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What are Basal IQ™ and Control IQ™ technologies?

tSlimX2 insulin pump with basal IQ

Tandem Diabetes Care announced that they will be offering Control IQ™ technology to those using their t:SlimX2 insulin pumps in the US. This is on top of the Basal IQ™ technology that is already available in the US and set to be launched in Canada in the coming months. But what do these new technological features really mean to people with type 1 diabetes? How do they differ from the features currently available on the Medtronic 670G? Here is what we found out.

What is Basal-IQ™ technology?

basal IQ tSlimX2

Basal IQ™ is a predictive low-glucose suspend algorithm that can be installed on Tandem’s t-SlimX2 ™ insulin pumps.  It utilizes the sensor values from an integrated Dexcom G6 sensor to help reduce the frequency and duration of a hypoglycemic event (low blood sugar). Because this system works with the G6, no calibration is required.

Basal IQ™ technology is essentially the bottom half of a closed-loop.  It reduces hypoglycemia by suspending insulin delivery when a low is predicted. It does not increase basal rates or correct highs, however.

How does Basal IQ™ technology work?

According to SixUntilMe, Basal IQ™  looks 30 minutes into the future and then uses its algorithm to decide what to do. If glucose levels are predicted to drop below 4.4mmol (80mg/dl) or if it are currently below 3.8mmol (70mg/dl) and dropping, basal insulin delivery is stopped.  Basal-IQ™ will then resume insulin delivery once the blood glucose levels start to rise.

Can Basal IQ™ be turned off?

Yes! If you don’t want to use this system or are not currently using a Dexcom G6, this feature can be turned off.

How do you get Basal IQ™ technology

You first need to have a t:slim X2™ insulin pump.  You will then have the option to add the Basal-IQ technology to your insulin pump by uploading the remote software.  If you are purchasing a new insulin pump from Tandem, your new pump may already be loaded with this latest addition. Contact your sales rep for more details or your country’s Tandem office for details on availability.

What is control IQ technology?

Control- IQ™ technology is another part of the closed-loop equation.  It allows the t:slim X2™ insulin pump to again work with the Dexcom G6. This time they use a built-in algorithm to adjust basal insulin delivery and give automatic correction doses of insulin.

How does Control- IQ™ technology work?

As Diatribe explains, Control-IQ™ technology uses a closed-loop algorithm to keep users between 3.9-10 mmol  (70-180 mg/dl) as much as possible.  It looks at the predicted CGM value for 30 minutes in the future and:

  • if a reading is going to be above 10mmol (180 mg/dl) it will give a correction bolus.
  • If it is going to be above 8.9 mmol (160 mg/dl) it will increase the basal rate
  • If it thinks blood sugars will be between 6.2-8.9 mmol (112.5-160 mg/dl) it will maintain the user’s default setting
  • If it thinks that glucose levels will drop below 6.2 mmol (112.5 mg/dl), it will decrease the amount of basal insulin.
  • If it thinks that readings will drop below 3.9mmol (70mg/dl), it will turn off the basal insulin

Users must still bolus for meals and there will only be one automated correction per hour during the day.

Can Control- IQ™ technology be turned off?

Most likely. We are unsure at the moment if this option can be turned off but since Basal-IQ can be turned off, we would assume that this is also an optional feature.

How do you get Control- IQ™ technology

For those living in the US, watch your email box for updates on how you can remotely upgrade your system.

How does Control-IQ and Basal IQ differ from the Medtronic 670G technology?

looped insulin pumps

The Medtronic 670G works with the Guardian sensor to adjust basal insulin delivery. It will give more insulin if the sensor says the user is starting to trend above 6.7mmol (120mg/dl).  If the sensor suggests that the user is going low, it will deliver less insulin or suspend insulin delivery.

Guardian sensors must be calibrated at least twice per day or every 12 hours, unlike the Dexcom G6 which does not require calibration.

The 670G will NOT give automatic correction boluses based on high CGM readings. If you miss a meal bolus on the 670G, you will still go high. The pump will only increase the basal insulin to a certain point but will not give a large correction bolus on its own.

What are their similarities?

  • Both require the use of a CGM
  • Both the Tandem and Medtronic systems require users to manually input food boluses.
  • Both systems will correct with an increased basal amount if you make a mistake in your bolus and run high (the amount of correction varies with each system)
  • Both systems can be turned off if the user does not want to avail of the technology

Basal IQ™ and Control IQ™ technologies automatically adjust your background insulin by increasing or decreasing it based on CGM readings. If you are not using a Dexcom G6 CGM, these options will not be available to you. Those using a Dexcom who wish to avail of these new technologies, will need to keep in touch with your Tandem rep for updates on when they will be available in your area.

Please note, according to information from Jake Kushner (and confirmed by industry sources) if you upgrade to Control-IQ™, the t:SlimX2 can’t currently be downgraded back to Basal IQ ™ .

Remember that Control IQ ™ works to minimize highs and lows but does it with a different algorithm than Basal IQ ™. Review the two options with a health care provider to decide if Control IQ ™ is right for you.

If you haven’t decided on an insulin pump yet or are unsure on where to start researching them, our insulin pump ebook can help. It provides you with a list of questions to ask yourself as well as potential reps before you commit to buy.

What you should know about ketones

Ketones (pronounced key-tones) are produced by the liver. They occur when the body breaks down fat for energy instead of getting energy from the carbohydrates found in your diet. If your diet does not contain enough carbohydrates to supply the body with sugar(glucose) for energy or if your body cannot use blood sugar (glucose) properly, stored fat is broken down and ketones are made.

