Celebrate National Ice Cream Day the Low Carb Way!

Low Carb Ice Cream

I scream, you scream, we all scream for low carb ice cream!🍦 Stop by your local grocer or churn your own. Get the scoop on our top 12 picks under 12 carbs (per serving) for diabetes-friendly ice cream brands and recipes.

Make Your Own Low Carb Ice Cream

Put your ice cream machine to use and whip up one (or more!) of these delicious low-carb recipes. From dark chocolate to light lemon, there’s something to please everyone’s palate.

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Store Bought Low Carb Ice Cream

No time to make your own ice cream? Throw these frozen treats into your shopping cart and enjoy without the guilt (or extra carbs!)

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How the DAWN2 study hits home: Work and life with diabetes

DAWN2 study researchers deal with diabetes at home and at work

Dr. Mark Peyrot, Professor of Sociology, Loyola University of Maryland, has over 300 publications, and is an internationally recognized speaker on the behavioral aspects of diabetes. In collaboration with Novo Nordisk and the International Diabetes Federation, Dr. Peyrot led the Diabetes Attitudes, Wishes and Needs (DAWN/DAWN2) studies. These studies identified challenges faced by people with diabetes and the people helping them.

Dr. Heather Stuckey collaborated with Dr. Peyrot as lead qualitative investigator on the DAWN2 study, and is Assistant Professor of Medicine at Penn State University College of Medicine. Professionally, both Drs. Peyrot and Stuckey research ways to improve the education, self-management support, and psychological well-being of people with diabetes and their families. Personally, Dr. Stuckey has type 1 diabetes.

In this two-part post, Mark and Heather first talk about their work on the DAWN2 study; then, they share how diabetes affects them both on a personal level.

Part I: Learning from people with diabetes and their families

You both worked on the DAWN2 study, one of the largest global studies understanding the needs of people with diabetes and their families. Who was involved and what did you learn?

Mark: We invited people with diabetes (PWDs) and family members (FMs) from 17 countries. FMs were defined as a household member who supports a PWD.

 

Getting support from a FM resulted in better mental health for the PWD, and FMs benefited from getting support from people beyond the PWD. The more involved FMs were in diabetes care, the more burdened they felt; however, that burden was offset when FMs were able to provide support in ways that were perceived to be helpful to the PWD.

 

We assessed a whole range of activities, including doing things with the PWD, doing things for the PWD, giving them advice, telling them when they were doing poorly or when they were doing well. There was agreement between PWD and the FMs of PWDs, both in terms of the different types of support being done and in terms of what was more or less helpful.

How does diabetes in the home affect family members who don’t have diabetes?

Mark: When we looked at the burden of diabetes on FMs, the effect was surprisingly very similar to PWDs. You might think a PWD is carrying all the burden and FMs are protected from that. But, when we looked at different impacts on your life, the numbers were almost identical except for physical health, obviously.

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Heather: FMs were very emotional, talking about the PWD’s hypoglycemia. They were scared about the PWD being alone and the FM not being around to help. There’s great worry and anxiety among FMs surrounding hypoglycemia, whereas the PWD generally had the attitude, “Well, yeah, it’s scary, but I live with this every day.”

Mark: We always tend to think of how things impact a person with diabetes. But, there’s a cost to caring. It’s not just a free resource.

Heather: One of the positive aspects for FMs is the PWD provided inspiration, and helped the FM make positive life changes.

Mark: The FMs would say, “We’ve put the whole family on a healthier diet. Everybody is eating better because we have someone with diabetes in the family.”

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Heather: They would say that the whole family now makes time to exercise, that they have more vegetables and fruits, that the children are paying more attention to what they eat. Someone said, “I followed the PWDs’ advice about nutrition and lost over 30 kilos.” The FMs would be proud of the PWD as a role model because managing diabetes requires so much work and emotional challenge.

One of the DAWN2 findings was that family members or support people wanted to help the person with diabetes, but didn’t know how. Can you talk about that?

Heather: We didn’t ask about this in the open-ended questions, but FMs spontaneously talked about not knowing how to help. FMs wanted to know more about diabetes complications and how to prevent them. They wanted to know about what to eat or not to eat to help the PWD.

Mark: Only about one quarter of the FMs, and only half of the PWD had any formal diabetes education. It was nowhere near what it should be if we want FMs to be really helpful to PWD.

What about other research you’ve done on this topic?

Mark: We’ve talked to men and women with diabetes and their spouses. For a man with diabetes, the wife was comfortable putting the family on the so-called “diabetic diet.” But, when she had diabetes, she didn’t feel comfortable doing that. For women, they didn’t want to mess up everyone else’s life. For a man with diabetes, spouses wanted to take care of him. It’s an interesting gendered pattern. Obviously, this isn’t always the case, but it does come up quite a bit.

Part II: The DAWN2 results in our day-to-day life

Speaking of spouses, you’re both engaged, so let’s talk support with diabetes on a more personal level.

