Lose extra weight. Moving toward a healthy weight helps control blood sugars. Your doctor, a dietitian, and a fitness trainer can get you started on a plan that will work for you.
Check your blood sugar level at least twice a day. Is it in the range advised by your doctor? Also, write it down so you can track your progress and note how food and activity affect your levels.
Get A1c blood tests to find out your average blood sugar for the past 2 to 3 months. Most people with type 2 diabetes should aim for an A1c of 7% or lower. Ask your doctor how often you need to get an A1c test.
Track your carbohydrates. Know how many carbs you’re eating and how often you have them. Managing your carbs can help keep your blood sugar under control. Choose high-fiber carbs, such as green vegetables, fruit, beans, and whole grains.
Control your blood pressure, cholesterol, and triglyceride levels. Diabetes makes heart disease more likely, so keep a close eye on your blood pressure and cholesterol. Talk with your doctor about keeping your cholesterol, triglycerides, and blood pressure in check. Take medications as prescribed.
Keep moving. Regular exercise can help you reach or maintain a healthy weight. Exercise also cuts stress and helps control blood pressure, cholesterol, and triglyceride levels. Get at least 30 minutes a day of aerobic exercise 5 days a week. Try walking, dancing, low-impact aerobics, swimming, tennis, or a stationary bike. Start out more slowly if you aren’t active now. You can break up the 30 minutes — say, by taking a 10-minute walk after every meal. Include strength training and stretching on some days, too.
Catch some ZZZs. When you’re sleep-deprived, you tend to eat more, and you can put on weight, which leads to health problems. People with diabetes who get enough sleep often have healthier eating habits and improved blood sugar levels.
Manage stress. Stress and diabetes don’t mix. Excess stress can elevate blood sugar levels. But you can find relief by sitting quietly for 15 minutes, meditating, or practicing yoga.
See your doctor. Get a complete checkup at least once a year, though you may talk to your doctor more often. At your annual physical, make sure you get a dilated eye exam, blood pressure check, foot exam, and screenings for other complications such as kidney damage, nerve damage, and heart disease.
WebMD Medical Reference Reviewed by Michael Dansinger, MD on February 17, 2019
In a small saucepan, combine Domino® Light and milk over medium heat. Stir well and bring to a boil for 11/2 minutes. Stir in peanut butter and vanilla
Remove from heat and add remaining ingredients; stir to incorporate.
Scoop oat mixture into1 Tbsp. balls and place on waxed paper. Let cool and refrigerate.
Insulin is a natural hormone produced by your pancreas that controls how your body uses and stores blood sugar (glucose). It’s like a key that allows glucose to enter cells throughout your body.
Insulin is a vital part of metabolism. Without it, your body would cease to function.
When you eat, your pancreas releases insulin to help your body make energy out of glucose, a type of sugar found in carbohydrates. It also helps you store energy.
In type 1 diabetes, the pancreas is no longer able to produce insulin. In type 2 diabetes, the pancreas initially produces insulin, but the cells of your body are unable to make good use of the insulin. This is called insulin resistance.
Unmanaged diabetes allows glucose to build up in the blood rather than being distributed to cells or stored. This can wreak havoc with virtually every part of your body.
Blood tests can quickly indicate whether your glucose levels are too high or too low.
Complications of diabetes include kidney disease, nerve damage, heart problems, eye problems, and stomach problems.
People with type 1 diabetes need insulin therapy to live. Some people with type 2 diabetes must also take insulin therapy to control their blood sugar levels and avoid complications.
If you have diabetes, insulin therapy can do the job your pancreas can’t. The following types of insulin are available:
Rapid-acting insulin reaches the bloodstream within 15 minutes and keeps working for up to 4 hours.
Short-acting insulin enters the bloodstream within 30 minutes and works for up to 6 hours.
Intermediate-acting insulin finds its way into your bloodstream within 2 to 4 hours and is effective for about 18 hours.
