Healthy Ramadan meals for people with diabetes

From gulftoday.ae/news

People with diabetes may still fast during the Holy Month of Ramadan with proper consultation and guidance with their diabetologists and/or endocrinologists.

This is to prevent four acute conditions brought about by “metabolic consequences of prolonged fasting combined with dietary changes and alterations to the dosage and timing of the medications,” Al Zahra Hospital-Dubai Endocrinology & Diabetes specialist Dr. Vikram Hundia said in an interview on Wednesday.

Hundia identified the complications as hyperglycaemia (high blood sugars), hypoglycaemia (mildly low blood sugars), severe hypoglycaemia, and diabetic ketoacidosis (characterized by the insufficient amount of insulin to produce glucose and a warning sign that the diabetes is getting out of control and may lead to body poisoning).

“It is never too late to consult with your doctor on what to do and not to do for the rest of the Holy Month of Ramadan. But make a clear written plan with your Diabetes Team about any changes to your insulin or diabetes medication dosage and timing to maintain satisfactory diabetes control and avoid hypoglycaemia or other diabetes-related complications,” he said.

Hundia added: “Check your blood sugar levels more frequently. Drink plenty of sugar-free fluids during the non-fasting times to avoid dehydration. Avoid caffeine.”

He emphasized the role of the dietician.

                                               Photo has been used for illustrative purpose.

Hundia’s colleague, Reshma Devjani was interviewed as well and while she offered healthy tips too, she also spent time dishing out menu samples for the diabetics.

Devjani pointed out seven causes why people with diabetes suffer from poor glucose control during the Holy Month of Ramadan, leading to the shoot up and/or prolonged high blood glucose levels and weight gain.

These are large meals particularly at Iftar; indulgence in processed food and refined carbohydrates; excessive consumption of empty caloric food namely dates, juices, colas, and sugary desserts; frequent snacking and inadequate meal spacing; fast-pace eating the consequence of which is over-eating; irregular blood glucose monitoring; skipping of medications, mismatching of medications or insulin to the altered “me timings.”

“Remember to keep meal portions in moderation. Choose to eat whole grains and seeds like barley, millets, oats, semolina, quinoa, wild rice, beans and lentils,” Devjani said.

Devjani’s meal sample for people with diabetes who fast during this Holy Month of Ramadan:

Iftar: one to two small dates plus one to two glasses of water; one cup of Tabbouleh Salad; 90 to 120 grams of Chicken cooked in Curry Sauce; one cup of Steamed Wild Rice; one cup of Low Fat Greek Yoghurt; and two glasses of water.

First Snack: one Baked Apple topped with Cinnamon plus 10 to 15 Walnut Halves and two glasses of water.

Second Snack: two to three tablespoons of Hummus Dip with Carrot/Cucumber/Celery Sticks as desired plus one cup of Laban and two glasses of water.

Suhour: two slices of Whole Grain Bread, Omelette with Grilled/Sautéed Vegetables on the side, one tablespoon of Peanut Butter or 30 grams of Avocado, one cup of Low Fat Greek Yoghurt or Laban, one-half cup of Strawberries, and two glasses of water.

For Ramadan Day 2:

Iftar: one to two dates plus one to two glasses of water, one cup of Homemade Lentil Soup, one cup of Green Salad topped with Lemon Dressing, 90 to 120 grams of Lean Meat, one cup of Cooked Quinoa, one cup of Low Fat Greek Yoghurt.

First Snack: one cup of Berries topped with two to three tablespoons of Low Fat Greek Yoghurt garnished with two tablespoons of Crushed Walnuts and Pumpkin Seeds and two glasses of water.

Second Snack: two Oven-Baked Chicken Spring Roll with one tablespoon Guacamole Dip plus one cup of Homemade Pumpkin Soup and two glasses of water.

Suhour: one Small Four-Inch Brown Pita Bread, one cup of Cooked Foul, two tablespoons of Low Fat Labneh with Zaatar plus three to four Olives, one cup of Low Fat Greek Yoghurt or Laban, one Small Plum and two glasses of water.

https://www.gulftoday.ae/news/2020/04/29/healthy-ramadan-meals-for-people-with-diabetes

People with diabetes encouraged to be cautious during COVID-19 pandemic

From wmcactionnews5.com

MEMPHIS, Tenn. (WMC) - People with diabetes are being encouraged to be cautious during the coronavirus pandemic.

Methodist Diabetes Care and Education Specialist Nykkia Sellers said, "Since it is an underlying condition, and if your diabetes is poorly controlled, and you have heart disease, lung disease, obesity, advanced age - those things do put you at a higher risk of contracting COVID-19."

Sellers added that there have been instances where people did not know they were diabetic until they had the virus.

“I know of one person, in particular, that was diagnosed with COVID-19 and also was newly diagnosed with diabetes. I can’t necessarily say which one came first but that has happened here recently,” Sellers said.

It is why she is recommending that people who may have a history of diabetes in their family, are overweight or are experiencing symptoms of diabetes, like excessive thirst, unexplained weight loss, and extreme fatigue, should contact a medical professional to get screened.

Contracting COVID-19 while also being diabetic presents serious complications. “You may have an increased risk of respiratory failure. You may have an increased risk of kidney disease. There’s a seven-fold increase of mortality associated with persistent hyperglycaemia - which is elevated blood sugar or diabetes - with COVID-19,” Sellers explained.

Sellers said keeping a log of your weight and spending time exercising will help with managing diabetes at this time.

"Taking your blood sugar, eating healthy, and staying away from processed food. I know that during this time people will lean to their quarantine snacks, but try to choose some healthy snacks as well." Sellers said.

https://www.wmcactionnews5.com/2020/04/28/people-with-diabetes-encouraged-be-cautious-during-covid-pandemic/

From aiding digestion to controlling diabetes: Know the many health benefits of curry leaves

From indianexpress.com

Curry leaves are easily available and can also be grown at home. They don't just add to the flavour to your food, but are beneficial for your health too.

Curry leaves are commonly used in several Indian dishes, from dals and chutneys to salads. They don’t just add to the flavour but are beneficial for your health too, said holistic wellness coach and nutritionist Luke Countinho in an Instagram video.

Curry leaves are easily available and can also be grown at home. Calling it an “Indian superfood”, Countinho went on to talk about their health benefits. They are rich in iron, calcium, vitamin A and most of the spectrum of vitamin B (can aid memory and skin problems), Countinho explained.

Benefits of curry leaves

1. Diarrhoea and constipation: Boil curry leaves in water and drink the liquid. You can also make a paste of the leaves and mix it in your food or consume it with jaggery for benefits.

2. Morning sickness, nausea: Consumption of curry leaves can reduce the feeling of nausea or morning sickness, commonly experienced by pregnant women. It is also used for patients going through chemotherapy or radiation to reduce nausea. You can grind curry leaves into a powder and sprinkle it on your lentil dish or khichdi or chutney, for instance.

                              Curry leaves have many health benefits. (Source: Getty Images)

3. Diabetes: Curry leaves are rich in iron, copper and zinc which help reduce blood sugar levels. It is therefore recommended that diabetics include curry leaves in their meals.

4. Boosts immunity: Curry leaves have antibacterial properties and can help your immune system. It is suggested that you have curry leaves while undergoing an antibiotic course.

5. Good for eyes: The vitamin A in curry leaves is good for improving eyesight. Vitamin A contains carotenoids that lessen the risk of cornea damage. Vitamin A deficiency, on the other hand, could increase the risk of night blindness, loss of vision and cloud formation, according to lybrate.com.