Heather: Yes, we were engaged this past year, and now we are both the PWD (me) and FM (Mark). We study what we experience. I was diagnosed with type 1 diabetes at age 12, and I’ve lived with diabetes over three decades!

How have people supported you and with your diabetes and how has that affected how you manage your diabetes?

Heather: My family was fairly hands-off about diabetes. I was on my own taking care of it, and I didn’t do a good job. I tried to do the food exchanges when I was first diagnosed. I attempted to follow the diet, and then I would alter the diet and see if anyone noticed. Nobody did. So, I’d feel like, “Alright, I’m just going to do my own thing.”

 

That attitude continued throughout my teens and early twenties. I became more aware of it when friends started to ask me, “So, how is your diabetes?” It got me thinking that people cared about how I was doing, and maybe I should, too. My diabetes educator was concerned about me, and I appreciated her help. Then, I got pregnant and I thought, “Now I’m living for this other person too. I really want to do better.” So, for a number of years I worked hard. Then I started back on the track of this is a lot of work.

 

I’d say in the last 10 years, I’ve had friends, and now Mark, who are interested in how I’m doing. They provide me with support in ways that are helpful.

What does helpful support look like?

Heather: For me, it’s being interested, but not pushy. One thing Mark will do, for instance, is say, “So how much insulin did you take for that?” We’ll calculate how many carbs are in the foods in front of us. So, he’s learning along with me. It’s not just my thing, where I’m doing whatever I think is best.

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Mark: It’s more that I’m curious, and I’m in this with you. It’s not advice.

Heather: I don’t take advice well. It’s why I’m in the perfect position to be a behavioral scientist because I know what doesn’t work. For me, emotional support is most helpful. I have the practical knowledge. I study this. I know what I need to do. There’s some instrumental support with putting on the CGM, so I’ll ask Mark for assistance. That’s the only thing I usually ask for.

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Mark: One twist on that is that my curiosity helps her be more mindful. Because I’ll ask questions, “How many carbs is in that?” She’ll throw out a number, and then she’ll say, “Well, actually, if I think about it, it’s this or that.” Or, I’ll ask, “How much insulin did you give for that?” And so, She’ll say “this or that.” Basically, in explaining it to me, she has to think more carefully about it than when she’s doing the calculations in her head. Sometimes there are discrepancies, and she may feel comfortable giving herself more insulin. In the DAWN study, helpful support was doing things with someone not for someone.

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Heather: Sometimes Mark carries juice for me because I don’t have pockets or because he feels better if he has juice for hypoglycemia, even though I don’t think I need it.

Mark: She had a severe hypoglycemic episode once when we were hiking. We were out hiking in a forest, and I had to run back to our room. I got a cup of water and grabbed a bunch of sugar packs and dumped the sugars into the water and stirred it up. Ran back, and she drank it and recovered quickly.

Heather: And that was the weirdest hypo I’ve ever had in my life. We had eaten and eaten, and I kept eating because I was certain my blood sugar would go up, but it never did. It went lower and lower.

Mark: Since then, there’s always juice in the car. She knows herself better than I do, so she’s more comfortable with being less cautious, whereas I’m not as comfortable. Of course, the vast majority of the time, she goes, “See I didn’t need it.” That’s OK — I’m still taking it with me — might as well be prepared.

Heather: He’ll say, “I’m going to take the juice anyway because it’s more for me than you.” I’m OK with that. Whatever makes him feel better. And if the tables were turned, and he had diabetes, I would carry juice for him too.

How does diabetes affect your interactions as a couple?

Heather: I like that Mark pays attention to my diabetes, but sometimes he’ll forget that I can’t see well, especially at night. I have diabetic retinopathy. When he doesn’t remember, I’ll nudge or remind him of that.

 

Mark also has a different eating pattern than I do. He prefers to not have much for breakfast or lunch, and then to eat more at night. I’m the opposite. I like to have more at breakfast and lunch and not that much at night. It’s been an adjustment for both of us to work through things like that.

How does a personal connection to diabetes affect your professional life?

Mark: I’ve learned more about the details that I didn’t know as a behavioral scientist. I knew them in a vague way, but I didn’t know how many carbs are in this or that. I used to think calories played more of a role, but they don’t.

Heather: We’ll have a barbeque, and he’ll say, “So it’s just the bread, right?” I’ll say, “Yes, it’s bread, but this sauce has more carbs than a chocolate cake.” And, then he’s like, “No way!”

Mark: Heather’s also my key informant. It’s led to a lot of innovative ideas to help more people with diabetes.

How has Heather’s diabetes affected you personally?

Mark: It’s a shared experience. The sharing’s incomplete, but I can look up how she’s doing on the Dexcom app.

Heather: I put him on notifications for extreme, urgent lows. He gets pinged because it may mean I’m not functioning as well as I could be. Sometimes I look at the number and I say, “This is high. Damn it.” Then, he’ll say, “So what’s your number?” Then silence. I may say, “It’s high. It’s too high.” It’s like, man I screwed that up. If I share that my blood sugar is high, I feel shame. It’s not that Mark makes me feel that way. It’s rooted in all the doctors telling me over the years that my numbers aren’t where they should be.