Why do we care about ketones when we have type 1 diabetes?

People with type 1 diabetes need to worry about ketones because they make the blood acidic. As the acid in the blood builds up it can quickly lead to a life-threatening condition called ketoacidosis or DKA.     

What are the symptoms of diabetic ketoacidosis (DKA)?

high blood glucose

The symptoms of DKA include:

  • Dry mouth
  • Feeling thirsty
  • Frequent need to urinate
  • Confusion
  • Extreme fatigue
  • Flushed skin
  • Fruity breath
  • Nausea
  • Labored breathing
  • Stomach pains
  • Vomiting

The most severe symptoms of diabetic ketoacidosis are loss of consciousness, diabetic coma, and death.

How do I check for ketones?

testing for ketones

The two main ways to check for ketones are through urine or blood. You can purchase sticks from your pharmacy that can be peed on or dipped in urine. They will change colour and give you a historic indicator of ketones in your body.  This method is preferred by some because of its low cost.

The more immediate and reliable way to check is with a blood ketone meter. Just like using a glucometer, you apply blood to the ketone test strips and it will provide a blood ketone reading. This reading will tell you if you have ketones in your system at that moment.  Test strips for a blood ketone meter are around a dollar each versus the few cents to purchase Ketostix®.

When should I check for ketones?

when to call a doctor

You should check

  • any time your blood glucose level is over 17 mmol (300 mg/dL)
  • Any time your blood glucose level has been over 13mmol (234mg/dL) for an extended period
  • When you are ill
  • If you have experienced a pump failure
  • You are vomiting
  • You are showing any of the above-mentioned symptoms
  • At times indicated by your clinic and/or their sick day protocol

What causes ketones?

They can occur when your blood glucose levels are high for an extended period of time.  This could be because

  • You forgot to take your insulin
  • You didn’t take as much insulin as prescribed or as needed
  • Your insulin pump failed
  • You are sick or have an infection
  • You are on a carb restrictive diet

What do the readings mean?

Trace amounts of ketones may occur after fasting, when following a ketogenic diet, or even upon waking up.  If these levels increase or are over 3mmol, you should consult your doctor.

What to do if I have ketones?

getting rid of ketones

As mentioned, ketones can be very dangerous for a person with type 1 diabetes. It is important to begin to flush them out of your system with large amounts of water.  You also want to bring down your blood sugar levels with insulin.  The amounts required to do this will vary.  You should always contact your doctor if you are spilling ketones and unsure what to do.

If you are vomiting or the ketones have persisted for a period of hours, contact your doctor or head straight to the nearest emergency room. Diabetic Ketoacidosis can escalate to a dangerous level very quickly.  IV fluids may be required to help you get things back under control.

Stay prepared by keeping a copy of our ketone chart handy.

What you need to know about checking your blood glucose levels

glucometer

When you are diagnosed with diabetes, one of the first things that your clinic will do is to give you a blood glucose monitoring kit (a glucometer).  It is vital that you learn how to use this kit because checking blood glucose levels allows you to better manage your diabetes. These readings will help you and your diabetes team know when you need more or less insulin.

How often should I check my bg levels?

checking blood glucose levels

According to Diabetes Canada’s Clinical Practice Guidelines, people with type 1 diabetes and those with type 2 who are on insulin, should at minimum be checking their blood glucose levels at least three times per day.  “More frequent testing before meals, two hours after meals, as well as overnight is often required to provide information to reduce the risk of hypoglycemia and well as night-time lows.”

Most people living with type 1 diabetes who wish to maintain tight control are checking their blood glucose at least 8-16 times per day.  They will want to monitor their range after food, before and after exercise, as well as during illness and times of stress. This information allows them to make changes to doses as well as to correct high or low blood sugars throughout the day and night.

Which glucometer should I use?

choosing a glucometer

There are many different glucometers available. Just like finding the right insulin pump for you, finding the right glucometer is a personal decision. You can use the kit that your clinic sent you home with or you can consult with your local pharmacy to find one that better fits your needs.

According to Top Ten Reviews, the Dario LC Blood glucose management system is the best overall blood glucose meter. It requires only 0.3 microliters of blood, gives results in under six seconds and does not require a battery.

The Accu-Chek Guide gets their stamp of approval as the best for sampling ease.  It provides results in four seconds but also requires 0.6 microliters of blood.

They rate the Bayer Contour Next One as having the best smart features. It gives results in five seconds but requires 0.6 microliters of blood.

A 2018 study published in the American Diabetes Association Journal also listed the Bayer Contour Next as the best glucometer, followed by the Roche Accu-Chek Aviva Plus meter.

How do I check my blood glucose?

Every glucometer is different but here are the basic steps to check your blood glucose levels.

  1. Thoroughly clean your hands.
  2. Remove a test strip from the container that goes with your glucometer and insert it into your machine.  This will turn on the glucometer.
  3. Wait for the blood drop icon to appear.
  4. In the meantime, lance your finger with a small, sharp needle called a lancet or poker. 
  5. Bring the fresh drop of blood to the side of a test strip and allow the blood to be sucked into the strip.  
  6. Within approximately 5 seconds a reading will appear on the glucometer’s screen. 
  7. Log the reading down in your logbook and follow your diabetes care team’s instructions on whether or not you need to correct the reading with more insulin, eat more food to bring up a low blood glucose level, or if you are fine to continue with your current activities.