6. Good for hair: One of the best treatments for your hair is coconut oil and curry leaves. For this, you can boil the curry leaves in coconut oil until it becomes thick and store it for three to six months. Curry leaves are great for the scalp and can treat dandruff, thinning hair, hair fall and premature greying.

7. Cholesterol: Curry leaves contain carbazole alkaloids which help control cholesterol production in the liver.

8. Digestion: Curry leaves are good for digestion because they help stimulate the production of digestive enzymes that break down carbohydrates, fats and proteins.

Moreover, they can be used extensively in the case of Alzheimer’s, dementia, Parkinson’s and cognitive brain disorders, because anything rich in the spectrum of vitamin B is good for the brain, added Coutinho.

https://indianexpress.com/article/lifestyle/health/curry-leaves-health-benefits-digestion-diabetes-eye-hair-6376088/

Diabetes Care During COVID-19 Lockdown

From medicinenet.com

APRIL 25, 2020 -- As concerns about coronavirus deter people from seeking hospital care, endocrinologists and a leading UK charity are calling for general practitioners (GPs) and the public to be aware of the signs and symptoms of type 1 diabetes.

Diabetes UK say they have heard anecdotally from clinicians that disproportionate numbers of young people are arriving for urgent care already in diabetic ketoacidosis (DKA) while the country is in lockdown.

And May Ng, MBBS, PhD, a paediatric endocrinologist and associate medical director at Southport & Ormskirk Hospital NHS Trust, UK, told Medscape Medical News that in her area they have already seen two presentations of severe DKA prior to type 1 diabetes diagnosis in the past 4 weeks, which she believes reflects the picture countrywide.

There have been similar reports from clinicians in Italy and China at the peak of their outbreaks, as previously reported by Medscape Medical News.
"We have been concerned about the delayed presentation of cases where children have attended accident and emergency [A&E] very unwell as they have not been seen earlier," Ng said.

"Many families are worried about COVID-19 and the risks of infection. And while they have done the right thing by keeping minor illnesses at home, the message must go out that if your child is unwell and you are worried, do not wait — seek help early with the GP and go to [the emergency room]."

But Simon Heller, MD, professor of clinical diabetes at the University of Sheffield, UK, isn't so sure this is the case.
"I'm aware of new cases of type 1 diabetes but they've been seen promptly by children's admissions, so I think it is a theoretical risk," he commented.

He said that, at least in the case of children with undiagnosed type 1 diabetes, paediatric emergency departments are relatively protected from COVID-19. So if a parent recognizes a child is ill, "they should be able to be seen by the GP in the normal way and be sent to A&E."

Nevertheless, he says it will be important to systematically gather findings on this issue and examine the impact of COVID-19 on new diagnoses of type 1 diabetes.

Diabetes UK stress that the early signs and symptoms of type 1 diabetes are easy to mistake for a viral infection or other illness, which is why it is so important to be 4T aware. 4T refers to toilet, thirsty, tired, and thinner.

• Toilet: Going to the toilet a lot, bed wetting by a previously dry child, or heavier nappies in babies.
• Thirsty: Being really thirsty and not being able to quench thirst.
• Tired: Feeling more tired than usual.
• Thinner: Losing weight or looking thinner than usual.

"It is vital that parents are aware of the early signs of type 1 diabetes and seek help if they need it," said Dan Howarth, head of care at Diabetes UK.
"DKA can be a life-threatening complication of diabetes. If a child or young person does not receive immediate treatment for DKA, it can lead to coma, or even death," he stressed.
"The quicker children are diagnosed the less likely they are to become seriously ill," Howarth noted.
And he also urged GPs not to forget about possible diabetes symptoms.

"When patients call or visit the practice, try to ensure that the tell-tale symptoms of type 1 diabetes are not overlooked — especially as the 4Ts may not be all present at the same time," he said.
"Signs of type 1 diabetes need to be addressed as soon as possible, because if not, it will lead to further risks for the patient and can potentially lead to an acute admission to hospital."

These concerns echo comments made last week by Stephen Powis, BM BCh, PhD, national medical director of NHS England, when he highlighted the need to ensure medical attention for non-COVID-19 diseases is sought in a timely way.

"If you have any emergency condition, whether it's a sick child, whether it's a mother or a pregnant mother...you should be seeking emergency services, just as you always have done — they are there for you. And although we are focusing on coronavirus, it's important that we also continue to focus on other emergency conditions," Powis said.

Even prior to the coronavirus pandemic, it's estimated that around 600 children and young people in the UK each year receive a type 1 diabetes diagnosis only after they develop DKA, based on National Paediatric Diabetes Audit Hospital admissions and complications reports (2012-2015, 2017).

https://www.medicinenet.com/diabetes_care_during_covid-19_lockdown-news.htm

Are carrots good for those with diabetes?

From medicalnewstoday.com

Some people believe that carrots raise blood sugar levels and that people with diabetes should not eat them. However, this is not the case.

In this article, we explore the effects that carrots can have on blood sugar and describe the ways in which carrots can benefit the health of a person with diabetes.
We also look into the carrots’ glycaemic index (GI) score, the most healthful way to prepare them, and other dietary tips for people with diabetes.

Should people with diabetes eat carrots? 

Because carrots are a non-starchy vegetable, people with diabetes can eat them freely, according to the American Diabetes Association (ADA).

In fact, carrots may benefit people with diabetes because they contain the following compounds:

Carotenoids

Carrots are a good source of carotenoids, a type of pigment.
In the diet, these compounds primarily occur in orange and yellow fruits and vegetables.

The pigment in a person’s eyes also contains carotenoids, and their antioxidant activity helps protect the retina from damage.
Some research suggests that carotenoids may be protective against diabetic retinopathy.
Diabetic retinopathy is a disease that can lead to loss of vision, and it is a common complication of diabetes.
According to a 2015 study, diets that contain high levels of alpha and beta carotene may contribute to a reduced risk of type 2 diabetes.
Carrots are rich sources of these carotenes, containing 8,285 micrograms (mcg) of beta carotene and 3,477 mcg of alpha carotene per 100 grams (g).

Healthful carbohydrates

Managing blood glucose, or blood sugar, levels is the primary goal of diabetes treatment. The total amount of carbohydrates that person consumes has a strong influence on these levels.
A medium raw carrot contains 5.84g of carbohydrates. Although carrots are not necessarily low in carbohydrates, they are a healthful source.

According to the Centres for Disease Control and Prevention (CDC), on average, carbohydrates should make up 45% of the calorie intake for people with diabetes.
Counting carbs and keeping them within a healthful range can help a person regulate their blood sugar levels and thus prevent diabetes complications, which can include:

• heart disease
• kidney disease
• vision loss
• stroke

Vitamin A

According to a 2015 article in the journal Diabetes Management, low levels of vitamin A may be an independent risk factor for diabetes.

Another article, published the same year in Endocrine, Metabolic & Immune Disorders Drug Targets, warns that people with chronic diseases involving carbohydrate intake, such as diabetes, should be sure to consume enough vitamin A.
This may be especially good advice for people with type 1 diabetes, which causes T-cells in the body to attack insulin-producing beta cells.

Vitamin A plays a crucial role in the pancreas and in the production of these beta cells.

The vitamin also helps regulate immune functions, such as T-cell-mediated immunity, which may affect the onset of type 1 diabetes.

Carrots are a good source of vitamin A, containing 835 micrograms per 100g.

Fibre

Eating more fibre can improve blood glucose levels and boost insulin resistance and insulin sensitivity, helping to combat diabetes.
People with diabetes should consume 20-35g of fibre per day, from vegetables, fruits, and minimally processed grains.
Carrots contain 2.8g of dietary fibre per 100 g.