Mark: I want to see her do better. I empathize with her, so when she’s not doing well, I kind of feel the same thing. The one exception is the severe hypos because it triggers an emergency response. It becomes my problem too. Also, she has concerns about her future, but she’s younger than I am.

Heather: I feel like I have a body that’s as old as his body. I’ve added so many medical issues to my body.

Mark: Except she exercises every day.

Chandra: I know, I saw her at the gym. (laughter)

What recommendations do you have for people with diabetes and their support people?

Heather: For support people, ask the person with diabetes, “What support can I give you? I want to care, and I want to support you, but I don’t know how.” This helps to avoid conflict and a nagging situation. People can say, “I don’t want to take ownership of your diabetes, but I want to be there and show that I care. How can I do that?” Mark does that by being curious. That relates to me because I’m curious, too. Instead of saying, “You didn’t take enough insulin for that,” he’ll say, “I’m just curious, I don’t know how many carbs were in that, how many carbs do you think were in that?” It gets to the same endpoint, but in a more positive way.

Mark: We share it. She’s not the only one who lives with diabetes. We both live with diabetes. It’s not that she’s either right or not right in what she does. I’m thinking along with her. Generally, following behind her, but asking questions along the way. She’s navigating, and I’m along for the ride.

Ready for an adventure? Meet the One Drop Caicos team!

One Drop Caicos Team

Erin and the Sea Peptide Salties to Trek 120 miles

Who doesn’t love a good trip to the Caribbean? Sparkling blue seawater, white sand beaches . . . And when you’ve got a T1D crew island hopping by way of hiking, swimming, cycling and paddleboarding, it sounds like the most picture-perfect adventure there could ever be! Enter Erin Spineto and her Sea Peptide Salties.  Each year, Erin leads a team of T1Ds on an adventure that would whip anyone into shape! Erin sums up her philosophy in 3 sentences:

  • Every person with diabetes can be happy.
  • Every person with diabetes needs others to commiserate with, to plan with, and to adventure with.

  • Your big adventure may not be the same as my big adventure — but whatever your BIG is, you can find a way to make it safe even with diabetes.

This Year’s Challenge

For their 2017 adventure, this gang of four is headed to the Caicos islands for straight-up sea, sun and swim, with a little diabetes sprinkled on top.

“The goal is just to get a group of type 1’s together to push what we think we are capable of,” explains Erin, captain of the 2017 adventure. She’s rounding up the troops in the Caicos islands, both north and south, for major island hopping (not to be confused with bar hopping, although sandbars will definitely be involved). Erin’s been adventuring like this for the past 5 years, making this her sixth Great Adventure. This year, she’s joined with Kati and Erika. They’ll be covering 50 miles on paddle boards, 20 miles hiking and swimming, and another 50 miles on bikes — for a total of 120 miles from South Caicos to North Caicos.

The team has already started hardcore training (January 1st, to be exact), and we’re hopping on board with them to get a feel for how all four of these kick-ass T1D’s are able to train and execute such an amazing feat – all while maintaining their BGs in the middle of uninhabited islands and waters. Before getting down and dirty with training routines, though, we wanted to introduce our One Drop fam to the crew!

What does it take to make the One Drop Caicos Team?

Erin emphasizes that having a good attitude and being flexible are key:

Each August, I open up the application period for the next year’s adventure. I am looking for people who have a good attitude and are flexible. It is so important when you travel with people that they are the type of people who can have everything go wrong and still look at it like a fun part of the adventure.

 

So, I look for people who want to be a part of a team not those who will force their ideas and demand that others follow. People who are encouraging and hold others peoples needs in high regard. We will all be pushing ourselves to the limit. We’ll all get moody and snap at some point in the trip. So knowing that that is a natural part of the journey is helpful.

And you don’t need to be a star athlete to join:

A good background in sport is important but it doesn’t necessarily have to be the sport we will be doing. This time, Kati has a background in synchronized swimming.

Meet the team!

So, now that Erin’s given us a rundown of everything these ladies are doing to prepare for this epic adventure, let’s meet the team! From now through the summer, we’ll be following their progress and keeping you updated on how they are training hard, having fun, and keeping it #diabadass.

How do you train for a challenge like this?

Although this crew has been training since last summer, the real training began on January 1st. The team spent August through December building a base of fitness, gathering their gear, and learning good form so that their bodies could handle all of the intense training they’ve been doing since the new year.

We all have such different backgrounds, lives, and bodies that we don’t all follow the same training plan. I tend to go into overtraining rather quickly so I max out at about three quality workouts a week with plenty of rest, stretching, compression clothing and pumping in between. I don’t know if this is a result of having to deal with thyroid issues on top of diabetes, my day job, my side job and my family, or the fact that I am just getting older.

 

Some of the younger girls can handle six or more workouts a week and feel better that way, so they do that. But we all do the same long workout each weekend to stay on track.

