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Arden's Day Blog

Arden's Day is a type I diabetes care giver blog written by author Scott Benner. Scott has been a stay-at-home dad since 2000, he is the author of the award winning parenting memoir, 'Life Is Short, Laundry Is Eternal'. Arden's Day is an honest and transparent look at life with diabetes - since 2007.

type I diabetes, parent of type I child, diabetes Blog, OmniPod, DexCom, insulin pump, CGM, continuous glucose monitor, Arden, Arden's Day, Scott Benner, JDRF, diabetes, juvenile diabetes, daddy blog, blog, stay at home parent, DOC, twitter, Facebook, @ardensday, 504 plan, Life Is Short, Laundry Is Eternal, Dexcom SHARE, 生命是短暂的,洗衣是永恒的, Shēngmìng shì duǎnzàn de, xǐyī shì yǒnghéng de

Filtering by Tag: Bold with Insulin

Sanofi Insulin Pricing Program

Scott Benner

from press release - 4/10/19

Starting in June, Sanofi will further expand its innovative Insulins Valyou Savings Program so people living with diabetes in the United States can pay $99 to access their Sanofi insulins* with a valid prescription, for up to 10 boxes of pens and/or 10 mL vials per month. The expansion of this program helps to address the challenge too many patients face regarding unpredictable and unaffordable pricing for their insulin. 

People living with diabetes in the United States can pay $99 to access their Sanofi insulins* with a valid prescription, for up to 10 boxes of pens and/or 10 mL vials per month.

People exposed to high out-of-pocket prices at the pharmacy counter can participate in the Insulins Valyou Savings Program regardless of income level. This includes those who are paying high retail prices for their insulin and those who don't qualify for other patient assistance programs. 

Under current government regulations, pharmaceutical companies cannot offer this type of program to patients insured under Medicare, Medicaid, or similar federal or state programs, though Sanofi supports changing rules to expand this access program to all those who might benefit.

For more information or to learn how to access this program, visit www.InsulinsValYOU.com.

Additional patient resources available for accessing Sanofi medicines

Sanofi continues to offer other resources to make insulins more accessible including co-pay cards which may limit out-of-pocket expenses sometimes to $0 for all commercially insured patients regardless of income level. In addition, Sanofi offers assistance programs that provide medications, including insulin, at no charge for qualified low-income, uninsured patients through the patient assistance component of the Sanofi Patient Connection program. Together, these programs demonstrate the company's dedication to finding support to help people living with diabetes gain access to the insulins they need.

Sanofi also encourages anyone who is prescribed a Sanofi medicine who may be having financial challenges or trouble navigating their insurance, to call Sanofi Patient Connection at (888) 847-4877 where eligible patients can be connected to the medicines and resources they need at no cost.

* The Insulins Valyou Savings Program does not include Sanofi's combination insulin product.


The entire press release is available
here








An Average Day with Type 1 Diabetes

Scott Benner

Most days are perfectly imperfect…

If you already listen to the Juicebox Podcast this quick post will serve as a reminder that:

  • There is a way to eat normally and achieve the A1c that you want.

  • A great A1c doesn’t necessarily mean that your BG is 85 (4.7) all day and night long.

  • Just because you haven’t figured something out doesn't mean that an answer doesn’t exist.

If you haven’t yet listened, I hope that this post represents what is possible when you:

  • Have easy to understand tools for using insulin.

Listen to the Juicebox Podcast at  JuiceboxPodcast.com ,  Apple Podcasts ,  Spotify  or on your favorite podcast app..

Listen to the Juicebox Podcast at JuiceboxPodcast.com, Apple Podcasts, Spotify or on your favorite podcast app..

Try these episode to start #11 Bold With insulin, #29 Fear of insulin, #37, Jenny Smith, #44 Diabetes Rollercoaster, #62 Unfounded Fear, #100 Revisiting Bold, #105 All About A1c, #121 Insulin, Insulin, Insulin

You can always listen to the Juicebox Podcast or your favorite podcast app but if you don’t have one try one of these.  Apple Podcasts/iOS - Spotify - Amazon Alexagoogle play/android - iheart radio -  .


On This day, January 11 1922: Insulin Was First Used to Treat Diabetes

Scott Benner

On Jan. 11, 1922 fourteen-year-old Leonard Thompson was injected with a pancreatic extract prepared by Dr. Frederick Banting, and medical student, Charles Best.

from TheStar.com:

Although his blood sugars went down a little, there was not a lot of change following Thompson’s initial injection, according to the University of Toronto’s heritage website.

