The Problem

It is time that the full scope of Type 1 diabetes is acknowledged, which includes millions of adults who are too frequently misdiagnosed as having Type 2 diabetes, an altogether different disease.

Sunday, September 9, 2018

Reporting on the 2018 TCOYD ONE: The Ultimate Conference & Retreat for Adults with Type 1 Diabetes


Last year, I had such a great time at the TCOYD ONE Conference, that I signed up for the 2018 event.  Kudos to the amazing people at Taking Control of Your Diabetes (TCOYD), who outdid themselves again.  Type 1 diabetes camp for adults?  Sign me up!  The conference was held at Paradise Point Resort in San Diego—a great location.  Also, many thanks to the sponsors—as a result of conversations with Tandem and Dexcom reps and the approval of my awesome endo, I have the Tandem tSlim + Dexcom G6 (and the Basal IQ, which is the predictive low glucose suspend) on the way.  I also was able to purchase an excellent travel bag for all of my diabetes supplies, courtesy of Eu Go (eugodiabetestravelcase.com).  TCOYD filmed all of the talks, and the 2018 talks have been posted online (the 2017 talks are also available).

The talks were incredible.  Dr. Irl Hirsch never ceases to amaze—this year, Dr. Hirsch spoke about optimal use of CGMs, and he also spoke about how to use your CGM to do basal rate testing.  I was blown away by the talk by Dr. Anne Peters, who I have long admired and who advocates for those with adult-onset Type 1 diabetes.  Dr. Peters revealed that she had autoantibody tests performed on herself, she is positive for four of the five autoantibodies (but is not yet symptomatic), and she is the oldest person enrolled in Type 1 Diabetes TrialNet.  Dr. Peters spoke about the use of Type 2 drugs in Type 1, and personalized it by talking about the drugs that she is using to try to slow the progression of Type 1 in herself (liquid metformin, for example).  There was a panel discussion on Type 1 TrialNet.  The amazing Kerry Sparling led a group discussion about the good, the bad, and the ugly of Type 1 diabetes.  IMO, negative emotions/negative outlook are a huge factor in how well we can care for ourselves—and yes it is up to us as individuals, with the support of our diabetes team and loved ones, to do the 24/7/365 drudgery.  Dr. Bruce Buckingham and Dr. Rayhan Lal, both from Stanford, spoke about automated insulin delivery systems (closed loop systems using a CGM + insulin pump + algorithm).  Dr. Lal talked about Looping (DIY closed loop systems and #wearenotwaiting); he has put hundreds of patients on DIY systems.

Dr. Jeremy Pettus gave a great talk about the rapid acting insulins Fiasp and Affreza—Affreza is an inhalable insulin that is significantly faster acting than injectable insulins.  Fiasp is only slightly faster than Novolog and Humalog.

Following last year’s conference, I reached out to Dr. Irl Hirsch, and I was able to interview him for my blog on the topic of misdiagnosis.  This year, I ran into him and was able to thank him—he is the most gracious, most brilliant man.

Tips and tricks:

·       Wash your hands before performing a blood glucose test—even milk on your hands will skew the result!  Especially if you are using any kind of closed loop system (insulin pump + algorithm + continuous glucose monitor, wash your hands to be sure that you get a good result.
·       Pre-bolus before meals.  Humalog/Novolog are not that fast acting—it is good to pre-bolus by 15 or 20 minutes—figure out what works for your body.
·       Dr. Edelman was campaigning to get more widespread use of CGMs.  CGMs are a game changer, and really improve the lives of people with Type 1 diabetes!

I had a great time hanging with my tribe, the amazing women of the Type 1 women’s group that I attend in Oakland, California (thank you Amber, Hanneke, and Sarah!).  When I was walking to the start of the morning activity of power walking, I met Amber V, who was diagnosed with Type 1 in pregnancy (yes, autoimmune gestational diabetes is a real thing, but overlooked).  In a Facebook group, I had provided Amber V with my blog on autoimmune gestational diabetes—it was the first time she had heard of it!  Amber V and I shared a big hug.

