30 Responses

  1. Nathan
    Nathan January 17, 2013 at 6:50 am | | Reply

    These are very encouraging changes! Thanks for reporting! I had gotten so disillusioned with them that I probably wouldn’t have gotten this info from them, but since you shined a light on it…

  2. Christine Zenka
    Christine Zenka January 17, 2013 at 6:53 am | | Reply

    Great news about the increased awareness of Celiac in Type 1! Just to clarify – does Amy have gluten intolerance or Celiac? They are two very different things. Celiac is the auto-immune disorder related more to Type 1, while “gluten intolerance” is not. The writing makes it seem as if they are the same thing.

    1. AmyT
      AmyT January 17, 2013 at 8:12 am | | Reply

      @Christine – I was told I have a severe wheat allergy, which was triggered by my other autoimmune issues (allergies are also autoimmune).

      But the lifestyle & treatment is nearly identical to celiac — I’m just not quite so hyper-sensitive as some with celiac. Please see:

      http://www.diabetesmine.com/2011/05/life-without-gluten.html

      1. Christine Zenka
        Christine Zenka January 17, 2013 at 8:47 am | | Reply

        Thanks for the clarification, Amy. I have Celiac, so I get a little picky about the way it is perceived. Since an intolerance (not immune related) is different from an allergy (immune related), I am curious why he chose “gluten intolerance” to describe your condition when what you really have is an allergy, which is more related to the topic about which he is writing. ? And someone with a wheat allergy can still eat gluten, correct? I think the more clear we can be about Celiac disease the better, as it is very misunderstood. I still think that the way the article is written makes it sound as if gluten intolerance and Celiac are the same thing.

        1. AmyT
          AmyT January 17, 2013 at 8:52 am |

          No Christine, I should have said gluten allergy. I cannot eat gluten.

  3. Kelly Rawlings
    Kelly Rawlings January 17, 2013 at 7:03 am | | Reply

    Thanks for pointing out these significant changes and enhancements in the Standards of Medical Care in Diabetes.

    As people living with diabetes, there’s an opportunity to get on the same page with practitioners regarding patient-centered care: The American Diabetes Association accepts public comments about the document and the related Clinical Practice Recommendations at http://professional.diabetes.org/ResourcesForProfessionals.aspx?cid=84160.

    1. MikeH
      MikeH January 17, 2013 at 7:43 am | | Reply

      Thanks so much for leaving this link, Kelly! So very important that we not only have this coverage when the standards come out, but that we in the D-Community participate in creating these written guidelines.

    2. Bernard Farrell
      Bernard Farrell January 21, 2013 at 2:41 am | | Reply

      Thanks for this link Kelly.

    3. Bernard Farrell
      Bernard Farrell January 22, 2013 at 6:34 am | | Reply

      Kelly, I’m glad to see they’re taking input — I’m sure this always happened, but it’s nice to know. I’ll take a good luck at this new document, so happy that it’s freely available.

  4. Terry
    Terry January 17, 2013 at 7:25 am | | Reply

    It’s great to read that the ADA published a standard for using more test strips. I’d like to see them modify their next iteration of this standard and encourage postprandial testing after every meal, not just “occasionally.”

    Successful diabetes management to me means that I’m a constant student of what food does to my BGs. Consistent postprandial fingersticks are critical to informing decisions that result in optimal control for me.

    I use, on average, 14 strips per day and consider this rate of strip use integral to my overall health and safety. I’m glad the ADA included language that recognizes that some diabetics may need to test more than 6-8 times per day.

  5. StephenS
    StephenS January 17, 2013 at 8:35 am | | Reply

    This is great news. Wil, thanks for including so much detail. I’m going to go read the standards myself, but I doubt I could spell it out as well as you did here. Thanks

    1. Kelly Rawlings
      Kelly Rawlings January 17, 2013 at 12:09 pm | | Reply

      I commend your intent to read the document! For those short on time, there’s an Executive Summary (the CliffsNotes-style version). Next up on required reading for informed patients: that package insert in our test strip boxes ;-)

      1. Bernard Farrell
        Bernard Farrell January 21, 2013 at 2:42 am | | Reply

        I love those inserts Kelly. Always carry a few with me..in case the table I’m sitting at is wobbly!

  6. Debi Henson
    Debi Henson January 17, 2013 at 8:45 am | | Reply

    How novel of the American Diabetes Association to finally update their standards for Type 1s. It isn’t enough to make me see them as a leader in diabetes care, however, since both my current and former endocrinologists have been applying these principals for at least 10 years. It’s an improvement, but it doesn’t make them a leader, only a follower.

  7. Marge Stromberg
    Marge Stromberg January 17, 2013 at 10:11 am | | Reply

    The diabetics in my family were diagnosed in early 30′s. So I made sure my daughter was aware of symptoms when she reached 30. It would be great to have the family tree noted re. this.

