Podcasts about dcct

Bài Tin Mừng mà Hội Thánh công bố trong Phụng vụ Chúa Nhật 7 mùa Phục Sinh năm B (Mc 16,15-20) kể lại cuộc hiện ra cuối cùng của Chúa Giêsu và biến cố Người được đưa lên trời. Kính mời quý vị cùng tìm hiểu bài Tin Mừng này với các phân tích của linh mục Giuse Nguyễn Thể Hiện DCCT.

Bài Tin Mừng mà Hội Thánh công bố trong Phụng vụ Chúa Nhật 5 Mùa Phục Sinh (Ga 15,1-8) nói với chúng ta về căn tính và sự tồn tại của Hội Thánh - cộng đồng nhân loại mới, đó là tham dự thiết thân vào sự sống của chính Chúa Giêsu. Kính mời quý vị cùng tìm hiểu bài Tin Mừng này với các phân tích của linh mục Giuse Nguyễn Thể Hiện DCCT. 

Trong bài Tin Mừng của Lễ Chúa Chiên Lành (Ga 10,11-18), Đức Giêsu khẳng định một cách tường minh rằng Người chính là Mục Tử Nhân Lành, đồng thời Chúa nói đến 4 đặc điểm quan trọng làm nên dung mạo Mục Tử Nhân Lành của Ngài. Kính mời quý vị cùng tìm hiểu bài Tin Mừng này qua phần chia sẻ của linh mục Giuse Nguyễn Thể Hiện DCCT.

Trong bài chia sẻ này, linh mục Nguyễn Thể Hiện DCCT sẽ trình bày những phân tích và suy niệm về bài Tin mừng được Phụng vụ công bố vào Chúa Nhật III Mùa Phục Sinh Năm B (Lc 24,35-43). 

Tuần Thánh bắt đầu với nghi thức kiệu lá. Trong cuộc kiệu lá Chúa Nhật Lễ Lá năm B, Hội Thánh công bố bài Tin Mừng Mc 11,1-10, kể lại biến cố Đức Giêsu tiến vào thành Giêrusalem trên lưng lừa. Kính mời quý vị cùng tìm hiểu bài Tin mừng Chúa Nhật Lễ Lá năm B: Mc 11,1-10, với phần phân tích và chia sẻ của linh mục Giuse Nguyễn Thể Hiện DCCT.

Linh mục Nguyễn Thể Hiện DCCT sẽ trình bày những phân tích và suy niệm về bài Tin mừng được Phụng vụ công bố vào Chúa Nhật V Mùa Chay năm B (Ga 12,20-33). Kính mời quý vị và các bạn cùng theo dõi. 

Bài Tin Mừng Chúa nhật thứ tư mùa Chay năm B (Ga 3,14-21) trích từ cuộc trao đổi của Đức Giêsu với ông Nicôđêmô. Trong trích đoạn này, tác giả Ga giới thiệu với chúng ta Đức Giêsu trong tư thế là Đấng Mêsia được giương cao. Người chính là nguồn mạch sự sống và là qui chuẩn mà chúng ta phải theo để đạt tới sự viên mãn đích thật. Kính mời quý vị cùng tìm hiểu bài Tin mừng Chúa Nhật IV mùa Chay năm B: Ga 3,14-21, với phần phân tích và chia sẻ của linh mục Giuse Nguyễn Thể Hiện DCCT. 

Kính mời quý vị cùng tìm hiểu bài Tin mừng Chúa Nhật III mùa Chay năm B: Ga 2,13-22 với phần phân tích và chia sẻ của linh mục Giuse Nguyễn Thể Hiện DCCT. Từng chi tiết của bài Tin Mừng này đều có sức chất vấn mạnh mẽ cuộc sống Đạo của chúng ta, trong tư cách cá nhân cũng như trong tư cách cộng đoàn. 

Bài Tin Mừng Mc 1,12-15 được Hội thánh Công Giáo công bố trong Chúa Nhật I Mùa Chay năm B, kể lại sự kiện Chúa Giêsu trong hoang địa 40 đêm ngày, và việc Người khai mạc công cuộc loan báo Tin Mừng. Trong bài chia sẻ này, chúng ta sẽ chỉ tập trung vào phần nói về sự kiện Đức Giêsu ở trong hoang địa (Mc 1,12-13); và những gì sắp được trình bày ở đây là một cách hiểu mới (và có thể bị tranh luận) về sự kiện Đức Giêsu ở trong hoang địa. Kính mời quý vị cùng theo dõi, qua phần phân tích và chia sẻ của linh mục Giuse Nguyễn Thể Hiện DCCT 

Phụng vụ của Chúa Nhật VI công bố bài Tin mừng Mc 1,40-45, kể lại sự kiện Đức Giêsu chữa lành một người bị phong hủi, qua đó mạc khải cho chúng ta về khuôn mặt của chính Thiên Chúa và sứ vụ giải phóng của Đức Giêsu.Kính mời quý vị cùng suy niệm bài Tin mừng Mc 1,40-45 với phần chia sẻ của linh mục Giuse Nguyễn Thể Hiện DCCT 

Phụng vụ Chúa Nhật V mùa Thương Niên năm B công bố bài Tin mừng Mc 1,29-39: Đức Giêsu chữa nhiều người ốm đau mắc đủ thứ bệnh tật khác nhau. Bài Tin Mừng Mc 1,29-39 gồm ba phần:Đức Giêsu chữa cho bà mẹ vợ ông Simon khỏi sốt (cc.29-31), Người chữa bệnh và trừ quỷ cho đám đông dân chúng “xúm lại ở cửa” (cc.32-34),Người âm thầm rời Capharnaum đi rao giảng Tin Mừng khắp miền Galilê (cc.35-39). Kính mời quý vị cùng suy niệm bài Tin mừng Mc 1,29-39 với phần chia sẻ của linh mục Giuse Nguyễn Thể Hiện DCCT

Phụng vụ Chúa Nhật III mùa Thường Niên năm B, Hội thánh Công giáo công bố bài Tin Mừng Mc 1,14–20. Với Mc 1,14-20 tác giả sách Tin Mừng Mc bắt đầu phần trình thuật nói về khởi đầu những hoạt động của Chúa Giêsu. Bố cục bài Tin mừng Mc 1,14-20 có thể chia thành 2 phần:Đức Giêsu công bố Tin Mừng (cc 14,15)Đức Giêsu tuyển chọn các môn đệ đầu tiên (cc 16-20)Kính mời quý vị cùng tìm hiểu nội dung và ý nghĩa của từng phần trong Mc 1,14-20; qua phần phân tích, chia sẻ của linh mục Giuse Nguyễn Thể Hiện DCCT. 

Được công bố trong khung cảnh những ngày bắt đầu chu kỳ Thường Niên, bài Tin mừng Chúa Nhật 2 mùa Thường Niên năm B - Ga 1,35-42 - nêu bật sự bắt đầu một giai đoạn mới với sự xuất hiện của Đức Giêsu và các môn đệ đầu tiên bước theo Người. Kính mời quý vị cùng với linh mục Giuse Nguyễn Thể Hiện DCCT phân tích các chi tiết của bài Tin mừng Ga 1,35-42. 

Vào Chúa Nhật cuối cùng của Mùa Vọng năm B, Hội Thánh công bố bài Tin Mừng Lc 1,26-38 thuật lại biến cố truyền tin cho Đức Maria, để nói với chúng ta về căn tính và sứ mạng của Đấng sắp giáng sinh, đồng thời mời gọi chúng ta, như Đức Maria, sống thái độ tâm linh thánh thiện đích thực để đón Người. Để hiểu rõ hơn về bài Tin Mừng Lc 1,26-38, được Giáo hội Công Giáo công bố trong Chúa Nhật IV mùa Vọng năm B, kính mời quý vị cùng theo dõi phần phân tích và chia sẻ của Linh mục Giuse Nguyễn Thể Hiện DCCT. 

 Bài Tin Mừng Chúa Nhật III Mùa Vọng gồm 2 phần: -Phần thứ nhất là phần trích từ lời tựa của sách Tin mừng thứ tư: Ga 1,6-8. -Phần thứ hai, Ga 1,19-28 là lời tuyên bố của ông Gioan Tẩy giả về chính ông. Ông có nhiệm vụ làm chứng về Đấng đang đến. Kính mời quý vị cùng suy niệm bài Tin Mừng Ga 1,6-8.19-28 cùng với phần phân tích và chia sẻ của linh mục Giuse Nguyễn Thể Hiện DCCT 

Vào Chúa Nhật thứ nhất Mùa Vọng năm B, Hội thánh Công giáo công bố bài Tin mừng Mc 13,33-37; điểm nhấn chính yếu của bài Tin Mừng hôm nay là lời mời gọi khẩn thiết phải tỉnh thức và sẵn sàng.Kính mời quý vị cùng theo dõi phần phân tích và chia sẻ của linh mục Giuse Nguyễn Thể Hiện DCCT, về Mc 13,33-37. 

It's In the News, a look at the top stories and headlines from the diabetes community happening now. Top stories this week: a new insulin pump gets FDA approval, once-weekly basal insulin for type 2 gets through another trial, New Jersey caps insulin prices for some, possible link between ability to chew and glucose control, a landmark diabetes study moves on to aging and T1D, JDRF Children's Congress and more! Learn about Moms' Night Out - a new event for moms of children with diabetes Please visit our Sponsors & Partners - they help make the show possible! Take Control with Afrezza  Omnipod - Simplify Life Learn about Dexcom  Check out VIVI Cap to protect your insulin from extreme temperatures Learn more about AG1 from Athletic Greens  Drive research that matters through the T1D Exchange The best way to keep up with Stacey and the show is by signing up for our weekly newsletter: Sign up for our newsletter here Here's where to find us: Facebook (Group) Facebook (Page) Instagram Twitter Check out Stacey's books! Learn more about everything at our home page www.diabetes-connections.com  Reach out with questions or comments: info@diabetes-connections.com   Hello and welcome to Diabetes Connections In the News! I'm Stacey Simms and these are the top diabetes stories and headlines happening now XX In the news is brought to you by AG1. AG1 helps you build your health, foundation first. XX Our top story, Tandem's Mobi Pump is approved. The FDA cleared the tiny pump for people with diabetes ages six and up. Tandem says mobie is fully controllable from a mobile app and is the world's smallest durable AID system. It still has a button on the pump to dose and holds 200 units. You use the same infusion set as the current Tandem pumps and Mobi uses Control IQ. Limited release planned for late this year and fully available early 2024. https://www.drugdeliverybusiness.com/fda-clears-tandem-mobi-automated-insulin-pump/ XX Learning more about a newly approved therapy for type 1 diabetes called Lantidra. Two safety and efficacy studies found that 21 participants who took Lantidra did not need to administer themselves insulin for a year or more. Twelve of those participants did not need to take insulin for up to 5 years, and 9 did not need insulin for over 5 years. Lantidra is an allogeneic (donor) pancreatic islet cellular therapy. In other words, Lantidra uses cells taken — or isolated — from human organ donor pancreases. “In [a] subsequent process, the insulin-producing islets are purified from the rest of the pancreatic tissue using a density gradient. Once the islets are isolated, purified, and put for a short time in cell culture, the cell preparation is infused into the liver of the recipient,” he explained. https://www.medicalnewstoday.com/articles/fda-approves-first-cellular-therapy-for-type-1-diabetes-what-does-it-do#How-does-islet-cellular-therapy-work? XX Once weekly basal insulin for type 2 gets through another trial. After 26 weeks of treatment and five weeks of follow-up, patients on weekly insulin icodec had significantly larger improvements in their HbA1C than those using daily insulin. Both groups had an extremely low rate of adverse events. These researches say next step is FDA evaluation. https://www.utsouthwestern.edu/newsroom/articles/year-2023/july-weekly-insulin-found-safe.html XX That's the idea behind Fractyl Health's treatment for type 2 diabetes—which could also be used for weight control. The Lexington, Massachusetts-based biotech company is in the early stages of developing a one-time gene therapy intended to lower blood sugar and body weight using the same mechanism as semaglutide. “You have this problem where you need to stay on therapy for efficacy,” says Harith Rajagopalan, a cardiologist by training and CEO and cofounder of Fractyl Health. “That's the Achilles heel.” The company wants to deliver an artificial gene to the pancreas that continuously produces the GLP-1 hormone so there's no need for weekly injections. The approach, called gene therapy, uses inactivated viruses to carry a therapeutic gene to pancreatic cells. (Viruses are used because of their natural ability to deliver genetic material to cells.) The company is aiming to begin an initial human trial by the end of 2024 https://www.wired.com/story/a-one-time-shot-for-type-2-diabetes-a-biotech-company-is-on-it/ XX Gov. Phil Murphy signed three bills into law Monday aimed at cutting the high cost of prescription drugs in New Jersey. The new laws will cap how much residents will pay for some popular medications such as insulin, prevent pharmacy benefit managers from engaging in practices that make drugs more expensive, and create a panel that will monitor prices set by pharmaceutical companies. One measure (S1614) would cap the cost of insulin, epinephrine auto-injector devices and asthma inhalers for state and local public workers enrolled in the State Health Benefits Program, the School Employees' Health Benefits Program and other state-regulated plans. For a 30-day supply, insulin will cost $35, EpiPens $25 and asthma inhalers would be capped at $50, according to the bill. The law takes effect next year. https://www.nj.com/politics/2023/07/new-laws-to-stem-high-cost-of-prescription-drugs-in-nj-were-just-signed-by-gov-murphy.html XX The European Medicines Agency (EMA) said on Tuesday it has extended its probe into Novo Nordisk's (NOVOb.CO) diabetes drugs Ozempic and weight-loss treatment Saxenda, following two reports of suicidal thoughts, to include other drugs in the same class. The agency began its review on July 3 after Iceland's health regulator flagged the reports of patients thinking about suicide and one case of thoughts of self harm after use of Novo's drugs. https://www.reuters.com/business/healthcare-pharmaceuticals/eu-extends-ozempic-probe-include-other-drugs-2023-07-11/ XX We often hear that diabetes can lead to problems with your teeth.. but one researcher says it might be the other way around. A University at Buffalo researchers says there is a notable correlation between chewing functionality and blood glucose levels in people with type 2. Specifically, he found that patients with T2D who maintain a full chewing ability exhibit significantly lower blood glucose levels compared to those with compromised chewing function. The thinking here is that chewing stimulates the body in all sorts of ways, including releasing hormones that help you feel fuller and help in digestion. More studies are expected. DOI: 10.1371/journal.pone.0284319 https://scitechdaily.com/the-surprising-connection-between-chewing-and-type-2-diabetes/ XX The next step of the landmark Diabetes Control and Complications Trial will focus on aging with type 1 diabetes. The original randomized DCCT clinical trial results, published September 30, 1993, in the New England Journal of Medicine, proved that early intensive glycemic control was the key to preventing or slowing the progression of long-term eye, kidney, and nerve complications of type 1 diabetes. Subsequently, EDIC has yielded many more major findings including that early tight glycemic control also reduces cardiovascular risk and prolongs survival in type 1 diabetes. subsequent EDIC data also have suggested that it is never too late to initiate intensive glycemic control Together, DCCT and EDIC — both funded by the National Institutes of Health at 27 sites in the United States and Canada — have changed the standard of care for people with type 1 diabetes Prior to the DCCT, between 1930 and 1970, about a third of people with type 1 diabetes developed vision loss and one in five experienced kidney failure and/or myocardial infarction. Stroke and amputation were also common, DCCT/EDIC chair David M. Nathan, MD, said while introducing the symposium. "All of the advances in care of type 1 diabetes have developed because this study demonstrated that it was important — continuous glucose monitoring (CGM), new insulins, better [insulin] pumps…I think the most profound finding is that mortality in our intensively treated cohort is the same as in the general population. That says it all," Nathan told Medscape Medical News. https://www.medscape.com/viewarticle/994221 XX Commercial – AG1 XX Today, JDRF, the leading global type 1 diabetes (T1D) research and advocacy organization, urged members of the Senate Appropriations Committee to renew the Special Diabetes Program (SDP) and support policies to ensure insulin is available at an affordable and predictable price. Opened by U.S. Senator Patty Murray (D-WA) and led by U.S. Senators Susan Collins (R-ME) and Jeanne Shaheen (D-NH), the hearing took place during the 2023 JDRF Children's Congress, a biennial event that brings over 160 kids and teens living with T1D face-to-face with lawmakers and top decision-makers. The youth delegates traveled to Washington, D.C. from across the country and JDRF's international affiliates in the United Kingdom, Australia, the Netherlands, and Canada. The SDP has accelerated the pace of T1D research through a long-term investment of funding at the National Institutes of Health. The program has led to significant scientific breakthroughs, including Tzield, the first disease-modifying treatment for T1D, which can delay the onset of the disease by over two years. Without Congressional action, the SDP will expire at the end of September. "The Special Diabetes Program has fundamentally changed what it means to live with diabetes, put new life-changing therapies in our hands, and brought us closer to cures," said Aaron Kowalski, Ph.D., JDRF CEO. "We must keep this momentum going so we can capitalize on the progress to date and realize cures. However, until we have cures, people need access to affordable insulin. JDRF urges Congress to pass the bipartisan INSULIN Act of 2023, which will establish a $35 per month insulin copay cap for people with commercial insurance and includes other provisions that would make insulin more affordable for everyone, regardless of insurance status." Dr. Kowalski was joined at the hearing by Dr. Griffin Rodgers, Director of the National Institute of Diabetes and Digestive and Kidney Diseases at the National Institutes of Health, who provided testimony on the scientific value of the SDP, and Jimmy Jam, award-winning producer, songwriter, musician, member of the Rock & Roll Hall of Fame, and T1D parent. "My son Max, who is now in his twenties, was just two years old when he was first diagnosed with type 1 diabetes. Late nights working on music became late nights working on music and waking up my son to test and manage his blood sugar levels," said Jimmy Jam. "Type 1 diabetes should be one of those things we can all agree on. Diabetes doesn't care if you're a Democrat or a Republican. We can all agree that there should be research to improve the lives of those with diabetes. We can all agree that insulin should be affordable for all who need it." Two 2023 JDRF Children's Congress delegates shared their T1D experience with the committee: Maria Muayad: 10-year-old Maria is from Maine and is a member of her school's civil rights club and math challenge group. Every November, Maria, and her mother, Golsin, give blue ribbons to the staff at her school in honor of National Diabetes Awareness Month. Elise Cataldo: 15-year-old Elise lives in New Hampshire and is passionate about educating those around her about life with T1D and tries to use things like pump site changes and blood sugar checks as opportunities to help others learn. Following the hearing, the 2023 JDRF Children's Congress delegates continued their advocacy by meeting with lawmakers in their Capitol Hill offices. https://www.prnewswire.com/news-releases/2023-jdrf-childrens-congress-delegates-urge-lawmakers-to-support-type-1-diabetes-research-and-access-to-affordable-insulin-301874927.htmlXX XX A 23-year-old with type 1 diabetes has broken the record for circumnavigating Britain in a kayak after paddling 2,000 miles in 40 days. Dougal Glaisher beat the previous record by 27 days. Glaisher was diagnosed with type 1 diabetes at the age of 19 shortly after winning the Oban Sea Kayak race in Scotland, when he had blurred vision and struggled to recover his energy. The expedition was to raise money for the UK-based charity Action4Diabetes and Glaisher livestreamed his blood sugar On Tuesday he was well stocked with a bunch of bananas and a stash of cereal bars lashed to his boat. But in remote areas it was more challenging. Around the islands off Scotland he ran out of freeze-dried meals and survived on porridge for several days. He also sourced drinking water from streams. . It is the first time anyone has used a surfski – a kayak that you sit on top of – to paddle around the country. XX On the podcast next week.. I sat down with Dexcom's new Chief Commercial officer to talk about their announcements from this week about the type 2 market and other features important to people with type 1. Our last epoisde is all about Kickass Healthy LADA That's In the News for this week.. if you like it, please share it! Thanks for joining me! See you back here soon.

