Lilly Humalog U-200 KwikPen Approved.

Lilly announced FDA approval of U-200 Humalog in a release today. 

U.S. Food and Drug Administration Approves Humalog® 200 units/mL KwikPen® 

Marks approval of first concentrated mealtime insulin analog in the U.S. and expands Lilly's portfolio of medicines for people with type 1 and type 2 diabetes 

INDIANAPOLIS, May 27, 2015 /PRNewswire/ -- The U.S. Food and Drug Administration (FDA) has approved Humalog^® 200 units/mL KwikPen^® (insulin lispro 200 units/mL; U-200), a pre-filled pen containing a concentrated formulation of Lilly's rapid-acting insulin Humalog^® (insulin lispro 100 units/mL) to improve glycemic control in people with type 1 and type 2 diabetes, Eli Lilly and Company (NYSE: LLY) announced today. Humalog U-200 KwikPen marks the first FDA approval of a concentrated mealtime insulin analog 

Humalog U-200 KwikPen holds twice as many units of insulin (600 units vs. 300 units) as the U-100 formulation in the same three-milliliter cartridge. This offers patients a pen that lasts longer between pen changes, allowing for fewer changes every month.* Humalog U-200 KwikPen delivers the same dose in half the volume of Humalog U-100 KwikPen with no dose conversions required, and can be dialed in one-unit increments to a maximum of 60 units per injection.

More: https://investor.lilly.com/releaseDetail.cfm?ReleaseID=914999

Gimme 5 - a new hypo strategy

It is. Is it? Isn't it?

Here is a conversation I have had at pretty much every annual review I have ever had for my diabetes:

HCP: How many hypos are you having?
Me: Well... erm... that kinda depends on what you mean
HCP: What?
Me: On how you define 'hypo'. What you mean by it. What number or experience you use.
HCP: Erm... well... I... er...

You might think that it is a fairly simple question. Anything below 4.0mmol/L right? "Four is the floor" and all that.

Except that in the US it would be below 70mg/dl (3.9mmol/L) not below 72mg/dl (4.0mmol/L) - so suddenly there are a whole bunch of results that don't 'count' if you live over the pond just to make the US version a round number.

The matter is even more complicated by inherent meter inaccuracy. I have to say I trust my current Contour Next USB more than any other I have ever owned. Previously if I wasn't sure of a result I would immediately retest and could get a new result perhaps a mmol/L or two different in either direction. With my Contour Next USB, double checked results are more often than not *exactly* the same, or at most within a few decimal places. But this aside, ALL blood glucose meters are only legally required to work to within +/- 20% of a lab value. As I have pointed out before this can mean that your 4.0 (72) reads anywhere between 3.2 (58) and 4.8 (86). So which of those sub-4s would you count if some of them might be over 4 with a different strip or from a different finger? I can't spend my whole life (and all my test strips) triple-checking everything and taking the mean value...

But even if we set aside the imperfections in the data feed and assume that all the numbers are the actual numbers, it still isn't that simple. Particularly if, like me, you have ever experienced a degree of hypoglycaemia unawareness. Because you, dear non-diabetic reader, could be quite happily pottering along right now with a plamsa glucose concentration of 3.8mmol/L and no warning signs, and no one would care a hoot. For me and rest of the pancreatically-challenged horde though... things are different. If we don't get clanging warning signs at every 3.9 there is a breed of healthcare professional that will believe you are a danger to yourself, society at large and will be lucky to make it down the stairs without collapsing into a coma.

Don't get me wrong. I do not underestimate the severity of Impaired Awareness of Hypoglycaemia. Far from it. I have lived with it, and through it, and (particularly if associated with Severe Hypoglycaemia as it so often is) it is miserable for you, your family and everyone you are close to.

But if people without diabetes can be 3.8 and not hypo... then... well... er... Are we pancreas impersonators supposed to perform better than a fully-functioning non-D?!

Added to this - some guidance describes treating levels below 4.0mmol/L to avoid hypoglycaemia. From this standpoint 3.x-3.9mmol/L could be seen as offering a sort of 'buffer zone', a tiny whisker of breathing room before things might start getting messy. But 3.what?

This study suggests that most non-diabetic people will begin to experience some early warning signs in the region of 3.6-3.9mmol/L

While this study puts the level at which the brain begins to malfunction as 3.0mmol/L. And this, after all, is what we are actually trying to avoid at the end of the day.

But you don't have to have lived with diabetes for very long before you realise that the more 3.7's you have, the harder they are to spot. And the more likely you are to start getting 3.2s. And so on... and so on...


