Get your new 2018 ADA Standard of Care here

[agedhippie]

The new 2018 Standard of Care is out. Find it here - link

If you just want to see the changes go here - link

[sexychefski]

I like in section 6, how the use of CGMs has been changed to all adults over 18 who are not at goal. The year of CGMs has begun.

[sayhey24]

The change on the CGMs is big. As I told Al at the 2015 ASM, spirometry was not the issue but rather the PWDs needing to understand the post meal spike. They need to see in real time what afrezza can do.

Now the monitoring companies and technology are coming together. The next piece are the "VDexs". This is the current missing link to join the PWD to the monitoring. Not all but many PWDs need personalized counseling. As VDex and others expand afrezza use the war will be won and afrezza will become first line usage for treatment of early T2s and prediabetics.

The sooner you treat with afrezza the better as the chances of reversing is huge.

[agedhippie]

Dec 14, 2017 5:30:12 GMT -5 sexychefski said:

I like in section 6, how the use of CGMs has been changed to all adults over 18 who are not at goal. The year of CGMs has begun.

That's still limited to Type 1 diabetics. The change is that Type 1s between 18 and 20 can now get insurance cover for CGMs which is good. The better insurers already cover that age range as well as pediatrics. Type 2 diabetics are still out of luck.

[lennymnkd]

One would think , only a matter of time for type 2 coverage/ CGM ....

[agedhippie]

Dec 14, 2017 8:18:51 GMT -5 lennymnkd said:

One would think , only a matter of time for type 2 coverage/ CGM ....

It's the cost. A Dexcom is several thousand a year. It was a huge fight to get insurers to cover Type 1s until the Kaiser study.

[sayhey24]

Dec 14, 2017 8:07:53 GMT -5 agedhippie said:

Dec 14, 2017 5:30:12 GMT -5 sexychefski said:

I like in section 6, how the use of CGMs has been changed to all adults over 18 who are not at goal. The year of CGMs has begun.

That's still limited to Type 1 diabetics. The change is that Type 1s between 18 and 20 can now get insurance cover for CGMs which is good. The better insurers already cover that age range as well as pediatrics. Type 2 diabetics are still out of luck.

Only Type 1, hmmmm.  So what is the definition of a type 1?  When I do the google I get answers like this

"In general, people with diabetes either have a total lack of insulin (type 1 diabetes) or they have too little insulin or cannot use insulin effectively (type 2 diabetes)."  Well we know from beta cell replacement almost all T1 still have some beta cell function so the word "total" is wrong.

Or I get answers like this
"Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin."

So do 70% of T2s become Type 1's?  My dad for example started on the orinase, then the diabinese then one shot then two before having the massive heart attack.  Based on the above definition was he at the end a type 1? 

Would he have qualified for the CGM?   One thing I know is he sure could have used one when they first put him on the orinase.   He would have been able to see what a mess it was making and he could have gone on the insulin day 2 which may have stopped the progression and limited the coronary disease.

[joeypotsandpans]

The Libre will be fine for a lot of the T2 population and it will be affordable for many without insurance if necessary. I know the alarm on Dexcom's CGM is important for T1's regarding the overnight situation but the last thing for a lot of T2's to worry about is going low overnight on Afrezza, just the opposite with their livers producing sugars while their sleeping for those higher fasting BG readings in the am. There is also the benefit of not having the cost of the strips, etc. as well and not having to carry meters and the equipment around. More importantly is compliance, call me a big wuss but those finger pricks suck all day long. Funny thing on a side note, Spiro took a pack of cartridges out and showed me how he rounded the edges on the blister pack to eliminate the edges being an annoyance while in pants pocket....I said I already just pop them out and keep them in my pocket individually...I had to laugh to be honest as that was the only thing that originally bothered me as well so that was solved pretty quickly, imagine that being the ONLY thing that bothers some lol...can't wait for the email letting me know my Libre is ready at the pharmacy

[agedhippie]

Dec 14, 2017 19:01:17 GMT -5 sayhey24 said:

Dec 14, 2017 8:07:53 GMT -5 agedhippie said:

That's still limited to Type 1 diabetics. The change is that Type 1s between 18 and 20 can now get insurance cover for CGMs which is good. The better insurers already cover that age range as well as pediatrics. Type 2 diabetics are still out of luck.