This long-awaited Medtronic 780G is now FDA approved. It's been out for two years in Europe and has features that are a bit different from other commercially available automated insulin delivery systems in the US, including a target range down to 100. This week you'll hear from Heather Lackey, global medical education director for Medtronic Diabetes who also lives with type 1 and has used the 780G. We talk about what else this system can do – remember this is the one with the 7-day infusion set – and Stacey asks a lot of your questions. This podcast is not intended as medical advice. If you have those kinds of questions, please contact your health care provider. More info here: https://diatribe.org/medtronic-minimed-780g-approved-fda Lackey mentions a study where even with no meal boluses for three months, people stayed mostly in range. Here's that study: The Official Journal of ATTD Advanced Technologies & Treatments for Diabetes Conference Madrid, Spain—February 19–22, 2020.  Diabetes Technology & Therapeutics. Feb 2020.A-1-A-250.http://doi.org/10.1089/dia.2020.2525.abstracts Please visit our Sponsors & Partners - they help make the show possible! Take Control with Afrezza  Omnipod - Simplify Life Learn about Dexcom  Check out VIVI Cap to protect your insulin from extreme temperatures Learn more about AG1 from Athletic Greens  Drive research that matters through the T1D Exchange The best way to keep up with Stacey and the show is by signing up for our weekly newsletter: Sign up for our newsletter here Here's where to find us: Facebook (Group) Facebook (Page) Instagram Twitter Check out Stacey's books! Learn more about everything at our home page www.diabetes-connections.com  Reach out with questions or comments: info@diabetes-connections.com Rough Transcription: Stacey Simms  0:00 Diabetes Connections is brought to you by The only Ultra rapid acting inhaled insulin by Omni pod five, the only tubeless pump that integrates with Dexcom G six mi Dexcom G seven powerful simple diabetes management. This is Diabetes Connections with Stacey Simms. This week, the long awaited Medtronic 780 G is now FDA approved. It's been out for two years in Europe and its features that are a bit different from other commercially available systems in the US, including a target range down to 100.   Heather Lackey  0:44 And it's just been proven to do so successfully without really increasing a lot of time below range. You know, what will the next system lead up? Will it be below 100? I don't know. But it's so nice to be waking up with glucose levels that are so much closer to someone without type 1 diabetes with this lower target.   Stacey Simms  1:05 That's Heather Lackey, global medical education director for Medtronic. She also lives with type one, we talk about what else the system can do remember if this is the one with the seven day infusion set, and I ask a lot of your questions. This podcast is not intended as medical advice. If you have those kinds of questions, please contact your health care provider. Welcome to another week of the show. Always so glad to have you here. You know, we aim to educate and inspire about diabetes with a focus on people who use insulin. I'm your host, Stacey Simms, and we are getting some big FDA approvals. Along with the Medtronic 780 G, we got word that beta bionics islet will soon be commercially available. As I am recording this I do have an interview set up with the beta bionics CEO. If all goes to plan that will be our show next week. Real quick, while the original islet dual chambered pump was not what was in front of the FDA, the pump that has been approved has some really interesting features. It's unique in that there are no steps to the programming. When you get your pump, you're not putting in basal rates or insulin sensitivity factors or anything like that. All you do is put your weight in. But that is for next week. You can follow me on social media. We've already shared some information about the islet and I've done many episodes in the past if you want to listen to those to get an idea of what was approved, but this week, we're talking about the Medtronic 780 G, as you likely remember Medtronic at the very first of what we now call a ID systems automated insulin delivery systems with their mini med 670 G and that was approved in 2017. We've been hearing about the 780 G for a long time. It was submitted in 2021. I've talked a lot about the delays in the in the news episodes. It has been approved in Canada since last year. It was approved in Europe in 2020. We're gonna go through lots of features of the pump, but you should also know that the sensor used with this system The Guardian four is approved with no finger sticks for dosing, which to me is one of the most significant changes. My guest to talk about all this is Heather lackey. She has been with Medtronic for more than 19 years. She delivers medical education strategy for insulin pump systems. She trains Medtronic education teams around the world. She lives with type one she was diagnosed at age 16. She was also a consultant on the movie Purple Hearts. She also popped up in a scene in that movie and yes, I asked her about that. Lots to get through. But first Diabetes Connections is brought to you by Afrezza. Afrezza is the only FDA approved mealtime insulin that comes in a powder you inhale through your lungs. So why should you consider this unique alternative to mealtime injections. Afrezzais another option if you want to lower your use of needles or if you're experiencing skin reactions at your injection sites, and it is ultra rapid acting so you can take it right when your food arrives. Even unexpectedly. Find out more see if Afrezza is right for you go to diabetes dash connections.com and click on the Afrezza logo. Afrezza can cause serious side effects including sudden lung problems low potassium and it's not for patients with chronic lung disease such as asthma or COPD or for patients allergic to insulin. Tell your doctor if you ever smoked ever had kidney or liver problems history of lung cancer or if you're pregnant or breastfeeding. Most common side effects are low blood sugar cough and sore throat severe low blood sugar can be fatal. Do not replace long acting insulin with Afrezza, Afrezza is not for us to treat diabetic ketoacidosis please see full prescribing information including box warning medication guide and instructions for use on our frezza.com/safety. Heather, thank you so much for joining me. I have a lot of questions for you about the new system but first welcome. I'm glad to have you here.   Heather Lackey  4:52 Oh thank you Stacey. It's my pleasure to be here and so nice to get to meet you. I listen to your podcast and just excited Good to be a part of this one.   Stacey Simms  5:00 Oh, well, I'm thrilled to have you. And I'm sure you don't mind if I say it has been a long time coming. Lots of people very excited about this improvement. Can we start by just talking about the seven EDG? What makes this different from the Medtronic pumps that have come before?   Heather Lackey  5:16 Yeah, well, the mini med seven add system is different in the fact of course, it let's say what it Phil has right still has automated basal insulin, and that insulin ID based on the sensor glucose values, but this system is set apart because it delivers does auto correction boluses, like every five minutes is needed. So we know that life with type 1 diabetes, as you well know, as a mom, someone with type one and be living with it, we know that life does not go as we expect all the time and as planned. And so many things affect our glucose outside of the three things that we've always tried to juggle for years, right? Food and insulin and exercise. But now that we really kind of identify that there's so many other things that are impacting our glucose, it really brings to light the fact that we don't get it right 100% of the time, when we dose insulin, we adjust food. And so that's where those auto corrections that are coming in real time, every five minutes, if needed, can really help. And what I love about the system is the auto corrections, you don't have to be sky high to get an auto correction. As a matter of fact, you don't even have to be high. before they begin. They're really kind of thinking like a pancreas than as soon as your glucose rises over 120 milligrams, as the basal is working as hard as it can and saying, Hey, I need help, then the auto corrections come into play. And they can start dosing a correction bolus every five minutes if needed.   Stacey Simms  6:59 So what is the difference between the auto basil and that bolus that you're talking about? Because you know, the automated systems that are out right now already adjusted basal every five minutes? What is actually happening when you say oh, and it's also giving a bolus?   Heather Lackey  7:14 Yeah, so the bolus happens every five minutes on top of the date. Right, facie, so let's say, again, the goal for many meds seven ad G, there were kind of two goals in play, right, we wanted to further improve time and range, you know, compared like with the mini med 670 G system without compromising any safety, because we all know we can drive down glucose, right, but you don't want to have a lot of lows. And we wanted to reduce the daily interactions with the system. And those daily interactions, right, the the alerts and the alarms and all of the safety pieces that were were added to mini med seven, add, those have all been now relaxed, and so less than erection and improvement in time and range without sacrificing hypoglycemia. So what's nice about the system is you not only are delivering the auto basil, like you said, right, we have auto basil and other systems that now if the auto basal cannot keep the glucose level in the target range, it predicts that the glucose level is going to go higher than it would like then that's when those auto corrections come. And they don't come once an hour, they come every five minutes. As soon as that since your glucose rises over 120 milligrams per deciliter. If the system says, Hey, I'm working as hard as I can with your basal, and I'm not able to keep your glucose at the target range that we want, right. And we'll talk about targets and here in just a minute, hopefully. But if we can keep your glucose at that target range, then I'm going to ask for some help. And that's where those auto corrections. And those are boluses. Right? boluses that happen every five minutes without the patient having to agree to them, or take any action on their part. They just happen automatically.   Stacey Simms  9:14 Alright, I have a few more questions about that. But I'll get back to that in a couple of minutes. Because I feel like most people will just see the results. And they they may not have too many questions about exactly what's going on there. But I want to get back to that bullets in a minute. But you mentioned range, and the seven EDG has a lower range than Tandem and Omnipod. Five have currently right it's correcting down to 100. Or that's a choice. You can adjust that.   Heather Lackey  9:37 Yeah, there's a couple of things that are different and new about this. And Minimates seven add definitely treats to a target, not a range. But you're right though the target is the lowest target at this moment that's available and so the auto basal target, you can set three settings Three different targets are available to where the person was diabetes , their healthcare provider can can really identify which target is best for them. But the three targets are 100 milligrams per deciliter, 110, and 120. Now 100 comes as kind of the default auto basal target. And that's because we know that this system was all of the copious data that we have. And all of the simulations that were done before this system was even launched, was using that 100 target. And that's what this system is built around to be the best target to you.   Stacey Simms  10:36 We should note that tide pool type pool loop, which was approved by the FDA a few months ago, can correct down to 87. But it is not available in any insulin pump, yet. It's a software program that was approved. So 100 for Medtronic is the lowest that you can actually use right now. But it's interesting, that's 101 10 and 120, where some other systems have, you know, an exercise mode that is a higher range, do you have any insight as to why those were chosen?   Heather Lackey  11:02 Well, those are that close to target to mirror a normal functioning, you know, system a system without diabetes . And the interesting thing is, is the 100 target is very much achievable without sacrificing time below range, right? So we're able to drive with the auto basal target being set at 100. And with having the auto corrections that are even delivering up to every five minutes, this is the system, you know, determined that those were needed. We have the algorithm that built to drive the system to 100. And it's just been proven to do so successfully without really increasing a lot of time below rage. You know, what will the next system lead us? Will it be below 100? I don't know. But it's so nice to be waking up with glucose levels that are so much closer to someone without type 1 diabetes. With this lower target.   Stacey Simms  12:03 Let's talk about the sensor because there are changes here too. Right. Tell me about the sensor that goes along with the 780G? Yeah, well,   Heather Lackey  12:10 the Guardian four sensor is the center that it works with the mini med 780G system. And the Guardian Force center was designed really to reduce the burden as daily finger sticks. That was the whole goal. Let's remove calibration from the system. And let's try to develop a system that doesn't require finger sticks. As we know, sometimes finger sticks still are needed with really with any of the systems and sensors. But the majority of the time when our patients are in the mark guard feature is they are using the SR glucose to bolus off that, you know, there's no real need for a fingerstick glucose. And interestingly enough, most patients bend upwards of you know, 95% or so in that smart guard feature. And so many patients will tell me, I am forgetting my glucose meter at home. And I had one patient that went on a trip, he went out of the country and he said, Look, I totally left insulin and glucose at home because I had kind of forgotten to take my meter bag with me. Wow, learning for sure.   Stacey Simms  13:27 Oh my gosh, yeah, my son goes without a meter quite often. Since you know his we use the Dexcom in the control IQ system from Tandem. But yeah, you don't want to forget your bag entire. That's not good   Heather Lackey  13:38 news. Okay, that's if that's now a burden that is taken off of you. And that's lovely. Yeah, no doubt. No need to be prepared, right?   Stacey Simms  13:47 Yep, absolutely. And I think it's worth pointing out that this is the only automated insulin system in the United States. That is one system, right? It's a glucose monitor infusions that insulin pump. That's all Medtronic and this system has that extended infusion set right so you're talking to sensor you were for seven days, and an infusion set for seven days, right. We'll get right back to my conversation with Heather but vs Diabetes Connections is brought to you by Omni pod. And when you're deciding that a random insulin pump, you got a lot to think about, especially if you've never used a pump before. It really can seem overwhelming. I remember that there are a lot of choices, and you want to make the right decision. And that's why I'm so excited to tell you about Omni pod five. Curious about trying an insulin pump or seeing what life without tubes is all about. Unlike traditional tube pumps, you can try Omni pod without being locked into a four year contract. You might even be eligible for a free trial, go to diabetes dash connections.com and click on the Omnipod logo for full safety risk information and free trial Terms and Conditions. Also visit omnipod.com/diabetes connections. Now back to Heather answering my question about this seven day infusion set   Heather Lackey  15:03 That's exactly right. One kind of new feature of the mini med seven add system is the extended infusion set. And that extended infusion set. It's been launched for a few months in a few different countries. But it comes now with de minimis 780G system, and really allowing people to just kind of have to think about changing a center and changing their infusions that just one day out of the week versus anymore. And so that system, you know, I have so many people that will go have our youth told us for years, you know, that we have to change our infusion set every three days. And why are we able to start to use that system now, and just been using that now for seven days. And the the, it's really simple to explain without getting into a lot of engineering details, but that infusions that is made with this advanced material. And what it does is it helps to reduce the insulin preservative, you know, kind of the loss that we would typically have, it helps to maintain the insulin flow. And it helps to maintain the stability of the unfolding. And so there's such a reduced risk of any kind of blockage or occlusions, with your infusion set whenever you use this new extended infusion set. And I always have to remind patients and people with that need us and their families, make sure you're only using the extended infusion set for seven days, and you're not using your current infusions that are that long, because the materials are different.   Stacey Simms  16:41 Yeah, good point. Can you use any insulin in those extended infusion sets?   Heather Lackey  16:47 So well, in the mini med 780G system, the insolence that are approved and on label are human log and Nova logs. So both of those are available to us with that set.   Stacey Simms  16:59 So no, Lusia if I ask, just checking, those are not approved at this time. Got it? Got it. I had a listener ask if the duration of insulin is adjustable, you know, is that a setting that people can kind of go in and tinker with?   Heather Lackey  17:13 Yeah, so active insulin kind of talks about the or is our duration and insulin kind of tuning knob that is in the programmable settings on the mini med 780G pump, the active insulin Time is of the two settings that are critical is one of the two, right the first setting is the auto label target, you know, looking at that 100 glucose target for most people with diabetes, but then also setting the active insulin time to two hours. And a lot of people will say, Look, I have never had active insulin or insulin on board. I've never thought that human log or Nova log was out of my body in just a couple of hours. And so it's interesting that Medtronic is recommending a two hour active insulin time. Why is that? And the real answer is this is what the algorithm was designed around, right, it's fine to have the ability to, you know, the algorithm is asking the patient, if you set the active insulin time to two hours, then that gives me the ability to calculate insulin, if I think it's needed, right, that doesn't always mean that you're just gonna get insulin stacked on top of, you know, each other dose on top of a dose every two hours. It just means that gives the algorithm the ability to give correction sooner. And whenever you're giving those auto correction. as frequently as every five minutes, it makes sense to be able to just kind of give the algorithm the freedom to make the decision if it's needed. And anytime I have someone that really wants to debate this, and understand how the algorithm works, I just always have to say, let's just look at the data. And you know, we're not stalking we're not having hypoglycemia in the 10s of 1000s of patients that we have data on.   Stacey Simms  19:06 Yeah, it's actually I wish I had a diabetes educator. Maybe this will be for another episode. You are obviously a diabetes educator. But it'd be fun to have somebody else from a different pump company because other pump companies will say no, no, no, exactly. As you're saying like you're stacking insulin. We set it this way for a reason. It's not adjustable for a reason. Is this two hour duration. A different setting from previous Medtronic pumps forgive me? I'm not as familiar with them.   Heather Lackey  19:29 You don't know. That's a great question. They see it the same accident one time. Honestly that has been a part of the bolus calculator settings, the bolus wizard and now the smartcard bolus feature that even since the paradigm days, right, when the bolus calculator was first presented, we're now looking at decades ago with the active insulin time. So it's the same setting we've had, but now it's kind of viewed in a different way than Then it has been in the past, right? In the past, it was very traditional, like you're saying and, and kind of how patients will think of it with, you know, whenever I'm in conversation with them, they're like, How can this be. And the simple fact is, with setting the accidents one time, as low as two hours, which is what we see the best control, the best time and range and the lowest time below range, right? So the fueler lows is actually set at two hours. And what that does is it just is a tuning algorithm knob. And it says, Hey, algorithm I'm going to allow you to give, if you determine that it's necessary, meet Insulet. And because you're looking at my rate of change, you're looking at how much insulin is on board, you know, how many grams of carbohydrate that I've entered, it takes all of this information into account and decide if action should be taken. And what lovely is the patient, the person with diabetes that mom, dad, the family, they don't have to make any of those decision, the system is doing it for them.   Stacey Simms  21:05 It should have probably started with this question. But what does the algorithm use as a starting base? You know, we're used to traditional insulin pumps where you sit with your educator or your doctor and you say, Here's my basal rate, here's my sensitivity factor or correction factor, or, as we're talking about here, duration, there is a pump in front of the FDA right now that just uses body weight. What is the 780? G use?   Heather Lackey  21:26 Yeah, that's a great question as well, algorithm really start with total daily dose of insulin, kind of as it is its starting point, right, the calculation. And that's why whenever you are new on the mini meds 780G system, people have to stay in manual mode. So the kind of the non auto basal in auto correction kind of piece of it. So they stay in manual mode for 224 hour days, right. So it's two days in manual mode. And then there's enough data as a starting point for this system to be able to, to say, Okay, this is a safe basal amount for you to begin with. In addition, if there's sensor glucose tracings, in that 48 hours of kind of that warmup period, to the smart guard feature, then those fasting sensor glucose level pump is looking to see like, how much insulin Do you require, whenever you're not announcing meals and, and so it see, okay, this is your center, glucose is in a fasting state. Now, how much auto Basil is being delivered. And that is kind of the two main pieces of information of how the system decides how much auto basil to begin with, and to deliver,   Stacey Simms  22:49 got it, can the user switch back to manual mode,   Heather Lackey  22:53 yet, they can, at any time, they can stop the smart guard feature, we know that the data is so overwhelmingly heavy weights heavy on the smart guard side. So we definitely see a major difference in time and range being improved. Whenever people are in this barcard feature versus in manual mode, right? They're always encouraged to say and   Stacey Simms  23:16 got it but the system doesn't like. And I hesitate to say it this way. But you'll know exactly what I mean, the system isn't kicking people out as much as one of the very early automated systems for Medtronic, right? That was a big complaint with the 670 was I got kicked out of auto mode.   