More bad news about pot and T1 diabetes

Study finds higher risk of diabetic ketoacidosis in pot users.

I love my daily diabetes updates- look what I found!

Study shows efficacy of mDiabetes app in reducing A1C levels

A study in Diabetes Care showed that type 2 diabetes patients who used mDiabetes, a smartphone-based app with an individualized diabetes management algorithm, significantly improved their A1C levels and had more significant A1C reductions below the 7.0% threshold after 24 weeks, compared with those who used a paper logbook. South Korean researchers recruited 172 patients, ages 19 to 80, and found that 31.1% of those in the mDiabetes group experienced a drop in A1C levels below 7.0% without experiencing hypoglycemia, compared with 17.1% among those in the logbook group.

What to do about your basal insulin

You've tried them all; Lantus, Basaglar, Levemir, Tresiba, Toujeo. Either they don't meet your needs or they cause side effects. What is next? An insulin pump! this is by far the most predictable delivery of basal insulin. You get a fine trickle of short acting insulin for 24 hours. The new pumps by Medtronic and Tandem are very high tech. If you want to get in to that I am more than happy to support you. If you want simple insulin delivery then go with the Omnipod. Few buttons to push, no tubing and if you order now you will get the DASH upgrade free when it ships next year.
Diabetes only gets more difficult with age. Modern technology makes it easier.

Is stress shortening your life?

Everybody experiences stressors. How this affects you health and longevity depends on how you respond to stress.  Do a Google search on "does stress shorten your lifespan" and you find an abundance of articles and research demonstrating the relationship between stress response and lifespan.

There is an abundance of resources to help you better respond to stress.  Many are free ans simple to do. But, similar to eating healthy and exercising, they are often forgotten or dismissed.  How you prioritize your health is reflected in what you do to stay healthy.

There is a more thorough approach to stress management called resilience training.  Resilience is the concept of dealing with stress in a positive and healthy way that allows you to bounce back better than you were before the stressor.  You know that muscles get stronger by using them to their maximum. In the same way you can get mentally and emotionally stronger by using stress as mental weight lifting. The challenge is to engage these mental exercises regularly, just as you should be doing with physical exercise.

The methods utilized in resilience training are quick, simple and have been shown to be clinically effective. Pick up a training book on Amazon, find a few exercises that fit with your schedule and personality, and DO IT.

I am planning to offer a resilience training workshop in February 2019. My current plan is to have a 60-90 minute session once weekly for 4 weeks. Start time would be 5:15 pm.  Attendees are expected to purchase the workbook and read the introductory chapter prior to the first class.  I haven't determined the fee yet, or if it will be billable to insurance. I will keep you posted via this blog and my office Facebook page.

Give me the placebo!

But don't tell me I'm getting it. If I know then it won't work.
I was looking at data on a recently-approved medication for migraine prevention. For $600 a month I can reduce my average migraine from 8 per month to 4 per month. The cost-free, side-effect free placebo reduced migraine days from 8 per month to 6 per month. If the placebo doesn't' work I can always switch to the real medication.
The power of placebo is real. Clinical trials routinely include a placebo group. The response rate to the placebo varies depending on what condition is being treated. The 'side effects' on placebo are also interesting, further demonstrating what the power of the mind can do.
I think that the power of placebo frightens off a lot of 'alternative practices' from doing any science to demonstrate safety and efficacy. What if they discover that the recent fad of (insert name of fad) is no more beneficial than placebo?  On the other hand, if I don't know that it's a placebo it might work for me!
Dr. George Lundberg has some excellent articles  that discuss the placebo effect. In 1998 he and Dr. Phil Fontanarosa wrote:
There is no "alternative medicine." There is only medicine:
Medicine that has been tested and found to be safe and effective. Use it; pay for it.
And, medicine that has been tested and found to be unsafe or ineffective. Don't use it; don't pay for it.
And, medicine for which there is some plausible reason to believe that it might be safe and effective. Test it and then place it into one of the other two categories.
This approach sounds simple. It also can be threatening to the multi-billion dollar industry of nutritional supplements. Try it and see if it works? Look back on the comment 'there is some plausible reason...". If it's cheap and harmless it might be worth a try. The likelihood of success depends on your susceptibility to he placebo effect.
There are plenty of trials for a variety of nonprescription therapies showing various benefits and failures. It's not always easy to find these reports. You need to know how to navigate PubMed and Google Scholar and know how to stratify the validity of the studies. As examples, there have been clinical trials for migraine headache using coenzyme Q10, riboflavin and melatonin. The studies weren't sufficiently large enough to garner the attention of the American Headache Society but the data supports at least giving it a try. On the other hand, herbal treatments purported to be useful for headache, including ginger, wood betony, feverfew and vervain, have no actual data. They have the support of history and urban legend. I have no idea what the effectiveness is above placebo.
I recommend the following articles by Dr. Lundberg to round out the discussion:
Accidental genius of homeopathy
Therapeutic (non) touch.

