Fall is in the air, and that means one thing: it’s pumpkin spice season! For those with Type 1 Diabetes (T1D), enjoying a delicious pumpkin spice latte doesn’t have to mean compromising on blood sugar management. With this easy, low-carb recipe, you can enjoy all the cozy fall flavors without the extra sugar. Featuring unsweetened almond milk, pumpkin puree, and a dash of pumpkin pie spice, this T1D-friendly pumpkin spice latte is both flavorful and nourishing!
Ingredients Breakdown:
This latte is made with simple, wholesome ingredients like unsweetened almond milk and pumpkin puree, making it not only delicious but also lower in carbs than your typical café pumpkin spice drinks. The stevia (or your preferred sugar substitute) allows you to customize the sweetness without the sugar spike.
Quick & Easy Preparation:
The preparation is as simple as heating, blending, and sipping! After warming up your almond milk and spices, a quick blend ensures the latte is perfectly frothy. Plus, the added vanilla extract gives this drink the perfect hint of sweetness.
Nutritional Benefits:
With just 15g of carbohydrates, this T1D-friendly pumpkin spice latte offers the perfect cozy treat for a crisp fall day. Enjoy it guilt-free knowing you’re nourishing your body without the extra sugar.
We often hear from people living with T1D that they want to stay up to date with new research in the T1D world but aren’t sure how to access this information. In this article, we will review some of these updates. This is especially exciting because other than insulin, we haven’t seen much in terms of novel therapies!
Teplizumab
This is a medication that was approved by the FDA in the USA in 2022. Teplizumab can delay the onset of T1D by approximately 2 years. You might be wondering: how does that work? This medication is a daily infusion that is taken for 12 days in a row for anyone aged 8 years and older who has ‘stage 2 type 1 diabetes’. Ultimately, this medication can preserve someone’s ability to make insulin, which can delay the onset of T1D.
What is Stage 2 type 1 diabetes?
Stage 2 type 1 diabetes is when the blood sugars are still within the normal range but the body’s attack on the beta cells in the pancreas has started. Currently, it is difficult to know if you are at risk for T1D, so typically this screening is only available to those who have close relatives living with type 1.
Next steps include studying this medication in those who are newly diagnosed with T1D since research shows that teplizumab lowered the amount of insulin these individuals needed, had a lower risk of severe hypoglycemia and were more likely to meet their time in range target.
Note that this medication has not been approved in Canada. If you interested in this type of research, check out https://www.trialnet.org/
BMF-219
This oral medication is currently in research trials. The hope of this medication is that it will improve beta cells (the types of cells that make insulin in the pancreas) to help increase insulin production. Menin, a type of protein in the body, is thought to put a “brake” on beta cell growth and therefore an agent that gets in the way of menin could regenerate beta cells. Currently the trial has had some positive results. A couple individuals with T1D have shown improvements in their estimated beta cells insulin production and one individual was able to reduce their insulin doses. Although it is still very early, it is quite an exciting and hopeful discovery! Click here for more information: https://biomeafusion.com/diabetes/
ZT-01
Low blood sugars are inevitable when you take insulin. Any T1D could agree that a low blood sugar can not only be inconvenient, but it can lead to further anxiety when managing T1D. Zucara Therapeutics is currently developing a medication that would be taken once per day to help prevent hypoglycemia. This medication works by stopping a hormone produced by the pancreas called somatostatin. This hormone prevents glucagon release from the pancreas. Glucagon would normally increase blood sugar to prevent hypoglycemia. Therefore, by interrupting somatostatin, glucagon would be available which would lead to less hypoglycemia. For more information, you can visit: https://www.zucara.ca/product/
Although there have been advancements in technology in T1D regarding devices such as new insulin pumps and continuous glucose monitors, it’s exciting to see different types of therapies in the world of T1D. The T1D community may feel small sometimes, but there are many people out there dedicated to improving the lives of people living with T1D!
In a medium pot, combine quinoa and water. Bring to a boil over high heat. Reduce heat to low, cover and simmer for 12-15 minutes, or until quinoa is tender and water has been absorbed. Remove from heat and let stand, covered, for 10 minutes. Cool completely.