Heather Lackey  23:30 That was a complaint. And we know that whenever the mini med six, seven ad system, the first hybrid closed loop system of its time was a pretty conservative algorithm, right? Because it was first of its kind, Medtronic really had to build on a number of safety precautions. And in many cases that led to those unwanted alerts and alarms and interactions with the pump to keep the system kind of in that auto mode, smart guard auto mode feature. And so with this, we the exits on mini med 780 G system. I mean, they're just not happening, right. And again, though, the number one of two goals of this system was to reduce the daily interactions with the system. So we can't have beats and alerts and alarms. And hey, you have to enter a BG all the time in order to stay in to the automation mode. This is a big difference that people especially those that have been on previous hybrid closed loop systems of all kinds, they're like this is really a pretty big change right? exits at night, exit in the daytime alerts at night. Those are some of the things that are really different from a user lens. Whenever I hear anyone asked my husband, you know, like what kind of from your standpoint In a view, what's the biggest change with you seeing your wife were the minimis 780G system for a while. And he just says, look, it just doesn't wake us up at night. And he just seems to be a little bit more pleased. A lot of surveys that have been conducted all throughout, you know, the countries where people are using and wearing many hats, 7080 G system, you know, it's like 94 95% of people are saying that they're satisfied with the impact on the their quality of life, they're happier with the quality sleep, that's one that's pretty high, ranked and desired by many. So for us to get a good night's rest and to feel confident to go to bed, lay our head down, not have lows or highs not have alerts and alarms. That's the system that we need. And that that's what people are enjoying.   Stacey Simms  25:54 One more question about manual mode, a listener had asked me is manual mode usable during the auto mode? In other words, if somebody really feels like they need to do an additional bolus, can they do it?   Heather Lackey  26:05 It can be done, but I would kind of ask why do they feel like it needs to be done? Right? Why would you need to go out to manual mode if you need to give an additional bolus. So carbs can be entered at any time that those are consumed? Right, we definitely want to announce our mills. And at any time in the smartguard feature, a patient can always look to see if if they what we kind of say a user initiated correction dose is needed. So you don't you know, I don't ever want people to feel like once I'm in the smart guard feature, guy can't take action. If I see glucose, where I don't want it to be or if I've eaten something that I didn't tell it, you know, go ahead and deliverable list, at least check to see if a bolus should be given. And maybe some of the feedback that patients had on mini med 670 G system where they felt like they had to enter in perhaps kind of ghost carbs or fake carbs when they weren't actually eating them to kind of trick the algorithm to giving more insulin, I think you'll find with now that control that we have able to control on this system like that active insulin times and the auto basal. I don't see that people at all are having to what we say automate the automation? Well,   Stacey Simms  27:27 yeah, we let me ask you a follow up on that. Because I don't know anybody who uses an AI D system who just puts in meal boluses and says, Great, I'm always in the range I want to be are you saying that's what's happening with the 780?   Heather Lackey  27:39 Well, I'm saying that anytime that you eat in any of the AIP systems, right, you can you can enter those grams of carbohydrate. But because many meds 780G system gives the autocorrection doses starting at anytime, and glucose is over 120 systems. If the auto basal can't handle that glucose response, then they're gonna get it. So because you start you intervene the system intervene early and intervene often, there's less of the need to take matters in your own hand. Right. So it's a different mindset. Really it?   Stacey Simms  28:18 Yeah, no, it's absolutely it sounds great. Well, we'll see. When you said meal announcements, to be clear, you're talking about carb counting and putting in the numbers of carbs you're eating, you're You're not just saying I am eating?   Heather Lackey  28:31 You're saying I Yes. You're you're entering grams of carbohydrate. Thank you for clarifying going   Stacey Simms  28:36 no, I'm just you know, I know it's coming. It's amazing to see how these things are changing. I just want to be clear as we go. Yeah. Well,   Heather Lackey  28:42 you know, that's kind of a segue Stacey to a lot of the different thoughts on do people have to now with autocorrection? Do people have to be so precise on the grams of carbohydrate that they're entering into those bits? Okay. Well,   Stacey Simms  28:59 let me give you Yeah, let me let's segue into that. Let me give you the best case use that I can make in my house or something like this. I have an 18 year old, he's a great kid. He's very responsible with diabetes. He is terrible about bowling before he eats. It's just it's just not happening. And so we have a lot of, you know, excursions that perhaps don't necessarily need to be happening. I would be thrilled at a more aggressive post meal bolused system. So talk me through what happens to scenarios for you. Somebody has an AD of just throw 85 carbs out there because this happened recently. So somebody has an 85 carb dinner, they bolus five minutes after they finish it. Or somebody has an 85 carb dinner and completely forgets to bolus how does the system handle those things? Oh, yeah.   Heather Lackey  29:45 Well, I'd love to show you my report. Because not only does it happen with an 18 year old, it happens with me more than I would like oh my goodness. I plan for 33 years. How am I forgetting to push the button,   Stacey Simms  30:01 I love it, you're human, you're human. I'm totally   Heather Lackey  30:04 human. So the 85 gram carb dinner, and they bill it five minutes later, right? We know that if you are not giving insulin before the meal, right, you're gonna have food most likely showing up to the party before the insulin arrives, right, so you're gonna have food, their glucose is gonna rise because of the food digest. And then here comes insulin. In that case, we would say, Look, if then, you know, if you're really bolusing, after the meal, you probably are going to need to reduce your meal Bolin, than we have some exact parameters for healthcare providers to kind of discuss with their patients. But you know, on average, it's like, look, probably just dose for, you know, maybe that path in your case, maybe it's not, because as you know, as those is that sensor, glucose starts to rise, the auto basal start to increase, it gets to the maximum, let's say, and then here comes the auto correction. And then you've got insulin, you know, from the bolus still showing up to the party at that point. So what's so great about this system is it knows like, okay, auto Basil is increasing, then there's some, you know, potential auto corrections, as soon as the bullet is given, the system goes, Okay, let's just, let's back off, right, let's see, what's gonna happen with the system before we really just push the pedal to the metal and start giving more correction. Right? So everything is done with the total safety in mind, right, which is something that's so great. Now for the 85 grams of carbohydrate, and they don't bolus at all, well, then that's really what are the auto corrections and the auto basil can shine, that's really where you're going to see sensor glucose is rising. And am I going to say they're never going to go high with an 85 gram carbon bill, I would say that wouldn't be, you know, really unlikely, depending on what what the nutrients are in that food, I would think it was going to be unlikely. And so glucose is going to rise, the system is going to to handle it as as well as it can. But what I can see time and time again, with when mills are skipped, that patients don't go as high and they don't say as high as long. But we have a study that actually support that patient who did zero pole was seeing for a period of time. So this is every single meal for this length of time. And I'd have to look at the report to know exactly the days, but their time and range was just right under that 70% of time and rain. Yeah. And so that's not at all what we are recommending, because we know that if you bolus and you're using the recommended settings, it doesn't matter if you're eight year old, or if you are a 18 year old, or if you're a 58 year old or if you're a 78 year old, we know that for everyone, you can have an upward time and range of 80% plus, right. So we know it's better. And we absolutely want to provide the charge that we should be announcing mil but it's so nice, whenever the occasional I forgot to bolus to you know,   Stacey Simms  33:29 sort of occasional   Unknown Speaker  33:32 got your back for some more than   Stacey Simms  33:36 excellent. I did get this question about the bolusing system, how much of a correction is given? Because on some of these other systems, it's a partial correction. I don't know if you can share that, you know, it's it may be part of the algorithm that you can't share. And then also, how does the system differentiate? Or does it between a missed meal and a random high? You know, a high that may come for another reason?   Heather Lackey  33:57 Yeah. Thank you good questions. Okay. So for the repeat the first one, if you don't mind, sure   Stacey Simms  34:03 how much of a correction is given, you know, like on the T slim, I think I may not be correct here, but it's something like, you know, once an hour can give 60% of the program to bolus. So is that something that the Medtronic keep some good and maybe proprietary? Well,   Heather Lackey  34:16 I can tell you this is the difference with the mini med 780G system is it gives a full correction, you know, if needed every five minutes and every correction bolus, right? It's like if you were giving a correction yourself with a pump, you're going to enter your glucose. The system does the same. It says look, this is where the glucose is. This is where I want it to be. And it's targeting 120 Whenever it's giving a correction dose of insulin, right. That's why after 120 it can start to deliver a correction dose and it looks at the difference and it sees how much insulin is going to be needed. And then it also applies other metrics as well like how much insulin is circulating in the body and And then it determine the safe amount that is going to be needed every five minutes. Got it?   Stacey Simms  35:06 Got it. Okay, great. And then the other question is about does the system differentiate between, you know, missing a meal or a high for another reason? And I could think of highs, you know, and teenagers for, you know, hormones or exercise, things like that, does the system differentiate? And I guess the follow up is, does it need to, or is a high, just a high,   Heather Lackey  35:24 you know, really high is the high and and that's what's so great about the the system anytime there is a rising rate of change, and you know, parameters are met, that the pump says, Wait a second, this is a rising rate. Oftentimes, it's a meal that's missed right? To meet the parameters. When the system sees that this is Matt, what it does is it allows a correction dose to be delivered even a little bit more aggressively. Right. So you know, it does have a mill detection module built in. It has mill detection technology built in, but it doesn't so much say, Oh, this is your sensor, glucose is rising now because of the meal. So I'm going to act this way. Versus your since your glucose is rising, because you have hormone releasing in the middle of the night and you're sleeping, right. Either way, this system is looking at the sensor glucose response. And if it's corrections need to be delivered in a more aggressive manner, or larger corrections need to be delivered either way, then the system is able to do that. You know,   Stacey Simms  36:40 we've mentioned several times that you live with type 1 diabetes. I mean, I know I can talk to you about the pump for probably another two hours. And I hope you'll come back on and we can talk more about it. But I want to ask you about your your journey. You were diagnosed as a teenager, what did you use what was the first diabetes technology, I assume it was a blood sugar meter. coming right back to Heather in just a second. But first Diabetes Connections is brought to you by Dexcom. And Benny has been using the Dexcom CGM for almost 10 years now, that first insertion was in 2013, just before he turned nine. I mean, it was great. Then if you've done finger sticks for a while you know how amazing it is to go from that to continuous glucose monitoring. But it is even better. Now. The Dexcom CGM systems just keep improving, continuing to get more and more accurate with no finger sticks or scanning required. The easy push button insertion has made it easy for Benny to do it himself. He has done every one since we switched to the GS six in 2018, which is really great for his independence back then, as a younger teen. Of course, we still love the alerts and alarms, and that we can set them how we want if your glucose alerts and readings for the G six do not match symptoms or expectations. Use a blood glucose meter to make diabetes treatment decisions. To learn more, go to diabetes connections.com and click on the Dexcom logo. Now back to Heather talking about what things were like she was diagnosed at age 16.   Heather Lackey  38:10 Yeah, you know, I was diagnosed in 1990. And of course, I had a meter. The old lancing device that I had was the one that you lay on the table and it's spring loaded and it like warm around like a hammerhead, and it would poke your finger. Right. So that was my first one. And you know, I was just on conventional insulin therapy, right, at least had disposable syringes. I wasn't sharpening a needle or have a glass of orange or anything like that. And you know, for me, Stacy, my parents were so great. My dad worked internationally. And they were just constantly talking to people like what, there's got to be something that right because I was doing everything I could, I mean, I really tried hard. And I have for, you know, three decades, tried hard to really kind of manage things. And they said, you know, there's got to be something better. And that was right at the end was actually before the end of the DCCT trial, when my parents were told, Hey, there's, we've got to get her on something better. We're starting to notice that these multiple daily injections are going to be a lot better. So went to went and started multiple daily injections. And at that point, this was in 1992. At that point, they they the healthcare team said you ought to consider a tump you're you're young your parents have insurance. You guys are certainly kind of wanting to have the best control you should consider a pump and Stacy for cash for seven years. The first seven years after I was diagnosed I did not want an insulin pump to save my life. I wouldn't even think about it until someone said hey, I had gained some weight in college, as many females and male do and I was trying to lose weight exercising to on the elliptical and or the treadmill, either one. And every time I would exercise, I would go low. And every time I would go low, I would have to have juice and peanut butter crackers, or whatever the case was, and I was having more calories than I had exercised off, you know, you can see the counter of your calories that you're burning. And I'm like, This is ridiculous, I'm going to continue to go low, and not be able to trim down my weight some, and I didn't have the right tools. And so that's the reason I started on a pump and then have been on a pump. For the last, I don't know, 2026 27 years, maybe when you   Stacey Simms  40:37 used to do a lot of patient training on insulin pumps, I know you still do some now, I'm even in your role here. What are their biggest concerns? You know, there's a lot of mechanical learning if you've never used an insulin pump before. But there's also as you mentioned, there's a reluctance sometimes. Can you share a little bit about what patients tell you?   Heather Lackey  40:54 I think the unknown is the biggest thing for patients, right? They don't know if it's surgical, they don't know if it how this goes in how you disconnect, how you're going to get live. The five emphases as I call it, you know, how do you sleep? How do you shower? How do you swim? How do you go in, you know, with exercise and do sports, what happens with intimacy and things like that, you know, those are unknown if you haven't met with a an educator or you haven't had a friend or even a health care provider that's kind of talked to you through that. So I think once people understand how insulin pumps and continuous glucose sensors kind of work inside of our life, and really how easy they are. The trainings are so much more simplified today, because the therapy is so much easier, right? And so I think once they start to see they're starting to put the pieces together, like the technology is working in the background, I don't have to work as hard. Here's the the, you know, two or three things that I have to do change my infusion set once a week, change the sensor once a week, and then I have to enter some grams of carbohydrate, however those grams of carbohydrate are calculated, then they start to understand this is not as big of a deal.   Stacey Simms  42:09 All right, I have to go back. You said the five S's and then I kind of heard you editing as you went, you can say six on this podcast. But what were the other ones we had sleep swim.   Heather Lackey  42:18 So fleet that were when boarding and zek?   Stacey Simms  42:22 That's great. I love that list. That's a great list. All right, before I let you go, I can't let you leave without talking about Purple Hearts, this Netflix movie that you were a consultant on, right? Tell me a little bit about what happened there. This is a character that has type one. And she marries a marine to get benefits health benefits. And it's a very romantic story. How did you come to be a consultant on that? And what was it like? Well, what was so interesting   Heather Lackey  42:46 about this, I mean, it was I mean, what a one and a life champ or V I mean, it was really great. The director, or producer, I think it was the director, she had reached out to Medtronic, specifically, because she was, you know, obviously going to be doing this movie, and the hurt. So her team had reached out to Medtronic. And she really wanted to one US product in the movie. But I guess her colleagues and friends and and others that he had talked to whenever she mentioned that this character was going to have type 1 diabetes. They were all like, Yeah, well, we, you know, we've learned that Medtronic pump for, you know, years and years. And so that's why she reached out, right, so reached out to our communications team and our marketing team. And those teams were so great to say, hey, look, they're going to be using a pump and sensor on the set, they might need to have some help. Just making sure that everything is used correctly. And you know, you're always in film, in movies, etc. Whenever I see things being used in an incorrect way. So yeah, so anyway, I was able to go out on the set. And then, you know, one thing just kind of led to another and they were like, well, you know, we're gonna need someone to train. You know, Sophia Carson is the actress. I mean, like, what an amazing thing to be able to beat her and all the other dudes amazing talent on that, that and they were like, Why don't you I mean that you do this? So why don't you just do this in the movie. And I was so happy that that tiny little piece was not cut it, it was such an important thing for my friends and family to be able to see so. And it really does kind of make people with type one I've heard over and over it was kind of cool for the film to kind of walk through people without type 1 diabetes. Like there's a trainee, you know, like, we have to get to understand how to use this equipment. And it's kind of the big day whenever you go on an insulin pump. The coolest thing about the scene that I was in with Sophia Carson, whenever she we finished the scene and she got on the system and we had everything is moving and working at and it was it was there. She was like, Heather, this is amazing that people go through this. And then she was like, gonna give you a hug like this is like I feel empowered having this system on me whenever I'm playing a character that has type 1 diabetes, so it was very organic and natural. And that wasn't anywhere in the script, you know. So it was just a true testament to how powerful technology is and people with diabetes. Five,   Stacey Simms  45:31 is there going to be a second one?   Heather Lackey  45:32 I have pushed. I have said, I hope that there is everybody wants to know what happened to those two characters. I don't know about it, but I would I would love to see a second movie as well.   Stacey Simms  45:45 That'd be great. Well, we will leave it there. Thank you so much for sharing so much of your time with me. I would love to have you back on to talk more about this system. We still have a lot of questions. I'm sure we just scratched the surface. But I really appreciate your time. Thanks so much for sharing so much information.   Unknown Speaker  45:59 Thank you Stacey. Have a great day.   Stacey Simms  46:05 You're listening to Diabetes Connections with Stacey Simms. Lutz where information with diabetes dash connections.com. I know we didn't get to all of your questions. I will definitely talk to the folks from Medtronic. Again, I thought Heather was really terrific. And she laid everything out. I loved her five S's. But you should also know that the 780 G she mentioned this. It's currently approved for users seven years old and above with type one, they have started taking pre orders that happened in the middle of May, and they will be shipping later this summer. throughout the US. If you have a 770 G, you will be eligible for a free upgrade through remote software. If you want to be notified more, you can go there's a link in the show notes and get their upgrade notification newsletter. So just go to diabetes connections.com Click on this episode's homepage. It'll give you all the information that you need. I'm taking a deep breath because as I have been telling you, my May was bananas. It was wonderful. It was busy and all the best ways. But I mean, I went to Ireland at the beginning of the month. Then I went to New Orleans for my daughter's graduation. Then we had a giant family reunion at my house. So hopefully as you're hearing this, nothing that busy has popped up for the month of June. What I do have on the calendar is the ADA Scientific Sessions conference toward the end of this month. I have never been to this. I've always tried to make it but it's never worked out. So I have immediate pass. I have my microphones packed Well, not yet, really. But I am going to be going and talking to all of these companies. I'll be putting stuff in the Facebook group. So please join Diabetes Connections, the group or sign up for our newsletter. And you can do that at diabetes dash connections.com Because I'm gonna be asking what you want here, who do you want me to talk to what questions you want me to ask. I'm going to try to do a whole bunch of interviews while I'm there and set up a whole bunch more. You can always email me Stacey at diabetes connections.com. I'm super excited about going to this event and really hoping to bring your questions to more of these folks. As I mentioned at the beginning of the show, I am scheduled to talk to beta bionics about the eyelet so that should be next week's episode. And of course we have in the news this Friday to fill you in if there are any more FDA approvals a there's more stuff in front of them. This has been a really interesting year so far, and we're not halfway through. Thank you to my editor John Buchanan, audio editing solutions. Thank you so much for listening. I'm Stacey Simms. I'll see you back here soon until the end. Be kind to yourself.  