Frequently amongst people with Type 1 you hear, “There is too much money to be made on treating those of us with Type 1 diabetes, so there will be no cure.”  I would challenge you to listen to these extraordinary men and women (Hirsch, Buckingham, Edelman, Peters, etc.) who are doing so much to improve our lives.  Many thanks to Steve Edelman, founder of TCOYD, and his team for putting on this extraordinary conference.

Sunday, August 5, 2018

Traveling with Type 1 Diabetes: Melitta’s Best Tips


I love to travel!  I got the travel bug from my mother; I had the good fortune to travel with her to many places (New Zealand, Africa, Turkey, Chile, Mexico, Canada, plus lots of the USA) before she departed this Earth.  Traveling with Type 1 diabetes is a challenge, but by being prepared (yes, I was a Girl Scout) it can be less challenging, and of course lots of fun.  Note that I wear an insulin pump and a continuous glucose monitor; that influences my tips.

(1) Make a packing list
I have a basic packing list on my computer, which I adapt for the needs of each trip.  List ALL of your needed diabetes supplies.  Like Santa:  make a list and check it twice!  I love a packing list!  Not only do my packing lists includes what clothes, shoes, and gear I will need, they also include all of my diabetes supplies.  I start with a core packing list and adapt it for the specific length and environment of each trip.   

(2) Like NASA, always have a backup plan in case things go wrong.  Have your backup supplies (lots!), and know that your devices may fail!
My insulin pump failed while on a remote island in the Bahamas.  I always carry both long and short acting insulin, plus syringes, so I just switched from my dead pump to MDI (multiple daily injections).  Some people like to carry an extra pump as backup—me, I like “old school” MDI.  While traveling in Bhutan, I accidentally dropped my testing kit without knowing it.  When I discovered the loss, after a moment of panic, I calmed myself by reminding myself that I had a backup bag with everything I needed.  Luckily, through the efforts of some fabulous Bhutanese guides, I was reunited with my primary kit. 

(3) Take your diabetes supplies in your carryon luggage—do not check it!
Luggage gets lost and things get stolen.

(4) Don’t put all of your eggs in one basket
You never know when your bags will get lost by the airlines, a purse snatcher will grab your bag, or when you will just lose something along the route.  So, split your supplies into multiple bags.  If you have a travel partner, have your partner carry some of your supplies.  If you are traveling solo, split your supplies between several bags.  Carry an extra glucose monitor, and remember spare batteries for all your devices.

(5) Get trip insurance (for some trips)
For most of my trips out of the country, and for some USA travel to remote locations, I get trip insurance.  Get coverage that offers medical evacuation and connection with local English-speaking doctors.  I use Travelguard—I still have never made a claim or used it, but it gives me and those with whom I am traveling peace of mind. 

(6) Wear a medical alert bracelet and carry a medical alert card in your wallet
For me this is something I do every day but on vacation it is even more important.  If you are unable to speak for yourself, these can be your voice in an emergency. 

(7) Carry lots of hypo treatments + things to fuel exercise
I carry lots of glucose tabs to treat lows, plus dried fruit and Gu packets to fuel my exercise (I prefer to set a temp basal for exercise, but sometimes you need fuel).  I also always carry glucagon—in 23+ years of diabetes, I still haven’t needed to use glucagon, but I still always carry it just in case.

(8) Be prepared to assist fellow travelers who have diabetes
When I was in Punta Cana, Dominican Republic, the sister of a woman with diabetes approached me in the resort dining room.  She saw my Dexcom on the back of my arm, and let me know that her sister had forgotten her insulin, and only had a little bit left in her insulin pump.  Since I carry lots of insulin, we were able to refill the woman’s pump.  I now have a beautiful custom necklace, courtesy of the PWD’s grateful sister, for that simple act of helping another PWD.

