A Craftsman Blames His Tools: Blood Glucose Meter Accuracy & Long-Term Diabetes Control

A Craftsman Blames His Tools: Blood Glucose Meter Accuracy & Long-Term Diabetes Control
Summary
After consistently receiving higher-than-expected A1c results, I tested my meter against four of the most popular meters available to see if systematic bias was at the heart of my frustration. The results were particularly damning to not only my meter, but to the landscape as a whole. I found that meter accuracy alone could be responsible for a full 1.5% difference in A1c without any change to perceived glucose control, resulting in significantly different treatment plans and emotional outcomes. This contrasts the rhetoric presented by device manufacturers, medical providers, and leading diabetes organizations, all of whom take a particularly casual approach to the question of accuracy.
Introduction
When I started using Dexcom’s G4 Platinum w/ Share continuous glucose monitor (CGM) about a year ago, I found that my average glucose was not correlating well with my periodic A1c results. Specifically, for three separate three-month periods, my A1c came in a full percentage point higher than my average glucose (as calculated from my CGM data) would predict. This was especially frustrating given how much effort I was spending tuning my homemade artificial pancreas. While there are numerous potential sources for this discrepancy, the fact that it was occurring consistently pointed me in the direction of something that could cause systematic bias: the twice-daily blood glucose meter readings used to calibrate my CGM.
For the past seven years or so, I have been using the Johnson & John Continue reading

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What is diabetes?

Diabetes is an incurable condition in which the body cannot control blood sugar levels, because of problems with the hormone insulin. There are two main variations of the illness, Type I and Type II.
How does the body control blood sugar levels?
Your body uses blood sugar (glucose) for energy. Glucose is a basic ingredient of sweet foods such as sweets and cakes. It can also be produced by carbohydrates such as potatoes, pasta or bread when they are digested and broken down.
Under normal circumstances, the hormone insulin, which is made by your pancreas, carefully regulates how much glucose is in the blood. Insulin stimulates cells all over your body to absorb enough glucose from the blood to provide the energy, or fuel, that they need.
After a meal, the amount of glucose in your blood rises, which triggers the release of insulin. When blood glucose levels fall, during exercise for example, insulin levels fall too.
Types of diabetes
There are two main types of diabetes. In Type 1 diabetes the cells of the pancreas stop making insulin. In Type 2 diabetes, either the pancreas cells do not make enough insulin, or the body's cells do not react properly to it. This is known as insulin resistance.
Type 1 diabetes is an autoimmune condition, and the immune system attacks the cells of the pancreas. It tends to affect people before the age of 40, and often follows a trigger such as a viral infection.
The exact mechanisms that lead to Type 2 diabetes are not fully understood, but an underlying genetic susceptibility is usually present. This could be a family history of the illness, f Continue reading

LI doctor leads study of Type 1 diabetes’ effects on the brain

For nearly a century, scientists have asked how diabetes affects the aging brain. Now a Long Island medical investigator — with the help of a $4.2 million grant — is beginning the hunt for answers.
Dr. Alan M. Jacobson, chief research officer at NYU Winthrop Hospital in Mineola, has been awarded the money by the National Institutes of Health. He is to lead a consortium of medical centers throughout the United States and Canada with the aim of understanding how Type 1 diabetes affects the most complex organ in the known universe — the human brain.
Participants will be 60 and older, ages when the risk rises for cognitive impairments, with or without diabetes.
Earlier medical investigations have shown that diabetes adversely influences the brain through a telltale triad — uncontrolled blood sugar, high blood pressure and high cholesterol. All three are part of the condition.
The team will be on the lookout for key predictors of cognitive impairments as they collect information on hundreds of people over the next five years. The research is just getting organized, Jacobson said.
His game plan is to delve into every possible nuance about cognitive function under the impact of a lifelong and powerful disease, and employ imaging technology to eavesdrop on each participant’s brain.
“We will be using MRI and a variety of different techniques to study brain structure, brain physiology and changes in vascular blood flow,” Jacobson said. The research will attempt to answer unresolved questions about brain shrinkage, memory loss and cognitive declines in thinking and probl Continue reading

Counting Carbohydrates Like a Pro

Practical Tips for Accurate Counts
Let’s get this straight: There is no such thing as a “pro” when it comes to carbohydrate counting. There is no master’s degree or PhD in Carbohydrate Science at any major university, nor is there a course focusing on counting carbohydrates in any dietetics or nutrition science program. And I’ve yet to meet anyone at a circus or carnival who, for a mere dollar, will “guess the carbohydrates” in your favorite food item, lest you win a valuable prize. So why would anyone with diabetes want to count carbohydrates “like a pro”?
Simple. When it comes to keeping blood glucose levels in control, carbohydrate counting works better than any other system. Better than counting calories. Better than avoiding sugar. And certainly better (and simpler) than the exchange system.
Carbohydrate is what raises blood glucose level abruptly after meals. Not fat or protein or vitamins or minerals. Just carbohydrate. Counting and managing the amount of carbohydrate in your diet has important benefits. If you take multiple daily injections of insulin or use an insulin pump, carbohydrate counting allows you to match doses of mealtime rapid-acting insulin to the foods you eat. This allows for almost unlimited dietary flexibility and helps to prevent post-meal highs and lows.
If you control your diabetes with diet and exercise, pills, or just one or two insulin injections a day, you can also use carbohydrate counting to improve your control. Researchers at the University of Texas School of Allied Health Sciences in Galveston found that consistent car Continue reading

Treating gum disease may lessen the burden of heart disease, diabetes, other conditions

In the folk song “Dem Bones,” every bone is connected to the next one in line. Here’s an interesting wrinkle on that idea: The gum bone, or at least problems with it, are connected to all sorts of health problems.
Gum disease—which begins when the sticky, bacteria-laden film known as plaque builds up around your teeth—is closely linked to premature birth, heart disease, diabetes, and other chronic health problems. Now, a report in the August issue of the American Journal of Preventive Medicine finds that treating gum disease (also called periodontal disease) can lead to better health — as evidenced by lower health care costs and fewer hospitalizations — among people with common health conditions.
The study looked at health and dental insurance records from nearly 339,000 people, all of whom had periodontal disease and one of five conditions: type 2 diabetes, cardiovascular disease, cerebrovascular disease (usually a stroke), rheumatoid arthritis, or pregnancy. Researchers found that people with four of the five conditions (all except rheumatoid arthritis) who had at least one periodontal disease treatment had lower medical costs and fewer hospitalizations within four years of the treatment compared with people who weren’t treated.
The savings were especially striking — 74% lower — among pregnant women. The savings came from avoiding the costs associated with premature births, which has been linked to periodontal disease, and other complications. People with cardiovascular disease and diabetes who had their periodontitis treated had health-care costs that Continue reading