Tiếp tục các buổi tọa đàm cùng linh mục Giuse Nguyễn Thể Hiện DCCT,  phân tích trình thuật Thương Khó trong Tin mừng Nhất Lãm. Trong bài chia sẻ này, chúng ta cùng tìm hiểu trình thuật Mt 27,45-54, kể về biến cố Đức Giêsu sinh thì trên thánh giá.Quý vị có thể xem lại video phân tích tại đây: https://youtu.be/xrnfs9WO5_o

Tiếp tục tìm hiểu trình thuật Thương Khó của Chúa Giêsu theo các Tin mừng Nhất Lãm, trong bài chia sẻ này, chúng ta sẽ cùng với linh mục Giuse Nguyễn Thể Hiện DCCT phân tích trình thuật Mt 27,11-14, kể lại sự kiện tổng trấn Philatô thụ lý vụ án Chúa Giêsu. Vào giai đoạn đầu của cuộc điều tra, Philatô đối diện với một bản cáo trạng lạ thường và với những lời tố cáo do chính Thượng Hội Đồng đưa ra. Vào giai đoạn cuối của cuộc điều tra, ông chứng minh sự vô tội của Đức Giêsu và phải đối diện với âm mưu nhất định kết án tử hình Đức Giêsu, một âm mưu không thể còn bị che đậy bởi bất cứ lời cáo tội nào. Trong phần này của trình thuật, rõ ràng rằng những lời tố cáo trình bày Đức Giêsu như là một vị Mêsia chính trị đã phá sản, không có căn cứ; rằng ông Philatô không muốn kết án tử hình Đức Giêsu; và rằng tất cả ý muốn, âm mưu và nỗ lực trực tiếp đẩy Đức Giêsu đến chỗ chết đều là của Thượng Hội Đồng Do Thái.Quý vị có thể xem lại video phân tích tại đây: https://youtu.be/EzRy6xRIhkE

Tiếp tục tìm hiểu trình thuật Thương Khó của Chúa Giêsu theo các Tin mừng Nhất Lãm; hôm nay, chúng ta sẽ cùng với linh mục Giuse Nguyễn Thể Hiện DCCT phân tích trình thuật Lc 23,2-16, kể lại sự kiện tổng trấn Philatô thụ lý vụ án Chúa Giêsu. Trong sự kiện này, chúng ta sẽ thấy ông Philatô bỏ rơi công lý, không hành xử căn cứ theo những kết quả điều tra chứng minh rõ ràng sự vô tội của Đức Giêsu. Philatô, bất chấp sự vô tội của Đức Giêsu, vẫn sẵn sàng trừng phạt Người... Quý vị có thể xem lại video phân tích tại đây: https://youtu.be/cmlAhablaPk

Xin kính mời quý vị và các bạn cùng với Linh mục Giuse Nguyễn Thể Hiện DCCT tìm hiểu trình thuật Mt 27,3-10, kể về sự kiện Giuđa - kẻ phản bội đã hối hận và đi thắt cổ tự tử. Trong bài chia sẻ này, chúng ta sẽ phân tích: Cách phản ứng của Giuđa khi thấy Đức Giêsu bị kết án tử hìnhCách phản ứng của Thượng Hội đồng Do Thái trước sự hối hận của GiuđaVai trò của Mt 27,3-10 trong trình thuật Thương Khó theo Tin mừng Mt.Quý vị có thể xem lại video phân tích tại đây: https://youtu.be/Loz6r7DAe4s

Trong Mùa Chay năm 2023 này, chúng tôi kính mời quý vị cùng với Linh mục Giuse Nguyễn Thể Hiện DCCT tìm hiểu một phần Trình thuật Thương khó theo các Tin mừng Nhất Lãm, với tổng cộng 14 cuộc trao đổi. Hôm nay, trong bài chia sẻ đầu tiên, chúng ta cùng tìm hiểu trình thuật Mt 27,1-2 về sự kiện Thượng Hội đồng Do Thái nộp Chúa Giêsu cho quan Philatô.Quý vị có thể xem lại video phân tích tại đây: https://youtu.be/BV8R1VA4Q2Y

Kính mời quý vị và các bạn cùng bắt đầu loạt bài tìm hiểu về trình thuật Phục Sinh trong Tin Mừng Gioan - Gioan chương 20 và chương 21.  Trong bài đầu tiên này, chúng ta sẽ tìm hiểu tổng quát về chương 20 của Tin Mừng Gioan. Giáo sư môn Thánh Kinh: Linh mục Giuse Nguyễn Thể Hiện DCCT, sẽ đồng hành với chúng ta trong loạt bài này. 

Liên tục loạt bài tìm hiểu về trình thuật Phục Sinh trong Tin Mừng Gioan - Gioan chương 20 và chương 21. Trong bài chia sẻ này, kính mời quý vị bắt đầu tìm hiểu trình thuật thứ nhất Ga 20,1-10 (Trình thuật về Ngôi mộ trống), với việc tìm hiểu bố cục và phân tích câu đầu tiên của trình thuật (Ga 20,1). Giáo sư môn Thánh Kinh: Linh mục Giuse Nguyễn Thể Hiện DCCT, sẽ đồng hành với chúng ta trong loạt bài này.

It's in the News.. the top diabetes stories of the past seven days. This week: new research looks at off-label use of GLP and SGLT drugs for people with type 1, Medtronic gets 780G approval in Canada, finger prick early detection of type 1, and lots going on for Diabetes Awareness Month. Check out Stacey's book: The World's Worst Diabetes Mom! Join the Diabetes Connections Facebook Group! Sign up for our newsletter here Episode Transcription Below (or coming soon!) Please visit our Sponsors & Partners - they help make the show possible! *Click here to learn more about OMNIPOD* *Click here to learn more about AFREZZA* *Click here to learn more about DEXCOM* Hello and welcome to Diabetes Connections In the News! I'm Stacey Simms and these are the top diabetes stories and headlines of the past seven days. XX In the news is brought to you by T1D Exchange! T1D Exchange is a nonprofit organization dedicated to improving outcomes for the entire T1D population. https://t1dexchange.org/stacey/ XX And by my new book “Still The World's Worst Diabetes Mom: More Real Life Stories of Parenting a Child With Type 1 Diabetes” available on Amazon now. XX Our top story this week, Researchers say a blood test for early diagnosis of type 1 diabetes can stave off serious illness and hospitalization in children. This Australian study looked at the finger prick sample that is collected in the home and mailed to the lab. It included more than 17-thousand children and young adults, mostly in families with a history of type 1. The team of researchers are the first to use this method to screen diabetes in Australia. They said, We want to make type 1 diabetes screening accessible to every Australian child no matter where they live. Our recent work has proven that we can do this cheaply, accurately, and conveniently," The study is published in Pediatric Diabetes. https://medicalxpress.com/news/2022-11-home-screening-diabetes.html XX Medtronic gets the okay from Canada for it's MiniMed 780G system. It's now available in more than 60 countries around the world, with the U.S. notably missing from the list. Current 770G users will be able to upgrade their devices with the new system's software. The MiniMed 780G is equipped with Medtronic's SmartGuard technology, a hybrid closed-loop system what works with Medronic's CGM. It's approved for ages 7-80. Medtnoic submitted to the FDA in the spring of 2021, nearly a year after securing CE mark approval in Europe. The U.S. sign-off has been slow to arrive, however, thanks in large part to the FDA's discovery of quality control issues at the California headquarters of Medtronic's diabetes business. A December 2021 letter from the agency outlined shortfalls it discovered at the Los Angeles-area facility in a routine inspection, prompting Medtronic to implement corrective actions and other process improvements to address the issues. https://www.fiercebiotech.com/medtech/still-awaiting-us-approval-medtronics-auto-adjusting-insulin-pump-lands-canadian-nod XX XX People with type 1 diabetes who take GLP-1 receptor agonists or SGLT-2 inhibitors in real life seem to line up with controlled trials. The GLP-1 medicines have brand names like Ozempic or Trulicity and the SGLT-2 are Invokana or Jardiance. These are newer medications and people with type 1 are cautioned to take them carefully because of the higher risk of DKA. However, these researchers say after 12 months of use people taking a GLP-1 receptor agonist had a significant reduction in glycated hemoglobin (HbA1c), from an average of 7.7% to 7.3% (61 to 56 mmol/mol), as well as in bodyweight, from an average of 90.4 to 85.4 kg. and they used less insulin overall. SGLT2 inhibitors were used by 39 study participants for an average duration of 24.2 months, mostly with the intent to achieve better glycemic control (73.3%), but also for weight loss (37.8%), reduced insulin requirements (26.7%), and reduced glucose variability (24.4%). Also, about 12% of users initiated SGLT2 inhibitors for their beneficial cardiovascular or renal properties. In line with clinical trial findings, these real-world users had significant reductions in average HbA1c after 12 months of use, from 7.9% to 7.3% (63 to 56 mmol/mol), and in basal insulin dose, from a daily average of 31.3 to 25.6 units, but not in bolus insulin. And contrary to the results of controlled trials, although SGLT2 inhibitor users had a weight reduction, this was small and not statistically significant, at an average of 89.2 and 87.5 kg before and after 12 months, respectively. https://www.medwirenews.com/diabetes/real-world-adjunctive-medication-outcomes-type-1-diabetes/23662504 XX Taking a personalized approach to kidney disease screening for people with type 1 diabetes (T1D) may reduce the time that chronic kidney disease (CKD) goes undetected. The finding, published in Diabetes Care(link is external), provides the basis for the first evidence-based kidney screening model for people with T1D. Current CKD screening recommendations include annual urinary albumin excretion rate (AER) testing for anyone who has had T1D for at least five years. The new findings suggest that AER screening could be personalized to optimize testing frequency and early detection of CKD. Specifically, people with T1D who are at low risk of developing CKD could be tested for AER less frequently to reduce burden and cost, and those at high risk for CKD could be tested more frequently to facilitate earlier CKD detection. People with T1D have an estimated 50% risk of developing CKD over their lifetime. Important to note, these numbers and this study is based on 30 years of data, dating back to the landmark DCCT trial. https://www.nih.gov/news-events/news-releases/nih-funded-study-finds-personalized-kidney-screening-people-type-1-diabetes-could-reduce-costs-detect-disease-earlier XX Lots of stuff happening for diabetes awareness month. Embecta Corp. (“embecta”) (Nasdaq: EMBC), one of the largest pure-play diabetes care companies in the world, today announced it will ring the opening bell at Nasdaq on November 1, 2022, in recognition of National Diabetes Awareness Month. “We are proud to celebrate this year's Diabetes Awareness Month by ringing the Nasdaq Opening Bell with representatives of several organizations that make diabetes, and supporting the people who are living with diabetes, their sole focus,” said Devdatt “Dev” Kurdikar, president and chief executive officer of embecta. “Our company is honored to recognize the patients, caregivers, healthcare providers, and advocacy organizations working together to improve access to education and progress toward the vision of a life unlimited by diabetes.” embecta also recognizes the 100-year milestone of the first successful injection of insulin that was administered to a person with diabetes. Today, 1 in 10 adults around the world live with diabetes1, an estimated 537 million people, and almost half don't know they have it. “Our community often faces stigma and isolation associated with diabetes as we frequently practice self-management of the disease,” said Anna Norton, chief executive officer of DiabetesSisters. “Increased access to education and resources that will improve the standard of care and quality of life across the community is essential, and we're proud to stand with embecta to share in this mission.” The bell ringing ceremony will be streamed live via Nasdaq's Facebook page. Additionally, highlights from the ceremony will be shared across embecta's social media channels. Please visit embecta.com for additional information regarding Diabetes Awareness Month. About embecta embecta, formerly part of BD (Becton, Dickinson and Company), is one of the largest pure-play diabetes care companies in the world, leveraging its nearly 100-year legacy in insulin delivery to empower people with diabetes to live their best life through innovative solutions, partnerships and the passion of more than 2,000 employees around the globe. For more information, visit embecta.com. XX Dexcom has teamed up with ESPN's Adam Schefter – his wife has type 1 – to launch Dexcom U, the first-ever NIL (name, image, likeness) program designed to celebrate college athletes with diabetes and inspire people with diabetes who have athletic dreams of their own. NIL is name image likeness, it's the new program that allows college athetes to be paid. Dexcom says According to a recent study, nearly half (43%) of adults with Type 1 diabetes felt like quitting sports and physical activities because of their diagnosis, and one in five (20%) went through with quitting. These athletes tell their stories and how Dexcom helps them. I'll link up the video and we are set to speak with some of them in the next couple of weeks. XX A new study released by the American Diabetes Association® (ADA), illustrates the significant barriers that low-income Americans, people of color, older Americans, and people with diabetes living in states with the highest prevalence of the disease face in accessing continuous glucose monitors (CGM). These barriers are especially high for Americans on Medicaid, who are the least likely to have access to a CGM. CGMs continually monitor blood glucose (blood sugar), giving real-time updates. The devices provide significant, potentially life-changing benefits for diabetes management, and in turn for the avoidance or delay of serious co-morbidities, hospitalizations, and even death. “It is disappointing to see that access to vital diabetes management tools like CGMs often depends on your income, the color of your skin, your age, and where you live,” said Dr. Robert Gabbay, chief scientific and medical officer at the ADA. "The ADA is committed to addressing access barriers—such as inadequate health insurance coverage, steep Medicare and Medicaid coverage requirements, and physician shortages—to ensure that everyone who can benefit from a CGM can get one.” The ADA is working with the Centers for Medicare and Medicaid Services, state Medicaid programs, and Congress to eliminate barriers people face in accessing diabetes technology like CGMs. The CGM study is available on the ADA's website. XX Diabetes on Nasdaq XX Great start to a blog post by Tim Street, he writes over at DiabeticTech. He's trying out 6 CGMs currently on the market. Dexcom ONE Medtrum Nano Dexcom G6 Glucomen Day GlucoRX Aidex Freestyle Libre2 You can check out his blog to see the photos of him wearing all of the CGMs and hear his methods for testing. https://www.diabettech.com/cgm/unboxing-and-applying-the-six-cgms/?utm_source=dlvr.it&utm_medium=facebook XX Dexcom also has a See Diabetes campaign for this month which gives you a chance to create your own overlay patch. I've created one for the show, you can it on social along with others with the #SeeDiabetes hashtag. Patti LaBelle, Mark Andrews and Nick Jonas are taking part.. If you design an overlay – I'll put the link in the show notes – you may be order a few for free – they're saying limited supply. A cynic would say this is a creative way to use up the G6 overlay patches before the G7 comes out but.. personally I think it's a really creative and fun idea. I like how mu patch came out, but I doubt my son will wear it! XX Back to the news in a moment but first.. The T1D Exchange Registry is a research study conducted online over time, designed to foster innovation and improve the lives of people with T1D. The platform is open to both adults and children with T1D living in the U.S. Personal information remains confidential and participation is fully voluntary. Once enrolled, participants will complete annual surveys and have the opportunity to sign up for other studies on specific topics related to T1D. The registry aims to improve knowledge of T1D, accelerate the discovery and development of new treatments and technologies, and generate evidence to support policy or insurance changes that help the T1D community. By sharing opinions, experiences and data, patients can help advance meaningful T1D treatment, care and policy. The registry is now available on the T1D Exchange website and is simple to navigate, mobile and user-friendly. For more information or to register, go to www.t1dregistry.org/stacey XX XX XX On the podcast next week.. Tom from Type One Talks The past episode was all about thinking through your use of CGM, questions to ask of yourself, your family and anyone with whom you plan to share. Listen wherever you get your podcasts That's In the News for this week.. if you like it, please share it! Thanks for joining me! See you back here soon.