What is the GI score of carrots?

The GI is a tool that measures how the carbohydrates in specific foods affect a person’s blood glucose levels.
A type of food with a high GI score will raise blood sugar levels more than a food with a low GI score.
The ADA consider foods with scores of 55 or under to have low GI scores. Boiled carrots have a GI score of 33, and raw carrots score even less.
The association recommends eating at least 3-5 servings of vegetables a day. One serving is about:

• ½ cup of cooked vegetables
• 1 cup of raw vegetables

Choosing non-starchy fruits and vegetables, with GI scores of 55 or less, can help a person with diabetes manage their blood sugar levels.

Other non-starchy vegetables, which people with diabetes can eat freely, include:

• leafy greens, such as kale and spinach
• salad greens
• tomatoes
• mushrooms
• peppers
• onions
• green beans and wax beans
• celery
• cucumbers
• brussels sprouts
• cabbage
• artichokes
• asparagus
• cauliflower and broccoli
• okra
• summer squash

Healthy eating tips for diabetes 

The following strategies can help a person with diabetes follow a healthful diet:

• Choose higher-fibre, minimally processed carbohydrates: These come from whole grains, fruits, vegetables, and dairy products.
• Limit salt: A person should consume no more than 6 g of sodium per day.
• Choose healthful fats: These come from nuts, avocados, seeds, oily fish, and vegetable oils.
• Limit red and processed meats: Opt for lean sources of protein instead, such as pulses, eggs, poultry, unsalted nuts, and fish.
• Reduce sugar intake: It is important to check labels carefully for added sugar and look to fruit when sugar cravings strike.
• Choose healthful snacks: For a person with diabetes, these include yogurt, nuts, seeds, fruits, and vegetables.
• Limit alcohol consumption: The ADA recommend that males have no more than two drinks per day and females have no more than one.
• Avoid supplements: Try to obtain vitamins and minerals from the diet, unless a doctor recommends specific supplements.

Summary

People with diabetes can eat non-starchy vegetables freely — including carrots.

Eating them raw or cooking them very lightly can help prevent the preparation from increasing the GI score.

Various compounds in carrots, such as carotenoids, fibre and vitamin A can help manage blood sugar levels and prevent complications, such as diabetes-related eye damage.

Maintaining a healthful diet, reducing the intake of carbs, and boosting levels of physical activity can all play important roles in managing diabetes.

https://www.medicalnewstoday.com/articles/are-carrots-good-for-diabetics#tips

Seniors with diabetes: Questions to ask your doctor

From signalscv.com

If you’re a senior with diabetes, you’re not alone. The statistics are eye opening — more than 25% of Americans age 65 and older have diabetes, according to the American Diabetes Association. What’s more, the Centres for Disease Control and Prevention reports diabetes as the seventh leading cause of death in the U.S.

If you’re a senior and have diabetes or help care for a loved one with diabetes, you probably have a lot of questions. Thankfully, technology has advanced incredibly over the last decade, and can now change how people manage diabetes for the better.

Building a strong relationship with your doctor is one of the best things you can do to help manage your diabetes and stay healthy. Be sure to keep an open dialogue and come with questions before any appointments.

To get you started, here are three important questions you should ask your doctor.

What is continuous glucose monitoring and how can it help me?

People with diabetes who take insulin must monitor their blood glucose levels frequently. Uncontrolled glucose can cause health complications and even death.

The traditional standard-of-care for glucose monitoring has been a blood glucose meter, which is painful and time consuming, as patients must test their blood multiple times throughout the day.
A continuous glucose monitoring (CGM) system can help people with either Type 1 or Type 2 diabetes to track glucose levels on a continuous basis. Unlike blood glucose meters, CGMs can help eliminate painful finger pricks and provide vital health information.

CGMs are discreet, easy to use and relay a user’s glucose levels instantly to a compatible smart device or dedicated receiver, providing the direction and rate of glucose change with the touch or scan of a screen.

They can help you understand the impact of physical activity and certain foods on your health and glucose levels, as well. The Dexcom G6 CGM, which is reimbursed by Medicare for eligible patients, also has an app option that gives patients the ability to share glucose information with up to 10 people who can view it through a separate Follow app.

How can I be more active?

Regular exercise is important for everyone, but it’s particularly important for people with diabetes. According to the American Diabetes Association, your cells become more sensitive to insulin when you’re active, so it works more effectively. Being active helps manage a healthy weight, which is also important.

You may think that due to your age or physical ability you can’t exercise, but talking to a physician can reveal options that fit your personal needs. Slow walks, stretching, yoga and even swimming are good, low-impact activities.

Check community centres and local gyms for classes that are geared toward seniors. When beginning an exercise regimen, talk to your doctor to discuss any concerns you have and get his or her recommendations on what will work best for you in order to exercise in a safe manner.

How can I eat healthier?

Following a nutrition plan is an important part of managing diabetes. Patients with diabetes have extra nutritional considerations to keep insulin levels in check. Doctors can provide insight into healthy eating and explain how carbohydrates impact blood glucose levels.
You can also consider speaking with a registered dietitian to help you evaluate your eating habits and create a nutrition plan with foods you enjoy that are also complementary to a healthy diabetes lifestyle.
Let these questions help guide you to a productive conversation about diabetes with your doctors and other members of your health care team.

https://signalscv.com/2020/04/seniors-with-diabetes-questions-to-ask-your-doctor/

Coronavirus health warning: Obesity bigger risk than heart disease or diabetes

From express.co.uk

  OVERWEIGHT and obese people should be given better protection from coronavirus, say scientists

It follows research showing obesity is a bigger risk factor for deadly complications of Covid-19 than heart disease, high blood pressure and diabetes put together in the under-50s. At present those shielded include over-70s, people on immune suppressing drugs and with lung diseases. They also include people who have previously suffered from cancer - but this group does not so far appear to be at more risk. The public health focus has so far concentrated on protective measures from isolation and hand washing to healthy eating and exercise.

Dr Rajarshi Banerjee, from Oxford University Hospitals NHS Foundation Trust, believes obese people may be more at risk because their internal organs are damaged due to inflammation caused by fatty deposits.
He has launched a study into patient recovery from Covid-19 to identify risk factors of the virus.

Dr Banerjee said: "Studies like these should inform our thinking as to who needs cocooning or shielding such as obese patients who have unseen and silent internal damage to their organs, such as liver and kidneys, putting them more at risk of complications.
"Research into this will likely be a key to understanding who are most at risk and perhaps the treatments that can help. Also it will help us decide if we isolate obese patients or those with fatty liver disease for longer.
"This plague of our times targets obesity and this is linked with inflammation in the liver and fatty liver disease which is more of a hidden problem affecting 20 per cent of the UK population."

Dr Banerjee's study, which begins next week, will be carried out by Perspectum, an Oxford-based healthcare and diagnostics company together with data from the UK genetic health resource UK Biobank to determine how much damage Covid-19 causes to patients' internal organs with particular focus on obese patients.

    Dr Banerjee's study, which begins next week, will be carried out by Perspectum (Image: Getty)

A new study from the US Centre for Disease Control based on 99 counties and 14 states from March examined the underlying conditions of patients hospitalised with the virus to determine which risk factors led to the most severe disease.

These included heart disease, diabetes, chronic lung disease, obesity and high blood pressure. For those over 65 the biggest predictor of being hospitalised was high blood pressure, accounting for over 70 per cent, with heart disease accounting for half.