Long-acting insulin starts working within a few hours and keeps glucose levels even for about 24 hours.
Insulin injection sites
Insulin is usually injected into the abdomen, but it can also be injected into the upper arms, thighs, or buttocks.
Injection sites should be rotated within the same general location. Frequent injections in the same spot can cause fatty deposits that make delivery of insulin more difficult.
Insulin pump
Instead of frequent injections, some people use a pump that regularly delivers small doses of insulin throughout the day.
The pump includes a small catheter that is placed in the fatty tissue underneath the skin of the abdomen. It also has a reservoir that stores the insulin and thin tubing that transports the insulin from the reservoir to the catheter.
The insulin in the reservoir needs to be refilled as necessary. To avoid an infection, the insertion site must be changed every 2 to 3 days.
Produced in the pancreas
When you eat, food travels to your stomach and small intestines, where it’s broken down into nutrients that include glucose. The nutrients are absorbed and distributed via your bloodstream.
The pancreas is a gland located behind your stomach that performs an essential role in the digestion process. It creates enzymes that break down the fat, starches, and sugar in the food. It also secretes insulin and other hormones into your bloodstream.
Insulin is created in the beta cells of the pancreas. Beta cells comprise about 75% of pancreatic hormone cells.
Other hormones produced by the pancreas are:
glucagon, which alerts your liver to raise your blood sugar if it gets too low
gastrin, which stimulates the production of gastric acid in your stomach
amylin, which helps control your appetite
Energy creation and distribution
The function of insulin is to help transform glucose into energy and distribute it throughout your body, including the central nervous system and cardiovascular system.
Without insulin, cells are starved for energy and must seek an alternative source. This can lead to life threatening complications
Liver storage
Insulin helps your liver take in excess glucose from your bloodstream. If you have enough energy, the liver stores the glucose you don’t need right away so it can be used for energy later.
In turn, the liver produces less glucose on its own. This keeps your blood glucose levels in check. The liver releases small amounts of glucose into your bloodstream between meals to keep your blood sugars within that healthy range.
Insulin helps your muscles and fat cells store extra glucose so it doesn’t overwhelm your bloodstream.
It signals your muscle and fat tissue cells to stop breaking down glucose to help stabilize your blood sugar level.
The cells then begin creating glycogen, the stored form of glucose. Glycogen provides your body with energy when your blood sugar level drops.
When your liver can hold no more glycogen, insulin triggers your fat cells to take in glucose. It’s stored as triglycerides, a type of fat in your blood, that can be used for energy later.
Balanced blood sugars
Blood sugar, or glucose, is used by your body for energy. When you eat, it’s created by many of the carbohydrates you’re consuming. Glucose is either used right away or stored in your cells. Insulin helps keep the glucose in your blood within a normal range.
It does this by taking glucose out of your bloodstream and moving it into cells throughout your body. The cells then use the glucose for energy and store the excess in your liver, muscles, and fat tissue.
Too much or too little glucose in your blood can cause serious health problems. Besides diabetes, it can lead to heart, kidney, eye, and blood vessel problems.
Healthy cells
Cells in every part of your body need energy to function and remain healthy. Insulin provides the glucose that cells use for energy.
Without insulin, the glucose remains in your bloodstream, which can lead to dangerous complications like hyperglycemia.
Along with glucose, insulin helps amino acids enter the body’s cells, which builds muscle mass. Insulin also helps cells take in electrolytes like potassium, which keeps your bodily fluids level.
In the bloodstream
When insulin enters your bloodstream, it helps cells throughout your body — including in your central nervous system and cardiovascular system — to absorb glucose. It’s the circulatory system’s job to deliver insulin.
As long as the pancreas produces enough insulin and your body can use it properly, blood sugar levels will be kept within a healthy range.
A buildup of glucose in the blood (hyperglycemia) can cause complications like nerve damage (neuropathy), kidney damage, and eye problems. Symptoms of high blood glucose include excessive thirst and frequent urination.