But biochemist Bert Collip, who had been working with Banting and Best in a lab provided by the university’s head physiologist, Prof. J.J.R.. Macleod, developed a method to refine the extract and daily injections of this extract started Jan. 23. Improvement was immediate and remarkable. The boy’s blood sugar levels dropped to normal levels (Thompson would live another 13 years with daily injections of insulin, before dying of tuberculosis.)

It was not a cure but it was a monumental breakthrough in treatment for what had been an untreatable disease.

In March, 1922 a paper describing the case of Leonard Thompson, and six other patients the Banting and Best team treated with the refined extract, was published in the Canadian Medical Association Journal. It was the first official announcement of an extract developed to alleviate the symptoms of diabetes.

A message of hope to sufferers from diabetes goes out authentically today from the medical research laboratories of the University of Toronto. The modesty of medical men and scientific investigators of the genuine brand attempts to minimize the results obtained. The harm of exaggeration and the injustice to both parents and research men in awakening false and premature hopes before the extracts can possibly be manufactured cannot be over-emphasized. But the fact remains that one of the most important discoveries in modern medical research has been made at the university here. It is not a cure for diabetes, its authors state. Within six months, however, their discovery will be used on a large scale, they hope, to prolong life quite considerably at least. There will be no secrecy, as from the beginning. The medical profession will know all the facts.
— The Toronto Daily Star - March 22, 1922 Edition

The Toronto Daily Star broke the news a day before other outlets. The March 22, 1922 bold all-capital headline ran eight columns on the front page: “Toronto doctors on track of diabetes cure.” A subhead stated: “Discovery made at University of Toronto will be means of prolonging life considerably — F.G. Banting and C.H. Best pushed experiments all last summer.”

The Star referred to the Alliston-born Banting — who had won the Military Cross in 1916 for bravery in World War I — as being “strangely slow in speech” and “unassuming” but he also had “the reputation of coming across with the punch at the critical moment.”

click to enlarge

Two months later, on May 22, 1922, Prof. Macleod delivered a paper on the U of T team’s findings to the American Association of Medical Physicists in Washington, D.C. and got a standing ovation. Macleod used the term “insulin” to describe the extract. According to the Canadian Encyclopedia, “in the eyes of most of the world,” this was considered the announcement of insulin.

The next year, on Oct. 26, 1923, the first Nobel prize awarded to Canadians was given to Banting and Macleod.

But the reaction of Banting and Macleod to the prize revealed a little of the testy relationship that had existed in the background between the two men.

According to an account on the website scienceheroes.com (similar to other published reports) Banting was furious that he was sharing the award with Macleod, not Best, and at first swore he “wouldn’t accept the award.” But friends persuaded him that it wouldn’t be smart to refuse the first Nobel for a Canadian (he remains the youngest Nobel Laureate in Physiology/Medicine). Instead, Banting announced he would split his share of the $40,000 monetary prize with Best.

read the story in it’s entirety at TheStar.com


Contour Next One App

Scott Benner

The Contour Diabetes app now integrates with Apple Health. Once you enabled the feature, data from the Contour app will be available in the Blood Glucose area of your iOS Health app.

Available in the iTunes app store   here    -  Also available for     Android

Available in the iTunes app store here - Also available for Android

This is the meter that Omnipod users will be receiving when the DASH PDM is released sometime in the first quarter of 2019. Arden is using it now and we are finding the accuracy to be terrific!


You Too Can Bolus for Chinese Take Out

Scott Benner

A successful insulin bolus is all about the balance between amount and timing.

Arden recently had Chinese takeout that consisted of sesame chicken, white rice and edamame. 

Take a look at her 24 hour Dexcom graph and see if you can guess what time Arden ate the Chinese food. The yellow block represents a restart of her Dexcom CGM.

CF1.jpg

Now lets talk about the insulin that we used for the meal. Try not to look at the next graph yet...

History tells me that Arden will need between 9 and 10 units of insulin for this food. I don't know how much she'll eat and I don't know how many carbs the food contains. Honestly, I don't care about the carb count for two reasons. 1. I know historically how much insulin this food requires, the trick is to time it correctly. 2. Even if I use the correct amount of insulin the bolus won't work if it's mis-timed.

Example of Correct Amount of Insulin not leading to desired result

Bolusing the entire amount too soon will cause a crash while eating because the carbs will get overpowered by the insulin. Correcting this low will lead to a crazy high later (unless you add insulin, which you'll likely be afraid to do because of the initial low. However, that would likely be the correct thing to do). Outcome: UNDESIRED

Bolusing the entire amount too late will cause a spike that won't come down because the carbs will overpower the insulin, rocketing the BG. This result now voids the "correct" amount of insulin. Yes you used the correct amount of insulin for the food initially but the unintended spike has not been compensated for by insulin. Mis-timing the insulin created another insulin requirement. This spike will last forever without more insulin. Outcome: UNDESIRED

Take away: The insulin, even in the correct proportion, will inevitably not be successful if it is mis-timed. 

