Blog | Diabetes Physician Assistant (Diabetes_PA)

DIABETES PHYSICIAN ASSISTANT (DIABETES_PA)

Nalani Hunsaker, PA-C, MCMSc, BC-ADM

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Gastroparesis

Dec 20, 2018
2 min

Gastroparesis

We all have heard of diabetes leading to neuropathy. Unfortunately, neuropathy is not only limited to our feet (although that is the most common). Neuropathy can occur in all nerves, including those in our intestines. Gastroparesis is a common, but less talked about form of neuropathy called autonomic neuropathy. Motor function of the gut is dependent on the firing of neurons and pacemaker cells in the stomach and intestines. Our gut only works properly if our nervous system

Planning for pregnancy

Dec 11, 2018
2 min

Planning for pregnancy

I’ve had a lot of T1D soon to be mamas lately so let’s talk a little bit about planning for pregnancy with type 1… It is important for women with type 1 to plan for pregnancy to ensure that baby is healthy! I encourage my type 1’s who are sexually active to take steps to prevent unwanted pregnancy, especially if current BGs are not at goal. Don’t be afraid to bring up this topic with your clinician. Many women with diabetes are scared to bring up pregnancy with their clinicia

Temp basal

Dec 3, 2018
1 min

Temp basal

Temp basal is available on all pumps and is used to temporarily increase or decrease the user’s basal rate by a percentage for up to 24 hours. This temporary basal rate can be cancelled at any time. How can this be helpful? By using the temp basal feature, PWD can program the pump to give an increased basal percentage over an extended period; say for instance, 110% temp basal (10% more insulin than the current basal rate) over 12hrs. As you all know, I believe in being proact

Holiday highs

Nov 28, 2018
2 min

Holiday highs

Does anyone else get overly stressed out during the holidays? Don’t get me wrong, I love the holidays, but with all the presents to buy, trips to plan️, parties to attend, and meals to cook sometimes I feel like my head is going to explode! On top of that, this time of year always puts a huge dent in my bank account making my stress level even higher. But, you know what causes me the most stress? High blood sugars. You know what causes my high blood sugars? My stress. It’s a

Bolusing for pizza (and other fatty foods)

Nov 28, 2018
2 min

Bolusing for pizza (and other fatty foods)

Today I want to discuss an important and very useful tool in advanced pumping called the “extended bolus” feature (aka dual/square wave on Medtronic). This feature is amazing for high fat foods such as pizza (my diabetes nemesis), hamburgers, Mexican foods, etc. Every PWD knows that these foods are difficult (if not impossible) to manage, but why? Let me explain through an example... George loves pizza. Although he doesn’t eat it often (because it isn’t worth the BG roller-c

Our dangerous obsession with food (diabulemia)

Nov 27, 2018
2 min

Our dangerous obsession with food (diabulemia)

Today, I want to discuss something that although incredibly important, isn’t often talked about… As PWD, we are taught to be obsessed with our food; what we eat, how much we eat, how many carbs, etc. This obsession is essential for BG control, but can also carry a huge emotional burden. Moreover, outside of diabetes, women face a constant societal pressure to be thin. The pressure is everywhere and for someone who is already obsessed their with food, this combination can be d

Hypoglycemia and hypo unawareness

Nov 27, 2018
2 min

Hypoglycemia and hypo unawareness

Hypoglycemia is not only one of the most dangerous challenges we face as people with diabetes (PWD), but it is also one of the scariest. Hypos can be caused by many things; exercise, excess insulin, alcohol, or a sulfonylurea (glipizide, glimepiride, etc.) just to name a few. These lows make us feel shaky, dizzy, irritable, sweaty, and weak. Our brains depend solely on glucose for fuel! When there is an inadequate amount of glucose available, the body reacts! This reaction ac

The 15 minute rule

Nov 27, 2018
2 min

The 15 minute rule

Why are people with diabetes (PWD) constantly told to bolus (take insulin) 15-20 minutes before meals? It’s incredibly inconvenient, but let me share with you why we need to do it as well as a personal tip. With insulin, timing is everything. Incorrect timing is the MOST COMMON reason for post-meal BG spikes. Why? Because current “rapid-acting” insulin is just not rapid. Carbohydrate digestion is much quicker and when a bolus is taken immediately before a meal (or worse, afte

Hypertension

Nov 27, 2018
2 min

Hypertension

Hypertension (HTN) is a frequent problem in both type 1 and type 2 DM. Many people with type 2 diabetes present with HTN at their initial diagnosis, however in type 1, the incidence of HTN tends to rise with the duration of the disease. There is also a strong correlation between HTN and microalbuminuria, tiny amounts of protein in the urine caused by early kidney disease. Often, people with progressing microalbuminuria are diagnosed with HTN within a matter of years, and peop

Why should I carb count?

Nov 27, 2018
4 min

Why should I carb count?

