The 2012 International Children with Diabetes Conference — Friends for Life
Gary Scheiner offers tips for managing hypoglycemia and combating after-meal highs.
By Adam Brown
"What in the world are we doing in Orlando in July when it's hot, humid, and overrun with tourists? We're here because we want to make a difference in the life of someone we love." With those words, Jeff Hitchcock (Founder, Children with Diabetes) opened the 2012 International Children with Diabetes Conference — Friends for Life (FFL). This is one of our favorite conferences because the vibe is so different — children, teens, and adults with diabetes and their families gathering together to learn from brilliant faculty, share best practices, and have an absolute blast every summer. This year's conference had over 3,000 attendees, including a whopping 800 first-timers, several hundred type 1 adults, and even a few celebrities with type 1. We attended a number of excellent talks at FFL, including two from diaTribe contributor and CDE extraordinaire Mr. Gary Scheiner (Integrated Diabetes Services, Wynneword, PA) that stood out as particularly helpful for patients: one on addressing hypoglycemia, the other on tackling after-meal hyperglycemia.
Hypoglycemia Prevention and Treatment
In one of our favorite talks of the conference, Mr. Scheiner gave an outstanding review of hypoglycemia prevention and treatment. He focused on measuring lows, strategies to minimize them, and planning for proper treatment. This talk was full of gems for patients looking to minimize and manage hypoglycemia:
1. Fewer than 10% of glucose readings should be below target at each time of day. For example, if someone was reviewing two weeks' worth of glucose readings and looking at the morning period from 8-11 AM, fewer than 10% of the readings should be below 70 mg/dl. If more than 10% are below target, that's a time of day that needs to be addressed.
2. Have an insulin program that makes sense. The foundation of success is a proper basal insulin program, which can be evaluated by doing fasting basal tests. A proper correction factor is also essential — Mr. Scheiner emphasized that most people need different correction factors at different times of the day. As an example, Mr. Scheiner explained that most people are more insulin resistant in the morning, meaning they would need more insulin to drop their blood sugar the same amount. As a starting point, he looks at a patient's total daily insulin dose and divides that by 1500 (aggressive) or 1800 (conservative). These should then be refined over time with experience.
3. Use a continuous glucose monitor (CGM). Mr. Scheiner recommended setting a CGM low alarm at 80-90 mg/dl — this way, the CGM alarm will go off before a low is reached. We look forward to newer, more accurate CGMs from Dexcom and Medtronic, which should be available within the next year (both are currently pending FDA approval).
4. Account for insulin on board properly (i.e., insulin that has been taken but has not dropped blood sugar yet). To avoid hypoglycemia, insulin on board should be deducted from correction boluses. Mr. Scheiner recommends using the following as a guide. (Note that if you use an insulin pump and enter your current blood sugar into the bolus calculator, the pump will subtract insulin on board automatically. However, different pumps do this differently.)
|Amount of Insulin Remaining|
|One Hour||Two Hours||Three Hours||Four Hours|
|70% left||40% left||10% left||0% left|
|Aggressive Approach||67% left||33% left||0% left|
Apple Honey Kuchen Strawberry Custard Brulée Spiced Berries Firecracker Barbecue Pork Deviled Steak Christmas Popcorn Roasted Tofu and Peppers with Lime Sauce Fruit Salsa Italian Turkey with Polenta Asian Fish Cakes
Many people say that depression is a side effect or complication of diabetes. Without discounting the association of the psychological condition with the physical one, I'm not convinced that our high and/or unstable glucose levels are directly responsible for that change in our mental state. My belief is that the unrelenting need for self-care, for following the sort of care schedules that can drive licensed, professional caregivers crazy, is what overwhelms us...