Advanced diabetes management webinar with Medtronic

FREE Diabetes Education for Patients Taking Multiple Shots Daily

FREE Diabetes Education for Patients Taking Multiple Shots Daily.
DATES: First Monday of each month
Location:  Dr. Caruso’s office
Educator:  Lynea Albers MEd, RD, CDE (916) 396-7678 (Omnipod employee)
Call or text to schedule appointment.

Medicare pays for continuous glucose sensors

But...there are a lot of rules. If you want a Dexcom you will order from Dexcom. If you want a Freestyle Libre you need to order through one of their partners.
Here are the rules:

• The beneficiary requires a therapeutic CGM. The beneficiary has diabetes mellitus; and,
• The beneficiary has been using a home blood glucose monitor (BGM) and performing frequent (four or more times a day) BGM testing and records are kept or meter is downloaded for 30 days; and,
• The beneficiary is insulin-treated with 3 or more daily injections (MDI) of insulin or a continuous subcutaneous insulin infusion (CSII) pump; and,
• The beneficiary's insulin treatment regimen requires frequent adjustments by the beneficiary on the basis of therapeutic CGM testing results.
• Within six (6) months prior to ordering the CGM, the beneficiary had an in-person visit with the treating practitioner to evaluate their diabetes control and determine that the above criteria are met; and,
• Every six (6) months following the initial prescription of the CGM, the beneficiary has an in-person visit with the treating practitioner to assess adherence to their CGM regimen and diabetes treatment plan.

Happy to pass this along

Coming Soon! Adult Education Workshop

The Nevada Diabetes Association will be offering an Adult Diabetes Education Workshop in Reno this spring. This workshop will be field trip based one day, every 2 weeks, from February 15th, 2018 to April 26th, 2018.   Please take this anonymous survey so we may provide the best possible workshop for you.  Your feedback will be very helpful in the planning process.     Take this survey

 I am now providing a non-drug treatment for neuropathy, insomnia, anxiety and depression. It is called Alpha Stim. Treatment takes 20-30'. I will have you fill out a neuropathy pain score before and after treatment. These treatments will be $30 per session. I do not bill insurance for treatments alone. If you have a treatment done the same time as your appointment the fee will be included in your office charge. Please call for an appointment. My medical assistant will be providing this service on Tuesdays and Thursdays.
If you want to order one for yourself I will be happy to provide a prescription for established patients only.
http://www.alpha-stim.com/

Live on-line support for T2 diabetes

The American Diabetes Association has a series of live webcasts for T2 diabetes. They are also available as podcasts if you don't have time for the live session. Past sessions are also recorded.
REGISTER TODAY! Visit diabetes.org/experts. Text EXPERTS to 828282 to register for the series.
QUESTIONS? Contact the ADA at 1-855-565-0595 or via email at askada@diabetes.org