Accurate carb coverage in a diabetic who is on insulin is essential for success! There are a couple of commonly used methods of dosing prandial (mealtime) insulin. Some diabetics use “set dosages” which are established by their clinician and are based on past glucose patterns. Ex. someone might give 8 units for breakfast, 10 units for lunch, and 6 units for dinner every day independent of glucose levels, type of carb intake, or amount of carb intake. The “sliding scale” metho

Junior pens- not just for kiddos

Nov 27, 2018
2 min

Junior pens- not just for kiddos

All of you pen using pin cushions out there; did you know that there are both Humalog and Novolog pens that provide 0.5 unit dosing!? This is especially useful for all type 1’s who are insulin sensitive or “brittle”. Why? Because it allows for more specificity! One of the great benefits of pumping insulin is the ability to be specific about dosages (as specific as 0.1 unit). Most rapid acting pens are prescribed as disposable pens dosed in 1-unit increments. This requires the

Neuropathy

Nov 27, 2018
2 min

Neuropathy

Neuropathy is a common complication of both type 1 and type 2 diabetes. According to the American Diabetes Association, 50% of people with diabetes experience some form of nerve damage in their lifetime. In fact, a fairly large percentage of diabetics show signs of neuropathy at diagnosis indicating that early glucose impairment, such as in prediabetes, is associated with neuropathy. It is more common , however, in people who have had diabetes for many years and/or diabetics

Insulin stacking

Nov 27, 2018
3 min

Insulin stacking

What is it and how can we avoid it? Julie just finished cooking and then eating a delicious Thanksgiving meal. This was her first Thanksgiving as a diabetic and she was feeling accomplished. She counted all her carbs and even took additional injections for a second helping of mashed potatoes and for Uncle Dave’s infamous pumpkin pie. A couple of hours after dinner Julie decided to check her BG. Her meter read 264mg/dl. What!? She thought she carb counted perfectly! She even m

Afrezza- inhaled insulin

Nov 27, 2018
2 min

Afrezza- inhaled insulin

Wow!? When I was first diagnosed I would have never dreamed that something like this could exist. But here it is, and it’s just one of the many incredible advancements that have been made in diabetes over the last few years. As I always say, having diabetes sucks, but now is a really good time to have it. So… how does Afrezza work? Does it work at all? And what is the context in which it should be used? Afrezza is a rapid-acting insulin that comes in powder form and is inhale

What's up 670G?

Nov 27, 2018
4 min

What's up 670G?

How does it work? How can it help? The Medtronic 670G needs 3 key parts to function; a continuous glucose monitor (CGM) with a sensor, an insulin pump, and a special algorithm imbedded in the pump called the PID-IFP algorithm (this is what makes it special). The CGM works similarly to the CGMs that I described in my previous posts. It is minimally invasive, and reads the users glucose levels every 5 minutes (see previous post for more details on CGMs). These glucose readings

It's all about the glycemic index

Nov 26, 2018
3 min

It's all about the glycemic index

Diabetic’s lives often revolve around carbs; counting them, avoiding them, cursing them (you all know what I mean). It’s a love/hate relationship. But how do we know what carbs we can and can’t eat? What are “good carbs” and what are “bad carbs”? Carbohydrates are usually classified as simple and complex (depending on the # of sugar molecules they possess). We have all been told, stay away from simple sugars!!! Why? Because it is commonly believed that complex carbohydrates s

Pumping

Nov 26, 2018
4 min

Pumping

Insulin Pumps What are they, how do they work, and what are the advantages? The number of pumpers in the diabetes world has been growing rapidly! Although this is partially due to the more recent advances in pump therapy, it can also be attributed to passionate pumpers (like myself) sharing their experiences. Deciding to switch from multiple daily injections (MDI) to pump therapy is a pivotal point in a diabetic’s life. For those of you who have already chosen this, I congrat

Don't drink and hypo (alcohol and DM)

Nov 26, 2018
3 min

Don't drink and hypo (alcohol and DM)

Alcohol and Diabetes. Is it off limits? When it comes to diabetes, alcohol consumption is a big topic of controversy. Is it okay? Is it not okay? And why or why not? First and foremost, I’d like to say that it is important to consult your clinician regarding any alcohol use. That being said, I am personally a firm believer in the “everything in moderation” philosophy when it comes to my diabetes. I don’t like being told that I “can’t” do things or am restricted by my diabetes

The dreaded DKA

Nov 21, 2018
2 min

The dreaded DKA

Diabetic Ketoacidosis (DKA). What is it and why is it so scary? DKA is a very serious complication of diabetes that occurs when there is a partial or complete lack of insulin in the body. Although it more commonly occurs in people with type 1 diabetes, it can happen to type 2 diabetics as well! How? Insulin is essential to carry glucose from the bloodstream into the cells to be used for energy. When insulin is unavailable, these tissue and muscle cells starve. Out of necessit

GLP-1 agonists (type 2)

Nov 20, 2018
3 min

GLP-1 agonists (type 2)

GLP-1 (glucagon-like peptide 1) receptor agonists DM is a progressive disease caused by insulin resistance and a partial or complete lack of insulin produced by the pancreas’ beta cells. Frequently, T2DM is not diagnosed until the beta cell have been damaged enough to impair their function (decreased insulin secretion). This is made worse by insulin resistance. The harder the beta cells work to compensate for insulin resistance and hyperglycemia, the quicker the disease progr