As for the workouts themselves, they are varied and intense! But, of course, plenty of rest is also built into the plan:

The workouts rotate through all of our disciplines — hiking, stand up paddleboarding, swimming, and cycling on Electra Cruisers — with a focus on paddling, since such a large part of our trip, 50 miles, will be on Stand Up Paddleboards (a.k.a. “SUPs”). And it is also one of the more dangerous of the activities. With cycling, if we need to pull over or stop, we can. With SUP we will be covering 50 miles of uninhabited islands and waters. So, pulling over isn’t really an option.

 

Our workouts will increase in intensity at a set interval so that we don’t stress out our bodies too much, usually never more than a 10% increase each week. We also have built into the plan a rest week every five weeks.

 

And they’re off!

What a great source of inspiration to keep us all moving this 2017! We can’t wait to see the progress as Erin, Erika, and Kati push themselves to the limit. Go team! #OneDropCaicos

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Dr. Jeffrey Gonzalez shares tips for staying on top of your diabetes medications

Dr. Jeffrey Gonzalez shares advice on taking medications

Dr. Jeffrey S. Gonzalez, PhD is an international expert on medication-taking among people with type 2 diabetes. He’s a Clinical Psychologist and Associate Professor in the Department of Psychology at Yeshiva University and Associate Professor in the Departments of Medicine and Epidemiology and Population Health at Albert Einstein College of Medicine. Dr. Gonzalez is a NIH-funded investigator who designs and tests programs to help people with diabetes successfully take their medications.

I’ve known Dr. Gonzalez for over eight years. We share a passion for understanding, predicting, and promoting medication adherence in diabetes. We’ve shared the stage at the American Diabetes Association Scientific Session, collaborated on research and co-authored papers together, and served on the National Diabetes Education Program’s Medication Adherence Task Force. I caught up with Dr. Gonzalez at the recent Behavioral Research in Diabetes Group Exchange meeting in San Antonio, Texas. We chatted about our shared interest in helping people take their medications. Here’s our conversation in a nutshell…

How do you describe what you do?

My work gets at how people take their medications, what gets in the way, particularly depression and distress, what helps, and developing programs to help people become more successful.

How is taking medications different for people with diabetes?

Taking medications can be challenging. With diabetes, we’re talking about taking medications for a life time. That’s different from taking aspirin for a headache, and when the headache goes away, you don’t need more. Or, you take one round of antibiotics to clear up an infection, and then you’re done with it. For someone with diabetes, the signal of how a medication is working can be a lot less clear.

What gets in the way of people taking their medications?

Across studies and chronic conditions, forgetting is the number one reason why people don’t take their medications as prescribed. But, there are two types of non-adherence. One is intentional and the other non-intentional. Intentional non-adherence is when people don’t take their medications because they’re concerned about side effects, cost, and the negative consequences of doing so. Non-intentional nonadherence often has to do with forgetting and not having routines that support medication taking. The more people can develop routines, automatic habits, and integrate their medication taking into their daily life, the more successful they’ll be at taking their medications.

The cost of insulin and other diabetes medications is a huge challenge for people. What can people do to get around that?

Quote from Jeffrey Gonzalez on cost of medications

Treatment for diabetes is life-saving and has enormous benefits. On the other side of these benefits is a cost. Medications have financial costs and time costs. Providers aren’t always attuned to that. It’s important people with diabetes be empowered to ask questions and have cost be a part of the conversation about what regimen is right for them. If there’s a regimen that’s just as effective, but less costly in terms of the time it takes to take the medications and the financial commitment, that medication regimen might be a better match.

What tips, strategies, and recommendations do you have for people with diabetes?

First, understand the importance and that there’s a benefit to be had. The benefit is about delaying and preventing complications of diabetes.

Second, make sure you understand why you’re being prescribed a particular regimen. You need to have enough information so you can fully commit. Learn what actions your different medications have and why they work together. Ideally, you should be getting some feedback from your doctor on how your regimen is working. Ask your doctor about what changes you should be seeing in your blood glucose readings, and in your A1c values. And, track that over time, so you get feedback that it’s actually working and your getting a benefit.

Third, once you understand a regimen’s importance and are convinced it’s a good fit for your health, lifestyle, and wallet, given other options, it’s important to routinize the regimen. The more integrated medication taking is in your routine, the more likely it is that you’ll successfully maintain it over time. Rather than thinking of a dosing schedule in clock time, like a morning dose at 8 am and a night dose at 8 pm, think about what you do around those times every day. Tie the medication taking activity with another daily activity like a cup of coffee in the morning and brushing teeth at night. That’s a more successful strategy.

Fourth, reminders are also great. People set alarms. They make check boxes on a physical calendar. They use apps. There’s no one right strategy. Whatever works!

And, finally, prepare for schedule disruptions! Your schedule will be disrupted. Life gets in the way. People travel, or something unexpected will undoubtedly happen. Prepare for that. Have a back-up dose in your glove compartment, in your desk at work, or in your wife’s purse. Maybe even make medication packing the first part of packing for a trip. That way you can enjoy more of your vacation and not waste it orchestrating an emergency supply.