If these guidelines differ from what you were advised by your clinic or the glucometer manufacturer, always follow the instructions that you received from them. These guidelines for your reference only and do not replace medical advice.

Should I use a continuous glucose monitor or a glucometer?

continuous glucose monitors

Some continuous glucose monitors (CGM) and flash monitoring systems like the Dexcom G6 and Libre do not require you to calibrate with a glucometer.  The decision of whether to use one of these systems or not is a personal one that should be discussed with your diabetes team. 

If you do use a CGM, make sure to always use a glucometer if you feel that the readings are off or you feel that you are low but your sensor says otherwise.

Learn more about what to consider when purchasing a CGM.

What do I do with my glucometer readings?

diabetes logbook

It is important to keep track of your blood glucose readings. This can be done digitally by uploading your readings to an app provided by the manufacturer or saving them on an excel spreadsheet. You can also manually log your readings on sheets or in a logbook.

No matter how the information is stored, it is important to review it regularly.  You can do this with your diabetes team as well as on your own.  While your diabetes team may not want you to make adjustments, you will be able to see times when you are having problems and bring it to their attention in between your scheduled appointments.

Grab our free checklist of things to consider when you are searching for a glucometer.

Why we need a cure for Type 1 diabetes

why we need a cure for Type 1 diabetes Diabetes Advocacy

According the data acquired by Beyond Type 1, in the US there are approximately 1.25 million Americans living with Type 1 diabetes. In Canada, the figure is thought to be over 300,000 and in the UK it is estimated that 1 in every 430-530 people under the age of 19 has Type 1 diabetes. The number of diagnoses each day keeps growing, as does the number of deaths. We need a cure for Type 1 diabetes.

The general public often thinks that diabetes is no big deal.  You inject some insulin or perhaps you wear an insulin pump that injects it for you.  You avoid sweets and get on with your life. There is nothing to it.

too much insulin can be deadly Diabetes Advocacy

What they don’t understand is that too little or too much insulin can be deadly. They have no idea of how difficult it can be to get just the right amount of insulin to cover a meal, deal with an illness, or manage a stressful situation.

Fat content, the amount of protein, complex carbohydrates, simple sugars, exercise, activity from two days ago, illness, stress, and anxiety are just a few of the many things that impact blood glucose levels at any given time.  It is easy to become overwhelmed and depressed.

A cure would mean the end of diabetes-related depression

depression and diabetes Diabetes Advocacy

Again, the daily grind of constantly monitoring everything that you do, feel and eat can be stressful.  High blood sugar levels can cause depression. Fighting lows can create fatigue and depressions as well. When you are depressed, it can make it impossible to function properly or even get out of bed.

If there was a cure, people with Type 1 diabetes wouldn’t be worried about how to pay for their supplies

financial stress from diabetes Diabetes Advocacy

Highs and lows can cause depression but the stress of trying to figure out how you will pay for your diabetes supplies can also create anxiety and depression.

Diabetes is an expensive disease to properly manage.  You must be able to afford insulin (which if you live in the US, is no small feat!).  You will need to check your blood glucose with a glucometer and test strips at least or, ideally, monitor it with a continuous glucose monitor.

Finally, you must somehow be able to get the insulin into your body either through multiple daily injections or an insulin pump. All these things cost money and must be used multiple times during the day.  The costs quickly add.

Read about how much it costs to live with diabetes

If there was a cure for Type 1 diabetes, we would no longer fear missed diagnoses

symptoms of highs and lows

The symptoms of type 1 diabetes often look like the flu.  You feel tired and nauseous.  You are thirsty and need to use the washroom a lot. 

Even doctors can overlook the obvious signs of diabetes and treat you with antibiotics to cure the flu. When you have Type 1 diabetes, not getting insulin right away can be deadly. If we had a cure for diabetes, we wouldn’t have to fear a diagnosis being overlooked. We could give a person the cure just in case and save their life!

If there was a cure for Type 1 diabetes, it would no longer kill our children

we need a cure for type 1 diabetes

Whether it is dead in bed, depression, insulin rationing, or misdiagnosis, type 1 diabetes is deadly. It is not the “no big deal” that the general public often believes.

This past weekend, our community lost another child.  She was 23 years old.  She was a mother, a sister, and a daughter gone far too soon.  Sadly, she was not the only one with type 1 diabetes to die this week.  By one person’s count, she was the third person that they had heard of this week.  Three people living with type 1 diabetes dead in one week.

I wish I could say that was rare but it isn’t . I wish I could say that this is the first family that I had known for years to lose a loved one but it isn’t.  My heart breaks.

Type 1 diabetes costs countries millions of dollars in health care and lost wages. It costs families in stress, worry, financial hardship and grief.  The cost to the individuals living with type 1 diabetes is the highest.

For them, the constant stress of blood glucose checking, insulin dosing, carb counting, paying for supplies, visiting clinicians, and the unpredictable swings of blood glucose levels is unimaginable. For those individuals living with type 1 diabetes, the ultimate cost of living with this disease can be quality of life and even life itself.  We need a cure.

Please consider supporting organizations that work towards a cure for type 1 diabetes.

Download the signs of high and low blood glucose levels.

How to enjoy tasty treats over the holiday season with diabetes

tasty eating with diabetes over the holidays

If you live with diabetes, holiday eating can be stressful. You may worry that you can’t enjoy tasty treats over the holiday season when you have diabetes.