In a large bowl, stir together cooled quinoa, mangos, edamame, bell peppers, almonds, raisins, onions, coconut and cilantro. Set aside.
In a small bowl, whisk together olive oil, lime juice, vinegar and honey. Pour over salad and mix well. Add salt and pepper to taste and mix again. Chill until cold.
Nutrition: Per cup, 269 calories, 13 g total fat, 34 g carbohydrate, 5 g fibre, 101 mg sodium
The feeling of shame can be very common when living with type 1 diabetes (T1D). Shame is a feeling of distress, guilt or humiliation when we feel that we’ve done something wrong. How can anyone live up perfectly to the demands of diabetes without doing something “wrong”? It’s impossible to predict every low and high blood sugar! Between carb counting, the unpredictable effects of some meals and insulin doses, handling sick days, renewing prescriptions, appointments (and the list goes on!) – add these tasks on top of everyday life and it’s easy to feel like we aren’t doing enough, or we aren’t good enough.
Shame can negatively impact our mental health which of course can then impact our physical health. How we manage our feelings of shame can look different for each person living with T1D. For some, they may avoid aspects of our self-care to avoid shame. This might mean avoiding checking blood glucose levels so that they don’t see a high blood sugar reading or avoid a doctor’s appointments so that they can’t hear bad news. That person can usually recognize that this isn’t helpful, yet it is a way to minimize stress. Shame may also show up as anger and we may look to blame and shift the responsibility towards others. On the other hand, we may do the opposite and try to control everything related to blood sugars by minimizing variables. For example: eating a restrictive diet, not engaging in physical activity, avoiding social events, avoiding travel, etc. Living a life limited by T1D can often lead to diabetes burnout. Lastly, some may cope with shame with substance abuse which in turn can also cause havoc on blood glucose levels.
The examples above may not help resolve feelings of shame. Instead, identifying the source of shame and why that feeling is coming up can be a good place to start. However, learning how to understand and process our feelings is not easy. This tool can be helpful in identifying more specific feelings that might help you understand why you are feeling what you are feeling: https://feelingswheel.com. We recommend taking a screenshot of this wheel, saving it on your phone or printing it for easy access.
In addition to identifying how we feel, we need to give ourselves grace, forgiveness, and compassion. There’s no way to perfectly manage T1D or our health in general! We can only do our best, and remember, T1D has a mind of its own which we cannot control! As health care providers, we often hear someone living with T1D sheepishly admit “I don’t like counting carbohydrates” or “I don’t needles” …. Of course you don’t! This is a very normal reaction! You are normal for feeling that way. We acknowledge that these behaviours can be challenging, and we want to work with you on how T1D can fit into your life and help you find strategies that can make T1D behaviors a little easier.
Self-acceptance doesn’t happen overnight, and it may take time to shift those negative thoughts into positive ones. Strategies such as practicing affirmations, gratitude and journaling can help reframe some of your thinking to ultimately feel some relief while living with T1D. Lastly it may be helpful to talk it out. Connect with others in the T1D community, a loved one or your health care provider to express your feelings and challenges – we are here for you.
Stay Hydrated: With the heat of summer, it’s crucial to stay hydrated to maintain stable blood sugar levels. Keep a water bottle with you at all times and sip regularly throughout the day.
Protect Your Insulin: Insulin is sensitive to heat, so be mindful of where you store it. Avoid leaving insulin in direct sunlight or in a hot car. Consider using a cooling pouch or insulated bag when traveling to keep your insulin at the right temperature.
Monitor Blood Sugar Frequently: The summer months can bring changes in activity levels, diet, and stress, all of which can impact blood sugar levels. Be vigilant about checking your blood sugar regularly, especially before and after physical activities like swimming or hiking.
Sunscreen is Essential: Spending time outdoors means exposure to the sun’s rays. Protect your skin with sunscreen to prevent sunburns, which can cause stress on the body and affect blood sugar levels.
Be Prepared for Summer Activities: Whether it’s a day at the beach, a hike in the mountains, or a backyard barbecue, plan ahead to manage your diabetes effectively. Pack snacks, glucose tablets, insulin, and any other supplies you might need to keep your blood sugar stable while enjoying summer fun.