Married Stanford professors dance with diabetes at work and at home

love and diabetes

Dr. Korey Hood is a clinical health psychologist and Professor of Pediatrics and of Psychiatry and Behavioral Sciences at Stanford University. He directs NIH- and foundation-funded clinical research to improve the health and quality of life of people with diabetes. He designs programs that (1) address barriers to managing type 1 diabetes, and (2) optimize the use of diabetes devices and technologies to improve outcomes. He also coordinates the Human Factors assessments in national and international closed loop trials. Last, but not least, Dr. Hood is married to Dr. Diana Naranjo.

Like Dr. Hood, Dr. Naranjo is a clinical health psychologist. She is an Associate Professor of Psychiatry and Behavioral Sciences and Child and Adolescent Psychiatry at Stanford University and has a private practice working with families with diabetes. Much of her work involves training community mental health professionals about diabetes as a way to reach and support people with diabetes nationally. She’s studied individual, family, and digital factors affecting the management of type 1 diabetes, and, with Dr. Hood, published a review on how psychological factors affect diabetes technology use.

Drs. Hood and Naranjo met six years ago at a Behavioral Research in Diabetes Group Exchange (BRIDGE) meeting. They’ve been married for almost four years.

Diabetes brought them together. It is the focus of their work. Diabetes is also a part of their home life because Korey has diabetes.

Love and diabetes

I recently caught up with Korey and Diana at BRIDGE. We chatted about their work/life diabetes dance. Here’s how that went down…

Diabetes is a huge part of your professional and personal lives. What does that look like day-to-day?

Diana: Korey and I talk about diabetes A LOT together. We talk about his diabetes, all diabetes, about research, about cases, about new ideas. We are super collaborative in both life and work.

Tell me about your diabetes diagnosis and what helps you manage it.

Korey: Six months into working on a PhD focused on the behavioral and psychological health of people with type 1 diabetes, I was diagnosed with type 1 diabetes. That was 17 years ago. I manage a lot on my own, and I don’t need handholding or guidance. I definitely don’t want a lot of advice.

Diana: Any advice. (laughter…)

Korey: Help with the things I need, occasionally, is helpful. I get a lot of emotional support from being around other adults with type 1, or even couples. We know other couples where one person has type 1.

 

Most of the teens with diabetes I see in clinic want peers with diabetes they can talk to. They don’t want to talk about diabetes, per se. I’m the same way many times. I don’t need to talk about my diabetes with people with diabetes. Just being around other people with this shared experience is helpful. It’s because they get it.

 

My professional life is all about diabetes. Many times it’s complete diabetes overload. It’s less about the personal stuff. It’s more the professional side – being in diabetes all the time. I notice when I have breaks from work, even for 4-5 days, I’ve thought less about diabetes. And, that’s refreshing. I have to find those times when I can step away. It helps in my own management. I’m on autopilot when I’m busy, and tons of things are going on with me professionally.

Has being married to someone with type 1 diabetes shaped your work in diabetes?

Diana: It gives me street cred. I study diabetes, counsel people with diabetes, but I live in a household with diabetes. I see the daily tasks, the difficulties, the triumphs — all of it. If it’s in your life, you have a different understanding of it than if you only see it in your office. That being said, I don’t understand it to the level Korey understands it because it’s not mine.

How does Korey’s diabetes affect you?

Diana: Living closer to diabetes has changed my attitude towards diabetes technologies and devices. There are a lot of pros, but a lot of cons. The CGM alarm is loud and goes off all night, all the time. It vibrates. It repeats. It’s irritating.

 

It can be stressful when I know he’s making choices that are going to affect my sleep. He’ll get a craving for cereal before bed, and I know what’s coming because cereal always elevates blood sugars overnight.

 

It’s a delicate balance. I want him to feel like he can do whatever he wants to do, but his decisions also affect me.

 

The cereal scenario is an example of a short term issue, but longterm complications worry me most. My life is connected to his life. I feel like I have a right for him to be as healthy as possible, so we can experience this life together. So, I take some ownership of that. That can be complicated because it’s not my body. It’s not my diabetes. It’s not my food choices. It’s not our exercise routines. But, it’s our collective life.

Korey: There are many times I don’t want to validate those worries or concerns, especially in the moment. But, she has to put it out there, and then it takes me some time to think through it. If, at the same time, she is saying I’m concerned about this and worried about that, she is also saying I’d like you to do this… it doesn’t go well. Instead, if I have time to process her worries, I can think through ways to change that are good for my health and validate her concerns.

CO-koreyHood-quote1How do you help Korey?

Diana: In specific ways. If Korey’s gone down to the kitchen three times for low supplies in the middle of the night, I’ll go down even though I don’t want to get out of bed. Or, when there’s a site he can’t reach, I’ll help push it in. I’ve gone to a few doctors appointments. I’ll send him articles about new drugs or devices, but he’s usually seen them already.

 

I’m also a buffer between Korey and his family. Korey’s parents are on the Dexcom share. So when the alarm goes off, they call and text me in the middle of the night, asking, “Is he doing ok? Has he taken juice?” I’m the one telling them he’s ok.