    I use a pump and find that Medicare will give me more strips if I provide a log every few months… a nuisance, but I’m willing to do it since they come at no cost to me.

  8. Daniel
    Daniel January 17, 2013 at 6:46 pm | | Reply

    In so many ways, the ADA has failed to advocate for Type 1 diabetics. I agree they are following the obvious in this report. But, since this is what we have, at least some good news is coming our way. There is no doubt, without frequent knowledge of blood sugar, there is no way one can keep their blood sugar range in tight control.
    If we care about ourselves, all type 1 diabetics would demand that care equate to a hemoglobin A1c level of at least 6.5 (or so). It is well known that anything above that level (long term) leads to undesirable consequences.
    So, whatever is needed to support us to get there must be provided (whether you need a pump, strips, a CGM, or education, or a partnership with other diabetics, or a course on carb counting, etc.). This also means that Type 1 diabetics should keep the pressure on everyone to provide us with tools that allow us to control our blood sugar. CGM is a start. But we need innovation. We need to demand companies put silicon efforts into bringing quality products to us. At least Dexcom is one company we could use as an example. In this respect, JDRF is way ahead of the ADA in supporting technology companies in making cutting edge devices.
    But why is it that it takes the ADA to say we have known for so long in order to get the changes we need to be implemented. I think this organization has too much clout. It is 2013, and they finally state a diabetic has a right to test themselves 6-8 times per day. I was doing that 20 years ago. And it is a tragedy for this organization to have taken so long to advocate on our behalf.

    We need a serious movement to shake things up. I would advocate it starts here at Diabetes Mine and all the followers of this wonderful blog. I think the ADA should answer why it has taken them so long to do the obvious. They need to recognize their shortcomings.

    It is truly amazing that in the year 2013, a type 1 diabetic has to fight his or her insurance company for 8 test strips a day.

    It is depressing state of affairs. We need to demand basic level of care as we know it should be (a CGM is you need it, a pump if you will use it, 10 to 20 strips is so required, and the insulin that works best for you—believe it or not, Humalog and Apidra work very differently in action and duration in different people).

    1. Bernard Farrell
      Bernard Farrell January 22, 2013 at 6:39 am | | Reply

      Daniel, FYI 6.5% isn’t always achievable even with a lot of work. There’s increasing evidence that glycemic variability plays a key part. I shoot for 7.5% to reduce my risks of lows and seizure. I’m thrilled for those who can hit 6.5% or less, but it’s not worth the risk to me.

      I do fully agree that we need to be given every tool (devices, training, coaching, etc.) that lets us achieve targets that work well for us.

      I’ve been a member of the ADA naysayers group. They may not work solely on the behalf of T1s but they do accomplish a lot of advocacy and legal stuff that makes living with diabetes much easier.

  9. Ruth Deming
    Ruth Deming January 18, 2013 at 6:28 am | | Reply

    as a Type 2 on Medicare, my pharmacy doesn’t allow me to test more than 3 times per day UNLESS i have a note from my endo. my drugstore – giant supermarket in willow grove pa – mails me a form to fill in my glucose numbers which i must mail to them monthly. quite a hassle but i do test 6 times a day and need them strips. today i also have an appt with my CDE – nutritionist – b/c i still need help with my diet.

  10. Kate
    Kate January 18, 2013 at 7:58 am | | Reply

    As a Type I, I had stopped all support of the ADA. It was frustrating to get so much Type II advice in Diabetes Forecast. I felt like were were never the focus of anything. Thank you so much for this update; I would have never known that they updated their recommendations without this article.

    I’m just on the cusp of getting the CGM. My insurance company (which in every way is an EXCELLENT provider for diabetes-related care) asked for 30 days of blood sugars and then 90 days before they would grant approval. I believe that approval was granted because of hypo unawareness and because I take between 6-12 blood sugars a day anyway. I’m so grateful to the ADA for recommending this as a standard tool for care.

    Diabetes is ALL about prevention and maintenance. Until medicine, as a whole, starts taking preventive care seriously (CGM, gym memberships, education payments, cheaper strips), insurance companies will continue to pay out money for hospital stays and we will continue to suffer with complications.

  11. Daniel
    Daniel January 18, 2013 at 6:43 pm | | Reply

    For those who are interested, this is article will explain what I mean by the in-depth cholesterol test:

    http://www.drsinatra.com/the-cholesterol-numbers-doctors-should-be-measuring

    This test just might save your life.

    The ADA is all wrong on this issue. Maybe in 15 years they will get it right.