These mouthwatering quinoa cakes pack tons of flavour into perfectly portioned patties! Eat them any time of day as a meal or a snack!
Ingredients:
2 cups peeled, cubed sweet potatoes
2 tsp + 1 tbsp olive oil, divided
1 cup no-salt added canned black beans, drained and rinsed
1 ½ cups cooked quinoa, cooled
½ cup finely chopped red onion
3 tbsp minced cilantro (optional)
2 tsp minced garlic
2 tsp ground cumin
1 tsp chili pepper
½ tsp smoked paprika
¼ tsp each salt and pepper
½ cup roasted red pepper hummus (store bought is fine!)
Preheat oven to 400 degrees. Line baking sheet with parchment paper Spread potato cubes and drizzle with olive oil. Mix well with your hands. Roast potatoes for 20 minutes or until tender. Stir once, halfway through cooking time. Transfer to a large bowl and let cool slightly. Mash with a fork
Mash beans with fork, leaving them a bit lumpy. Add beans to potatoes, along with quinoa, onions, cilantro, garlic, cumin, chili powder, paprika, salt and pepper. Mix until well blended. Cover and refrigerate for 1 hour (important!)
Form mixture into 3.5-inch cakes (½ cup mixture per cake). Heat remaining oil (1 tbsp) i a non-stick pan over medium-high heat. Add cakes and cook for about 3 minutes per side, until outside is crispy and inside is heated through.
Serve with hummus and enjoy!
Nutrition information: Per cake: 237 calories, 33 grams of carbohydrate, 7 grams of fibre, 8 grams of protein, 9 grams total fat (0.8 g saturated fat), 267 mg sodium
As you know, learning and improving self-management skills is key to living well with T1D. Skills can look like adjusting your insulin to your nutrition, but it can also be learning your risk factors to help improve your overall health. In this newsletter, we will focus on your heart health and how to manage your cholesterol and blood pressure levels.
Did you know that living with diabetes increases the risk of heart disease by 2-4 times? In addition, women who live with T1D are at higher risk of heart disease compared to women who do not have T1D. The good news is that there are many ways to decrease the risk of heart disease with a combination of lifestyle changes and prescribed medications.
What is heart disease?
Heart disease (also known as cardiovascular disease) refers to different conditions that affect the heart (examples include heart attack, heart failure and irregular heartbeat). It can also affect our arteries and brain. High blood pressure can also cause damage to the kidneys. There is also a specific type of heart disease that affects the nerves in the heart and is found in those living with T1D. It is called cardiac neuropathy.
How is this monitored, and how often?
Your endocrinologist and/or family physician will check your blood cholesterol levels at a frequency determined specifically for you. This could vary between every 3 months to every 3 years. Blood pressure is checked at every visit, usually every 3-6 months. If you take a blood pressure medication and/or a cholesterol medication, your doctor might want to check your levels more frequently. You can also check your blood pressure if you have a home monitor or at a pharmacy or other facility. This might be a good option for those who experience ‘white coat syndrome’ or feel stress or anxiety prior to a medical appointment.
What are the targets?
Generally, LDL cholesterol (the type that contributes to plaque buildup in the arteries – think of L in LDL for Lousy cholesterol) levels are recommended to be less than 2 mmol/L. Blood pressure targets are generally less than 130/80mmHg.
How are they treated?
It is important to know that medications may be recommended to you despite having normal cholesterol or blood pressure levels. This is normal. Think of these medications as tools to protect the heart and kidneys. The recommendation is based on the increased risk of heart disease and the risk reduction that occurs from the medication. The recommendation is individualized to you and based on how long you have lived with diabetes, family history, your age, family planning, etc. For example, if you are between the age of 30-40 years old and you have lived with T1D for over 15 years, then medications may be recommended for you. If you are over 40 years of age, medications are recommended for most individuals. Do not hesitate to ask your physician or pharmacist if you have any questions. Remember, decisions regarding medication and your health should always include you.
Blood cholesterol and blood pressure levels can also be reduced with the help of small and consistent lifestyle changes. These lifestyle changes not only help cholesterol and blood pressure readings but can also improve your sugar levels, and overall health as well.
