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America on the Move

We have all heard about small changes reaping huge benefits to achieve a healthy lifestyle, but the question is usually "How?” America on the Move is all about helping individuals make and maintain small changes in diet and exercise. You can log physical activity, plan meals, challenge your friends, be accountable to buddies, and search for nutritional values of food. It’s free to use the website, and it also contains a useful database of tips for healthy living.

An insurance plan – just for diabetes

The insurance company UnitedHealthcare (United) is starting a new health care plan to help people better manage diabetes and control employers' increasing insurance costs. Their approach sounds promising to us. The plan will provide special benefits to those with diabetes and pre-diabetes who work to improve their disease management by completing regular blood glucose testing, routine exams, preventive screenings, and wellness coaching. The benefits range from supplies and medication at no charge to lower co-pays for related physician visits. Participants can access online monitoring and educational tools for free and may save up to $500 per year overall on expected diabetes expenses. Self-insured commercial health plan customers can enroll in the plan, and employers will have the option of offering it as a stand-alone or enhancement plan. We looked closely at the plan, and we believe that for many people, there’s a good chance of improving the condition of your health and your wallet at the same time. If you have United health insurance through your employer, ask them about this plan. For more information, you can see UnitedHealthcare’s fact sheet at UnitedHealthcare’s fact sheet.

My Food Advisor

It’s often a challenge to figure out the carbohydrate content of different recipes. A new website, My Food Advisor, might be of help. It’s an online nutrition tool created by the American Diabetes Association (ADA). In addition to figuring out the number of carbs, calories, or grams of fat in more than 5,000 foods (an impressive database), it holds thousands of great recipes from the ADA’s recipe books, archived into searchable categories. The site lets you enter nutrition guidelines for your recipe searches, ensuring your recipes do not exceed a certain number of calories, or amount of carbohydrates, sodium, or saturated fat, and that they contain at least a specified minimum amount of fiber. You can create your own dish or analyze a favorite to get nutrition information, and you can even search to find healthier alternatives for specific ingredients in your recipes. There are still a few improvements that could be made in terms of navigating the site (don’t hit the ‘back’ button or you’ll get kicked off your search), but in general we're impressed with this functional, eye-pleasing tool.

Sleep Apnea Products

Obstructive sleep apnea is one of the most common medical conditions suffered by people with type 2 diabetes, but many people are unaware of its scope and impact. A study recently presented at the American Association of Diabetes Educators meeting suggests that while 94% of doctors recognize the connection between sleep apnea and diabetes, only 47% screen for the condition in their patients. The study estimates that about 85% of sleep apnea cases in people with diabetes go undiagnosed. In patients with sleep apnea, the upper airway collapses during sleep, preventing air from moving through the airway freely. Sometimes the person stops breathing entirely for several seconds, and this can happen hundreds of times a night. A bed partner may witness gasps that are followed by a coughing sound, as the person struggles to resume breathing.

Sleep apnea not only disturbs sleep, it also results in lower levels of oxygen in the blood. Untreated sleep apnea is a risk factor for high blood pressure, heart disease, and stroke. For people with type 2 diabetes, sleep apnea can worsen diabetes control and make it harder to lose weight or stick to a regular exercise regimen.

Fortunately, there are many companies selling and developing sleep apnea products, including ResMed, Covidien, DeVilbiss, and Philips, among others. The most common treatment for sleep apnea is called continuous positive airway pressure (CPAP), which maintains an elevated level of air pressure throughout the night and keeps the patient’s airway open.

We recently met with representatives of ResMed who discussed with us the three types of CPAP masks they manufacture: nasal masks (fitting around the nose), face masks (covering the entire face), and nasal pillows (resting inside the nose). Also, there are different kinds of air pressure units, some of which give constant pressure and some that can vary the pressure level automatically.

If you have been experiencing problems like chronic fatigue or a difficulty concentrating, we encourage you to bring up sleep apnea with your doctor. To determine if you actually have sleep apnea, you’ll probably need to have a sleep study (which is usually done over one night in a clinic) to measure your breathing patterns while you’re asleep. If the study confirms a diagnosis of sleep apnea, your doctor will advise you on how to proceed with treatment. Always check with your insurance provider to be certain a specific product is covered.

Article in Diabetes Care journal sheds light on Levemir dosing

Many different factors play into the choice of a basal insulin, and the number of required injections per day can make a big difference. A new study released in the January 2009 Diabetes Care shows that, at least among adult patients with type 1 diabetes, taking a single dose of Levemir at bedtime may be as effective as taking two doses each day. According to the authors, this makes sense, because the pharmacological profile of Levemir (the way it is absorbed by your body) suggests that it should last for almost 24 hours. In the study, patients who injected Levemir twice a day for four months had no statistically significant improvements in A1c compared to patients who injected only once a day. However, patients who injected twice a day had a flatter blood sugar profile throughout the day, with lower levels after lunch and dinner compared with the once-daily group. As always, talk to your doctor before making any changes to your treatment regimen. If you point your diabetes team to this study, you can discuss your options together. The study summary can be found here.

Halozyme Therapeutics’ new insulin enhancer

Halozyme Therapeutics wants injected insulin to work faster and more efficiently, and, toward that end, it’s combining insulin with an enzyme called recombinant human hyaluronidase, or rHuPH20. This enzyme is known to break down obstructions beneath the skin that slow down absorption and dispersion of insulin after it’s been injected into the body. The value of breaking down these obstructions (called the extracellular matrix of the skin) is that the insulin gets into the blood much faster and consequently is able to start reducing blood sugar faster as well.

In a study presented at the ADA meeting in June 2008, Halozyme presented data comparing Humalog combined with the rHuPH20 enzyme to Humalog injected without the enzyme. The company found that 15 minutes after injection, three times as much Humalog was in the blood stream of those patients injected with the combination than those injected with Humalog alone, and with Humulin R, there was 24 times as much Humulin R present when it was injected along with the enhancer. This product is still in its early stages of clinical trials – Halozyme just recently started phase 2 testing in 28 patients with type 1 diabetes, and hopes to have results in June 2009. We understand that Halozyme also plans to test this insulin in pumps, and we look forward to reporting more data when it becomes available. Learn more in the indepth scientific discussion of the product.

Insight foot care scale

Diabetic neuropathy affects the feet and is a common complication of poorly controlled diabetes. The drug works by inhibiting the action of connective tissue growth factor, which helps to reduce damage to the kidney from high blood sugar. The Insight foot care scale is a new product designed to make the task of caring for your feet easier. Essentially, it’s a bathroom scale with a lighted mirror inside that lets you see the soles of your feet more easily—and seeing it sitting in your bathroom can serve as a reminder to perform foot checkups. Foot care is extremely important for people with diabetes—the ADA recommends that you check your feet for cuts or sores daily, and the Insight scale can be a helpful tool to help you meet that goal – much better than using a hand mirror or having to do yoga to see your own feet! The scale can be purchased online at www.focusonyourfeet.com, and we have been able to obtain a discount for diaTribe readers. Just enter the code ‘Diatribe5’ when you purchase the scale online and you’ll get a $5 discount off the typical $100 price tag. The scale is not currently covered by insurance.