Only Type 1, hmmmm.  So what is the definition of a type 1?  When I do the google I get answers like this

"In general, people with diabetes either have a total lack of insulin (type 1 diabetes) or they have too little insulin or cannot use insulin effectively (type 2 diabetes)."  Well we know from beta cell replacement almost all T1 still have some beta cell function so the word "total" is wrong.

Or I get answers like this
"Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin."

So do 70% of T2s become Type 1's?  My dad for example started on the orinase, then the diabinese then one shot then two before having the massive heart attack.  Based on the above definition was he at the end a type 1? 

Would he have qualified for the CGM?   One thing I know is he sure could have used one when they first put him on the orinase.   He would have been able to see what a mess it was making and he could have gone on the insulin day 2 which may have stopped the progression and limited the coronary disease.

The insurers usually require a diagnosis of Type 1 and a c-peptide test showing minimal insulin production (I cannot remember what the exact level is off-hand but it's very low). There are cases of Type 1s not meeting the c-peptide bar. They used to also require that you show either hypo-unawareness, or 'brittle' diabetes (that's a contentious term now).

Personally I hate sulfas like orinase and diabinese. I would certainly tell anyone on them to swap immediately.

[babaoriley]

Dec 14, 2017 19:05:43 GMT -5 joeypotsandpans said:

The Libre will be fine for a lot of the T2 population and it will be affordable for many without insurance if necessary. I know the alarm on Dexcom's CGM is important for T1's regarding the overnight situation but the last thing for a lot of T2's to worry about is going low overnight on Afrezza, just the opposite with their livers producing sugars while their sleeping for those higher fasting BG readings in the am. There is also the benefit of not having the cost of the strips, etc. as well and not having to carry meters and the equipment around. More importantly is compliance, call me a big wuss but those finger pricks suck all day long. Funny thing on a side note, Spiro took a pack of cartridges out and showed me how he rounded the edges on the blister pack to eliminate the edges being an annoyance while in pants pocket....I said I already just pop them out and keep them in my pocket individually...I had to laugh to be honest as that was the only thing that originally bothered me as well so that was solved pretty quickly, imagine that being the ONLY thing that bothers some lol...can't wait for the email letting me know my Libre is ready at the pharmacy

So, Joey, during your time with Spiro, which one of you said the most words?  

[alethea]

Dec 14, 2017 19:05:43 GMT -5 joeypotsandpans said:

The Libre will be fine for a lot of the T2 population and it will be affordable for many without insurance if necessary. I know the alarm on Dexcom's CGM is important for T1's regarding the overnight situation but the last thing for a lot of T2's to worry about is going low overnight on Afrezza, just the opposite with their livers producing sugars while their sleeping for those higher fasting BG readings in the am. There is also the benefit of not having the cost of the strips, etc. as well and not having to carry meters and the equipment around. More importantly is compliance, call me a big wuss but those finger pricks suck all day long. Funny thing on a side note, Spiro took a pack of cartridges out and showed me how he rounded the edges on the blister pack to eliminate the edges being an annoyance while in pants pocket....I said I already just pop them out and keep them in my pocket individually...I had to laugh to be honest as that was the only thing that originally bothered me as well so that was solved pretty quickly, imagine that being the ONLY thing that bothers some lol...can't wait for the email letting me know my Libre is ready at the pharmacy

I was diagnosed 14 years ago.  Pricked my fingers for only a couple weeks or so as I was lucky enough to have the pharmacist suggest forearm testing.  It is literally painless 98 times out of 100.