Plus ca change
And so it goes... I have some sub-4s, I try to have fewer. Some months it works. Other months it doesn't. Sometimes people are advised to 'run a bit higher' for a while (though there is little evidence that this relaxing of targets actually works to be honest). And I'm always caught by not really knowing how important a handful of readings between 3.5 and 4.0mmol/L are in the absence of Severe Hypoglycaemia and with relatively reliable warning signs that usually kick-in around 3.0-3.5mmol/L. And yet some clinic appointments make me feel like an abject failure for missing a 3.8 here or there. And the lower your HbA1c, the more twitchy your clinic tends to be about how many 'hypos' you are having - the very people who will be asked about your fitness to drive, for example. It's a quandary.


New strategy... Gimme 5
So as of this month, I have decided to try something new. I have been treating 5.0 as if it were 4.0. Any reading below 5.0 I have been treating as if hypo with fast-acting carbs (I have never been a follow-up carb person). And anything below 5.5 I have been treating more moderately with a smaller amount of fast carbs and/or a short sharp TBR - say 30-60 minutes dropped down to 10%.

Results so far are fairly encouraging. As an approach it certainly hasn't resulted in the general hike in BG averages that I have seen previously when trying to get rid of a few more of those pesky dips below 4. Hard to be sure and I'd have to run the system for a few more months but my best guess is that I might have lost perhaps 25-40% of sub-4 readings so far.

What do you think? Am I the only one who drives themselves nuts over this? How do you go about hypo-busting?

You're a Fat F@#! and You Give Diabetes a Bad Name!

When I was diagnosed with type 2 diabetes, it took me some time to become aware of all the various resources that were out there for me. There were various mainstream informational websites, and a few personal blogs. I didn't even have an inkling that there were exclusive forums for people with diabetes, until I found a reference for one in a blog.

So I joined the forum, excited to meet other people and see what it was all about. It opened my world to a whole new level of knowledge I had not been exposed to through the mainstream informational websites, and it made me consider so many questions related to day to day living with diabetes. At the time, I was struggling with other life challenges, as well: I had been struggling with underemployment, lack of medical coverage, and a lack of food, so the forum provided for me a place to come, get some encouragement, and escape reality for a little while.

While I made many valuable friendships, and met folks who helped me realize that I'm not alone in my path with diabetes, I also met a lot of jaded and hurtful individuals. And I was very much not prepared for that. Sure -- there are always trolls and mean persons on every corner of the internet, but this was different: these were people who exclusively hated me and held me in contempt for having the 'wrong' type of diabetes. And that was something I could not understand.

Now, I am well aware that I may not have the most easy going personality -- but this problem was beyond my having ever joined this forum. A simple search through their archives, and one could find thread upon thread of vitriolic, incredibly detestable hate-filled fests against persons with type 2 diabetes. On top of that, administration seemed to care little about monitoring this type of bullying, and called it "constructive dialogues that needed to be had." It was frankly, quite off-putting. The forum quickly became detrimental to my health, contributing to feelings of shame, self loathing, and depression. I felt myself addicted to it, as someone who's addicted to the person who has become their abuser. I was glad when I was finally banned -- a woman took to insulting me after an innocent reply to a post, and when I replied in self-defense mode, she conveniently deleted hers... It was hurtful, and I felt very much betrayed. I still do. But it was for the best. There were people who only pretended to be my friend, and after I was gone, completely stopped speaking to me. Just like junior high. The whole thing was gross.

It wasn't all a loss, however. Some of the people who I had friended decided to find me and friend me on other social media outlets. They missed my insights and my writing, and encouraged me to blog; they were instrumental in me even starting this blog. Many of them are still my friends till this day. I value those friendships very much, and my life is richer for having them.

But... after leaving that forum, I found that this terrible hatred, and vitriolic scene was not just a problem exclusive to them, but instead it was a part of a greater online diabetes culture. No matter what group, page, or discussion you joined, there would always be discussion about persons with type 2 diabetes being to blame, being fat and gross, having a 'different disease that is not mine and needs to be renamed so we're not associated with them because they gave it to themselves,' not having 'real diabetes,' not being important or deadly, and not to be considered as allies, but as people who have ruined things for 'the rest of us.'

Frankly... I've never been hated so much by someone for just existing. Not even as a Latina woman, in a predominantly Caucasian state; not even as an obese woman by persons without diabetes!

I quickly became very resentful of these people. I sought out many arguments purposefully, and tried to argue it out with as many of these haters as I could. In my mind, I saw them as immoral, awful people, who needed to be put in their place. I saw the culture of rampant discrimination, bullying and persecution, and I just had to get on my little crusade to fix it. I sought to try to force people to see that type 2 diabetes was very much misunderstood, and that they needed to see this for themselves as much as their own type of diabetes was misunderstood. I argued, and I got on my soapbox, and I ran myself ragged.

Some folks were on my side and argued for me, and even wrote extensive blog posts... and some other folks were not. Some other folks were more lukewarm: they could sympathize with me, but they still wanted the 'comfort' of relating to others about how much they resented my own type. I felt like these folks wanted to eliminate us, like a kind of ethnic cleansing: obliterate us from existence, so they could get justice served for their own misfortunes. We are 'the punching bag' for their child, or their spouse, or their whoever having gotten their type of diabetes.