About 60 per cent of hospital cases under the age of 50 were obese, compared with 18 per cent with high blood pressure, 19 per cent with diabetes and four per cent with cardiovascular disease.
Obesity accounted for 50 per cent of hospitalisations in those aged 50-64 and 40 per cent in those aged over 65.

Studies from the UK, US and Italy suggest hospitalisation rates for Covid-19 may escalate far more than in China because patients with fatty liver disease - associated with bad diet and excess weight - are at a much higher than average risk of complications of the virus. Research shows they also remain infectious for longer - 17 days rather than 12 days in patients without liver disease.

https://www.express.co.uk/life-style/health/1270935/coronavirus-health-warning-obesity-heart-disease-diabetes-risk-factor-vulnerable

Obesity Is Biggest Type 2 Diabetes Risk Factor

From usnews.com

THURSDAY, April 16, 2020 (HealthDay News) -- Whether you have a low or a high genetic risk for type 2 diabetes, obesity seems to be the driving factor in developing the disease, Danish researchers say.

Their new study found that obesity increased the risk of type 2 diabetes by at least six times, no matter what a person's genetic risk was.

"Obesity and unfavourable lifestyle are associated with increased risk of type 2 diabetes irrespective of genetic risk," said study author Hermina Jakupović. She's a doctoral fellow in biomedicine at the University of Copenhagen in Denmark.

These findings suggest that no matter what your family history might be, maintaining a healthy weight is a key to keeping type 2 diabetes at bay.

"Weight management by healthy lifestyle should be recommended as a prevention strategy, regardless of genetic predisposition," Jakupović said.

Her team used data from a diet, cancer and health study in Denmark. It included people whose health was tracked for a median of 15 years (meaning half were followed longer, half for less time). More than 4,700 adults developed type 2 diabetes during the tracking.

Among all these study participants, the average age was 56, and slightly more than half were men. Nearly 22% were obese, while 43% were overweight. Just over 35% were normal weight, the researchers reported.

Lifestyle was assessed using a score based on physical activity, diet, alcohol consumption and smoking. About 40% had a favourable lifestyle score and just over 25% had what the researchers called an unfavourable lifestyle.

Genetic risk was measured with blood tests that looked for 193 gene variants known to be associated with type 2 diabetes. The genetic results were grouped from lowest risk to the highest (having the most genetic variants). People with the most genetic variants were twice as likely to develop type 2 diabetes as those with the least, the findings showed.

Compared to people whose weight was normal, those who were overweight had a 2.4 times higher risk of developing type 2 diabetes during the study. For those who were obese, the risk was six times higher.

When researchers looked only at lifestyle, people with the least healthy habits -- the unfavourable group -- were 18% more likely to get type 2 diabetes than those with the healthiest habits.

People with the unhealthiest lifestyle, a high genetic risk and obesity had more than 14 times the risk of type 2 diabetes.

Dr. Robert Eckel, president of medicine and science for the American Diabetes Association, said the findings weren't a surprise. Obesity is a well-known risk factor for type 2 diabetes, he said.

"Genetic variants only explain about 10% to 15% of type 2 diabetes risk, although I think we may not completely understand all of the type 2 genes," he noted.

Eckel said the findings are yet more evidence highlighting how important it is "to prevent obesity to begin with. Everyone needs to control their energy balance." That means you can't eat more calories than you use up with activity.

Physical activity is an important component of maintaining a healthy weight, too, he added.

Previous studies have shown that losing even a little bit of weight can help people manage type 2 diabetes. The American Diabetes Association says dropping 10 to 15 pounds can help you control your diabetes.

"It's not just losing the weight, though," Eckel added. "Keeping it off is important."

The findings were published April 15 in Diabetologia.

https://www.usnews.com/news/health-news/articles/2020-04-16/obesity-is-biggest-type-2-diabetes-risk-factor

A non-invasive way of monitoring diabetes

From sciencedaily.com

Saliva could be used instead of blood to monitor diabetes in a method proposed in research involving the University of Strathclyde.

The test has been developed as an alternative to the current prevalent practice of monitoring blood glucose, which can be invasive, painful and costly.

Lab tests of the saliva process had an accuracy rate of 95.2%. The research shows promising results for monitoring diabetes, which affects an estimated 425 million people worldwide -- around half of them undiagnosed.

The research has been published in the journal PLOS ONE. It also involved partners at the Federal University of Uberlandia in Minas Gerais, Brazil, the University of Vale do Paraíba in Sao Paolo, Brazil and the University of Saskatchewan in Canada.

Dr Matthew Baker, a Reader in Strathclyde's Department of Pure and Applied Chemistry and lead researcher in the project, said: "Frequent monitoring of diabetes is essential for improved glucose control and to delay clinical complications related to the condition. Early screening is also paramount in reducing these complications worldwide.

"Blood analysis for screening, monitoring and diagnosing diabetes is widely practised but is quite invasive and painful. The constant need of piercing the fingers several times daily for most patients may lead to the development of finger calluses, as well as difficulty in obtaining blood samples; furthermore, not everyone would want to give blood and there are circumstances in which it could be dangerous.

"Saliva reflects several physiological functions of the body, such as emotional, hormonal, nutritional and metabolic, and so its biomarkers could be an alternative to blood for robust early detection and monitoring. It is easy to collect, non-invasive, convenient to store and requires less handling than blood during clinical procedures, while also being environmentally efficient. It also contains analytes with real-time monitoring value which can be used to check a person's condition."

Dr Robinson Sabino-Silva, an associate professor at Federal University of Uberlandia (UFU) and a partner in the research, said: "The present protocol used in the infrared platform is able to detect spectral biomarkers without reagents. The combination of a non-invasive salivary collection and a reagent-free analysis permit us to monitor diabetes with a sustainable platform classified as green technology."

The lab tests used a scientific system known as Attenuated total reflectance Fourier transform infrared (ATR-FTIR) spectroscopy. This has been used in the diagnosis of several diseases, although its applications in the monitoring of diabetic treatment have begun to emerge only recently. Samples were assessed in three categories -- diabetic, non-diabetic and insulin-treated diabetic -- and two potential diagnostic biomarkers were identified.

The researchers are hopeful that the process they have developed could be used for both Type 1 and Type 2 diabetes, although further study will be required to confirm this.

https://www.sciencedaily.com/releases/2020/04/200416135954.htm

American Organizations coming together to represent Type 1 diabetics during coronavirus

From abcnews.go.com

A new study is set to look at how COVID-19 affects Type 1 diabetics

Patients with novel coronavirus each have their own unique set of circumstances for treatment, especially if they already have underlying medical conditions, like diabetes.

The Centres for Disease Control and Prevention say people with diabetes have an increased risk of severe illness from COVID-19 infection, but the agency does not differentiate between Type 1 or Type 2 diabetics.

Now, researchers are launching a study to evaluate the impact of COVID-19 on people living with Type 1 diabetes, specifically. The data from the study will be used to understand what happens as a consequence of COVID-19 infection in this group of people and how to improve the quality of care and response to this pandemic, according to Dr. Osagie Ebekozien, an endocrinologist and the vice president of Population Health and Quality Improvement at T1D Exchange.
"What does COVID 19 mean for people with Type 1 diabetes? Everyone kept responding, we don't know, we don't know," said Ebekozien.

According to the American Diabetes Association, 34.2 million Americans are living with diabetes. The majority have Type 2 diabetes, a disease closely linked to obesity and poor diet, when the body stops producing enough insulin.

