexcom G7 coming early 2023)
- Abbott Libre 2 and 3
The best way to determine which is right for you is to see which fits your lifestyle the best. There are many different factors, including if the CGM works with the insulin pump you use (or want to use), if your insurance covers it, and what you’re looking for in the CGM system. There’s a great website, Diabetes Wise, that presents information about diabetes technologies from an unbiased perspective and can help you decide what’s right for you.
2. Adjust Your Bolus Based on Your Meal
Obviously, if you’re eating a very high carbohydrate meal, you’ll have to take more insulin compared to when you eat lower carbohydrate. But, in addition to adjusting the amount, the timing of the bolus is equally important! If you are taking your bolus right when you sit down to eat and you’re using one of the insulin analogs (Admelog, aspart aka NovoLog, lispro aka Humalog), odds are the insulin will not start working in time to keep your post-meal blood sugars from going up. It can be hugely beneficial to take at least some of your bolus up to 20 minutes before you eat,4 unless you are using Afrezza.
In contrast, there are some meals that have higher fat or protein content, or both, and, in this case, if you take too much insulin up front, you’ll find yourself riding some serious blood glucose roller coasters. You will go low and then high for possibly hours, which can be so frustrating! So, if you find yourself eating pizza, a protein bar or something similar, you’ll actually want to do an extended bolus (also called dual-wave).5 With this type of bolus, you ask the insulin pump to give you a certain percentage of insulin up front while the rest is given over an extended time frame. Typically, healthcare providers will recommend starting with a 50-50% ratio over two to three hours, and sometimes longer if it’s a higher fat meal, and adjusting based on your blood sugars’ reaction. You can also do this with injections by dividing up your doses into multiple injections over time, and if you do this – you are a hero committed to your health!
3. Think Outside the Diabetes Box
There are so many different technologies, insulins, other medications, types of health care providers, etc., for diabetes, and finding what works for you best can be a game-changer. It can be helpful to learn about what other people in the diabetes world are doing and note what health care professionals and/or organizations are saying. For example, there are many people who have type 1 diabetes who are taking medications designed for people with type 2 diabetes, such as SGLT-2 Inhibitors6 or GLP-1 agonists.
There are people who prefer to see an endocrinologist for their care and others who see a family health care professional instead. As long as you are getting the care you need and meeting your goals for diabetes and general health, it doesn’t really matter. The pandemic has also shown us that telemedicine is a very viable option for PWD.7 Some people prefer to eat low carb diets, while others do not. It’s not a one-size-fits-all condition, and it changes over time depending on what stage of life you’re in.
Trying new things to manage your diabetes is an important part of your diabetes journey, and crowd sourcing is a great way to see what different people have found works for them. This is where being involved in the diabetes online community or having friends with diabetes can make a huge difference.8 If you’re looking to meet others with T1D, check out cwd.is/community for upcoming online and in-person events as well as reports from our past events.
4. Taking Care of Your Mental Health is Equally Important to Your Physical Health
This goes for people with diabetes, caregivers and loved ones alike! A focus on mental health has been part of the core of CWD since its inception, and continues to be a cornerstone of the Friends for Life conference curriculum. There are many studies that show that mental health, among other psychosocial factors, affects diabetes management outcomes as well as quality of life.9 So, making sure that you are staying mentally well through all the chaos of life, diabetes, and of course a pandemic, is incredibly important!
That goes for caregivers, also – especially mothers. In our recent article, The Burden of Diabetes on Mothers, we discussed the new research showing how mothers bear the brunt of diabetes burden for most families. And, when we polled CWD Moms, their replies reflected the research with 47% saying they are struggling with coping. This can also negatively affect your child’s diabetes, in case you need a child-focused reason for helping yourself this year.
Remember it’s Just Data
CWD’s founder, Jeff Hitchcock, has been quoted in multiple books about diabetes management. In Adam Brown’s Bright Spots & Landmines, one of the things included, “BG numbers are NOT good or bad. They are just information to make a decision. No judgement, no blame.” (p. 93) It is so easy to get caught up in the moment with blood sugars that are out of range, but it’s important to remember that diabetes is hard. Diabetes is so difficult that there are special titles for health care professionals, like Certified Diabetes Care and Education Specialist, whose entire job is helping people with diabetes.
By the way, those of us that have T1D and are CDCES’s still don’t get it right every time and have 100% time in range. But we keep trying and working towards our goals, and that’s all we can do. Cheers to the new year and best of luck to you in whatever resolutions you make this year – diabetes or not.
References
- Time-in-Range vs. HbA1c
- Barriers to Continuous Glucose Monitoring in People with Type 1 Diabetes: Clinician Perspectives
- The Impact of Implicit Bias on Prescribing Habits in Type 1 Diabetes
- Let’s Get Ready to Bolus
- Bolusing for Fat & Protein
- Type 1 Diabetes and SGLT-2 Inhibitors
- Telemedicine and Diabetes
- Why We Need Friends with Diabetes (FWD)
- Psychosocial Factors in Type 1 Diabetes
Written and clinically reviewed by Marissa Town, RN, BSN, CDCES