How do you like being the buffer?

Diana: Sometimes it’s a little overwhelming. I’m already getting woken up from the alarms. I’m already worried and trying to take action, and then I’m trying to take care of them too.

Korey: For people doing Dexcom share or any other kind of remote monitoring, you have to have rules of engagement. Otherwise, it can be counterproductive. Sometimes I turn off the share function, and other people talk about this as well, because I already know something’s up. I don’t need to hear it from anyone else.

What additional advice do you have for couples or family members with diabetes in the mix?

Korey: Advice I often give couples or parents or teens, is to ask the person with diabetes, “What can I do to help?” Find out the kind of support they want. Like me, occasionally, I need someone to bring me juice. I don’t need someone to prime my pump. But, there are plenty of couples we know that the person with diabetes let’s the partner give insulin in the middle of the night if there’s a high blood sugar. It’s not that I don’t trust Diana to do that. It’s just I would rather do it.

Diana: Take the lead from the person with diabetes. I could easily have jumped in and said, “I know all about support, coping, and destressing.” But that’s not what he’s looking for. I try not to say things in the moment because it never goes well. Instead, I try to wait, collect some data and present it in a way that’s cohesive and curious “Hey, so for the past month it seems like your mood has been a bit low, and your sugars have been kind of high. Just wondering what you think about that?” He’ll weigh in, or I’ll ask, “Is there anything I can do to help?” Often there’s not much I can do to help. Though, sometimes he’ll ask for specific things. And, I’m happy to do them.

Dr. Adam Kaufman shares his thoughts on diabetes and technology-enabled behavior change

Dr. Adam Kaufman is CEO of Canary Health. He uses his skills in business, software development, technical operations and healthcare industry economics to develop and implement technology-enabled behavior change and self-care support solutions. I spoke to Dr. Kaufman about his work in diabetes, and got his reactions to our One Drop | Premium subscription service. Here are some gems from our chat.

Tell me about your diabetes work with Dr. Kate Lorig at Stanford University.

Canary Health develops and deploys the digital versions of Dr. Kate Lorig’s diabetes programs. Dr. Lorig and her team studied 1200 people with type 2 diabetes. They gave people a group diabetes program digitally or in person. Groups helped people reflect on what matters, set action plans, and get support.

 

At 6 months, people with an A1C above 9% dropped their average A1C by .93%. They reduced hypoglycemic and depressive symptoms. They also improved their confidence, communicated better with their doctor, and were more physically active.

How does your academic training give you an edge?

My training helps bridge technology with evidence. The technology has to be great, but it’s insufficient to have great technology. You have to design studies that prove it works. Then you have to communicate the evidence in a way that’s meaningful to people.

How does technology make health promotion more effective?

Technology plays a role, but it’s a second order. You have to first resonate with people so that they own their journey. For us, cracking the code on engagement is about story telling. We want people to write their own story. And, see in what they’re doing – the arc of their own narrative that matters to them. We show people stories of someone else to get them there. The stories look like what you do without you having to make it your own.

 

A lot of this is executed with technology – audio, video, and tech helps with the entertainment quality. If Hollywood’s taught us anything, it’s that when this is done well, it’s incredibly powerful. It helps people see their story can be shaped the way they want, and then actually help them tell it.

 

Technology lets us push the limits — to have peers support each other, to have a virtual interaction with a clinician, to be able to electronically share data rather than physically come in to show it on a paper log. We couldn’t do what we do without it.

What’s the biggest drawback to digital health solutions?

When technology is supposed to help you do something, it can’t be another thing that you have to go do. Until we figure out how technology seamlessly fits into people’s lives, we’re going to struggle with that. I think we’re getting better, but we have a ways to go.

Our One Drop | Premium subscription service pairs our app, meter, and in-app coaching to ultra personalize self-care support. What’s your reaction to our Premium service?

That approach makes sense. We need to take devices and connect them to behavior change and coaching services. I can imagine how a combination of a modern meter tied into a personal health management app could be really powerful.

More than Numbers: Dr. Mary de Groot on Diabetes Psychosocial Care

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Living with diabetes can be challenging. Stress, burnout, embarrassment, hopelessness, depression and other psychosocial factors affect diabetes, in addition to our ability to manage it.

The American Diabetes Association (ADA) has long recognized there are psychosocial aspects to living with diabetes. Finally, in December 2016, the ADA issued its first comprehensive and specific standards for psychosocial care. The article delves into the latest diabetes research, mental health recommendations, and expertise in the field. The authors are coming from the National Institutes of Health (NIH), Johns Hopkins University, Stanford University, and other reputable institutions.

One of these authors is Dr. Mary de Groot, Associate Professor of Medicine and Psychology at Indiana University. Not only is she a licensed clinical psychologist, but she also has over 20 years of diabetes research and clinical experience. She’s led diabetes professional organizations and been on the editorial board of scientific journals. Funded by the NIH, her research examines the link between diabetes and depression, as well as how to treat depression in adults and diverse populations with diabetes.