Trong bài phân tích này, chúng ta sẽ cùng với linh mục Giuse Nguyễn Thể Hiện DCCT tìm hiểu ý nghĩa của 3 chi tiết trong Mc 4,29:  “Lúa chín” nghĩa là gì?“Đem liềm ra gặt” nghĩa là gì? “Đã đến mùa” nghĩa là gì? Bạn sẽ gặp ở đây những cách giải thích bất ngờ về các chi tiết đó. Mời bạn cũng theo dõi và học hỏi.

Kính mời quý vị cùng Linh mục Giuse Nguyễn Thể Hiện DCCT, tìm hiểu bản văn Tin Mừng được Phụng vụ Hội Thánh Công Giáo công bố trong Chúa Nhật XV Thường Niên Năm C - Lc 10,25-37.Bài Tin Mừng này được chia thành 2 phần:Phần 1: Thỉnh vấn về điều răn trọng nhất (Lc 10,25-28);Phần 2: Dụ ngôn người Samari nhân hậu (Lc 10,29-37).

Người ta thường bị cám dỗ nôn nóng can thiệp vào sự tiến triển tâm linh của người khác. Mc 4,28 nhắc chúng ta phải kiên nhẫn và tin tưởng trong sự tôn trọng tiến trình biến đổi nội tâm của người đón nhân Tin Mừng. Mời bạn tiếp tục cùng với Linh mục Giuse Nguyễn Thể Hiên DCCT phân tích dụ ngôn hạt giống âm thầm mọc (Mc 4,26-29) và suy tư về giáo huấn đó của Tin Mừng. 

Trong bài chia sẻ này, linh mục Giuse Nguyễn Thể Hiện DCCT sẽ phân tích bản văn Tin Mừng Ga 20,19-23 mà Phụng vụ công bố trong Chúa Nhật Lễ Chúa Thánh Thần Hiện Xuống năm C.

Hôm nay - cùng Linh mục Giuse Nguyễn Thể Hiện DCCT, chúng ta cùng tìm hiểu bài Tin mừng được Hội Thánh công bố trong ngày Chúa Nhật 2 mùa Chay năm Phụng vụ C: Lc 9,28b-36. Bài Tin mừng này kể câu chuyện về cuộc hiển dung của Đức Giêsu, chuẩn bị cho chúng ta hiểu mầu nhiệm vượt qua mà Ngài sẽ thực hiện tại Giêrusalem. 

Hôm nay - cùng với Linh mục Giuse Nguyễn Thể Hiện DCCT, chúng ta phân tích phần cuối cùng trong trình thuật về cuộc gặp gỡ giữa Chúa Giêsu với người phụ nữ Samari tại giếng Giacóp - Ga 4,4-44. 

This week, the top diabetes stories and headlines in the news include: the popular Sugarmate app loses Dexcom connection, interesting study about internal clocks and type 2 diabetes, the FDA approves new "POGO" BG meter, T2D remission might be more common than thought, Type 1 college scholarships and lots more. -- Join us LIVE on Facebook and YouTube every Wednesday at 4:30pm EDT Check out Stacey's book: The World's Worst Diabetes Mom! Join the Diabetes Connections Facebook Group! Sign up for our newsletter here ----- Use this link to get one free download and one free month of Audible, available to Diabetes Connections listeners! ----- Get the App and listen to Diabetes Connections wherever you go! Episode transcription below: Click here for iPhone      Click here for Android Hello and welcome to Diabetes Connections In the News! I'm Stacey Simms and these are the top diabetes stories and headlines of the past seven days. As always, I'm going to link up my sources in the Facebook comments – where we are live – we are also Live on YouTube and in the show notes at d-c dot com when this airs as a podcast.. XX In the News is brought to you by The World's Worst Diabetes Mom, Real life stories of raising a child with diabetes. Available in paperback, on Kindle or as an audio book – all at Amazon.com -- Top story this week.. Big issue for a popular app – users of Sugarmate have been told as of this week – November 4th to be precise – customers in the US will lose connection. Those outside the US have seen issues since October. This is because of a change Dexcom made to its servers. Sugarmate says Dexcom is working with them to fix the issue – basically they're going to join the Dexcom Partner API – we've told you about that, it's how third party apps can talk with Dexcom.. In the meantime, Nightscout is probably the best alternative if you use Sugarmate. Quick note: Tandem acquired Sugarmate last year. And you'll recall that Dexcom does own a small piece of Tandem. So it looks like this will all probably work out.. but exactly how in the long run will be interesting to watch. -- https://help.sugarmate.io/en/articles/5678010-faqs-sugarmate-and-dexcom-connection?mkt_tok=MzQ4LVJYVi03MDUAAAGAgZ5w-m8YKeY90ybxznIKZ4b4XWStjdvSjf7vH3dNx8PMDzDa9sJP0En6odZtM-Z4UthLL9z7MNV86wnQ4R9o61-islyzvtyvg13By4FB5A&fbclid=IwAR39j2vxjr3JuUbcQdruIAttCSuRl5dD1jVbdNKrm1b5JQpuyYlQiwH1xXs XX A study of “dented” internal clocks seems to build evidence for a theory that people who work late or irregular hours are more at risk for diabetes. Researchers at the University of Pennsylvania created a timing mismatch by altering the function of a molecule within the brains of mice.. shortened their circadian rhythms from 24 to 21 hours. These mice gained more weight, had higher blood sugar, and fattier livers. This all corrected when the researchers changed their environment – sleep and meals – to match that shorter, 21 hour day. They say it might be a good idea for shift workers to try to do the same – eating meals and going to bed in a cycle that works better for them. https://www.pennmedicine.org/news/news-releases/2021/october/a-dented-internal-clock-provides-insight-into-shift-workers-weight-gain-and-diabetes XX New Blood glucose meter gets FDA approval. This is the POGO … with 10-test cartridge technology. The strips and lancers are loaded inside already, so you don't carry anything separate. You just put your finger down and press the button. They're calling this automatic blood glucose monitoring or ABGM. On the inside it's still a basic finger stick and blood collection. But you don't see any of that on the outside. Of course, there's a Bluetooth connected app for you and your healthcare team to use. The product is called POGO. the app is Patterns. https://finance.yahoo.com/news/pogo-automatic-one-step-blood-113000135.html XX New numbers out for diabetes around the world and the International Diabetes Federation says it's a pandemic of unprecedented magnitude. The IDF says more than 10-percent of adults worldwide live with diabetes.. by 2045 that number will be one in eight. The report also says that one in two people with diabetes across the world who need insulin cannot access or afford it. The theme of World Diabetes Day this November 14th is Access to Diabetes Care. https://www.prnewswire.com/news-releases/diabetes-is-a-pandemic-of-unprecedented-magnitude-now-affecting-one-in-10-adults-worldwide-reveals-the-international-diabetes-federation-301413238.html XX Good news for people with type 1.. when more intensive glucose management starts early, it greatly reduces the future risk of heart and kidney issues. This info comes from a look back at the DCCT and EDIC trials – which are 100% worth looking into if you aren't familiar with them. By the way, in these trials “intensive” glucose control was pegged at an A1C of 7 and the riskier group had an A1C of 9 or above. The earlier the A1C was brought down to 7, the less risk of complications. https://www.endocrinologyadvisor.com/home/topics/diabetes/type-1-diabetes/earlier-intensive-type-1-diabetes-treatment-reduces-long-term-cardiovascular-and-kidney-complications/ XX How common is type 2 remission? It's hard to say but a new study from Scotland suggests it's more common than we might think. These University of Edinburgh scientists say in Scotland, it's one in 20. They looked at everyone in the country over the age of 30 with type 2, based on A1C levels -that's about 160-thousand people. Then they said during the study year, 77-hundred people went into remission, which means their A1Cs dropped to 6.5 without medication. Those people were older, had lost weight since their diagnosis, had no history of glucose lowering therapy or bariatric surgery, and generally had healthier blood readings at the time of their diagnosis. https://www.sciencealert.com/reversing-type-2-diabetes-seems-to-be-more-common-than-scientists-realized XX College scholarship contest to tell you about. Senita (sen-EE-tuh) Athletics is partnering with Insulet to award four $5,000 scholarships to people with type 1 diabetes. In honor of National Diabetes Awareness Month, the athletic fashion wear maker is looking for 'Senita Scholars.” The co-founders have a younger brother with type 1 and their fitness gear is known for really good pockets. To be eligible, students across the U.S. must be either a graduating senior in high school or a current undergraduate and have type 1 diabetes. Applications close on Nov. 30. https://finance.yahoo.com/news/senita-athletics-partners-insulet-corporation-150000801.html XX Lots of events happening around the diabetes community for this awareness month. Friends for Life virtual starts next week as does Together T1D. I mention this because it's got a powerful lineup, with Olympian Charlotte Drury, Pietro Marsala, the first person with T1D to get a commercial pilot's license in the US and more… XX And finally, a big happy diaversary to a previous guest of the podcast – Yerachmiel Altman is marking 60 years with type 1 on November 8th. I'll link up my episode with him.. he worked on early insulin pumps and has worn every bit of tech you can think of.. Wishing you continued good health and thank you for sharing your experience and wisdom with us. -- quick reminder that the podcast this week is with Ken Rodenheiser – a diabetes educator who now works with Dexcom. He explains how he went from angry and lonely as a teen, to helping others start off on the right foot at diagnosis. It's a great story you can listen to wherever you get your podcasts or if you're listening to this as on a podcast app, just go back an episode. That's In the News for this week.. if you like it, please share it! Thanks for joining me! See you back here soon.  