What does timing mean in simple terms?

The fight between carbs and insulin needs to be balanced. Imagine a tug of war. If one side pulls first, the flag in the middle of the rope becomes uncentered. Now the side that pulled first has a huge advantage that the other side probably can't overcome. When we bolus we want the insulin and the carbs to pull at the same time so that the flag stays right in the middle. 

The first step to a balanced pre bolus is understanding the insulin. Man-made insulin does not work immediately and you need to figure out how long it takes to work for you. It may be five, ten, fifteen or more minutes, figure it out. None of this will work without pre bolusing. Trust that. 

Once you know how long it takes for your insulin to begin to reduce your BG, consider the food. Something sugary will hit your BG quicker while a heavier less volatile carb like bread may take longer to start pulling up your BG but then last much longer in your system. Each food type will need different timing considerations and hence a different pre bolus. 

None of this needs to be perfect because you can always readdress as you go (made easier with the Dexcom CGM and an insulin pump but not undoable with injections).

Understand the roll of basal insulin. Pumpers have a basal rate set that is trying to hold a steady BG during the day. When carbs are added and your insulin needs increase, you aren't just stuck with one weapon (bolus) you can also blanket the carb richer hours with more basal insulin. (Extra basal also does wonders bringing down a spike or stubborn high BG). So don't just use a targeted strike (bolus), carpet bomb too with an increased basal rate. Decreased basal rates are also effective in handling stubborn lows without carbs. 

Okay lets take a breath because none of this is nearly as complicated as it seems. Lets go over some basic tenets and then look at the Chinese food graph.

  • You have to pre-bolus to create a balanced fight between carbs and insulin.

  • Temporary basal rate increases and decreases are a vital tool.

  • If your BG is too high. You didn't use enough insulin, you mis-timed it or a combination of both.

  • If your BG is too low. You used too much insulin, you mis-timed it or a combination of both.

  • When your BG gets high do not spend time trying to figure out why, just get it down. Figure it out later.

  • When something goes wrong, its not a mistake to beat yourself up over. It is actionable data, a learning experience that will help you make a better decision next time.

  • CGM users: Stop the arrow without causing another one. Bump and nudge the graph line. Small adjustments will keep you off the diabetes rollercoaster.

  • It is far easier to stop a low or falling BG then it is to effect a high and stubborn BG.

  • Often you get what you expect so expect BGs in the 70 - 110 range and make them your goal. CGM users: Set thresholds that allow you to react before it is too late.

  • Be bold with insulin.

It's time to look at the graph from the Chinese food. Do you remember when you thought Arden ate? Did you guess around 3 pm? Actually, the spike at 3 pm was one tiny snack with a mis-timed pre-bolus. The take-out was at 7 pm. Check it out.

Simply put. I cranked up Arden's basal about 20 minutes before the food arrived and bolused 3.00. Thats 4.00 units in, 6.00 more needed. The next 1.50 went in when the food began to create space between pre-bolus. I need to stretch the insulin impact because there are two different carbs at work in this example. The sugar on the chicken is going to act fast so the pre-bolus and temp basal needed a head start. The next issue is the white rice which brings a heavy impact that is also long-lasting so we need force and staying power. I held the balance of the insulin until the rice started to make its impact around 7:40 pm. I should have bolused the remaining 3.80 all at once but I played it a bit safe because I knew that we were about to lose the Dexcom data for two hours. Had I sent the entire 3.80 at 7:40 the BG wouldn't have made it to 140. Thats it. We tested half way through the Dexcom restart to be safe and to make sure that Arden didn't need more insulin. 

You may be inclined to say that this is too much effort but I contend that the few moments that it took to make these adjustments is a far better world to live in then spending the next five hours bolusing a high number that just won't move. It will take you a few tries to make sense of everything but one day you'll have it and all of this will feel easy. Arden eats what she wants and her A1c has been between 5.6 and 6.2 for four years. Be bold with insulin!

You many also like:
Blog post: Anatomy of a High Carb Breakfast
Podcast: Bold With Insulin

If you want to continue to find out more about how we manage type 1 diabetes please check out my podcast. The Juicebox Podcast is free and available on all podcast apps and online. Subscribe and start listening today!


I am not a doctor and this is not advice. Disclaimer is here.