We have you covered! Previously we provided you with a few tips for handling parties and events.  Now we want to share with you how to enjoy tasty treats when you have diabetes—type one or type two or even celiac disease!

Meals and eating shouldn’t be stressful but when you live with diabetes or a food-related illness, your anxiety levels can quickly go through the roof over the holiday season. Previously we provided you with a few tips for handling parties and events.  Now we want to share with you how to enjoy some tasty treats when you have diabetes—type one, type two, or celiac disease. 

Holiday eating with type 1 diabetes

holiday eating with type 1 diabetes

If you have type 1 diabetes, you know that you really can eat anything but poison and simply dose for the carbohydrate count.  Granted the actual process is a little more complex but basically, if you have insulin and a carb count, you can eat to your heart’s content.  This can be a great way for parents of children with diabetes to navigate those holidays meals—count carbs and dose accordingly allowing the child to just enjoy being a child during this time. 

As you age, many adults want to have a bit tighter control and you may begin to restrict your food choices a bit more. You may be reducing the number of complex carbs you are eating or even trying out the keto method of eating. 

Whether you are counting carbs and dosing or carefully monitoring your food intake, a good carb counting app can be a lifesaver to enjoy tasty treats when you have diabetes.  A few that we recommend are Calorie King, MyFitnessPal, and the Fitbit food diary.  All of them can be used to give you the nutritional analysis of many of your favourite foods.  If you are stuck, Google will also provide you with a quick estimate of carbohydrate counts for many foods.

Holiday eating with type 2 diabetes

holiday eating with type 2 diabetes

If you are living with type 2 diabetes, you may want to be a bit more cautious about carb counts and look for lower-calorie options.  Consider things like cauliflower mashed potatoes as a healthier alternative to traditional mashed potatoes. Instead of canned cranberries, this year, make your own cranberry sauce so you can control the sugar and preservatives. There are even some lower-calorie desserts like sugar-free pumpkin bread for you to try. 

There are two big things to remember when you are watching your calorie intake over the holidays. First is that sugar-free does not always mean lower carbohydrates.  Always make sure to thoroughly look at the nutritional analysis of your food before making decisions whenever possible.  The second thing is to note that many sugar-free candies and baked goods use sugar alcohols to replace sugar. Sugar alcohols can cause diarrhea if you consume too many so be forewarned!

Holiday eating ideas when following a Keto Diet

holiday eating on keto

Keto diets have become more and more popular for people who are watching their weight.  Some people living with diabetes also feel that this diet makes it easier for them to manage blood glucose levels. We advocate for healthy eating which includes a variety of foods but if you feel that keto is the right way for you to eat and your doctor agrees, then here are a few food ideas that you might find tasty this holiday season!

Gluten-Free Holiday treat ideas

gluten free holiday eating

Many people living with type 1 diabetes also have to deal with celiac disease.  This adds a new challenge to holiday eating.  Thankfully there are many amazing bakers who have given us many great recipes to try.  You can also purchase a lot of gluten-free treats online or through local grocers.

Remember that many of the holiday table staples are naturally gluten-free.  Mashed potatoes, sweet potatoes, carrots, and peas are all naturally gluten-free.

You can make your traditional gravy but make it gluten-free when you substitute cornstarch for your traditional flour.  There are many online recipes for gluten-free rolls or you can make biscuits with gluten-free Bisquick. Thankfully there are also thousands of amazingly tasty cookies and other baked treats that you can enjoy, just make sure to keep a close eye on the carb count of these items.  They can be higher than their gluten-made counterparts because of the variety of flours being used.

With a bit of planning, you can enjoy tasty treats when you have diabetes

tasty eating with diabetes

The holidays can be stressful but with a little planning, it can be manageable and you can enjoy tasty treats when you have diabetes

If you are a baker, make some of your own tasty treats this holiday season. Make sure to put them away in the freezer to keep them from being eaten all at once.

When you make your own food, you will be able to monitor the sugar content and know exactly what is in what you are eating.  This will also make it easier for you to count the carbohydrates.  Treats can then be brought with you to family functions or evenings with friends. Everyone will enjoy your treats and you can relax knowing that they are safe for you to eat.

If you are not a baker, make choices that you can be more confident of the ingredients and carb counts. Enjoy fruit platters and veggie trays when you are out.  Your waist will thank you in January!

The holidays are also the perfect time to support local businesses.  There are more and more bakers who are paying attention to the ingredients that they use. Attend local fairs, craft sales or look for a small store in your community that is dedicated to offering healthier options for their clients.  You may find some incredible gems that you can enjoy throughout the year!

How do you enjoy tasty treats when you have diabetes? We’d love to hear what works for you!

Read more tips on managing the holidays with diabetes.

How to have a diabetes meltdown day

Out of nowhere, my son came to me one day and said, “Mom, I think it’s about time for me to take a diabetes meltdown day. You know, like the kind of day that Joe mentioned? A day where I get to complain about how much life with diabetes sucks and you will just tell me I am wonderful and do everything for me.”

Ah yes, I remembered.  If you have never had the chance to listen to Joe Solowiejczyk talk about a diabetes mental health day, you are missing out.  Joe has lived with type 1 diabetes forever. He is a nurse as well as a family therapist who specializes in helping families living with type 1 diabetes. He advises that every once in awhile, everyone needs to have a meltdown for the good of their mental health.