What is it like to actually give someone emergency Glucagon? What happens next? This week, Stacey talks to Bonnie O'Neil whose son was diagnosed with T1D at age 5 and is now 24. They had a scary situation while on vacation and out of the country. Everything worked out; Bonnie shares what she learned and what she wants other families to know. Bonnie is the author of a brand new book: Chronic Hope (learn more here). She has a unique family history of diabetes, losing a brother before she was even born and has a older sister who is still thriving today. In Tell Me Something Good this week, a big honor for one of our favorite frequent guests and fun news if your child plays Minecraft. This podcast is not intended as medical advice. If you have those kinds of questions, please contact your health care provider.   EPISODE TEXT HERE... Check out Stacey's book: The World's Worst Diabetes Mom! Join the Diabetes Connections Facebook Group! Sign up for our newsletter here ----- Use this link to get one free download and one free month of Audible, available to Diabetes Connections listeners! ----- Get the App and listen to Diabetes Connections wherever you go! Click here for iPhone      Click here for Android Episode Transcription  Stacey Simms  0:00 Diabetes Connections is brought to you by Daria health. Manage your blood glucose levels. Increase your possibilities by Gvoke HypoPen the first premix auto injector for very low blood sugar, and by Dexcom take control of your diabetes and live life to the fullest with Dexcom.   Announcer  0:21 This is Diabetes Connections with Stacey Simms   Stacey Simms  0:27 this week, what is it like, what really happens, when you need to use that emergency glucagon, I talked to a mom who found out while on vacation out of the country,   Bonnie O'Neil  0:37 I was just all I could do to stop my hands from shaking and mix that glucagon and get it in him. So point number one was when you go on vacation, make sure that glucagon doesn't stay in your hotel, keep it on your person you just never know.   Stacey Simms  0:52 Bonnie O'Neil's son was diagnosed at age five and is now 24. She has advice about using and carrying glucagon. She also has a unique story. She'll talk about growing up in the shadow of a family tragedy with diabetes, and how she and her sister have overcome that in tell me something good this week, a big honor for one of my favorite frequent guests. And does your child play Minecraft? Stay tuned. This podcast is not intended as medical advice. If you have those kinds of questions, please contact your health care provider. Welcome to another week of the show where we aim to educate and inspire about diabetes with a focus on people who use insulin. My son was diagnosed with Type 1 14 years ago, my husband lives with type two diabetes. I do not have diabetes myself, I have a background in broadcasting. And that's how you get the podcast. longtime listeners will know that this show is not really about our experience my family's experience of diabetes week in and week out. I don't share a ton of personal information about Benny, but we do talk about our experiences. And I bring that up because I did a show recently with him to mark 14 years, which was a pretty big milestone. And we've done a couple of shows together over the years. I always say Benny is a big goofball. But you know, he's got good things to say I like to talk to him. I'm very proud of him, even though I give him a hard time. And I got a really nice review that I wanted to share. I don't ask for reviews very often. Maybe I should if you'd like to leave a review, you can send one to me at the email address at Stacey at Diabetes connections.com. You can leave them on whatever podcast app you're listening to. You can drop them in the Facebook group. But this one really was nice. And so I wanted to share it and say thank you to Ruth Ann, who posted it following that 14 year episode where I talked to Benny and she says “I listened to it yesterday and came away feeling understood. I've had type one for almost 45 years diagnosed at age 12. Then he was honest in the way teenagers can be when they don't feel pressured to spin things to make other people happy. I found him incredibly inspiring.” She goes on to write “To me The message was you can be upbeat about life. But don't succumb to pressure to sugarcoat the hard realities of managing type one. I think being real is the healthiest approach to coping with a challenging chronic illness. Please tell him thank you from a grandma in Utah, Ruth.” And I will say thank you to you. That meant the world to me. I agree. I think it's so important to be honest to write that line of diabetes can't stop you from doing the things you want to do. But it will stop you and slow you down sometimes right not to sugarcoat things too much. I really appreciate you taking the time to write that down and share it with me. And of course, I will share it with Benny and Wow, good luck to you. 45 years with type one, you're the inspiration. If you would like to tell us something always happy to get nice messages like this. I'm always happy to take constructive criticism as well. I do have a few people over the years who have yelled at me. But I think I'm pretty easy to find either on social media or via the email address. And you can always go to Diabetes connections.com and get all the contact information there. But Ruth boy you made my day All right, we're gonna talk about using glucagon what that is like, and Bonnie's really interesting story in just a moment. But first Diabetes Connections is brought to you by Dario health. You know, over the years, I find that we manage diabetes better when we're thinking less about all the stuff of diabetes tasks. And that's why I love partnering with people who take the load off on things like ordering supplies, so I can really focus on Benny, the Dario diabetes success plan is all about you all the strips and lancets you need delivered to your door one on one coaching so you can meet your milestones, weekly insights into your trends with suggestions for how to succeed, get the diabetes management plan that works with you and for you. Dario has published Studies demonstrate high impact clinical results, find out more go to my radio.com forward slash Diabetes Connections. My guest this week is here to talk about using glucagon and I think we can all From that, but she has another important story that I don't want to gloss over. Bonnie O'Neil has been part of the diabetes community since before she was even born. bit of a warning, this may be hard to hear Bonnie's older brother died when he was eight, his type one went undiagnosed until it was too late. Now, this was back in the 1960s. But we know that's still gonna happen today. Her older sister was later diagnosed, she survived and is still thriving now. And Bonnie has a new book out. It's called chronic hope. So there's a lot to unpack here, including that very valuable information about her family's experience with glucagon. I found this to be a very valuable and eye opening conversation. And I hope you do too. Bonnie, thank you so much for joining me. Congratulations on your book. And I'm excited to learn all about you. Thanks for jumping on.   Bonnie O'Neil  5:48 Thank you for having me. I'm excited to be here today. Stacey,   Stacey Simms  5:51 tell me about your son. But he's doing now because he was diagnosed as a little kid. And he is all grown up now.   Bonnie O'Neil  5:57 Yes, I've lived all the stages with him. So he was diagnosed as a five year old and he is now 24. So he's living not too far away from me about 15, 20 minutes, which I guess is every T one D mom's dream when their kid grows up that they live independently, but yet, we can still get our eyeballs on them and our arms around them from time to time. So yeah, he's doing great.   Stacey Simms  6:22 You it's funny because being diagnosed, what does that 19 years ago? Isn't that long ago. I mean, my son was diagnosed 14 years ago. But in some ways, it feels like a different world. Do you mind taking us back to that time, if you could tell us the diagnosis story. And I'd love to also talk about what you all started in terms of management.   Bonnie O'Neil  6:41 Sure, yeah, that's actually an interesting story. So I have diabetes in my family. So my brother was unfortunately died in the diagnosis process when he was eight years old. And that was before I was born. And so my parents had me in their 40s, basically to, you know, replace the child that they had lost. And then my sister was diagnosed when she was 16. And I was eight years old. And so I just grew up with it. We grew up with this fear of it being there. So I was always on the lookout for it. And I remember my first pediatrician when I want to have my first child, I said to him, so how do we test for this thing? Because I don't want it to be in in my child. This wasn't Austin. This is my oldest son, Alexander. And, and he's like, oh, Bonnie, you know, it comes on acutely. We can't just run a blood test every every few months, but you'll know it if you ever see it, frequent urination, and intense thirst. And so I was always looking and so the day that I noticed that in my son, Austin, you know, obviously, there's the major panic, but I had grown up through my three pregnancies, I had done the urine testing for gestational diabetes. And so I knew exactly what to do. I went to the pharmacy, I bought a test kit, and I dipped Austin's urine in it, and it turns deep crimson. And so I diagnosed him at home freaking out going to the doctor and saying, they're like, calm down. This is Odile, like it, maybe it's not type 1 diabetes. I'm like, Well, do you know what else it could be? And so we, you know, I bundle up the three kids and we're living in Connecticut at the time, I took them over to the pediatrician. And he didn't have ketones, because we caught it so early. And so their practice was leaning into something that they told me was what Yale was practicing at the time, although I have an endocrinologist friend from Yale, who assures me they never offered, I suggested that, but the thinking was, if your child doesn't have ketones, you don't admit them to the hospital. Hmm. So we went home, we literally went home without so much of the shot of insulin. As you can imagine, I was just freaking out because my brother didn't make it through his diagnosis story. So I was like, you know if you can remember Terms of Endearment and Shirley MacLaine, like shaky over the crib. Yeah, that was me that night, just like leaning over my son and just making sure all night long that he stayed alive anyway, that the pediatrician, the endocrinologist that my pediatrician was able to find for us was one who really didn't work with pedes. The youngest children they saw were really about 15 or 16. So we saw him The following day, and the long acting insulin that he gave him was Lantus.   Stacey Simms  9:37 I was wondering if that was even approved, because I remember was not really 2000 so it was for little guys.   Bonnie O'Neil  9:43 Okay, it was not it was it was not under age 10 and so I don't I didn't know any of that you know, and so, so that was the first there's two things that were very interesting in our in our care different so that was the one and then when we got to CHOP the Children's Hospital. Philadelphia. A week later, I forgot to say all this diagnosis happened exactly one week before we moved house from Philadelphia. Oh   Stacey  10:07 my god,   Bonnie O'Neil  10:08 I never recommend that moving house be part of your diagnosis to be that as it may that was our case. And so when we got to CHOP our the endocrinologist there was actually very keen to see know what would happen to this child being on Lantus at age five, I'm pretty sure that it's going to work out well, I can't prescribe it. But he came to me that way. So I can leave him on his protocol. So that was interesting. And it worked beautifully. So my son never used NPH. And I had friends at that time, who were very familiar with that insulin and just told me how fortunate we were that he never had to be on that. So that was one thing. And the other was, so my sister, the reason I gave you the backstory on my sister was that I grew up in a family of using exchanges, where you counted your you didn't count carbohydrates, but you looked at food, in terms of whether it was fat, or protein, or carbohydrate. And you gave each one an exchange. And so I was used to that world. And I literally was given a counting book that had both on it, it was the exchanges and the carbs. And it was kind of you could do it however you wanted. They were recommending I just use the carbs, but the exchanges were there as well. So that was interesting. Oh, and then there's a third one.   Bonnie O'Neil  11:33 But I remember. So his diagnosis was shortly after the DCCT trial, results came out and talking about intensive insulin therapy and how important that was. And I remember several visits, going in and talking to my CDE and saying, I'd really like Austin to be on that intensive insulin therapy. And she would, she would look at me like I had 12 eyes and like to say something, and I didn't understand what she was saying. And she didn't understand what I was saying. And it was many months later that I realized that Austin was   Stacey Simms  12:11 using Lantus and short acting together. Yes, exactly, was   Bonnie O'Neil  12:14 exactly. So yeah. So I was sort of living in some a couple of old paradigms and had to get with the program pretty quickly. Yeah,   Stacey Simms  12:22 but what a transitional time. Here was that that he was diagnosed,   Bonnie O'Neil  12:26 it was 2002. Yeah. And I'm so thankful I that is it is that so spot on Stacey, because just a few years earlier, and and the story would have been very different. My sister's story is very different. Sure.   Stacey Simms  12:37 And let's talk about your family for a moment. If we could be there's so much information there. You mentioned your brother, gosh, I can't I'm not even sure what to ask. But he died before he was diagnosed or during his diagnosis story. Was   Bonnie O'Neil  12:48 this in the 70s? The 80s Yeah, it was 1962   Bonnie O'Neil  12:57 Yeah, yeah. So my sister was six years old, my my sister Barb, and my sister Johnny, my brother, Johnny was eight. And so it was Christmas week, and my sister had the stomach bug. And a couple of days later, after she got better, my brother started throwing up. And they assumed that he just had the stomach bug as well. And he may have had that, but it clearly he then slipped into decay. And so by the time he got to the hospital, which was actually New Year's Eve, what he was in a coma. And so he passed away three days later, to make the story even more unbelievable. My mother delivered my sister Betsy, just nine days after that.   Stacey Simms  13:43 Oh my gosh. Oh my goodness. Yeah. You know, DKA is I don't have to tell you this. You know, it is the most dangerous time for people with type one and it's amazing to me how now. Gosh, we are you know, more than 50 years after what happened with your family with your brother? Yeah, we are still having something like 30 to 40% of people who are diagnosed with type one diagnosed in DKA, I know you work a lot are you you've written a lot with beyond type one. You know, are you involved in efforts? Do you see the you know the DKA awareness that's something that you you talk about.   Right back to my conversation with Bonnie and we are going to hear her talk about glucagon in just a minute or two. And when you hear her talk about the emergency redbox, please remember, there are more options now and Diabetes Connections is brought to you by one of those by Gvoke Hypopen. Almost everyone who takes insulin has experienced a low blood sugar and that can be scary. A very low blood sugar is really scary and that's where Gvoke Hypopen comes in. It's the first auto injector to treat very low blood sugar. Gvoke Hypopen is pre mixed and ready to go with no visible needle. That means it's easy to use. Find out more go to Diabetes connections.com And click on Gvoke logo. Gvoke shouldn't be used in patients with pheochromocytoma or insulinoma, visit Gvoke glucagon.com slash risk. Now back to my conversation with Bonnie and I just asked her about her family's tragic experience with DKA and how that's influenced her with what she does now in the diabetes community.   Bonnie O'Neil  15:22 Yeah, I mean, I do write for beyond type one, and I'm very active with JDRF. I'm on the board of the founding chapter, the greater Delaware Valley chapter. And I know that we're doing a lot of advocacy work around that and, and even just trying to get the shift in titling someone has type 1 diabetes, a JDRF, has done a lot of work around that, and is seeing that that shift so that it's, you know, reframing it, so it's not Oh, they got diabetes, or my son didn't get diabetes on June 19 2002. That was when we discovered that he would be insulin dependent for the rest of his life. He was developing the disease before that. And so we're trying to change that language. I think we're making progress. So that there's there's an understanding that you are, you know, certainly with some of the antibody tests, that testing that is being done now to be able to know that, you know, this person's body is being set up to get the disease, you know, if you have, I think it was three out of the four markers. It's, yeah,   Stacey Simms  16:31 well, and I was gonna ask you about that, about T one detect, we just did a show on that. We did an episode on that a couple of weeks ago. And when you think about something like that a person who has type one in their family, like you had and was so front of mind, I would imagine that you would have taken advantage of that with your kiddos, you know, years and years ago.   Bonnie O'Neil  16:48 Yeah. And, you know, back then, and that was something that I asked my endocrinologist was, so should we do any sort of testing and their response, and I had to agree with it was, well, there wasn't anything that they could offer. Other than Gee, I'm really sorry, it looks like your child is probably going to get type one. So the way I've handled it now, as a mother of two adult children who don't have diabetes, is that decision is yours. If you want to be tested, we can get you tested. If you don't want to, I have to respect your decision.   Stacey Simms  17:25 One of the things I really was looking forward to talking to you about and looking forward as a term I really should not use there. But I was very interested in is you were one of the few people I know who has had to use glucagon on their child, and then wrote about the experience. So I really appreciate you talking about this publicly. It is a fear that so many people have, you know, we have never had to break out that red box. And I'm so thankful for that. Would you share that story with us? You're even at home, right? You're on vacation?   Bonnie O'Neil  17:54 Yeah. And I'd be happy to because you know, it's a it's a story that still brings up a lot of emotion in me, but it does have a happy ending. And there are some good takeaway points for your listeners in terms of preparedness. So yes, I'm happy to share the story. My family went on vacation to Costa Rica. So it was my oldest son's first year in college, Austin, that would have made him a sophomore, I think in high school and my daughter would have been eighth grade. And we realized that all the spring breaks were aligning all three kids were in three different schools. And we're like, Yes, let's go and do something fun. So we plan this, this sort of dream trip, you know, where you're going to be renting, staying in a treehouse. And like, I'd have some time at the seaside all kinds of great stuff. So adventure, but fun. Yeah, so we get there and the very the very next day, I think we got there like late afternoon. So the next day, spent a little time poolside and then decided to go to this restaurant for lunch that was literally like an oasis on the seashore. So like in the sand cluster of trees and this restaurant was in these trees on the sand. And so it's just a walk up the beach, it was probably, I don't know, 20 minutes of a walk. We get up there. My son Austin actually ordered the only sensible meal he ordered a pizza which is cooked my husband and I ordered cbj which is raw and my other two kids ordered some sort of salad again raw and when you're in a developing country, you should go cooked rather than right anyway. So you know it was a big piece of pizza and or you know, personal pizza. And so we give this was before wearing a Dexcom so we have no arrows indicating the dress. In which his blood sugar is going, we just have a blood sugar of somewhere around 250 probably. So we have to give a nice correction dose, I have to give the combo bolus that we were doing for the pizza to accommodate for the, for the fat. So it's gonna be dripping in for a while. And I didn't factor in the walk that he had just had. So right after lunch, he and his brother asked to go into the sea and play. I'm like, Sure, that's fine. So they did about five minutes later, he came back and he said, I feel shaky. So I tested him and he was in the mid 60s. And we ordered him a coke. And he started to drink. And still his blood sugar wasn't going up. Eventually, he drank the whole big bottle of Coke, and still really wasn't going up. And I was getting a little suspicious. And then he said, I don't feel well. I feel nauseous. And then I knew we were in trouble. And your mind just immediately goes to like, the cheese was tainted. The basil on it hadn't been washed and was in was unclean. Something, you know. Yeah. And I knew that he had like, over 10 units of insulin on board. And then the next thing I know he he starts vomiting. And I mean, pardon me, but projectile vomiting. And this is one of those moments when you just snap into too high alert gear. And it's to my son, and my, my oldest son and my husband go back to the hotel, get the glucagon because of course the glucagon was with us. But it wasn't with us.   Unknown Speaker  21:39 Right? It was   Bonnie O'Neil  21:40 in the hotel, helping the pillows in case they had a low but now it was it was tucked away with all the other supplies. And so the two of them ran back along this shoreline. And I knew it would have to be at least 30 minutes before they would get back. Right? Because there and back. And actually my son got back before my husband did because the roads were so rutted and so circuitous, that it just took him forever, it seemed to get back in the car. So all the while I don't speak Spanish, I speak fluent French, I don't speak a lick of Spanish. And all of these people were trying to help me and they didn't speak any English. And they all they could do is bring towels and bags for my son. And you know, I knew that if he drank any more, he was just going to vomit it. So there was no point in trying to give him more to drink. And so we just waited. And I have never seen a sunset so fast in my life. Oh, I don't know if it was where we were located on the Costa Rica coast. I know we were having a late lunch. But anyway, it just started to get dim. And by the time my eldest son got back with the the glucagon and cuts all over his bare feet, it was just all I could do to stop my hands from shaking, and mix that glucagon and get it in hand. So point number one was, when you go on vacation, make sure that glucagon doesn't stay in your hotel, keep it on your person, you just never know. Point number two with practice that injecting or at least mixing up glucagon. Every year, when your glucagon expires before you throw it away. Don't neglect that gift of having the opportunity to practice drawing it up because I was going to ask you,   Unknown Speaker  23:27 did you ever do that?   