Tell me about the new ADA position statement on psychosocial care for people with diabetes?

This is the first comprehensive statement put forth by the ADA on the topic of psychosocial care of people with diabetes. It reflects over 40 years of psychosocial behavioral research and state-of-the-art clinical practice.

I’m honored to be a part of the writing team. Much credit goes to Dr. Deborah Young-Hyman, as well as all the others involved in our writing team and the ADA staff. Our writing team represents expertise in type 1 diabetes, type 2 diabetes, pediatric care, adults… We are all delighted this Position Statement is now available to the diabetes community.

What are some takeaways from the position statement?

First, successful management of diabetes extends beyond blood sugars and A1c numbers. While our numbers tell us how well our medical and lifestyle treatments are working, we are more than just our numbers. And, we know the behavioral demands of a self-management regimen are burdensome, but necessary, to reach treatment outcomes. We need to treat the behavioral and emotional needs of people with diabetes alongside their medical needs. Doing so has a synergistic effect — improve patient engagement in care, health outcomes, and overall well-being, and, in doing so, make it more likely that patients/families can carry out what patients and providers agree must be done to achieve better health.

Secondly, diabetes can go hand-in-hand with an increased risk for some mental health conditions — diabetes distress, depression, disrupted eating, and anxiety. These conditions not only impact quality of life and relationships for people with diabetes, but they also affect diabetes outcomes. This is a link people aren’t always aware of. It’s important to know there are successful ways of treating these conditions in people with diabetes just as there are in the general population.

Finally, there are many ways to deliver and receive psychosocial care. One size does not fit all! For patients, care should be tailored. It should be flexible, dynamic and change to meet the needs of people and their families over time. And, the models of healthcare delivery are not a one-size-fits-all proposition either. There are a lot of different ways providers can incorporate this care if they’re not already doing so. There are ways providers can maximize the care they already provide by leveraging other resources and partners — mental health providers, diabetes educators, community partners — to extend their reach, so patient receive what they need when they need it.

Diabetes Distress: How Diabetes and Mental Health Go Hand-in-Hand

DIABETES AND MENTAL HEALTH

A diabetes diagnosis increases the risk of a mental health condition like general anxiety or major depression, and diabetes distress. Defined as feeling burdened or defeated from having diabetes, people with diabetes distress tend to have higher blood glucose and more diabetes-related complications. Both mental health issues and diabetes distress interfere with quality of life.

I recently talked with expert, Dr. Julie Wagner, about depression, distress, and quality of life in people with diabetes.

Who is Dr. Julie Wagner?

Diagnosed with type 1 diabetes at age 2, Dr. Julie Wagner is Professor of Behavioral Sciences and Community Health at the University of Connecticut Health Center and a licensed clinical health psychologist. With funding from the NIH, American Diabetes Association, and American Heart Association, she studies how psychological experiences and exposures affect risk for diabetes and its complications. In the October 2016 “Diabetes and Psychology” Special issue of American Psychologist, Drs. Julie Wagner, Mary de Groot, and Sherita Hill Golden authored the article Psychological Conditions in Adults with Diabetes.

With a bio like that, Dr. Wagner is the perfect person to discuss just how diabetes and mental health really do go hand-in-hand. Below, Dr. Wagner breaks down some basics for us.

How do we prevent diabetes distress?

Diabetes distress comes from the day-to-day burden of managing diabetes. We don’t know how to prevent it, but we know what it’s related to — long-term complications, being on insulin for people with type 2 diabetes. Once we know who’s vulnerable to diabetes distress, we can target and tailor solutions to different groups.

What’s the best way to treat diabetes distress?

Confidence combats diabetes distress. Improving people’s self-efficacy — helping them be more confident about their ability to manage their diabetes – may reduce diabetes distress. It also helps to know that difficulty meeting treatment goals is a normal part of living with diabetes for most people. A coaching expert can increase people’s confidence and self-efficacy and can help normalize the struggle of living with diabetes.

 

Common reasons for diabetes distress are not meeting treatment goals, not knowing what to do in certain eating situations, and a constant worry about complications. Access to a support team can help with each of these reasons.

What’s the best way to stay on track when life gets in the way of managing diabetes?

Chronic stressors, major life events, and daily hassles affect everyone. For people with diabetes, they may contribute to diabetes distress, co-morbid depression, and quality of life. When this happens, people need someone who listens well and provides non-judgmental support. Encouragement, motivation, and even a little humor and commiseration are helpful. For dealing with everyday stressors, diabetes-specific knowledge or expertise is less important. Social and emotional support without the diabetes specific-ness may be sufficient.

The One Drop | Mobile app offers anonymous data sharing, allowing people to learn from and support each other. How helpful is this?

There’s probably a good number of people who find this helpful. They may feel less isolated, less stigmatized, and feel a sense of social connection. Some people find it quite helpful to receive positive regard for certain health behaviors such as acknowledging that they got through the night without eating or that they reached their walking goals for the day. Many of us need a little cheerleading!