Insulin is a hormone that helps regulate the amount of sugar in the blood, so Type 2 diabetes causes your body to be resistant to the effects of insulin or doesn't produce enough to maintain a normal blood sugar. Risk factors include genetics and lifestyle, like lack of exercise and obesity, according to the Mayo Clinic. Type 2 diabetes can be managed through medications, diet and exercise.

But 1.6 million Americans have Type 1 diabetes, an autoimmune condition that is usually diagnosed early in life, but also sometimes in adulthood. Its causes are not fully known, and there is currently no cure, according to the Juvenile Diabetes Research Foundation.

"Because Type 1 diabetics are unable to release insulin after consuming carbohydrates, they must use insulin injections or a pump to survive," said Dr. Mary Pat Gallagher, a paediatric endocrinologist and the director of the Paediatric Diabetes Centre at NYU Langone Health's Hassenfeld Children's Hospital.

In addition to the need to manually control blood sugars, patients' immune systems overreact to parts of the body for which it should be "tolerant," according to Gallagher. As long as blood sugars are well controlled, this inappropriate immune response should not necessarily increase the risk of developing infections.

A woman with diabetes monitors her glycaemia in Paris on March 24, 2020, on the eighth day of a strict lockdown in France aimed at curbing the spread of COVID-19 caused by the novel coronavirus. Franck Fife/AFP via Getty Images

People with Type 2 diabetes are also found to have hypertension and obesity, which increase the risk for poorer health. However, Gallagher explained that a high body mass index and hypertension are associated with severe illness, regardless of whether a person has diabetes or not.

Gallagher said it's not clear if people with Type 1 and Type 2 diabetes are at similar risk for COVID-19, because there are multiple factors at work. T1D Exchange, the non-profit research organization coordinating the new study, plans to share initial results by the end of April. As data continues to emerge from the long-term study, the organization will continue to update recommendations at least twice a month.

"We looked at the data that came out from China and Italy and it is skewed toward Type 2 diabetes. We wanted to know, 'How is the presentation of COVID-19 different in these patients in comparison to another adult or child without diabetes?' There are so many unknowns, so we are working with our partners to answer these questions," said Ebekozien.

Separately, researchers are also studying the effects the COVID-19 pandemic might be having on people with Type 1 diabetes -- particularly children and young adults who are no longer getting regular medical care or nutritional help at school. Ebekozien hopes that with this project, they can help patients and families learn how to manage blood sugars at home due to the school closures across the country.

Experts know from experience with other types of infections that people with Type 1 and Type 2 diabetes can show different symptoms. People living with Type 1 diabetes usually respond to an infection with dangerously high blood sugar levels and acid in their blood, called diabetic ketoacidosis.

"There is a certain percentage of people that die from diabetic ketoacidosis each year," said Gallagher. "When stress hormones are released by the body [because of an infection], insulin requirements increase and because their body cannot meet those requirements anymore it begins a whole cascade of things. ... You have acid build up in the blood that can be deadly."

That threat makes it important to study the way people with Type 1 diabetes react to COVID-19 infection.

To accurately treat diabetic ketoacidosis, health care workers need to check on people with Type 1 diabetes every hour until their blood sugar is at a safe level. If a patient with Type 1 diabetes is infected with COVID-19, managing their blood sugars can be difficult with the health care workers having constant exposure to the virus as hospitals deal with a lack of personal protective equipment.

To help alleviate this issue, Abbott Laboratories, a medical device company, has partnered with the American Diabetes Association, Insulin for Life USA and the Diabetes Disaster Response Coalition to donate 25,000 Libre blood sugar devices which patients can place on the back of their arm.

Through this patch, patients have their blood sugars tracked at all times, which can be monitored through an app on their phone and by physicians on a computer screen. This way, there is less interaction between patients and clinicians in a hospital setting.

These donations will be sent to areas in the U.S. that have a high number of COVID-19 cases. There are other brands of continuous glucose monitors, including products from Dexcom or Medtronic, that many people with diabetes already use as part of their routine.

"There is a power of coming together, cross learning and cross sharing," said Ebekozien. "We encourage patients to talk to their providers to be a part of this study and share their reports. We hope to be a support and voice for patients at this time; it will come from a collaborative effort to improve lives today and tomorrow. I hope we all ride this wave coming out better and learning a few things as well."

Patients and their providers are able to register on the T1D Exchange webpage to participate in the two studies launched earlier this month.

Lily Nedda Dastmalchi, D.O., M.A., is an internal medicine resident physician at The George Washington University and a contributor to the ABC News Medical Unit.

https://abcnews.go.com/Health/organizations-coming-represent-type-diabetics-coronavirus/story?id=70120156

Tips for People with Diabetes During the Stay-at-Home Orders

From diabeteseducator.org
By Melissa Young, PharmD, RPh, BC-ADM, CDE

Now that many of my clients are sheltering in place during the COVID-19 pandemic and telling me they are bored with Netflix binges; I am asked for tips on things they should do with the extra time on their hands. It is a stressful time, especially for those at high risk for complications. Remember, improving management of blood glucose helps the immune system function properly to fight viruses. This is an opportunity to take advantage of the downtime, stay busy and focus on forming healthy habits! Here are 11 tips for people with diabetes while sheltering in place. For more information on healthy behaviours, visit DiabetesEducator.org/healthybehaviors.

• Practice social distancing.
  A word of caution…BEWARE of close contact with other shoppers at the grocers! Food delivery services in many areas are now mandated to provide “no contact” delivery - the groceries are simply left on your doorstep.

• Take a Coronavirus news break.
  Take a break from Coronavirus news each day. Constant involvement can increase your stress level and affect your blood glucose.

• Prepare for sick days. 
  While you have the time, prepare a sick day kit and plan. Be prepared with extra medications, diabetes supplies and contact your diabetes care team for a sick day plan to know if/how much you should adjust insulin or other medications when blood glucose is affected by illness.

• Relieve stress.
  Take a few minutes and experience the many benefits of meditation. Stress reduction and improved focus are just two of the benefits of practicing mindfulness. Check out Mindful.org to get started and you will be a meditation expert in no time.

• Pay attention to dental care.
  People with diabetes are at an increased risk for gum disease, which in turn can lead to elevated blood glucose. Start an optimal dental care routine with brushing twice daily and flossing every day. If you have red or painful gums, call your dentist!

• Eat healthy.
  Healthy eating strategies are critical to managing your diabetes. There are many online resources to get you started. Ask your health care provider for a referral to a certified diabetes care and education specialist who can teach nutrition strategies via online video or telephone visits while you are sheltering in place.

• Make mealtimes a family affair.
  Practice preparing healthy meals with your family. Quality time with the family and healthy eating habits for all! Go to the American Diabetes Association’s Diabetes Food Hub for some quick, easy and healthy recipes.

• Care for your feet.
  Don't forget your feet! Wash, dry and moisturize every day. Thoroughly dry, but do not moisturize, between the toes. Trim toenails carefully straight across, inspect for blisters/sores/redness in skin every day (use hand mirror for soles of feet) and never go barefoot!

• Stay active.
  Keep it moving! Just 10 minutes of exercise increases oxygen to the brain, lowers stress, calms nerves, and improves mood. Start low and go slow. Activity groups with friends, family and co-workers using text, Facetime, Skype or Zoom are a great way to motivate. Many companies are offering free or trial access to their apps and local gyms may be streaming group fitness classes. If you have limited mobility, then chair exercises are a perfect option to stay active!

• Connect to peer support.
  Connect with others. Talk with people you trust about your concerns and how you are feeling. Online peer support communities offer an outlet available 24/7. For more information, visit DiabetesEducator.org/PeerSupport. 