If you live with type 1 diabetes, you get tired. I am not talking the regular, I haven’t slept tired. I am talking about the mental and physical exhaustion that comes from bolusing, testing, counting carbs, and treating highs and lows numerous times every single day of your life.

It is not surprising that after years of this life, people with diabetes become depressed or burnout.  For the good of your mental health, a diabetes meltdown day is an option.

What is a diabetes meltdown day?

diabetes meltdown day Diabetes Advocacy

According to Joe Solowiejczyk, every once in awhile, it can be therapeutic to simply spend the day hating your diabetes.  Allow yourself to wallow in how crappy things are and be supported by your friends. You get to do this for a full 24 hours or until you have had enough.

How to plan for your diabetes meltdown.

Before you can have your diabetes meltdown, some plans must be made.

  • Have a loved one available to take care of your diabetes needs for the day.
  • Make sure that you have friends who are willing to call and text you every hour to tell you how brave and wonderful you are.  They should pile on the compliments and empathy like there is no tomorrow.
  • Have a glucometer or other diabetes device ready that you can sacrifice under the wheels of your car.
  • Line up your favourite feel-good movies or tv shows that you can binge-watch all day long.
  • Fill your freezer with your favourite ice-cream flavours and make sure you have enough insulin to cover your misery.  
diabetes meltdown

How to have a diabetes meltdown.

Step one

Once you have everything set up and are ready to take your mental health day, the first thing to do is to take that glucometer (or whatever device you have decided to use) outside and run it over.  Put it under your car’s wheels and crush it like you would love to crush your diabetes.

If it is a child with diabetes who is having their meltdown day, take them to a safe place, give them safety glasses and a hammer and let them pound out their frustrations on the device.

Step two

Next, you can settle into your day of feeling sorry for yourself.  Have your loved one or dear friend check your blood glucose levels for you.  Keep your phone near to you and fully charged so that you can receive all of your phone calls and text messages.

Find your most cozy pj’s and blanket and settle in.  Get your bowl of ice-cream and have your support person tell you how amazing you are for counting carbs and injecting every day as they give you the insulin you need to cover your food. 

Step three

Begin to binge-watch your favourite comedy or sappy show while managing your messages of empathy and support.

Keep this up for as long as you need.  Allow yourself to just hate having diabetes.  Give yourself the chance to set your mind free watching something that makes you feel happy.

How long will it take?

It is your mental health and your break. You can do this for as long as you like over the course of 24 hours. For my son, well it didn’t last very long.  He liked the break but soon felt like getting back to his life.

The moral of the story

The point behind Joe’s diabetes meltdown day was simply a day to allow yourself to feel, grieve, and take a break.  Perhaps you don’t have someone who can come over and care for you for a day but you probably have an old glucometer that you no longer need.  Put it under the wheel of your car or take a hammer to it. Release some of your frustrations in a relatively harmless way.

You may not like ice-cream.  Go for a walk or exercise instead.  Do something that is a pleasure for you that has nothing to do with diabetes care. Perhaps you would rather lose yourself in a book rather than a tv show. Again, it is okay. Do whatever allows you to focus on your mental well-being and unclutter your mind.

Take time to look after your mental as well as your physical health with diabetes

Create your own diabetes meltdown day and customize it for your own needs.  Take a day, an afternoon, or just an hour and make it all about you and not you and your diabetes. Find a safe way to put diabetes out of your mind for a period of time.  Focus on refreshing yourself and allowing yourself to recharge in a safe and healthy way.

Check out our Diabetes Planner for more mental wellness tips.

Is a Continuous Glucose or Flash Monitor is right for you?

A Continuous Glucose Monitor (CGM) or Freestyle Libre Flash Monitor can be a wonderful device to add to your diabetes tool kit.  It is important that you work with your healthcare team to decide if either a system is right for you. Once you decide that you need to have one, here are a few things to think about when considering using a Continuous Glucose Monitor or Libre Flash Monitor.

What is a Continuous Glucose Monitor?

continuous glucose and flash monitoring systems Diabetes Advocacy

A Continuous Glucose Monitor is a small device worn under the skin that uses interstitial fluid to monitor blood glucose levels. It then transmits readings to a receiver and allows a person with diabetes to have a guide to what blood glucose levels may be at a given time and whether they are expected to rise or fall in the near future.

See a complete list of CGMs available in North America here.

Is a Continuous Glucose Monitor the same as a Flash Monitor?

Flash vs CGM Diabetes Advocacy

No, a continuous glucose monitor is constantly transmitting blood glucose levels to a transmitter.  A Flash monitor, however, provides snapshots of blood glucose levels.  You scan the sensor and it will give you your reading at that time as well as show your historical trends.

Do I have to wear an insulin pump to use a CGM or Flash Meter?

No.  The Libre© Flash meter, Dexcom©, Guardian™ Connect CGM and Eversense© CGM are considered stand-alone devices.  The Dexcom© will work with some insulin pumps but all of these systems can also be used by people using multiple daily injections.

Which CGM talks to my insulin pump?

The Dexcom© and the Guardian© systems both work with an insulin pump, transmitting data directly to specific insulin pumps.

Should I get a Continuous Glucose or Flash Monitoring system?

There are many reasons to get a CGM or flash monitor as well as a few reasons why they may not be a fit for you.