You’re knowledgeable about diabetes and co-morbid depression. Our One Drop | Experts are certified diabetes educators, but not necessarily clinical psychologists. How might they still be a part of the solution?

Behavioral theories say that depression is caused and maintained because the person lacks positive interactions with their environment such as the family and workplace. Anything that introduces and reinforces positive events and activities can reduce depressive symptoms. 24/7 support from a coaching expert may introduce and reinforce such positive interactions in many people’s lives.

 

A program like One Drop | Experts can also help people improve problem-solving skills and communication skills. Both are important for reducing depressive symptoms.

 

Experts can also provide another set of eyes and ears to recommend that people seek professional mental health treatment if it becomes necessary.

You’ve studied low-income minorities with diabetes. How is One Drop poised to help vulnerable populations with the condition?

One Drop may not be for everyone, but there might be a sizable amount of people who will benefit from it. I’d love to see it be an equalizer. People with diabetes may live in rural areas, be disabled, lack transportation to get to the doctor’s office, etc. If One Drop’s | Premium subscription service successfully makes it easier to access care, it could be a game changer.

Anything else?

It’s difficult to live with and manage diabetes. Addressing the emotional side of diabetes, especially diabetes distress, is important. My opinion is that it’s as important as achieving glycemic targets.

There’s always plenty more room for discussion in the diabetes and mental health realm. For more reading material, read up on our Expert, Dr. Mark Heyman’s definition of diabetes and mental health, and how much further is needed to go in promoting awareness for diabetes distress.

 

How do we close the gap between health tech and behavioral science?

The Annual Diabetes Technology Society (DTS) meeting was held this month. It brought together scientists, clinicians and technology developers to discuss and facilitate new technologies to help people with diabetes. Dr. Shelagh Mulvaney was on a particular panel discussion about the “Use of Mobile Apps to Increase Adherence.”

Dr. Mulvaney is an Associate Professor of Nursing, Pediatrics, and Biomedical Informatics at Vanderbilt University. She uses behavioral science in the design of mobile and web applications to help teens with type 1 diabetes problem solve. She’s an expert in using mobile technology to assess behavior and improve self-care and outcomes among people with and affected by diabetes. In our interview, Dr. Mulvaney explained the importance of mobile health, her research findings, the need to bridge the behavioral science/tech gap and the potential progress that could be made.

What surprised you at the DTS meeting?

Behavioral science has a big place at the table. For instance, behavior was discussed in many sessions at this tech-heavy meeting! Health behavior experts have a lot to offer. What we bring may not be fully integrated into technologies, so we need to close that gap.

How do we close the tech and behavioral science gap?

Behavioral scientists must focus on what’s translatable and relevant. Get to the point and show industry how what we’re doing can help. Measurement is the biggest frustration on both sides, especially when talking about complex behaviors. Conversations are a great compliment to sharing in academic journals, which can be limited to a certain audience. Productive conversations can focus on how to measure behavior accurately, feasibly, and meaningfully, and make abstract concepts (like stress, mood and quality of life) concrete by showing how these things relate to outcomes, and, by how much.

At the DTS meeting, you were on a mobile health panel and shared some of your work. Tell us about that.

We had teens with type 1 diabetes use a mobile app with a bluetooth meter or just a bluetooth meter. The app measures context, location, stress, energy, mood, and other psychosocial factors. It then relates those factors to blood glucose excursions, missed blood glucose checks and boluses. It does all of this in real-time. We asked teens to enter app data four times a day. The app then displays data trends through graphical feedback, putting all of this information together in a coherent way so users can make causal inferences about their data patterns.

What did you find?

Fatigue was associated with missing insulin boluses. Teens also told us viewing their data was surprising. It gave them new insights and created awareness. We’re banking on a bit of this curiosity as a catalyst for viewing feedback. We will then integrate that feedback into a problem solving support system.

What was discussed at the mobile health panel?

Somebody asked if apps work. It’s not the right question to be asking ourselves. You don’t ask if the field of medicine works. Why would you ask if apps (as a category of treatment) work? It’s more complicated than that. To get at this answer, we need to measure meaningfully, evaluate rigorously and share what we know.

How should behavioral scientists and diabetes tech teams come together?

Let behavioral science contribute and collaborate with designing systems that actually get used, and see the fruits of our labor integrated into practice more frequently. We don’t just want to help people in our research studies, we want to help people more quickly and more broadly.

User engagement is a huge part of all this. At the meeting, we demonstrated the varying levels of user engagement by showing multiple app engagement profiles. We had teens who were power users with a gradual decline, teens who were variable users, and others who rarely ever used the app. This is market segmentation because one size doesn’t fit all. We have to be adaptive, we can’t engage with everyone. Engagement is a shared challenge in the scientific community and commercial community — it’s ripe for collaboration.

With people like Dr. Mulvaney paving the way, bridging the behavioral science and tech gap is possible, probable and likely to happen soon. Behavioral science and tech collaborations could revolutionize what’s available for people with diabetes. We’re all about that agenda!