Here are some top tips to help reduce your risk:
Limit sodium intake to less than 2000 mg per day or 5% or less on the food label. Some foods that are higher in sodium include cereal, cheese, deli meats, sauces & condiments.
Add more soluble fibre to your meals and snacks. When eaten, soluble fibre creates a gel-like substance that can help move things along your digestive system. This can slow your digestion (keep you fuller longer) and can also reduce cholesterol and blood sugar levels. Foods high in soluble fibre include oats, fruits, vegetables, and legumes (beans & lentils).
Eat more fruit and vegetables. Fruits and vegetables are high in minerals, fibre and water. These nutrients can reduce blood pressure, cholesterol and can help stabilize your sugar levels. Consider pairing your fruit with protein for increased nutrition.
Add nuts & seeds to your meals and snacks. Nuts that are higher in Omega-3 fats can help reduce cholesterol levels. Omega-3 rich nuts include walnuts and chia seeds. Other nuts like almonds are also high in fibre.
Switch to whole grain products. Not only are 100% whole grain products higher in fibre, whole grains are also higher in nutrients such as magnesium which can reduce blood pressure.
Reduce alcohol consumption. In general, drinking alcohol can further increase our risk of high blood pressure and heart disease. Aim for 0-2 drinks per week.
Move more. Exercise does not need to be overly challenging. Choose something that you enjoy! Aim for 150 minutes of cardio exercise per week and resistance exercise (working your muscles) at least 2 times per week. If 150 minutes is too much, start with a realistic amount of time for you. This can look like a 5–10-minute walk 2-3 times per week. Consider gradually increasing duration and intensity over time.
It is proven that a small reduction in body weight (as little as 3% of your body weight) can impact our health. Weight management is challenging. Sign up for LMC’s Weight Management Series to learn tips & tricks for weight management: https://app.acuityscheduling.com/schedule.php?owner=15031958
Speak to your diabetes team to learn more about your heart health and to help you implement a goal to help reduce your risks!
3 cups finely chopped mushrooms (1 package of 227g)
1 jar (25 oz) your favorite marinara sauce
1 can diced tomatoes (with liquid)
1 tbsp balsamic vinegar or red wine
2 tsp dried Italian seasoning
1 can (19 oz) lentils, drained and rinsed
2 tbsp minced fresh parsley – optional
Heat olive oil in a large soup pot over medium-high heat. Add onions, carrots, celery, and garlic. Cook and stir until vegetables begin to soften (about 3 minutes). Add mushrooms and continue to cook until mushrooms are tender (about 5 minutes).
Stir in marinara sauce, tomatoes with their liquid, vinegar (or wine) and Italian seasoning. Bring the mixture to a boil. Reduce heat to low, cover for 15 minutes. Add lentils and cook for 5 more minutes. Remove from heat and stir in parsley (if using). Serve over your favorite hot pasta or use in any recipe to substitute pasta sauce!
Nutrition information per cup: 156 calories, 2.8 g total fat (0.3 g saturated fat), 7.7 g protein, 26 carbohydrate (7.6 g fibre), 335 mg sodium. Total net carb per cup of sauce: 18 grams Check out how to make it here: https://www.youtube.com/watch?v=aN6KtsxWokk
The new year can be a time to set new goals and learn more about what tools are available to help you manage your T1D! In this newsletter, we are sharing the new features of each continuous glucose monitor (CGM) that is available in Canada. Please keep in mind that depending on your coverage and compatible devices, these may not be available yet. Speak to your diabetes team to learn more.
If you are new to CGMs, they are wearable devices that monitor glucose (sugar) levels every few minutes. You can view your glucose reading with a receiver, phone app and/or on your insulin pump. They also provide an arrow indicating the direction of your glucose to give you an idea of where it is heading. Diabetes Canada guidelines recommend that individuals living with T1D use CGM to improve A1C and lower risk of hypoglycemia, but also to improve quality of life and overall satisfaction with your management.
Let’s review new features and CGM options in Canada:
Abbott Freestyle Libre
The Freestyle Libre 2 is a 14-day wear flash glucose monitor which requires users to scan the sensors with a phone app or reader to view the sensor readings. Recently however, Abbott came out with an app update to allow users to view their sensor readings on the app without scanning the sensor. Scanning is still required when initializing the sensor and if there are any Bluetooth disruptions. If you use the Libre reader, scanning is also still required. Currently, Libre sensors are not compatible with any insulin pump.