The upside to using a continuous glucose monitoring system include:

  • These systems provide you with a lot of information to make treatment decisions. It shows how your readings have been as well as where they are at any given moment.
  • It provides peace of mind with trending graphs and predictive algorithms that can tell you if your blood glucose levels are rising or falling to dangerous levels.
  • Blood glucose readings at a glance without needing to lance your finger.
  • Historical trends make it easier to make adjustments basal patterns and bolus ratios

There are some also some downsides to having a CGM:

  • If you don’t have insurance coverage, these systems are expensive and can be cost-prohibitive
  • It is another piece of equipment to wear on your body.  For small children, with very limited body mass, it can be difficult to place both an infusion set and a CGM on their young bodies.
  • While these systems are becoming much more accurate, you cannot always completely rely on them and fingersticks are still relied upon when there is any question of accuracy.
  • CGMs alert you to rising and falling bg levels.  These alerts can be bothersome at times.
  • Sometimes all of this data can be a bad thing.  You can become obsessed with the numbers and experience information overload.
  • Some people experiencing skin reactions to the adhesive.
  • The insertion of CGM sensors can be painful for some.

Ultimately when considering using a Continuous Glucose Monitor or Libre Flash Monitor, the decision is up to the individual.  It is simply another diabetes management tool that can be used to help tighten blood glucose control.   

Visit our CGM page to compare all four products or download our free comparison of key features.

Life Before and After an Islet Cell Transplant

islet cell

Words like “The Edmonton Protocol” and “islet cell transplants” are ones that people with type 1 diabetes have read with great enthusiasm over the years.  When news of the Edmonton Protocol was first released, many wondered when they would be able to sign up to be cured.  In the summer of 2007, I learned that this was a therapy and not a cure.

What is an islet cell transplant?

An islet cell transplant requires the isolation of islet cells from a donor pancreas.  Approximately 500,000 cells are isolated from one donor.  They are then transplanted into a waiting recipient. Each recipient requires at least 300,000 cells and will need a second transplant within a few months of the first to successfully reduce or remove the need for injected insulin.

One Step Up From a Lab Rat

One step up from a lab rat

I was recently given the opportunity to learn a lot more about the Edmonton Protocol and the people who have received islet cell transplants.  Donna Marcelissen asked me if I would be interested in reading her book “One Step Up From a Lab Rat”.  It was a self-published book about going through the transplant process, what led her there and what happened after. I jumped at the chance to learn more and was amazed by what I read.

The experience of an islet cell transplant recipient

Donna had had type 1 diabetes for over 20 years before getting her first islet cell transplant. In her book, she explains that her successful business had to be scaled back over time because of severe neuropathies of the stomach, chest, hands, and legs.  She was using injected Gravol daily simply to be able to function.  She also was going blind despite 23 eye surgeries and was hypoglycemic unaware.  Donna stated that “most people believe that insulin and diet are all that a diabetic needs to follow in order to live a healthy, complication-free life….however, this is a disease and how the body reacts to it is not predictable.” My heart broke.

Even though Donna was experiencing incredibly debilitating complications because of type 1 diabetes, she was cautious about subjecting herself to the Edmonton Protocol. She was one of the very first thirty-five people to receive this treatment.  She knew very little about the process and there was no one to ask if the challenges would be worth the results. As Donna filled out forms and subjected herself to further testing to see if she was an eligible candidate for the process she began to fear not being able to have the transplant.

 “This transplant would alleviate the guilt of feeling there should be something more I could do.  We could begin to make future plans.”

The financial burden of islet cell transplants

Donna Marcelissen lived in Ottawa and had to relocate to Edmonton for at least one year.  They had to pay out of pocket for a second home and all of its expenses in Alberta while continuing to maintain their family residence in Ontario. Donna and her husband were also responsible to cover the $3000 airfare to fly at a minute’s notice to Edmonton to have the first procedure done.  There were also drugs that would cost her over $35,000 per year that had to be covered. 

Between her income and her husband’s, the Marcelissens were able to cover the expenses associated with Donna’s transplant but in her book she brings up two very valid points… “Should money be the deciding factor as to whether someone should live or die?” and what were the cumulative costs of all of the complications she was experiencing? Surely the cost of procedures, medications as well as a significant reduction in her taxable income were all far greater than the cost of covering islet transplant therapy.  

Donna tells me that the procedure itself is no longer covered by provincial governments. “Capital Health covers their constituents.  The government of Ontario refuses to cover it.  It is only through applications and special access that the possibility transplantation exists for individuals.  The costs of medications, staying in Edmonton while waiting for the procedure, and traveling (by air) are not covered, however.”

Donna Marcelissen’s story is amazing

As you read Donna’s story you struck by many things.  First is her strength and courage.  The pain and suffering that she experienced both before and after her transplants will bring you to tears. 

As Donna writes, you are compelled to hang on every word. She describes her first breakfast reading after the procedure in exquisite detail. 

Her pre-breakfast reading was an incredible 5.2mmol (94mgdl) and she treated herself to a glass of cranberry juice.  This was a luxury she hadn’t afforded herself in 21 years because of the high fructose and glucose content. “It was sumptuous, with a fragrant, ripe sweetness that left a tangy aftertaste to linger on my tongue.  Flowers in my mouth…”

By Donna’s second transplant, she enjoyed a longer period of time completely insulin freedom.  In the book One Step Up From a Lab Rat, she also shared the incredibly emotional experience of having some of her vision restored as her blood glucose levels stabilize into a normal range.  Her descriptions made you part of the experience and you could feel her joy.