• Learn to cope.
  Many people are under large amounts of stress and anxiety during this time. It’s important to practice healthy coping strategies, which for people with diabetes can help avoid spikes in blood glucose. For additional guidance from the CDC on healthy coping and managing stress, checkout their resources. 

https://www.diabeteseducator.org/news/perspectives/aade-blog-details/adces-perspectives-on-diabetes-care/2020/04/13/tips-for-people-with-diabetes-during-the-stay-at-home-orders

COVID-19 is changing everything. Here's what that means for diabetes

From fiercehealthcare.com

Social distancing is critical in managing the spread of COVID-19, particularly for diabetic patients who are at high risk for serious complications if they catch the novel coronavirus.

But being stuck at home also poses major barriers to managing their diabetes in the first place.

Now, health plans and their tech partners are adapting to a world where their members with prediabetes or Type 2 diabetes are encouraged to stay within their homes—adapting existing tools aimed at lifestyle change to meet the new, more isolated reality.

Angie Kalousek, director of markets and lifestyle medicine at Blue Shield of California, who helps run the insurer’s Wellvolution program, said that’s also required a shift in priorities to meet member needs. Emotional health and well-being are becoming a central focus, she said. 

Alex Petrov, CEO of Yes Health, a tech platform that partners with Blue Shield, agreed, saying that amid financial worries and increasing isolation, addressing behavioural health has edged out fitness and nutrition in the hierarchy of needs amid the pandemic. 

“The COVID-19 reality has completely changed our story and our approach,” Petrov said. 

That’s a trend that’s not limited to Blue Shield and Yes Health. Sean Duffy, CEO of Omada Health, said that his company has a seen its diabetes patients increase their use of Omada’s behavioural health tools by 10 times of late. 

That led Omada to more directly integrate some of its behavioural health modules into its platform for chronic disease management, he said. 

“The reality is everyone’s feeling it in their own way,” Duffy said, “but the month of April for the country is associated with extraordinary levels of anxiety.” 

Chronic care management companies and their health plan partners have also been forced to quickly roll out options to help people work out at home and manage their nutrition more independently. 

Kalousek said that Blue Shield’s partners like Yes Health are offering virtual exercise options, and the insurer has also been making video content available to members directly.  

Blue Shield launched an internal program for employees to encourage them to stay fit while staying home, and the positive response has led the company to share those clips through social media so members can view them as well.  

The content varies and includes popular options such as zumba and yoga to keep the experience fresh, she said. 

“We don’t know where COVID is going and we don’t know how many people are going to get it, but I think now more than ever, especially for people in the diabetes population, this is the time for them to address their issues,” Kalousek said. 

Omada added new communities to its app to help its users stay fit and healthy at home, Duffy said. About 1,100 people signed up for the “Staying Active at Home” community within its first 24 hours, and 922 joined the platform’s “Healthy Eating at Home on a Budget” community in its first day. 

Omada’s app uses modular tiles for personalized alerts, and the company launched 28 new tiles in response to COVID-19 and nixed 12 that weren’t appropriate for users during the pandemic, he said. Omada also added 10 new goals for users and temporarily removed 24 that didn’t work for now. 

The company’s product team holds a daily virtual meeting to weigh ongoing platform changes to better suit users’ needs as they stay home, Duffy said. 

“We have never had to use as much of the modular features to make pivotal product changes as quickly as we have over the last month, because the realities for our participants were so night and day different,” he said. 

Diabetes management companies are also seeing changes in medication management and adherence thanks to the pandemic. 

Anurati Mathur, CEO of Sempre Health, a platform that offers point-of-sale dynamic drug discounts and text reminders in concert with health insurers, said signs point to diabetes patients more closely managing their medications as the pandemic continues. 

“With what we know about patient behaviour at this time, they’re actively managing their chronic conditions and staying on top of refills in a way that may not have previously,” Mathur said. 

Sempre is also seeing the pandemic lead to more users understanding the benefits they have available to them—such as home medication delivery—that will still be options when the crisis has waned, said Kyle Wildnauer-Haigney, vice president of business development at Sempre Health. 

The changes brought on by social distancing are likely to have a lasting effect on managing diabetes, Duffy said. He expects that the increased use of telehealth and digital health tools will stick. 

For example, Omada offers continuous glucose monitors to some of its members, which cut down on the need for visits to the doctor for HbA1c tests. It’s a great perk when people are asked to stay home as much as possible to limit the strain on the system during a pandemic, but also one that can avoid visits in more normal times, too. 

“There's never been a stronger case in my mind that one should ask yourself, ‘Do you really need to go in person for this element of care or not?’” Duffy said. 

https://www.fiercehealthcare.com/payer/how-covid-19-changing-care-management-for-diabetes-patients

Are You At Risk Of Developing Type-2 Diabetes?

From ndtv.com

Diabetes is a progressive disease that occurs when your body is unable to produce or use an adequate amount of insulin. Early detection and prevention can help control the condition. Here are risk factors, symptoms and much more you need to know about type-2 diabetes.

At present, there are approximately 77 million Indians living with diabetes. This means that every sixth person with diabetes is an Indian. Around the world, Type-2 diabetes accounts for about 90 to 95 percent of all diagnosed cases. There has been a staggering increase in diabetes in India over the last 3 decades. It is estimated that in Indian metropolitan cities, almost 20% of people at the age of 20, and 35-40% at the age of 60 may have diabetes. (CARRS Study 2013).

Furthermore, there is a sharp increase in type-2 diabetes in children and teenagers, even though it was traditionally regarded as a disease of adults. It is estimated that by 2030, nearly 98 million people in India may have type-2 diabetes. These alarming figures make it imperative to stem the rising tide of diabetes. Even as type 2 diabetes has continued to permeate in Indian society, awareness of its causes, symptoms, and treatment is low. To mitigate the risk of developing type-2 diabetes, it is important to educate everyone on the issue and ensure that the early symptoms of type-2 diabetes are not ignored and are given proper medical attention and care.

What is type-2 diabetes? Know causes, symptoms and much more

Diabetes is a progressive disease that occurs when your body is unable to produce or use an adequate amount of insulin, resulting in high blood glucose levels that can damage your body over time. Insulin is a hormone that uses glucose from food for energy. Type-2 diabetes occurs when your body cannot produce enough insulin and cannot effectively use the produced insulin. This condition is called insulin resistance, and it may take several months or even years to develop.

Causes of type-2 diabetes

The symptoms of type-2 diabetes may not be visible at onset - in fact, 50% of those with diabetes have no symptoms. Some may present with acute symptoms early in the course of disease but often by the time symptoms manifest, organ damage may already have taken place. Testing blood glucose in those at risk of developing diabetes is important even if they have no symptom. All Indians should be screened periodically once they cross 30. Earlier testing should be carried out for all those with family history, obesity, and women with a history of PCOS or large sized babies. Those presenting with high blood pressure or high cholesterol are also more likely to be suffering from diabetes.
Scientific evidence suggests that not only Indians have an increased degree of insulin resistance as well as pancreatic beta cell dysfunction.

Although genetic predisposition to diabetes is a concern, lifestyle choices are worthy of equal consideration. Adapting an active lifestyle that incorporates a healthy diet plan and regular exercise, can significantly reduce the risk of developing type-2 diabetes - even for people who have a family history of diabetes. It is essential to keep weight in control if the BMI is below 23, the risk of diabetes is clearly low. The ideal waist circumference is below 80 cms for women and 90 cms for men.