Bonnie O'Neil  23:28 I did it every year, I never threw one away without mixing it up. Because I knew that if I ever needed it, I wasn't going to be able to stop and read the directions. I just needed to know what to do. Because the only reason you would use it is if you're in an emergency. And in an emergency. We don't think so clearly, or our hands are shaking, you might be thinking but your hands are shaking so much that you just need to go from muscle memory. So eventually my husband got their like gate. So I drew it up. I gave him the glucagon. My husband got there. And we're in the car. And I was just surprised Stacey, his blood sugar didn't come right back up. I expected it would come up to like, I don't know, a perfect 110 would have been nice. You can even give me a question 150 I'd be happy with and if it didn't, it was I don't even know if it hit at oh well. And so I remember being in the dark in the backseat of that car just like trying to get every little whiff of the glucagon out and into him. And, and then I just realized I don't have another glucagon. I brought one. I didn't bring two and he's not in a stable enough place. Like I we need a doctor. So thankfully, this was probably the nicest hotel we had ever stayed at. And and I'm really thankful because they had a doctor on call. So we as soon as we got back to the hotel, we asked the concierge to call for a doctor and he was there. Oh probably within 45 minutes, something like that. What did he do for you? Did he give him more like IV glucose? Yeah, so he unfortunately was this big, you know, had a big headboard, big posters on it, and like a poster board sort of thing. And he just hooked an IV up to him and tied it up to the to the bedpost. And so the following morning, when he came back, Austin had a fever by that point. And he said, You know, I can't rule out that this isn't appendicitis, you have to get an emergency surgery in Costa Rica, this was not what I had in mind. And long story shorter, what ended up happening was he said, You've got to get him down to the Capitol to San Jose, four hours back down the way we had come up, you know, just two days before. So we have to do that, you know, it could have been the fever could have been from the food poisoning, which it was, but he said, you know, we have to be safe, it couldn't be appendicitis or something else. And so that was the longest four hour ride I've ever had in my life.   Stacey Simms  26:02 Yeah, it was not appendicitis, it turns out to just be   Bonnie O'Neil  26:07 a lot it was it was just the food poisoning. And he spent three days in hospital. And there again, you, as a diabetes parent know more about diabetes than emergency room physicians do. And it's important that you know that and that you believe in yourself about that. My son, his freshman year in college had to go to the ER for the stomach bug. And there to the emergency room, physicians relied on me for what I knew about how to take care of his diabetes. And so when we were in Costa Rica, the attending physician gave me her cell phone number, and said, I want you to be in touch with me. If this doesn't come around, if his numbers don't go in the way we want them to, we're going to take the pump off. And we're going to do it our way. But I will give you it was basically I'll give you six more hours, I think this was like on day two or something. Because she was letting me manage his diabetes. Right? And but then she said, You know, we're gonna do it six more hours this way. And let me know how things go. And it did it worked out fine. So here's two more points coming to my mind when you're traveling. Don't just take one glucagon, you might need to use a second one when we were leaving the hospital. Among the other prescriptions that the doctor wrote for me. I said, Could you write me a prescription for glucagon because I use the only one I had. And clearly, my son didn't get a stomach bug. It was food poisoning. So food poisoning could happen again. And I want protection from that. And she looked at me with these beautiful, innocent eyes and said, Bonnie, we haven't had glucagon in this country in over 10 years. Wow. And so just don't imagine that it's going to be available for you. So travel with to glucagon when you travel. The other thing was, when we were in the hospital, the only ketone tests they were doing were blood ketone tests, they weren't doing any urine ketone test. So I had to wait until they would come back. You know, they weren't doing blood tests as frequently as we would expect to be doing our ketone tests. So again, don't just travel with a bottle that has maybe 10 ketone strips in it. I had a nearly new bottle of 50 ketone strips, and I was worried that I was going to run out   Stacey Simms  28:29 going forward. I assume you're filming like to travel? I mean, this was obviously a big trip and a big treat. Did you hesitate about traveling again?   Bonnie O'Neil  28:37 I don't think I'll go to Costa Rica. I'm nothing against Costa Rica. It's just the memories are. They're profound. I do try to pay attention to where there is a hospital, which is an easy enough thing to figure out. We have continued to travel that is for sure. In my book, I talk about another episode that happened after that, where he his insulin pump broke, and we were in France, and he had to get a we had to locate him a pump in a foreign country. So that's another fun story. But no, we've continued to travel, but I think it's just being safe, bringing your supplies with you and an abundance of supplies, checking to know where the hospital is. And I think it's it's just about being comfortable. Making sure that you feel comfortable where you are. Well, you   Stacey Simms  29:32 mentioned your book. Let's talk about that. Sure. Yeah. Oh, congratulations. That's Thank you.   Unknown Speaker  29:39 Thank you very excited.   Stacey Simms  29:40 Yeah. So why'd you call it Chronic Hope? Tell me about where that title comes from?   Bonnie O'Neil  29:44 Okay. Well, you might want to edit this out. I'm not sure so I was I was thinking about how much you know, I loved my my son and the care I give for him. This As a chronic condition and the title chronic love came to my mind. And that actually had been my working title for a little while. And as I was working on my book proposal, I did a little research little Google search on chronic love, and it was a porn site. So I changed the title. And actually, once I came up with the subtitle, chronic hope, is exactly what I'm writing about. We all love our kids, we do in a way that we show our love to them, especially as full time caregivers, that just cannot be disputed. But there's some times when we as the parents just lose our way on the hope journey. Because it's, it's so long and so complicated and can be so unforgiving. And we can be unforgiving of ourselves. The message really is hope for us.   Stacey Simms  30:57 I may have to lead with the chronic love, I think that forget about editing that out. That's pretty funny. Oh, my goodness. But you've had this story and you for a long time. I'm curious what caused you to kind of write it now to release it now?   Bonnie O'Neil  31:14 Yeah, good question. Well, I love to write. That's the first starting point. I've been writing for a number of years and have been honing that craft. And as I was thinking about what the next topic was, that I wanted to write about, it just felt like it needed to be a story that I've been living, something that was really true. And that it wasn't just something I'm going through now, which so many of my blog posts words like, you know, it's that short, quick blog post is almost like an instant word. It's like what you're going through at that moment, and you write, but I felt like I needed to write something where I had come out the other side, and actually had some wisdom to share. And once I sort of landed at that place, it was well, this is what I know better than anything else. And living this story out first with my nuclear family. And then with my family with my children, I just have been steeped in that for so long. I speak for the jdrf education conferences, that type of nation summit, and that one of the earliest ones that I did, I was speaking on the psychosocial impact of T one D on the family. And it was the first time I had delivered the that talk and I was I was sharing about, you know, my nuclear family and then Austin's diagnosis and how that impacted me. And I was just really honest, and, and raw, and I talked about my anger, you know, the disease coming back into my family, and just the challenges with my husband, when the two of us were not on the same page and the fear, I carried my need for control, wanting to control the disease, and all of these things. And as I'm looking up at the group that I was speaking to, like, everybody's dabbing their eyes, and sometimes, like really crying and at the end, one man said to me, So when's your book coming out? And I chuckled and kind of tucked that away. And it later, I think informed me very well as to what I should write about next.   Stacey Simms  33:32 What is your I mean, you have more than one son, and I'm sure they are your children are all featured in the book in their own way. curious what Austin? Right Austin? Is your son with time? Yes. I'm curious what what Austin thinks of this?   Bonnie O'Neil  33:44 Well, Austin is a man of few words that he's not   Unknown Speaker  33:47 going to do. Much.   Bonnie O'Neil  33:51 I made sure that in the advanced copies that I have, that he was, he received the first one. And he very graciously accepted it and then said, Thank you. He has congratulated me a few times and said he was excited. I did ask him before I really started the writing, and was just sort of outlining things. I asked how he felt about it. And he said he was fine. And I did say to him, and it's the Absolute Truth. If there's anyone who looks ugly in the book, it's me. It's never hand because I am raw with how I processed my emotions. Because one of the things I feel like in that for us, parents have a child that lives with such a complicated disorder. 24 seven, we take so little time to attend to how we feel, you know, because it's how can I complain when my child has to go through so much. And so we don't really ever name what it is that we're feeling and give ourselves permission to feel what we're feeling. And so then we can't really attend to it and move along from some of those stuck places and I really feel that the You know, the emotional health of a family begins with that center of the mom and the dad. And we need to get our stuff together so that we can create a healthy family emotionally.   Stacey Simms  35:14 I agree it's so interesting because we, as you know, an initial diagnosis. And though those first few years, we as moms, I think so define ourselves by diabetes, it almost seems like we have it like and you come to a realization that Yeah, do not be do not have diabetes, we do not have our child's experience. But it doesn't make the experience of being a mom of a kid with a chronic condition, any less valid. It's just a different experience. And I think I'm hoping, kind of saying the same thing you are in that once you realize that it's a mom, that it's okay to take care of what you are going through, knowing that's different from what your kid is going through, you kind of name it and take care of it and acknowledge it and talk about how tough it is. And right now until you can do that. It's so difficult. Yeah,   Bonnie O'Neil  35:58 it's a kid. It is. And I'm so glad now that there's such increased talk about soul care, because that at least is putting it into the forefront of everyone's minds now. But I think parents of a child with a chronic illness just really need that permission to say, I too need this soul care. I am going through mourning. This wasn't what I was expecting. I was expecting my child to have the freest life imaginable. And they still do. But especially in those early years, it's a lot, we have to mourn the loss of this perfect health we had envisioned for our child, and we have to deal with the fact that Yeah, we are tired,   Unknown Speaker  36:42 a lot.   Bonnie O'Neil  36:43 And it's okay to say I'm really tired. And I think even under, like coming to terms with the fact that a lot of our friends just aren't going to get it. And there's a loneliness that we carry here as the caregivers of our children. And it's okay, and it's not it's once we begin to name it and look at it and explore it a little bit, and how it's affecting us. That's the beginning of healing and freedom.   Stacey Simms  37:09 And I meant to ask you earlier, and it's okay, if you don't want to talk about this at all, how is your sister doing?   Bonnie O'Neil  37:15 She has struggled in the last few years with some complications. She has had, I believe gastroparesis for, I think it's close to 10 years that I think, went largely undiagnosed, and then has been quite problematic in the last few years. She's begun going actually to my son's retinal specialist for some treatments for her eyes. And her second or third treatment, this most recent one, they found that the retinopathy had had gone away. So I'm very thankful for that. So she just maintains the most positive attitude through shouldering this disease through the longest time, but I can see that it you know, it has taken its toll.   Stacey Simms  38:06 And so in your family, you know, you have two people diagnosed at different times, but still almost, it's hard to describe how different it is. We talked about Lantus And then off air, you and I were talking about control IQ,   Unknown Speaker  38:19 right? No,   Stacey Simms  38:20 just a guess of reflection before we go of the technology and the advances of not only I assume your sister has is using different tools than she did when she was first diagnosed.   Bonnie O'Neil  38:30 She is for sure. And I think that has been a great asset to her. So yeah, she's using now the Omni pod and the Dexcom as well. I am so grateful for the time in which we live and for the medical advancements that Austin has been able to take advantage of. I know one of the my friends through jdrf. She said recently, I am so thankful for all of you parents who came before our family did who paved the way because my daughter her daughter was diagnosed at age two or three. I've never known what you have known. She's had the Dexcom as long almost as long as she's had diabetes. I don't know the sleepless nights that you know, I'm confident now like that each generation or micro generation is going to be able to say that to the ones who came before them that we're going to continue to advance and are the lives of our loved ones are going to continue to get better. And that also just gives me a lot of hope.   Stacey Simms  39:36 That's great. Well, thank you so much for joining me, Bonnie. I really appreciate your time. Best of luck with the book. I'm really excited for you. There's nothing like a book launch. And I hope we could talk again soon.   Bonnie O'Neil  39:47 Thank you so much. This has been such a joy to be with you. Thanks,   Unknown Speaker  39:50 JC   Announcer  39:56 you're listening to Diabetes Connections with Stacey Simms.   Stacey Simms  40:01 Learn more about Bonnie and her book and her story at Diabetes connections.com. In the episode homepage, as always, I put lots of links and info there, you could read an episode transcript, if you prefer to. Some people just like to read rather than listen to that it's fine by me as long as you get the info. In conjunction with this episode, I have a contest on social media. This is on the Facebook page for Diabetes Connections, not in the group this week. This is just on the page. And you can win a copy of her book chronic hope. I also want to point out and I know we had a commercial in there, but I think it's really important especially for newer families to know that there are now options when it comes to using emergency glucagon because since the 60s, we've had the red box or the orange box, which were basically the same thing as you heard Bonnie talked about there mixing it up, and the big needle and all that stuff. There are new options. gfo hypopyon, is one that I spoke about, they are a sponsor of the show, they are a you know premixed ready to go shelf stable glucagon. And it's very easy. It's all in the panel ready, nothing to mix and you don't see that huge needle, it's very different. It looks more like an epi pen or an insulin pen and simple to use. There's also baxi me, which is a nasal spray. And that is also very easy to use, I will link up more information about that. I just think it is enormously important to know that these things exist, knock on wood, knock on my head, knock on anything I can find. We haven't ever had to use emergency gun with Benny in 14 years. But as Bonnie illustrated, you just never know. So it's so important to be prepared. I'm also really interested in the future of this stuff. Because I keep hearing more and more people say that we're gonna be using it not just for Super lows, right? I mean, like me, you were probably told if He's unconscious, you know, if you can't keep anything down, that's when you use it. But now there's a new school of thought about using these in much smaller doses for less severe lows. So I don't have a lot of information on that. So I'm not gonna talk too much more about that. But I think that is very interesting. And something to watch. And certainly glucagon in an insulin pump is something that, you know, companies are working on, most notably the iLet from beta bionics. So, as we say all the time, stay tuned. Tell me something good, a big honor for a wonderful member of our community. And that's about Minecraft to just ahead. But first Diabetes Connections is brought to you by Dexcom. And you know, when Benny was very little, and in the bathtub or in the pool, anytime his hands would get wet. I always noticed his fingertips. You know exactly what I mean. Right? We poked him so much. They were just full of these little pinprick holes. It looks horrible. I mean, you can really see it when he got wet at age 16. I am not inspecting his hands. I rarely see his hands anymore, but his endocrinologist does. And we went for a checkup in early January, his fingertips are normal. It's incredible. We've been using Dexcom for seven years now. And with every iteration, we've done fewer and fewer finger sticks G6 eliminates finger sticks for calibration and diabetes treatment decisions that we used to do 10 finger sticks in the past. It makes me so glad that Dexcom has helped us come so far. It is an incredible tool. If your glucose alerts and readings from the G6 do not match symptoms or expectations, use a blood glucose meter to make diabetes treatment decisions or more, go to Diabetes, Connections comm and click on the Dexcom logo.   Over the almost six years of this show, I have been so fortunate to have some guests that really made an impact on me, who I'm really lucky, I think to call friends now, but who I turned to again and again for information. I know I can rely on them. They'll give it to me straight and in a caring way. And one of those people is Dr. Stephen ponder. Many people know him because of his sugar surfing talks and books, but he's a practicing endocrinologist. He's right there in the thick of things in Texas when he can pray and hopefully post COVID runs a fabulous diabetes camp and has lived with type one himself for more than 50 years. He got a really great honor recently, and he says he was stunned to learn that he has been selected for a big honor at the University of Texas Medical branch in Galveston. This is where he went to medical school. And then he stayed there another nine years where he says he became a husband, father, pediatrician and pediatric endocrinologist and the award is the Asheville Smith Distinguished Alumni Award. He will receive that formally in June during the graduation ceremonies at Galveston and the to read his post about this was it was really inspiring he gave a lot of credit to others and he finished by saying never in my wildest dreams did I imagine an honor such as this so congratulations to Dr. Steven ponder for a great award well deserved that's just fantastic. Another Tell me something good comes from Samantha Merwin who is the mom of Logan the elbow bump kid we've talked to them on the show before she is working to roll out a national program about Minecraft. This is a Minecraft t Wendy play project. She says she had a successful pilot and She's working to roll it out nationally, working out a lot of logistics apparently to roll it out for people outside of her home state. So more to come on that. And she's also been working on a project with the college diabetes network along with Cigna. This is a really cool program all about mentorship applications are going to open in February, I will link up the page that is already there for college diabetes network. Basically, it's a program for junior and senior undergraduate students, you got to be current junior or senior, and it pairs you with a Cigna employee who has a similar career interest. So if you want to learn more again, I'll put a link in the show notes. But this was really great. Samantha love the work that you're doing here definitely going to help a lot of people and keep us posted on both of these programs. My son used to love Minecraft he still plays it but man when he was like 12 or 13 that was all they played. It was pretty wild stuff. I don't know what he's moved on to now. Although that's a lie. He his friends are playing Uno. They were screaming and carrying on get the card game Uno. I asked him I was like why are you so loud? Kind of Be quiet. I figured there's like shooting people or doing something crazy. They're playing card games on the computer? I don't know, is there any sign that you're getting older than you don't understand the games your kids are playing. If you have a Tell me something good story, please send it Stacey at Diabetes connections.com or posted in the Facebook group.   Little bit of housekeeping before I let you go, starting next week, I'm going to be doing something different. I'm going to be releasing an additional episode every week. So we'll have the regular interview on Tuesday, the long episode with segments like Tell me something good and innovations and all sorts of stuff. The regular episodes on Tuesdays will continue that way. I'm adding an episode on Thursday. And these are going to be what I'm calling classic episodes. If you're a sharp eared listener, you will know that I dropped in a couple of these last year kind of as a test. They are interviews from several years ago, as I mentioned, we've been doing the podcast for almost six years now. This is Episode 347. So there's probably a couple that you have missed along the way. And what I'm going to do is put context to the interview, you know, kind of catch up with the person let you know what they're doing now, and then replay the interview from several years ago, we have really great stories from a lot of really terrific people that you may have missed. And this way, if you're newer, and you haven't heard it, it's super easy enough to scroll back. I mean, Apple podcasts only shows you 300 episodes Anyway, you don't have to go anywhere. It'll be delivered right to you. And you can catch up with some of the really cool people and stories that I spoke to back in 2015 and 2016. So that starts on Thursday, February 4. Right now I am scheduled to do it for about half the year. We'll see how it goes. And you'll have to let me know what you think. Because after all, the show is here for you. If you don't like it, don't wait half the year. Let me know right away. If you do like it, of course I would love to hear about that as well. Next week, you'll be hearing from Lily I talked to the folks from Ypsomed a couple of weeks ago. Ypsomed and Lily are partnering to bring a new insulin pump to the United States. It's not a new insulin pump elsewhere in the world, but it could be here as early as 2022. We're going to talk about why Lilly decided to pivot and go in this direction. That is next week. And thank you to my editor John Bukenas from audio editing solutions. Thank you so much for listening. I'm Stacey Simms. I'll see you back here next week. Until then, be kind to yourself.   Benny  48:29 Diabetes Connections is a production of Stacey Simms Media. All rights reserved. All wrongs avenged