Despite the highs and lows, Donna states that transplant recipients feel an obligation to their donors to do the very best with what they have been given…a gift of life. With this book and through her subsequent work with groups like Diabetes Canada, the Juvenile Diabetes Research Foundation and  DRIFCAN, Donna has done amazing things with her gift of a new life. 

Life after the Edmonton Protocol

Donna Marcelissen has had three islet cell transplants to date.  The option for another “top-up” is still available to her but she told me that she isn’t certain that she is ready.  “I have had my immune system greatly suppressed (Leukopaenic ) for each of the three transplants – I’m not certain I want to undergo that again. But never say never.  However, being able to say that I feel like I have an option is a good indicator that I am doing so much better. I have had a reprieve three times from this horrid disease.   I do deal with some stressful complications from long term immune suppression medication use – but I try to put it into perspective.  Issues arise, I seek medical help, learn to cope and work on moving forward.”

Final Thoughts on One Step Up From A Lab Rat

One Step Up From a Lab Rat is an incredible read.  You will find yourself alternating between wanting to turn the page to see how she is doing and having to step away because of the sheer depth of emotions that you are feeling. Donna reminds us that “Insulin is not a cure. It does not even sustain some.  Complications are not just from neglect but they can be the nature of the disease.

To purchase your copy of One Step Up from a Lab Rat, click on the button below. All proceeds from the sale of this book go to the DRIFCan to continue the work of the Edmonton Protocol.

For more great reads from people living with diabetes, check out our diabetes books page.

How to Manage Type 1 Diabetes When you are sick

managing type 1 diabetes when sick

No one likes to get sick.  We take our vitamins, use proper handwashing techniques and get our flu shots all to avoid getting any of the colds and flu bugs lurking around.  Despite our best efforts, many of us will still find ourselves under the weather. That is why it is important to keep your sick day protocol nearby so that you know how to manage your type 1 diabetes when you are sick.

When you were first diagnosed with diabetes, your clinic or doctor probably gave you a huge packet of information.  Besides telling you about high and low symptoms and when to take your insulin, there was most likely also a detailed sheet on what to do when you get sick. 

Click below to get our sick day protocol ebooklet.

Here are some of the things that you need to remember if you are sick and have type 1 diabetes.

caution sign

Below is general information regarding sick day management. It is not meant to replace the advice of your healthcare professional.  Should you require further information regarding your condition or treatment, PLEASE speak with your healthcare professional.

Take your insulin

take your insulin when sick and have diabetes

If you are sick and even vomiting, it is important to continue to inject your insulin. As your body works to fight the bug, your blood glucose levels will often run higher than normal and insulin will be vital to keep your readings in check. If you are on an insulin pump, you may have to temporarily increase your basal rates.

If you are unsure of how much insulin to take or how much of an increase you need, remember to check the sick day protocol prescribed by your diabetes team or contact your doctor for specific instructions.

Try to stick to your meal plan or get some solid foods into your system

If you are on a specific meal plan, try to stick to you if you can.  If you are having trouble eating, try bland foods like unsweetened apple sauce, regular gelatin, toast, or crackers.  If you can’t stomach bland foods, try clear soup or bouillon that contain salt.

If vomiting continues for any amount of time, contact your doctor to see if he/she would advise the use of products such as Gravol or Zolfran. They may be able to reduce nausea.

Stay hydrated

stay hydrated when you have diabetes

Staying hydrated is a huge thing for anyone but especially for those living with diabetes. Try to drink 6-8 ounces of fluids every hour.  Switch back and forth between drinks that contain sugar and drinks that do not. For example, for one hour, drink regular fruit juice and soft drinks. The next hour, drink sugar-free soft drinks, tea, or water.

If you are unable to keep liquids down, contact your doctor or head to the nearest emergency rooms for IV fluids.

How to handle low blood glucose levels when you are nauseous

Rescue doses of glucagon can be used to help bring back up blood glucose levels when a person with diabetes is unable to consume or absorb carbohydrate because of nausea, vomiting or diarrhea and blood glucose below 4 mmol/L or 72mgdL. 

Contact your doctor or diabetes team to see if they recommend the use of rescue glucagon when ill.

How to use rescue doses of glucagon

rescue glucagon guidelines

According to the instructions from the ADA, you should draw up your mixed glucagon in a standard U-100 insulin syringe.  

Children under 2 years of age should receive 2 units of glucagon. Children 2-15 years should receive one unit per year of age up to 15 units. Those over 15 years old should receive a maximum of 15 units.  Always check with your diabetes team before implementing this protocol.

Blood glucose levels should then be monitored every 30 minutes for the first hour and then hourly after that.  If the blood glucose levels have not raised over 5.5 mmol/L (100 mgdL), you can repeat the process. Discard any glucagon not used within a 24 hour period.  If blood glucose levels are still not responding, seek medical attention immediately.

When should you check for ketones

blood ketone meter Diabetes Advocacy

Be sure to keep a close eye on blood glucose levels when you are sick either on your Continuous Glucose Monitor or through regular finger pokes. If you have had consecutive high blood glucose readings or are vomiting, you should check for ketones. This can be done through blood ketone strips or by using urine on keto strips. While the urine strips are less expensive, there is also a time lag in results. For quick and accurate ketone readings, it is advisable to use a blood ketone meter and test strips.

blood ketone quick guide

When to contact your medical team?