Symptoms of type 2 diabetes

People may present with the following symptoms- alone or in combination:

• Frequent urination as your body expels excess glucose due to high blood sugar levels. The need for urination is higher, especially in the night time
• Increased thirst resulting from frequent urination. The resulting dehydration from frequent urination causes an urge to drink water to replenish the body
• Excessive hunger or increased appetite. Since glucose is unable to enter the cells, your cells signal that you should continue to eat so they can get the glucose they need
• Tiredness and fatigue as the sugar moving into the body's cells are insufficient, leading to the production of less energy
• Increase rate of infections as glucose in urine propels the growth of fungus and bacteria
• Poor or blurry vision due to the presence of high sugar levels in the fluid of your eye
• Sudden weight loss as your body substitutes fat for energy when the blood cells cannot absorb enough glucose.

If you are leading an unhealthy lifestyle, have a family history of diabetes or are experiencing against the symptoms as mentioned above, seeing your doctor to test for type 2 diabetes is essential.

Diagnosed early, type 2 diabetes can be controlled, and sometimes even reversed. A healthy lifestyle can certainly slow the progress of the disease and can prevent or reduce long term impact on the heart, kidneys, eyes and other organs

The components of a healthy lifestyle include a diet low in refined carbohydrates and trans or saturated fat, greater intake of fibre and protein, and regular physical exercise. Maintaining ideal body weight is your biggest protection against developing diabetes.

https://www.ndtv.com/health/are-you-at-risk-of-developing-type-2-diabetes-2210337

COVID-19: What T1 Diabetes Patients Need to Know

From webmd.com

THURSDAY, April 9, 2020 (HealthDay News) -- If you or your child has type 1 diabetes, you already have a lot of extra health worries, and now you need to add COVID-19 infections to the list.
You may be wondering if you have a higher risk of catching COVID-19, if you'll be able to get your diabetes supplies and how you might handle the illness if you do get sick.

Here's some information to help you get through this trying time:

Is my risk of COVID-19 higher?
      
Aaron Kowalski, CEO of JDRF (formerly the Juvenile Diabetes Research Foundation), has some good news on this front.
"Healthy type 1 folks aren't more at risk if they have a reasonable A1C," he said. An A1C is a blood test that estimates blood sugar control during the past two to three months.

But, for those who are having trouble keeping their A1C down, he added that consistently high blood sugar can make people more susceptible to infection.

Dr. Mary Pat Gallagher is director of the paediatric diabetes centre at NYU Langone Health in New York City.
"If you have an A1C that is less than 9.5%, you are not really considered immunocompromised," she said. "Higher blood sugar levels for more than two weeks can impair immune function."

But, she cautioned, "None of us has any immunity to this virus. We're all extremely susceptible, whether or not we have type 1 diabetes."
What about complications?

While some of the early data from China and Italy seems to suggest that people with diabetes have a higher risk of complications, Gallagher said those findings probably represent older people with type 2 diabetes and additional medical conditions.

"Children appear -- regardless of [any other illnesses] -- to be doing very well. There are definitely children in the hospital, but their risk of developing serious illness is much lower," Gallagher noted.
And, no matter your age, if your blood sugar is well-controlled, you probably don't have a higher risk of COVID-19-specific complications. But getting sick when you have type 1 diabetes is always a challenge.

Having an illness often wreaks havoc on your blood sugar control. Viral illnesses, like the flu, are known to increase your risk of ketones and diabetic ketoacidosis (DKA), so it's important to be extra vigilant when it comes to your type 1 diabetes management. Ketones are chemicals that can build up in the body when it breaks down fat for energy. When there are too many ketones, DKA -- a potentially life-threatening complication -- can occur.

Be aware that medications can raise your blood sugar, and some drugs affect the accuracy of readings on certain continuous glucose monitors.

"Getting sick definitely adds complexity to type 1 diabetes," Kowalski said. "Having a sick day management plan is important."
Gallagher recommended getting a 24-hour number for your doctor's office that you can reach in an emergency. Post it somewhere that's easy for everyone in the family to see.

Supplies to have on hand

Gallagher advised filling your prescriptions as soon as possible, if you haven't already. She suggested trying to get a three-month supply. "A lot of insurance companies are lifting prescription time restrictions," she said.

Supplies you should have on hand typically include:

• Insulin
• Back-up long-acting insulin (if you're currently using a pump)
• Glucagon
• Insulin pump supplies (such as reservoirs, infusion sets)
• Continuous glucose monitor (CGM) sensors
• Ketone strips
• Batteries for insulin pumps, CGMs and standard glucose meter
• Blood sugar test strips (be sure these aren't expired) and lancets
• Low blood sugar treatments (such as glucose tabs and juice)
• Easy-to-digest foods, like crackers, soup or ice pops
• Fluids with and without sugar (so you have options for both high and low blood sugar situations)

Kowalski said JDRF has been in touch with insulin and device makers, and the supply chain is strong. There are no significant shortage concerns. He said there may be spotty shortages for a few days at a time in some areas because a lot of people have been filling prescriptions all at once, and many have switched from one month at a time to three months.

What to do if you get sick

If you do get sick, call your doctor for more specific instructions on what to do.
Your diabetes sick day management should tell you when to test for ketones. As a general rule, if you're on an insulin pump and your blood sugar is over 250 milligrams per deciliter (mg/dL), and you haven't responded to a correction dose of insulin, check your ketones and call your doctor.

If you're on multiple daily injections and your blood sugar is over 250 mg/dL (despite a correction dose of insulin) for more than two or three hours, check for ketones and call your doctor, Gallagher suggested. Someone on your doctor's team will walk you through what to do next to help bring your blood sugar down.

Gallagher said it's important to remember that people with type 1 diabetes always need a long-acting insulin (called "basal" insulin in a pump), even when sick. She said you can reduce the basal insulin, but you shouldn't stop it, especially not for more than several hours without speaking with someone on your diabetes health care team.

If you have abdominal pain, nausea, vomiting, excess fatigue or fruity-smelling breath, call your diabetes doctor right away. These are signs of DKA.

Day by day
Kowalski suggested that everyone follow the guidelines on washing hands, keeping a safe physical distance from others, and getting up and moving. In scary times exercise can be a good way to work off stress, he said.

Gallagher emphasized the need for people with type 1 diabetes and their families to try to get some physical activity every day, while maintaining social distancing rules, of course. An hour is ideal, she said.

And, she said, "There's a lot of worry about consistent access to food, making it harder to meal plan. It's also easy to eat poorly when you're under stress, so try to make good food choices when you can."

https://www.webmd.com/lung/news/20200409/covid19-what-t1-diabetes-patients-need-to-know#1

18 of the Best Non-Perishables for People with Diabetes

From healthline.com

If you have diabetes, you may be concerned about eating well while social distancing or self-quarantining. Keeping non-perishable foods on hand can be a great way to minimize your trips to the store and ensure that you have all the ingredients you need to make nutritious meals.

Notably, numerous frozen or shelf-stable foods have a minimal effect on your blood sugar levels. You may even already have some in your pantry or freezer.

Here are 18 of the best non-perishables for people with diabetes.

1. Dried or canned chickpeas

Chickpeas are popular in numerous dishes. While they contain carbs, they’re also rich in fiber, protein, and fat — all of which help minimize their overall effect on your blood sugar levels.

You can use these tasty legumes to make hummus or falafels. What’s more, they make a filling meat alternative and can be added to soups, salads, and stir-fries.

If stored in a cool, dark pantry, dried chickpeas keep for up to 3 years.

2. Canned tomatoes

Canned tomatoes can flavour numerous dishes, including soups and stews.

These savory, red fruits are also rich in antioxidants, such as lycopene, which may promote heart health. Plus, they’re fairly low in carbs, so they only affect your blood sugar levels minimally.