Too little glucose in the blood (hypoglycemia) can make you feel irritable, tired, or confused. Low blood sugar can lead to loss of consciousness.
Ketone control
Insulin helps your cells use glucose for energy. When cells can’t use the extra glucose, they begin to burn fat for energy. This process creates a dangerous buildup of chemicals called ketones.
Your body tries to get rid of the ketones through your urine, but sometimes it can’t keep up. This can lead to a life threatening condition called diabetic ketoacidosis (DKA). Symptoms include sweet-smelling breath, dry mouth, nausea, and vomiting.HEALTHLINE CHALLENGESLooking to cut back on sugar? We’ll give you some sweet tips
Use Stevia (0 calories) instead, tablet or liquid artificial sweetenerlow joule jam/marmalade, Promite, Vegemite, meat/fish pastelow joule cordial/soft drink, plain mineral/soda water, pure fruit juice (limit to 1 small glass a day), coffee, tea, herbal teas, Green tea is highly antioxidant dry wine or spirit (1 to 2 drinks a day) low joule pastilles
Here is a list of the Best Antioxidants and Free Radical Scavengers that you should be taking as dietary supplements daily as recommended by Dr David Perlmutter, author of ‘Grain Brain’:
Tumeric
DHA Omega 3
B complex vitamins (including Vitamin B12)
Vitamin C & D
Bacopa
Brocolli
Alpha-Lipoic acid 300 (ALA)
Ashwagandha
Resveratrol
Milk Thistle
Green Tea
Probiotics
Coenzyme Q10 (coq10)
These nutritional supplements reduce oxidative stress on your brain and body, thus protecting your health.
Dr. Mercola Interviews Dr. David Perlmutter, Author of Grain Brain
Natural health expert and Mercola.com founder Dr. Joseph Mercola interviews Dr. David Perlmutter about the implications of diet to Alzheimer’s risk.
Here is a list of the Best Antioxidants and Free Radical Scavengers that you should be taking as dietary supplements daily as recommended by Dr David Perlmutter, author of ‘Grain Brain’:
Tumeric
DHA Omega 3
B complex vitamins (including Vitamin B12)
Vitamin C & D
Bacopa
Brocolli
Alpha-Lipoic acid 300 (ALA)
Ashwagandha
Resveratrol
Milk Thistle
Green Tea
Probiotics
Coenzyme Q10 (coq10)
These nutritional supplements reduce oxidative stress on your brain and body, thus protecting your health.
18 of the Best Non-Perishables for People with Diabetes
If you have diabetes, you may be concerned about eating well while keeping physical distance, also known as social distancing, or self-quarantining.
Keeping non-perishable foods on hand can be a great way to minimize your trips to the store and ensure that you have all the ingredients you need to make nutritious meals.
Notably, numerous frozen or shelf-stable foods have a minimal effect on your blood sugar levels. You may even already have some in your pantry or freezer.
Here are 18 of the best non-perishables for people with diabetes.
1. Dried or canned chickpeas
Chickpeas are popular in numerous dishes. While they contain carbs, they’re also rich in fiber, protein, and fat — all of which help minimize their overall effect on your blood sugar levels (1Trusted Source).
You can use these tasty legumes to make hummus or falafels. What’s more, they make a filling meat alternative and can be added to soups, salads, and stir-fries.
If stored in a cool, dark pantry, dried chickpeas keep for up to 3 years.
2. Canned tomatoes
Canned tomatoes can flavor numerous dishes, including soups and stews.
These savory, red fruits are also rich in antioxidants, such as lycopene, which may promote heart health. Plus, they’re fairly low in carbs, so they only affect your blood sugar levels minimally (2, 3Trusted Source).
Canned tomatoes can be used in cooking or to make sauces. Canned veggies typically don’t expire for several years after purchase.
3. Peanut butter
Peanut butter is an inexpensive source of healthy protein, fat, and fiber — and it has few carbs (4Trusted Source).