Contact your doctor or diabetes care team when any of the following occur:

  • Your sick-day management protocol dictates that you should
  • If your blood or urine tests positive for ketones or if you are vomiting repeatedly
  • If you become short of breath, excessively sleepy, have chest pains, fruity smelling breath or dry lips
  • You have had a fever for two days
  • You have been throwing up or have had diarrhea for 6 hours
  • You are unable to keep any fluids down
  • Blood glucose levels are way over target even with additional insulin
  • Blood glucose levels are under 3.9mmol/L (70 mg/dl) and are not responding with treatment
  • You have moderate or large ketones
  • You are not sure what to do

Sick days are manageable

Being sick with type 1 diabetes is a serious occurrence. It is vital that you carefully monitor blood glucose levels and watch for ketones. Stay hydrated and keep in contact with your diabetes team. When in doubt, go to your local emergency room for assistance. A person with type 1 diabetes who is sick can quickly become dehydrated and go into diabetic ketoacidosis.

Be prepared for your next sick day by downloading our sick day ebooklet.

when to contact your diabetes team

What you need to know if you have diabetes and want to get a tattoo

Tattoos can be an expression of yourself, used to memorialize a loved one, or even to make others aware that you have a serious medical condition. If you have diabetes and want to get a tattoo, here are a few things to consider.

Can you get a tattoo if you have diabetes?

people with diabetes can get tattoos

Absolutely! A person with diabetes can get a tattoo if they so desire but it is advisable that your A1c be under 8% and ideally under 7%. 

If you have had A1cs over 9%, are experiencing neuropathy, circulation or kidney problems, the University of Southern California’s REAL Diabetes program states that you could be putting your life in danger by getting a tattoo. This is because you will most likely have issues with healing that will make you more susceptible to infection and gangrene.

Need help keeping track of blood glucose levels and other tasks to manage your diabetes? Check out our Diabetes Planner

Do you need to talk to your doctor before getting a tattoo?

Again, if you have been maintaining good control and have experienced no diabetes-related complications to date, you should be fine to have a tattoo applied without contacting your diabetes team.  If you are unsure about your A1c or are concerned about your healing time, please consult your doctor before you begin.

Where should a person with diabetes have a tattoo placed?

where to place a tattoo when you have diabetes

If you have poor circulation, you will most likely NOT want to have a tattoo on placed on your buttocks, shins, ankles or feet.  You may also want to avoid common insulin injection sites like your arms, abdomen or thighs. Injecting insulin repeatedly into your tattoo could potentially mess up the design. Ultimately the choice of where you place the tattoo will be up to you.

Other things to consider if you have diabetes and want to get a tattoo

A tattoo is permanent.  While it may fade over time, it will be with you forever.  Before you commit to getting a tattoo make sure that you love the design. Find a reputable artist that can create the design that you have in mind.  Look at examples of his/her work before you begin to make sure that their style and yours are the same.

Also, make sure that the parlor your artist works in is clean and reputable.  They should only hire properly trained professionals who wear disposable gloves while working.  Needles should come from sealed containers and pigment trays should be new. The parlour should also have sterilization equipment and ensure that all surfaces are properly sterilized including their chairs.

How to care for your tattoo

Every tattoo parlor has a different protocol on how to care for your tattoo.  Follow their instructions.  They are the experts.  There are a few common practices that you should follow, however.

  • Gently wash your tattoo every morning and night with lukewarm water and antibacterial soap. Pat it dry with a clean towel or paper towel.
  • Rinse it with water (at least) any time it comes in contact with dirt or excessive sweat, or other dirty environments.
  • Apply a recommended “lotion” at least twice a day. Vaseline or cocoa butter are usually recommended. Avoid anything with added scents or colors–these could contribute to an infection.

What are the normal stages of healing for a tattoo?

It usually takes about 30 days for a tattoo to be fully healed.  During the first week you may see some oozing, swelling, and/or redness that gradually gets better each day.  There will be some scabbing that begins to form over the area. Remember do NOT pick at the scabbing.

During the second week, you may find that the tattoo is itchy and flaking may occur.  This will continue until all of the dead skin and scabbing has fallen off.

In the final 15-30 days, you will see that the tattoo looks fully healed but it may appear slightly cloudy still.  The deeper layers of skin are still healing during this time so it is important to continue to follow the wound care guidelines from your tattoo artist.

Signs that your tattoo could be infected

No matter what size of tattoo you have, there is always the slight risk of infection.  Here are some of the things that you should watch for.

  • Spotty rash: sometimes red, sometimes white
  • Extreme redness 5 days after getting the tattoo
  • Extreme itching (healthy scabs will itch a bit)
  • Feels hot to the touch
  • Swelling 5 days after getting the tattoo
  • Blistering
  • Excessive oozing, pus, especially associated with pimple-like bumps
  • Foul odor
  • Red streaking on the skin around the tattoo (also known as blood poisoning)
  • Swollen lymph nodes (a sign your body is trying to fight infection)
  • Fever and tiredness

If you have diabetes and want to get a tattoo, go for it! With proper care, good blood sugar levels, and a reputable tattoo artist and shop, you should not have to worry about infections in your new tattoo. 

If you are still undecided on your design, you can view some of the tattoos that others in the diabetes community have created over the years.

Once you have made your choice and are happy with your design, we would love to see a copy of the final product! Email us at advocacy @ diabetesadvocacy.com

What to know if you have diabetes and want to get a tattoo
If you have diabetes and want to get a tattoo make sure to watch out for signs of infection
if you have diabetes and want to get a tattoo make sure the site is clean