Canned tomatoes can be used in cooking or to make sauces. Canned veggies typically don’t expire for several years after purchase.

3. Peanut butter

Peanut butter is an inexpensive source of healthy protein, fat, and fiber — and it has few carbs.

It’s a great way to make a snack more filling. You can add it to toast or crackers, blend it into a smoothie, or use it as a dip for apples or baby carrots. It’s likewise great in savory dishes like Thai-inspired stir-fry.

Just be sure to choose natural peanut butter brands that don’t contain added sugar, as sugary foods negatively affect blood sugar control.

After opening, peanut butter lasts for about 1 year.

4. Pistachios

Pistachios are a tree nut that packs healthy protein and fat. They’re also rich in fiber, making them a great snack for people with diabetes.

They serve as a crunchy addition to salads and can be crushed to make breading for fish or chicken.

Pistachios last for about 6 months in your pantry, although refrigeration greatly extends their shelf life.

5. Canned salmon

Canned salmon is rich in omega-3 fatty acids, which benefit your brain and fight inflammation.
Moreover, this fish is packed with protein and has no carbs. Canned salmon also contains some bones, which are safe and edible — and provide a calcium boost.
You can use canned salmon on salads or in salmon patties. It typically doesn’t expire until 2 years after purchase.

6. Seed crackers

Seed crackers are crackers made from a variety of seeds, such as sesame, flax, and chia seeds.
Seeds serve as a healthy source of fat and fiber, which help slow these crackers’ effects on your blood sugar levels.

They can be paired with peanut butter or cheese as a snack, or included in a light meal like chicken salad or soup.

If kept tightly sealed and stored in a pantry or fridge, seed crackers should last for about 1 month.

7. Chia seeds

Chia seeds are tiny black or white seeds. They boost digestive health because they’re rich in soluble fiber and form a gel in your gut. This helps slow digestion and prevent rapid blood sugar spikes.

Chia seeds add crunch to salads and smoothies. You can also use them to make chia pudding, a delectable treat that’s delicious with fresh fruit.

These seeds last up to 4 years in your pantry.

8. Frozen berries

Berries like raspberries are relatively low in sugar and high in fibre compared with other fruits like bananas or apples, so they affect your blood sugar levels to a lesser extent.

Additionally, berries are packed with health-boosting nutrients and antioxidants.

Frozen berries can be used in smoothies, cooking, and baking, and they last up to 1 year in the freezer — although you’ll want to check them on occasion for freezer burn.

9. Frozen cauliflower

Cauliflower is a versatile ingredient that can replace mashed potatoes, rice, and even certain pastas like macaroni. Its mild flavour makes it a great substitute for these starchy carbs.
Plus, it boasts a very low carb count.

Frozen cauliflower can last for up to 1 year in the freezer but should be checked for freezer burn often.

10. Quinoa

Quinoa is a chewy whole grain with a taste and texture similar to that of brown rice. However, it has more protein and fibre — and fewer total carbs — than brown rice, making it ideal for people with diabetes.

Quinoa lasts for about 6 months to 1 year if properly stored in a sealed container in your pantry.

11. Canned mushrooms

Canned mushrooms, which taste milder than fresh varieties, give a nutrient boost to endless dishes. They’re particularly popular in soups and stir-fries.

Mushrooms are fibre-rich and low in carbs, so they affect your blood sugar negligibly. Some varieties, including white button contain ergothioneine, an amino acid that has antioxidant properties and may aid blood sugar management.

Canned mushrooms usually don’t expire until 2 years after purchase.

12. Canned or frozen spinach

Given that spinach contains very few carbs and calories, you can eat a large quantity with a minimal effect on your blood sugar levels.

You can cook it as a side or add it to soups, stir-fries, and many other dishes to increase your intake of fibre, antioxidants, and provitamins A and K.

Canned spinach lasts up to 4 years, while frozen spinach keeps for up to 1 year.

13. Canned chicken

Canned chicken is fairly lean, rich in protein, and contains almost no carbs. It’s also convenient, as it’s fully cooked and ready to eat.
You can use it in soups, salads, and casseroles in the same way as you would use cooked chicken that’s shredded or cubed. It also makes for easy chicken salad.

Canned chicken lasts up to 4 years.

14. Dark chocolate

Dark chocolate is a great treat for people with diabetes — and the darker the better, as chocolate with a higher cocoa content tends to pack less added sugar. Cocoa is also rich in fibre and healthy fats.

For instance, just 3 squares (30 grams) of 78% dark chocolate offers 14 grams of fat, 3 grams of protein, and 4 grams of fibre — with only 11 grams of carbs.

You can eat it on its own or include it in numerous desserts. A dark chocolate bar keeps for up to 4 months in your pantry, but freezing it extends its shelf life.

15. High protein pasta

High protein pastas are usually made from legumes, such as black beans or chickpeas, instead of wheat.
Legumes contain carbs but boast more fibre and protein than wheat, making high protein pastas a better choice for people with diabetes.

You can replace regular pasta with a high protein variety in any recipe. It lasts dry for up to 6 months.

16. Protein powder

Most protein powders are low in carbs and added sugars while providing hefty doses of protein. They’re also quick and convenient.

Whey protein is derived from cow’s milk, so if you prefer a plant-based option, you can use soy or pea protein powder.

Protein powders is a great addition to smoothies, protein shakes, and desserts. It typically lasts for up to 1 year if sealed and stored in a cool, dry place.

17. Shelf-stable milk

Shelf-stable milk, whether dairy or plant-based, is always good to have on hand.
Although cow's milk is slightly higher in carbs than some non-dairy alternatives, it has protein and fat — unless it’s skim — that reduce its effects on your blood sugar. Alternatively, some plant-based milks like unsweetened almond milk contain few carbs to begin with.

If you opt for plant milk, make sure to buy varieties without added sugar.

Both shelf-stable and plant-based milks can be used in various recipes, such as protein-rich smoothies, soups, and baked goods. They last unopened for several months but should be refrigerated after opening.

18. Olive oil

Olive oil is rich in anti-inflammatory compounds, and consuming it regularly may help you manage your blood sugar levels.

Olive oil is pure fat, so it contains no carbs to affect your blood sugar levels. However, it’s high in calories, so you should use it in moderation.
It’s a popular cooking oil and ideal for vinaigrettes, dressings, and dips.

Meal planning tips

Keeping blood sugar levels consistent is an important consideration for people with diabetes.
Since carbs affect your blood sugar levels more than protein and fats, your meals and snacks should all contain roughly the same number of carbs.

The number of carbs that you need or can tolerate depends on many factors, including your body size, activity level, insulin sensitivity, and calorie needs.

While the best way to determine the right amount for your needs is to consult a knowledgable healthcare provider, here are some examples of a single serving of some carb-rich foods:

• 1/3 cup (about 50 grams) of rice or pasta
• 1/2 cup (117 grams) of oatmeal or grits
• 1 slice of bread
• 1 small tortilla or dinner roll
• 6 crackers
• 1/2 cup (80 grams) of potatoes or sweet potatoes, cooked
• 1 piece of fruit or 1 cup (144 grams) of berries
• 1 cup (240 mL) of milk

Try to include protein and fat in each meal or snack to help keep you full and prevent your blood sugar levels from rising quickly.

Before making any large changes to your diet, consult your healthcare provider so that they can properly adjust your medications and insulin dosages if needed.

Summary
If you have diabetes, you should try to keep your carb intake consistent across all your meals and snacks.

https://www.healthline.com/nutrition/non-perishables-for-people-with-diabetes#Meal-planning-tips