What's New in Diabetes Management?

The Association of Diabetes Care and Education Specialists Annual Conference occurs every August. This conference offers diabetes educators the latest and greatest information about diabetes management. As a certified diabetes care and education specialist and a person who’s been managing my own diabetes for many decades, I sought out topics that would be really interesting to us as people living with diabetes. Here are my highlights from the conference:

The New Data: Time In Range

You’re probably familiar with the lab work called hemoglobin A1C (A1C for short). Your healthcare provider may order an A1C once, twice, or three times a year to evaluate your average blood sugars over the past two to three months. It’s been the gold standard for assessing diabetes management, but we’ve long been aware of some limitations. A1C represents a “weighted” average.

“Weighted” means that more recent blood glucose levels contribute more heavily to the A1C value than blood glucose levels last week or, especially, two or three months ago. “Average” could reflect many above-target readings and many below-target readings. For example, readings of 120 and 160 and readings of 50 and 230 both average 140. The American Diabetes Association’s recommended range for A1C is less than 7%, equivalent (more or less) to a 154 mg/dl average.

This year’s conference included a lot of focus on a newer way of seeing how your body is handling the management of your blood sugar. It’s called time in range (TIR). TIR captures the amount of time your blood sugar is in the range between 70 mg/dl and 180 mg/dl. Studies show that this is the ideal range to keep our blood sugar to achieve the best health outcomes. We want our blood sugar to be in that ideal range of 70–180 at least 70% of each day.

TIR information is more actionable than A1C readings. As I mentioned, A1C gives us an average, but TIR will tell us exactly the time of day or night that our blood sugar is above or below the ideal range. We can think of TIR as our GPS for diabetes management. The information helps us navigate the best routes. For instance, if we’re seeing that our blood sugar is dropping too low before lunch, we may want to look at our breakfast meal choices and add more protein and/or fiber to the meal to help keep our blood sugar steady until lunch, or we may need to discuss our medication regimen with our healthcare provider.

How do you find out what your TIR is? TIR is easiest to calculate if you wear a continuous glucose monitor (CGM) because a CGM captures an almost continuous stream of data. But you can also gather the BGM approximation of TIR, called Points in Range, by tracking your blood glucose readings at different times of the day for two weeks. And remember, your POGO Automatic® can help you get the data you need without the hassle of having to carry test strips and lancets, since they’re integrated into 10-test cartridges that you just pop into the monitor. It’s simple to use and it’s discreet, which makes it easy to check your blood sugar anywhere you choose. And your Patterns® app will help you get the data you need in one location. Note: The more readings you have, the more precise the TIR calculation will be —and the more precise your decisions will be, too.

Keep in mind that at least forty-two factors affect blood sugar readings. (It’s not just food, medication, and physical activity.) Knowing the time period when your blood sugar levels are going out of range helps us individualize your diabetes management and is super helpful when it comes to making changes in our diabetes management. I like to refer to this as making informed decisions.

Food Slant: Eating Plants

More and more studies are showing that plant-based eating offers improvements in diabetes management results. There is evidence that if you follow a low-fat vegan eating plan, you may be able to put prediabetes or type 2 diabetes into remission. The focus is on what you eat, not how much you eat.

For people with type 2 diabetes, cells (such as muscle cells) are really stubborn about responding to the natural output of insulin from the pancreas that’s intended to move excess glucose out of blood and into cells. This is often referred to as insulin resistance. Visually, you can think of insulin as the key that opens the lock to get glucose into the muscle—but with insulin resistance, the lock is blocked. Researchers have also found that people with type 2 diabetes have more fat droplets in their cells. Following a low-fat vegan plan will help reduce calories and unclog the cells that contain fat.

The whole-foods, plant-based eating plan is 100% plant based (no animal products) and low in fat and oils, and it uses lower-glycemic-index foods. No carb counting is required, nor is portion control as long as you’re choosing whole, plant-based foods. We suggest that you try this eating plan for three weeks to see how you feel and how your blood sugar levels respond.

If this sounds like too big of a change in your eating habits, start small by eating one meal a week that’s plant based and then gradually increase the number of plant-based meals you eat. As a guideline, choose a minimum of three servings a day from the four plant-based food groups: fruits, vegetables, grains, and beans/peas. Here are some tips on how to get started:

• Add items to your grocery list from each of the four food groups in the whole-foods, plant-based eating plan (fruits, vegetables, grains, and beans/peas).
• Fill up on fiber—make sure you’re choosing the high-fiber food choices within each of the food groups. Fiber helps us feel fuller and slows down the absorption of carbohydrate into our bloodstream, resulting in our blood sugar level rising more slowly.
• Swap animal protein food choices with plant-based ones. For example, at breakfast, have oatmeal with raisins or blueberries and coffee with soy milk instead of bacon and eggs. For lunch, eat a bean burrito and steamed broccoli instead of a lunch meat sandwich. For dinner, try minestrone soup, whole wheat bread, and steamed vegetables in vegetable stock served over barley.

Diabetes Is Challenging

“Mindfulness is awareness that arises through paying attention on purpose, in the present moment, non-judgmentally, in the service of self-understanding and wisdom.” – Jon Kabat Zinn-

The many opportunities for people with diabetes to have a quick reaction to a situation like an above- or below-target blood sugar reading can increase our stress and anxiety. Blood sugar management can be very distracting and interfere with life. Honestly, there are times we may not trust our body or feel safe in our body with all the ups and downs of blood sugar readings. Living with diabetes can be scary. Diabetes is challenging. This is where mindfulness can be very helpful. It’s a skill that gets easier with practice. Start by acknowledging that diabetes is challenging, be accepting that you have diabetes, be present in the moment, and understand that you’ll be okay. Make sure you don’t have unrealistic expectations of yourself concerning your blood sugar readings. Know that you aren’t alone in this journey and that problem solving happens many times throughout the day and night when you’re managing diabetes.

The presenters at the conference offered great suggestions for dealing with diabetes challenges. When you’re feeling lifestyle restrictions or any impact from the restrictions diabetes presents, use the mindfulness practice of accepting the present moment as it is. If diabetes is giving you discomfort from finger sticks or putting an insulin pump on your body, practice mindfulness by observing experiences without judgment. And if you’re feeling that diabetes management is setting you up for impossible expectations, use mindfulness to let go of expectations.

Mindfulness and meditation come in many forms: breathwork, compassion/self-compassion, loving kindness, gratitude, and yoga. My take-home message is to try to include meditation work in your daily life to help you feel balanced, centered, and calm. Namaste