(9) In areas with lots of pickpockets, carry your daily supplies in a slash-proof security bag
I like PacSafe and Travelon security bags—I wear the bag crossbody.  This allows peace of mind in areas with lots of pickpockets such as Paris, or where theft is a concern.

(10) Have a note from your doctor, translated into the local language if you are traveling to a non-English speaking country
The letter should state that you have Type 1 diabetes, and include descriptions of everything you carry—insulin pump, CGM, extra insulin, syringes, glucagon kit.  The letter can help you get through security checkpoints, and not just at airports, but say at border crossings.

(11) Get necessary vaccinations for where you are going in the world

(12) Consider the food and water supply
If the local water supply is not potable, use bottled water or have a way to purify your water.

(13) Carry the medications that you may need
I carry Cipro, Pepto Bismol tablets, and anti-diarrheal medication.  Also, I find that I often catch a cold when traveling, so I carry the cold medications that I prefer (Sudafed and nasal spray don’t affect my BGs).

(14) If traveling by plane, consider wearing compression socks
These help with circulation, and help you avoid swelling of the ankles.  Also, move around!  I like to do yoga poses on the plane to help my circulation and to stay as comfortable as possible.

(15) Consider Global Entry or TSA Pre-check
I have Global Entry—it gives me TSA pre-check (easier to get through airport security) and makes it much easier to get back through US Border Control.

Most importantly, travel!  See the world and expand your horizons.  Have fun, life is an adventure!


Saturday, April 14, 2018

Reporting on Carb DM SF Bay Area Type 1 Diabetes Summit

I was fortunate to once again be able to attend Carb DM's SF Bay Area Type 1 Diabetes Summit, held on March 25, 2018.  Carb DM does a remarkable job in getting the best speakers on Type 1 diabetes; this year was no exception.

The talk that I found most interesting was the keynote speaker, Yiduo Wu PhD from the U.S. Food and Drug Administration (FDA).  Dr. Wu heads the FDA's Diabetes Device Branch, where he has been instrumental in getting diabetes devices to the market faster, while taking a patient-centered approach.  With his team, Dr. Wu approved the first automated insulin delivery system, the Medtronic 670G.  I think even Medtronic was surprised by how quickly it was approved!  Notably, the FDA was able to approved a patient request in just one day--patients in the 670G clinical trials petitioned to be able to remain on the device, and one day later their request was approved.  That is a patient-centered focus.  Later, I was in the lunch line with Dr. Wu, and was able to personally thank him for his work and encouraged him to keep it up.  Two days after Dr. Wu presented to us, the FDA approved the Dexcom G6.  Wow!

Another speaker, Dr. David Maahs of Stanford, spoke about the progress being made with automated insulin delivery devices (AKA the artificial pancreas).  I ran into Dr. Maahs as I was headed for another program, and had a brief conversation where I thanked him for his work, and told him that when I was diagnosed I never imagined I would see this kind of progress in my lifetime.  Dr. Maahs said, "We are in the golden age of Type 1 diabetes."

I attended breakout sessions on exercise for adults with Type 1, and a session on diabetes apps by MySugr's Kyle Rose.  Exercise has always been my biggest challenge, where I have the most problem with lows.  The exercise panelists represented a broad range of exercise types, and their tips were useful.

A big help for me always is the vendor fair.  I bought the perfect Dexcom G5 receiver case from Too Sweet Boutique--I like to clip my receiver to my pant loop when exercising and now have the perfect case.  I also spent a lot of time talking with the Dexcom rep, as I have just moved to the G5 and wanted information; I also spent a lot of time talking with the Tandem T:slim rep, as I have an Animas pump and will need to move to a new system soon.

Kudos to the founder and executive director of CarbDM, Tamar Sofer-Geri (mom to a T1 child) and her team for this excellent conference!  Next year's Summit will be held on Sunday, April 14, 2019.