The Freestyle Libre 3 is an even smaller sensor – about the size of a penny and it will also come with improved accuracy. It should be available in Canada very soon!
Medtronic Guardian 3 is a 7-day sensor that links with the Medtronic insulin pump to provide glucose values to deliver automatic basal and corrective insulin adjustments through the SmartGuard feature. The Guardian 3 sensors still require calibration; however, the much-anticipated Guardian 4 will no longer require calibration! The Guardian 4 sensor will look the same as Guardian 3 and last 7 days. Both Guardian models have a transmitter which needs to be charged weekly and attached to the sensor manually.
Lastly the Dexcom G6 is a 10-day sensor which can be used as a standalone sensor, or it can be linked to the Tandem t: slim insulin pump. The sensor provides the glucose values to the pump to deliver automatic basal adjustments and auto-corrections through Control-IQ. Like the Medtronic Guardian sensor, the G6 has a transmitter that lasts 3 months and must be inserted into the sensor.
Recently, theDexcom G7became available in Canada in October 2023. Unlike the G6, the G7 no longer has a separate transmitter. Instead, the transmitter is attached to the sensor upon insertion, and is thrown out with the sensor at the end of 10 days. The Dexcom G7 sensor is much smaller and has a 30-minute warm-up period compared to the 2-hour warm-up period with the G6 – less time wondering where your glucose level is at!
Some noteworthy changes to the alarms have been made to the G7 app as well. The Delay 1st High Alert, which can be particularly helpful for after meals, and you can also choose Quiet Mode up to 6 hours if you want complete silence for a short period. This feature is great for meetings, special events, or if you just need a break!
Speak to your healthcare team for more information on what CGM might work best for you
Whether you’re coming due for a new pump soon or just staying up to date with the latest in type 1 technology, you may have seen exciting announcements about sensor augmented pumps recently and wondered, is this right for me? In this article we are going to discuss the pros, cons and options available for this technology.
What is a sensor augmented insulin pump (also known as hybrid closed loop)?
A sensor augmented insulin pump uses a continuous glucose monitor (CGM) and a specialized algorithm to allow the pump to make adjustments to the insulin being delivered, with the goal of keeping blood sugars within the target range. This includes increasing, decreasing and even stopping insulin delivery in response to the information it is receiving, and the trend in blood sugar that the CGM is predicting. The goal of all sensor augmented insulin pump systems is the same – to keep blood sugars in the target range more often, and reduce the number of pump related decisions a user may have to make in managing their diabetes.
What are the pros of this technology?
One of the biggest benefits of this technology is that the insulin pump can help manage the ups and downs in your blood sugars that may be difficult to predict. Did you know that there are over 42 known factors that can affect our blood sugars throughout the day? Most of these factors aren’t easy to predict or manage (check out this article on the 42 factors affecting blood sugars from DiaTribe for more https://diatribe.org/42-factors-affect-blood-glucose-surprising-update) .
These can include things like: ⦁ poor sleep ⦁ increased stress ⦁ exercise ⦁ hormonal changes
Sensor augmented insulin pumps can help manage the unpredictability of life with type 1 diabetes by changing insulin delivery to match what blood sugars are predicted to do rather than just delivering a set insulin rate like in your traditional pump. This can help with improving your time in range and your A1c.
While using a sensor augmented insulin pump doesn’t mean you can just “set it and forget it”, they can significantly reduce the burden of blood sugar management by dramatically reducing the number of decisions you need to make throughout the day. In fact, in most cases, these pumps work best when they have the least amount of intervention from the user.
Sensor augmented insulin pumps also do a great job at preventing and reducing the severity of low blood sugars. As your blood sugars start to drop, an automated pump will reduce or suspend your insulin temporarily to help keep your blood sugars in range. Think about times when you may have been more active than usual unexpectedly, or your meal may have been unexpectedly delayed, or perhaps you had alcohol and your blood sugar had started to drop without you knowing. These are all situations that can be improved with the help of a sensor augmented pump.