Dr Carolyn Lam:                Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the journal and its editors. I'm Dr Carolyn Lam, from National Heart Center and Duke National University of Singapore. Dr Greg Hundley:             And I'm Greg Hundley, associate editor for circulation from VCU Health Systems in Richmond, Virginia. Dr Carolyn Lam:                What does cardiac autoimmunity, glycemic control, and cardiovascular disease risk and Type I diabetes have in common? Well, you've got to wait for our feature discussion. This one's such a hot one, don't you agree, Greg? We could hardly finish talking. Dr Greg Hundley:             Absolutely, and Myra, you're just going to love listening to her. Dr Carolyn Lam:                Yep, but stay tuned. First, we're going to discuss a couple of papers each. Greg. Dr Greg Hundley:             Thanks Carolyn. So, the first paper I've got is from Professor Van Rein at Leiden University Medical Center. And basically he's getting at the issue of bleeding in patients with atrial fibrillation. So this is a retrospective cohort that evaluates different anticoagulation strategies for atrial fibrillation. They examined 272,315 patients that had a median age of 75 years and followed them longitudinally over time. These individuals experience 31,459 major bleeding events, and what he did is he evaluated whether they were not taking anticoagulant therapy, whether they were on a vitamin K antagonist, a DOAC, antiplatelet therapies, and then all combinations of the above, including single, double and triple therapy.                                                 What he observed is relative to taking a vitamin K antagonist alone. The hazard ratios range from 1.13 to 3.73 in those that were receiving dual antiplatelet therapy of vitamin K antagonist plus antiplatelet therapy, a DOAC plus antiplatelet therapy, and then of course triple therapy, which had that highest hazard ratio. Dr Carolyn Lam:                But were there particular combinations within these groups that had particularly high bleeding risk? Dr Greg Hundley:             Well, yeah, Carolyn. As we might expect, triple therapy was the worst, but those that were receiving triple therapy, there were two subgroups that were particularly susceptible to having a bleeding episode. First, those that were greater than 90 years of age, and second, those that had CHADS-VASc 2 scores greater than six. Of course, these are very complicated patients, often particularly that latter group. So there are clinical implications. I mean, clearly, this isn't a randomized trial, but what we should take away from this is that if we have one of those two patient groups, age greater than 90, CHADS-VASc score greater than six, that we ought to minimize the time that those individuals are on that triple therapy. Dr Carolyn Lam:                Talk about and bleeding, I've got a paper, and it's on the performance of the ABC scores for assessing the risk of stroke and systemic embolism or bleeding in patients with atrial fibrillation. This is a study that actually looked at the performance of these scores in an external cohort, which actually hasn't really been done. Now, as a reminder, the ABC score is actually the age biomarker clinical history stroke score, which helps to estimate the risk of stroke or systemic embolism. The ABC bleeding risk score incorporates biomarkers along with the clinical variables to estimate the risk of bleeding.                                                 All of these were tested in the ENGAGE AF-TIMI 48 trial, which was that multinational randomized trial of the oral factor Xa inhibitor edoxaban in patients with atrial fibrillation and a CHADS-VASc 2 score of two and above. Now, this was from Dr Morrow and the TIMI study group in the Brigham and Women's Hospital, Harvard Medical School in Boston, Massachusetts. Basically what they found was that the ABC stroke and ABC bleeding risk scores performed well in stratifying the risk for stroke or systemic embolic events or major bleeding in this multinational trial.                                                 Compared to the CHADS-VASc score, the ABC stroke score provided both correct upward and downward reclassification of the stroke systemic embolism risk. Compared with the HAS-BLED score, the ABC bleeding score resulted in a predominantly correct downward reclassification of the bleeding risk. Dr Greg Hundley:             So, this new ABC score, do we integrate it with HAS-BLED? Do we integrate it with CHADS-VASc 2? How do we use this clinically? Dr Carolyn Lam:                So first of all, there are some important remaining unanswered questions, and this was really nicely discussed in an accompanying editorial by Dr Hylek from Boston University School of Medicine. Among this, first of all, the ABC scores need to be validated in patients outside of a clinical trial. Remember, this was a clinical trial cohort. Then there are questions about the timing of measurements of the score, the different settings, hospital and otherwise. Do these scores perform equally well across different vascular beds and in diverse patient populations at the same thresholds used?                                                 So, all these things still need to be addressed. And really, in Dr Hylek's words, the work has just begun. Dr Greg Hundley:             This is an issue with the theme that might be bleeding, and I'm going to talk about a study from Professor Huisman from Leiden University again, and this is the RE-VERSE AD study. Again, patients that are receiving dabigatran and that may have a GI bleed or patients that are on this therapy and unexpectedly need an emergent surgical procedure, this investigative team evaluated the utility of idarucizumab on reversing that anticoagulant dabigatran. So what did they do? They administered 2.5 milligrams of idarucizumab twice separated by 15 minutes.                                                 And again, the study population was uncontrolled GI bleeding or those in need of an emergent procedure. The types of GI bleeds that were involved in this study, a third were upper GI bleeds, a third lower, and then a third, it was either unknown, or there was a mixture of both upper GI or lower GI bleeding. So how do we know that dabigatran is effective? We use a DTT time, and 98% of those with an elevated diluted thrombin time had that reduced after receiving these two twin 2.5 milligram doses at a time point of four hours after administration. Dr Carolyn Lam:                Okay, but were there any complications? Dr Greg Hundley:             Yeah, there were. So first of all, something to think about is that this is a high-risk group. In this study, 14.6% of the cohort actually later died either from the bleeding or what have you. Then another thing we need to be thinking about is when we reversed this anticoagulant, do patients experience thrombotic events? So what this group reported is 4.4% did within 30 days. What were those? Myocardial infarction, deep venous thrombosis, and subsequent PE. Then also at the 30-day time point, one patient experienced an ischemic event.                                                 Another question is once you've administered this, you've gone through the procedure. You stopped the GI bleeding, or you've had the surgery. In this particular study, 66% of those individuals had restarted their DOAC. Those events occurred on top of that. So, interesting information. Looking at administration of idarucizumab, and we'll be using this I think frequently as DOACs are used more frequently in the population, particularly dabigatran, so some important data in guiding us on what we might expect when we administer this therapy. Dr Carolyn Lam:                I think going back to atrial fibrillation though, this is my other selected paper, and it's actually results from the GARFIELD-AF Registry. It's from Dr Bassand from University of Besançon in France, and colleagues, and basically, they looked at the early risks of death, stroke, systemic embolism and major bleeding in patients with newly diagnosed atrial fibrillation in the GARFIELD-AF Registry. They basically found that the rates of all three major clinical events was significantly higher during the first month than in the subsequent period set following up to 12 months.                                                 The leading causes of early death were heart failure, sudden death, acute coronary syndromes, infection or sepsis, and respiratory failure. Dr Greg Hundley:             So, what's the take-home message here? Dr Carolyn Lam:                This is observational, so the key thing to understand here, it's a registry. It's observational. We can't really tell chicken from egg with regards to its newly diagnosed AF verses events, which comes first, which causes what. But nonetheless, the increased hazards of an early event and especially cardiovascular mortality in these newly diagnosed AF patients really point to the importance of comprehensive care for such patients and really should alert physicians to detect warning signs of possible early mortality in these newly diagnosed patients. Dr Greg Hundley:             Very good, Carolyn. Dr Carolyn Lam:                I think that wraps it up. Let's hop to our feature discussion, shall we? I'm so super excited about today's feature paper because it may explain that strong link between hyperglycemia and cardiovascular disease in type one diabetes and all by revealing a potential novel pathway that may have been hiding in plain sight. And yes, I'm stealing the words of editorialists and our associate editor, Dr Naveed Sattar from University of Glasgow, and we're all so pleased to have with us the corresponding author of today's feature paper, Dr Myra Lipes from Joslin Diabetes Center in Boston, Massachusetts. Myra, start us off by telling us a little bit about your study please. Dr Myra Lipes:                   Sure. So we were interested in examining the role of whether chronic hyperglycemia could trigger cardiac autoimmunity in type one diabetes, because chronic hyperglycemia is associated with subclinical myocardial damage, and we had actually previously observed just unexpectedly in a young adult cohort that ... Actually from Italy, where unexpectedly, we noticed that patients with the poorest glycemic control expressed cardiac antibodies. There's a lot of interesting people who are autoimmune-proned may overreact to injury of certain tissues.                                                 So, type one diabetes, it's a classical autoimmune disorder. So we examined, really tested this hypothesis, in stored samples from the DCCT/EDIC study, and this is a very landmark study where patients were randomized to tight glycemic control, intensive glycemic control. Then another group had just conventional control, and this was done over an average of six and a half years. So during this time, the samples were stored. Every year samples were stored from participants, and this was quite a rich data set that is publicly available. So we studied the development of autoimmunity in two groups that had very distinct separations of the A1C level.                                                 We specifically excluded people who developed kidney disease or cardiovascular disease events during the study. So this is a cohort that had relatively recent onset type one diabetes. They're relatively healthy, and again, groups were matched with cardiovascular risk factors at the beginning and the end of this DCCT period. And of course with our studies, we've also looked genetically because your HLA immune response genes can influence susceptibility to autoimmunity.                                                 These patients were actually matched in HLA genotypes. So what we found was that patients with poor glycemic control, there was expression over time. You could see a time course relationship between expression of antibodies over time on the levels of the antibodies that were different in the two A1C groups. The number of antibodies were different in that with the high group expressing more antibodies, more different types of antibodies. These are antibodies ... might say antibodies as like proteins in the blood, and they're actually directed against parts of the myocytes, the myofibrillar complex, and a major target is cardiac myosin heavy chain.                                                 We saw the different parts of the myosin heavy chain retarded, and the presence of two or more antibodies, different types of antibodies, different regions of the myosin to different isoforms. Also, we saw antibodies, the troponin, troponin I. So the number of antibodies with different ... with almost a complete absence of antibodies in a tightly controlled group. I might mention the A1C average was 6.5%, so this is a very tightly controlled group whereas the poorly controlled group is at the opposite extreme, the average A1C during DCCT. The mean updated A1C was about 10%.                                                 So, it was a very clean group, two different groups, and we could see that the number of the types, the number over time, very different in the two groups. In fact the profiles of these antibodies were almost very similar to patients with Chagas cardiomyopathy. That was our positive control group. Chagas cardiomyopathy is possibility to be a form of chronic myocarditis directed against cardiac myosin. So the profiles are almost indistinguishable. So on one hand, you have relatively healthy patients with type one before glycemic control, and that was very unexpected that this would look pretty similar.                                                 But very interestingly, and I might say unexpectedly, we saw ... It was very clear that the people with the highest titers of antibody and the most different types of antibodies, particularly two or more, were subsequently ... We noticed that those patients were at high risk for developing CVD events. And that's while the number of events was slow, we noticed that all the patients, some 60%, had two or more antibodies and developed cardiovascular events. Perhaps one more striking example is a single patient in the study could die of cardiovascular death, had a positivity for all five antibodies at highest titer.                                                 Then we looked at coronary calcification just to measure subclinical atherosclerosis. We noticed that the same numbers, two or more, and also the same antibody specificities that were the highest predictors of CVD events were also predictive of coronary ... had detectable coronary calcification. In addition, we looked at the levels trying to find mechanistically what could explain the link between cardiac autoimmunity and an increased risk for atherosclerosis. We looked at CRP, high sensitivity CRP levels.                                                 Again, these were measured about a decade after the antibody samples were obtained, and we saw that the positivity for multiple antibodies was also associated with markedly elevated ... subsequently elevated high sensitivity CRP levels with levels of six versus something like 1.4 in a group with one or less antibody. So these were very intriguing findings, suggesting a role for autoimmune pathways as a susceptibility to cardiovascular disease in type one diabetes. Dr Greg Hundley:             Myra, that was absolutely incredible description of the study and all the particulars of the findings. I wonder if I could ask both you and Naveed, where do you see the next steps moving forward with this research in the future? Number one. And number two, is this in any way can be used to segregate patients that may need, for example, really aggressive glucose control with an insulin pump or something of that nature? Naveed Sattar:                  I think we left this study as beautifully described as you see by Dr Lipes. I think the context ... We looked at this from editorial perspective ... is that most people don't realize if you have a middle-aged person with type one, their hazard ratio for cardiovascular risk is about somewhere between four to six fold for men and women respectively, which is much higher than type two. It's often thought that it's the area under the curve for hyperglycemia. But what this paper throws up is actually maybe there's another pathway, which we just didn't understand that this wasn't a permanent autoimmunity closing subclinical myocardial disease and inflammations.                                                 But potentially, for me though, there's a saying in British that one swallow does not make a summer. So, it would be nice for other groups to replicate this. I think the findings are, as they stand in isolation, fantastically well done. But it would be lovely if other groups had accessible samples, and I knew of several groups that have up towards tens of thousands of samples, maybe even not 10,000. Certainly 10,000 or so plus or minus samples for type and prospective outcomes to potentially validate the findings and extend them.                                                 And really, if the antibodies do help protect people at higher risk in a meaningful way and improve beyond what we can already do, then you're right. Absolutely. If we can pick up early people who are going to have substantially higher risk, you would want to potentially improve glycemic control, potentially pumps, CGM, closed-loop systems or more intensive statins or lower blood pressure targets or other types of antihyperglycemic agents, which seem to be being tested in type one as well. So that's really one example.                                                 And for me, the other thing would be really nice is to pull up any inflammation. Is this high systemic inflammation? Is it IL-6 level? Is it something else? What about troponin and BNP levels, et cetera. I'd be interested to hear what Dr Lipes thinks and how do you think to take it forward as well. Dr Myra Lipes:                   So, this is something Dr Sattar said and I completely agree. Actually, right now, we're looking at the DCCT cohort as a whole for already. It's relatively small compared to the population-based studies. But there's 1,400 patients, and the subjects had CMR studies that were published in Circulation. So we're going to actually study next whether we see CMR evidence of systolic dysfunction and looking at the broader DCCT cohort. So, those studies are underway. But of course the ultimate test would be looking at if there were samples available from the Swedish NDRs, Scottish registry.                                                 I think it's something that's not often done prospectively. So that would be incredibly exciting, and that's the important thing. I'd say with type one diabetes, for screening for type one diabetes, the use of autoantibodies and particularly two or more different types of islet autoantibodies, and this is just putting things in a broader context, is the entry criteria for type one diabetes prevention trials and something cardiologists wouldn't be aware of but this particular thing. So in decades, people, researchers, in the field has spent decades optimizing islet antibody assays.                                                 So by analogy, it would be really important to standardize assays so that they can be done in Sweden and Scotland and so that other groups could confirm this, and I'm confident that this could be done, since the setting up of our assays was really built on the experience of people of developing standardized assays and rigorous cutoff points for antibody positivity. So it would be really important to work internationally to try to tap into this. Dr Carolyn Lam:                Oh, my goodness. Myra, Naveed, these are such insightful comments. I think as Greg said earlier, I think we could go on forever discussing this paper, but I'm so sorry. Our time is up. Before we go though, I must point all readers to look at figure five of this marvelous paper. It puts together the whole schema of how autoantibodies can play a role both in myocardial and atherosclerotic cardiovascular disease and type one diabetes.                                                 Thank you so much. Greg and I loved having you. Listeners, don't forget to tune in again next week.                                                 This program is copyright American Heart Association 2019.  

Intensive Diabetes Treatment and Cardiovascular Outcomes in Type 1 Diabetes: The DCCT/EDIC Study 30-Year Follow-up. Diabetes Care. 2016 May;39(5):686-93

Dr. Doron Schneider and Dr. Jack Leahy discuss the Diabetes Control and Complications Trial and the follow up study, EDIC. These landmark, studies performed 30 years ago, have stood the test of time and still influences the standard of care today.

Dr. Doron Schneider and Dr. Jack Leahy discuss The Diabetes and Complications Trial, a landmark study that still influences the standard of diabetes patient care. 

 Dr. Schneider and Dr. Leahy, discuss the findings of the DCCT and EDIC studies as they relate to the impact of tight control of diabetes in the early stages of the disease.

 Dr. Schneider and Dr. Leahy discuss the surprising result of "metabolic memory" from the findings of the DCCT and EDIC trials.

 Dr. Doron Schneider and Dr. Jack Leahy discuss what the DCCT and EDIC trials found regarding type 2 diabetes.