I don't understand why people don't do forearm testing - especially us Type 2's.

Fingertip pricking really, really hurts.

[dreamboatcruise]

Dec 14, 2017 5:30:12 GMT -5 sexychefski said:

I like in section 6, how the use of CGMs has been changed to all adults over 18 who are not at goal. The year of CGMs has begun.

I had a family member pass less than a year ago who probably would still be alive if he had access to a CGM to expose the substandard care in his assisted living facility.

Hopefully this will actually mean people have access through insurance, Medicare and Medicaid.

[dreamboatcruise]

Dec 14, 2017 19:01:17 GMT -5 sayhey24 said:

Dec 14, 2017 8:07:53 GMT -5 agedhippie said:

That's still limited to Type 1 diabetics. The change is that Type 1s between 18 and 20 can now get insurance cover for CGMs which is good. The better insurers already cover that age range as well as pediatrics. Type 2 diabetics are still out of luck.

Only Type 1, hmmmm.  So what is the definition of a type 1?  When I do the google I get answers like this

"In general, people with diabetes either have a total lack of insulin (type 1 diabetes) or they have too little insulin or cannot use insulin effectively (type 2 diabetes)."  Well we know from beta cell replacement almost all T1 still have some beta cell function so the word "total" is wrong.

Or I get answers like this
"Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin."

So do 70% of T2s become Type 1's?  My dad for example started on the orinase, then the diabinese then one shot then two before having the massive heart attack.  Based on the above definition was he at the end a type 1? 

Would he have qualified for the CGM?   One thing I know is he sure could have used one when they first put him on the orinase.   He would have been able to see what a mess it was making and he could have gone on the insulin day 2 which may have stopped the progression and limited the coronary disease.

I thought the clear distinction between Type 1 and Type 2 is that Type 1 is autoimmune.  I would have assumed they diagnosed it with antibody tests.

I have a hypothyroidism disease of the autoimmune type (Hashimoto's Syndrome).  The differential diagnoses being an antibody test.  Many people get non-autoimmune hypothyroidism as they get older, but the autoimmune version often strikes earlier as it did with me, similar to the situation with diabetes.

[sayhey24]

Well, whats becoming clearer and clearer as testing is getting better is more and more T2s also test positive for autoimmune. We now call them LADAs. I suspect if we tested all T2s early enough and had tests sensitive enough most T2s lost pancreatic function because of an infection which affected the beta cells.

All diabetics share the same issue, they are not making enough insulin for their body's needs and all diabetics have the inability in their current condition to regenerate enough beta cells to over come their insulin shortage.

Then the question is, is the attack active or not. If it is not an active attack and the beta cells are not too badly damaged we can regenerate beta cells naturally by keeping the PWD in a non-diabetic range.

[agedhippie]

Dec 16, 2017 8:30:28 GMT -5 sayhey24 said:

Well, whats becoming clearer and clearer as testing is getting better is more and more T2s also test positive for autoimmune. We now call them LADAs. I suspect if we tested all T2s early enough and had tests sensitive enough most T2s lost pancreatic function because of an infection which affected the beta cells.

All diabetics share the same issue, they are not making enough insulin for their body's needs and all diabetics have the inability in their current condition to regenerate enough beta cells to over come their insulin shortage.

Then the question is, is the attack active or not. If it is not an active attack and the beta cells are not too badly damaged we can regenerate beta cells naturally by keeping the PWD in a non-diabetic range.

There has never been any evidence of beta cells regenerating (that's part of the holy grail). At best, beta cells that are dying may recover if levels are stabilized. That's what happens with the honeymoon phase in Type 1, or some of the stranger variants of Type 2 like Flatbush. However once a beta cell is dead it never regenerates.

In Type 2 the problem is apoptosis. The body naturally kills and replaces cells but there can be flaws in that process. When the body kills more cells than it produces you get degenerative diseases. In Type 2 the target that is under-produced is beta cells.