What about cons to this technology?
With all of these great features, it’s hard to imagine the downside of sensor augmented pumping. Here are a few things to consider:
⦁ Sensors may not be covered by your health insurance plan and they can add significant cost to your pumping budget. Before considering a sensor augmented pump, it is always best to look at the costs involved and sort out insurance coverage if available. A great resource is this calculator from Connected in Motion https://www.connectedinmotion.ca/ontario-diabetes-cost-calculator/
⦁ Some people simply don’t like having another piece of hardware attached to them. While sensor augmented pumps can be used in the traditional, non automated mode, to get the benefit of the technology means wearing both a pump and sensor 24/7.
⦁ Using a sensor automated pump requires the user to give up some control and put trust in the system for it to work its best. This can be difficult for some people who are used to constantly making adjustments to their pump or micro-bolusing. Consider your personality type and whether you will be able to relinquish some control of your pump management to a new automated system
⦁ You still have to carbohydrate count and deliver food boluses. Luckily, an automated pump can help reduce the impact of the inevitable inaccuracies that come with carb counting.
⦁ Currently in Canada, this technology is only available with tubed insulin pumps If you’re currently using a tubeless pump or are new to pumping and feel like tubeless is the most important feature for you, keep in mind that automation isn’t available at this time.
Although research has shown improvements in time in range and reduction in hypoglycemia with this technology, no system is perfect and therefore this is not guarantee. Luckily, with the help of your health care professional, usually improvements can be seen.
Think you’re ready to try sensor augmented pumping?
There are currently two options available: the Tandem T-Slim pump that pairs with the Dexcom G6 and the Medtronic 780G which pairs with the Medtronic Guardian sensor. Here is a chart comparing both pumps.
Pump Company
Medtronic
Tandem
Pump Name
Medtronic MiniMed® 780G™
Tandem t:slim X2™
Unique/New Features
⦁ Minimed Mobile App – Allows pump and transmitter to communicate with each other. ⦁ Carelink™ App allows data to be automatically uploaded. ⦁ Carelink™ Connect – Data sharing app ⦁ Upgradable via software. ⦁ You can choose: 5.5, 6.1, 6.7 mmol/L as target instead of just 6.7mmol/L with 770G ⦁ Temp target of 8.3 mmol/L
⦁ Control IQ when used with Dexcom G6 – pump adjusts insulin delivery based on 30 minute predictions. Also delivers an automatic correction bolus up to once per hour when sensor glucose (SG) is predicted to be above 10 mmol/L in 30mins. ⦁ Control IQ target: 6.1 mmol/l ⦁ Control IQ sleep mode: allows for tighter glucose control overnight ⦁ Control IQ Activity mode: prevent hypoglycemia with temporarily increased blood glucose targets.
Key Features
⦁ SmartGuard™Auto Mode capability when used with Medtronic’s Guardian™ (3) Sensor System – pump adjusts basal rate based on sensor glucose (SG) reading. Automatic correction boluses are delivered up to once every 5 minutes. ⦁ Integrated CGM with Suspend Before Low: insulin delivery automatically suspends 30 mins before reaching your preset low blood sugar level
⦁ Basal- IQ technology when used with CGM (Dexcom G6) – pump automatically suspends insulin if sensor glucose (SG) readings are predicted to drop below 4.4 mmol/L in 30 mins, and resumes as soon as SG begins to rise. ⦁ Touch screen ⦁ Upgradable via software ⦁ Share or review glucose data with the Dexcom Clarity or Dexcom G6 Apps. Manual download required to share all pump data.
Connection
Infusion set & tubing
Infusion set & tubing
Reservoir size
300 units
300 units
Max. bolus
25 units
25 units (with an option for additional 25 units)
Battery type
AA battery
Internal Lithium Polymer rechargeable battery
Water Proofing
Water proof up to 12 feet for 24 hours
Water resistant at 3 feet for 30 minutes. Recommended to remove for bathing, showering, swimming
If you would like to learn more about these as well as other pump options or if pumping is right for you, check out the LMC Diabetes Education Program Pump Ready Workshop! You can register by clicking this link: https://lmcvirtual.as.me/