It's become very challenging for me to not reserve a well of pure hatred for many, or most of these people. But slowly, and with time, I've come away to a different place when it comes to the conversation... I can't have anything but sympathy for these folks.

You see, the feelings, hatred and vitriol -- though hurled at me and others living with type 2 diabetes -- have absolutely NOTHING  to do with us... and everything to do with those who hurl them. They do not say a thing about us; they simply speak of unmet needs, of emotional trauma, of personal agony and challenge, of isolation and lack of recognition.

None of this has anything to do with me. It has everything to do with:

• The stress of living with a deadly chronic condition, and a lack of acknowledgement of this reality by friends, relatives, the media, and the medical community;
• The frustration of living in a world rampant with ignorance about diabetes in general, but especially about any other type that isn't type 2;
• The lack of psycho-social support and mental health available for people living with diabetes;
• The often inevitable feelings of seeing oneself through the lens of a victim's narrative because it's really hard to rationalize to ourselves the WHY we (or our loved one) got such a sucky hand in life (a subject that could well fill another blog post, on its own);
• The feelings of a need to 'make things right,' and avenge the lot in life we got (or our loved ones) by attacking others that society has told us 'gave it to themselves,' so that we can feel better that we were 'innocent' (as if those others were guilty, somehow) ;
• The desperation of not being able to find healing for ourselves, or for our loved ones... often, the desperation of complications, or a lack of research and a cure;
• Simply... the pent up agony and anxiety at not being recognized on almost any outlet, ever... even as rarer conditions get at least some moments in the limelight.

I have distanced myself a lot from many of these conversations, and forums. I went off to make my own diabetes support group where this type of vitriolic atmosphere is simply not tolerated. Where a culture of being one another's advocate is encouraged -- because we're all we've got. Outsiders are seldom interested in any diabetes, of any type. Period. It's up to us to educate ourselves as much as we pretend to educate others. 

But just because I've surrounded myself with love, and support -- and rewired the conversation -- doesn't mean that the hate fest doesn't live on outside of my bubble. Oh, it does.

So a couple of nights ago, when I was misguidedly arguing with a friend over an idiotic political meme (as you do) and they lashed out at me, declaring that I was 'a fat fuck, who gave diabetes a bad name,' I didn't even blink. They proceeded to unfriend me, and thus ended a long friendship... But I knew the insult had nothing to do with me. I knew the person had waited long and hard to find an apt moment to hurl the insult at any person with type 2, and therefore, stab life right in the groin. I knew the person had been struggling long and hard with some pretty scary complications from diabetes... and needed something or someone out there, to pay for it; to be their punching bag. I knew they were writing their own victim's narrative. 

Had they done all the right things, some might ask? I don't know. Does it matter? Do they 'deserve' their pain, somehow, if they had not? I think we've ALL done all the right things, and all the wrong things at one point, or another. At the end of the day, frankly, diabetes doesn't care whether you 'gave it to yourself,' or not. It has little empathy. In fact, it has none.

I simply don't get angry anymore. Instead, I love these people, and I let go.

Once one understands the mechanics of what's at play, it's easy to let go and forgive. It has nothing to do with me, after all, and it never has. I respect the walk of my fellow friend, though it's not my own. It's not my duty to make these people feel better about their own type of diabetes by letting them belittle me... no. 

But I understand, and thus I let go... For in unfortunate choices, or through hatred, and in pain, people are still human. They still deserve some dignity and some humanity. So you let people go, and you hope they find some healing. You hope their lashing out at you helped them, somehow. You hope they find their peace.

You let go of all the folks that do not build you up... so they can find whatever it is might build them up. We're all (though sometimes reluctantly so) in this together... So, off you go. 

Researchers at loggerhead over benefit of diet soda to weight gain and diabetes

Diet drinks are good but like other things should be consumed in small
quantity. As there are lots
of theories about why diet
drinks is safe and vice versa.

For instance, a study
published in the journal
Trends in Endocrinology and
Metabolism
in 2013 pointed that frequent
consumers of these sugar
substitutes (such as aspartame,
sucralose and saccharin) may
also be at increased risk of ...
metabolic syndrome, type 2
diabetes and cardiovascular
disease.

Also the findings of the San
Antonio Heart Study suggested a
strong link between diet soda
consumption and weight gain
over a long period of time.

Meanwhile there are also studies that
suggesting zero-calorie sweetened
beverages, including diet soda,
may help people in maintaining their
weight.
For instance, a study
found that overweight teens maintain their weight by switching from sugar-
laden drinks to zero-calorie
options such as diet soda.

So as researchers are at loggerhead over the benefit of diet soda
especially in relation to weight gain and diabetes, my advice for
consumers is to drink diet drinks moderately.