    1. Daniel
      Daniel January 18, 2013 at 6:46 pm | | Reply

      After reading the whole report, I found the dietary recommendation section well written in this respect: out with the one size fits all diet. The ADA paper talked about the utility of a low carb diet, Mediterranean diet, and a low fat diet. I prefer a low carb diet. But, I am must admit, I almost fell over when I did not read any scare tactics being given regarding a low carb diet. And at least ridiculous assumptions were never made about low carb diets in the paper such as ketones will kill you (this paper is excellent on many fronts and quotes the premier expert on metabolism as saying ketosis is a natural state of our bodies). Of course, he is not talking about diabetic
      ketoacidosis:

      http://www.nytimes.com/2002/07/07/magazine/what-if-it-s-all-been-a-big-fat-lie.html?pagewanted=all&src=pm

      But one part of this paper that should be read is in regards to heart disease. As you know, it states in the paper that there really is no study at all that proves a statin is effective in preventing heart disease in type 1 diabetics. Right there in the ADA paper this is expressed. In addition, all statin studies usually demonstrates that if something like 100 people are treated with a statin, you might be able to prevent 1 heart attack. Statins are not very effective. Though the paper does not quote the Farmington study which shows around 50% of people who have a heart attack have low cholesterol and normal LDL levels.

      But the ridiculous section of this ADA paper is the section stating that the ADA does not recommend particle size testing of our cholesterol. The ADA states we do not need to know this information because it probably will not change treatment. What a bunch of dopes for saying this. All diabetics should have a particle size test such as VAP to see what kind of HDL, LDL, and other markers such as Lpa. Knowing this tells you much more than a simple cholesterol panel. I encourage everyone to read up on this issue and demand quality care. For example, if you have high LDL but have large particle size LDL, you do not need a statin. VAP testing, or particle size testing, is the only way to know if you have a cholesterol profile that is dangerous. And of course, the ADA states know where that a cardiologist should be on our team of care providers. At least most endocrinologists understand particle size and the importance of it before treating everyone with a statin.

      I give this ADA paper a C-. And it definitely needs some improvement.

  12. Lars Stevenson
    Lars Stevenson January 19, 2013 at 9:05 am | | Reply

    Hi I am a T1 Diabetic from New Zealand that pic is what is happening over here our government has decided 1 size does fit all and has moved to a sole supply agreement with the CareSens brand of meters in the name of saving 30 million dollars.

  13. Regge Jones
    Regge Jones January 19, 2013 at 10:01 pm | | Reply

    As a T1 mom with 3 children with T1 we use the cgm not to lower their A1c levels but more for safety issues. And a bettter way to catch numbers from dropping too low (in our case) . It also educates me to see what foods are causing the spikes and how long it takes to spike…something the meter wouldn’t tell me unless I poked their fingers a hundred times a day (probably exaggerated.) Thanks for sharing all the great information!

  14. Debi Henson
    Debi Henson January 19, 2013 at 10:20 pm | | Reply

    Dear Regge, if I had a hat on I’d take it off for you! You must be one organized and disciplined mom to keep track of 3 T1 children’s diets, insulin and blood sugars – in addition to your own. Promise me that you’ll write a book someday soon about your life, I’ll buy the first copy! I am in awe.

  15. Bernard Farrell
    Bernard Farrell January 21, 2013 at 2:40 am | | Reply

    As soon as I get out of this hospital I’ll write a BIG thank-you card to Bob Ratner. That ‘small’ change alone is huge for so many folks. Thanks Wil for a wonderful overview and analysis of the article.

  16. {Diabetes Management} ADA’s Standards of Medical Care in Diabetes—2013

    [...] From DiabetesMine: [...]

  17. Leighann of D-Mom Blog
    Leighann of D-Mom Blog January 21, 2013 at 6:13 am | | Reply

    I see the value of CGM use for children that goes way beyond the A1c. It’s value actually has little to do with A1c, but quality of life for both parent and child.

    I began leaving a lengthy comment here, but expanded my thoughts in a blog post: http://www.d-mom.com/?p=20793

  18. Kelly
    Kelly January 23, 2013 at 8:31 pm | | Reply

    Looks like progress.

    Now if only my insurance company would cover a CGM without forcing me to let my numbers slide first!

  19. Anne
    Anne January 25, 2013 at 8:03 am | | Reply

    We are thankful for the JDRF and we must be thankful for all the ADA has done too.

  20. Adam
    Adam January 29, 2013 at 7:34 am | | Reply

    Thank you for bringing this to my attenion. I am glad to see the ADA promotes one aspect of Dr. Bernstein’s recommendations–SMBG–while
    he is still alive. Dr. Bernstein says that more than 90 % of his type 1 patients have hypothyroidism. And a majority have some other kind of autoimmune disorder, e.g. celiac disease or psoriasis or the even more obscure antibody disease he suffers from. Guess the human genome was not fully debugged before release. Too late now!

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