It’s a great way to make a snack more filling. You can add it to toast or crackers, blend it into a smoothie, or use it as a dip for apples or baby carrots. It’s likewise great in savory dishes like Thai-inspired stir-fry.
Just be sure to choose natural peanut butter brands that don’t contain added sugar, as sugary foods negatively affect blood sugar control.
After opening, peanut butter lasts for about 1 year.
4. Pistachios
Pistachios are a tree nut that packs healthy protein and fat. They’re also rich in fiber, making them a great snack for people with diabetes (5Trusted Source).
They serve as a crunchy addition to salads and can be crushed to make breading for fish or chicken.
Pistachios last for about 6 months in your pantry, although refrigeration greatly extends their shelf life.
Moreover, this fish is packed with protein and has no carbs. Canned salmon also contains some bones, which are safe and edible — and provide a calcium boost (7Trusted Source).
You can use canned salmon on salads or in salmon patties. It typically doesn’t expire until 2 years after purchase.
6. Seed crackers
Seed crackers are crackers made from a variety of seeds, such as sesame, flax, and chia seeds.
They can be paired with peanut butter or cheese as a snack, or included in a light meal like chicken salad or soup.
If kept tightly sealed and stored in a pantry or fridge, seed crackers should last for about 1 month.
7. Chia seeds
Chia seeds are tiny black or white seeds. They boost digestive health because they’re rich in soluble fiber and form a gel in your gut. This helps slow digestion and prevent rapid blood sugar spikes (11Trusted Source).
Chia seeds add crunch to salads and smoothies. You can also use them to make chia pudding, a delectable treat that’s delicious with fresh fruit.
These seeds last up to 4 years in your pantry.
8. Frozen berries
Berries like raspberries are relatively low in sugar and high in fiber compared with other fruits like bananas or apples, so they affect your blood sugar levels to a lesser extent (12Trusted Source, 13Trusted Source, 14Trusted Source).
Additionally, berries are packed with health-boosting nutrients and antioxidants (15Trusted Source).
Frozen berries can be used in smoothies, cooking, and baking, and they last up to 1 year in the freezer — although you’ll want to check them on occasion for freezer burn.
9. Frozen cauliflower
Cauliflower is a versatile ingredient that can replace mashed potatoes, rice, and even certain pastas like macaroni. Its mild flavor makes it a great substitute for these starchy carbs.
Quinoa lasts for about 6 months to 1 year if properly stored in a sealed container in your pantry.
11. Canned mushrooms
Canned mushrooms, which taste milder than fresh varieties, give a nutrient boost to endless dishes. They’re particularly popular in soups and stir-fries.
Mushrooms are fiber-rich and low in carbs, so they affect your blood sugar negligibly. Some varieties, including the white button, contain ergothioneine, an amino acid that has antioxidant properties and may aid blood sugar management (18Trusted Source, 19Trusted Source).
Canned mushrooms usually don’t expire until 2 years after purchase.
12. Canned or frozen spinach
Given that spinach contains very few carbs and calories, you can eat a large quantity with a minimal effect on your blood sugar levels (20Trusted Source).
You can cook it as a side or add it to soups, stir-fries, and many other dishes to increase your intake of fiber, antioxidants, and provitamins A and K.
Canned spinach lasts up to 4 years, while frozen spinach keeps for up to 1 year.
13. Canned chicken
Canned chicken is fairly lean, rich in protein, and contains almost no carbs. It’s also convenient, as it’s fully cooked and ready to eat (21Trusted Source).
You can use it in soups, salads, and casseroles in the same way as you would use cooked chicken that’s shredded or cubed. It also makes for easy chicken salad.
Canned chicken lasts up to 4 years.
14. Dark chocolate
Dark chocolate is a great treat for people with diabetes — and the darker the better, as chocolate with a higher cocoa content tends to pack less added sugar. Cocoa is also rich in fiber and healthy fats.
For instance, just 3 squares (30 grams) of 78% dark chocolate offers 14 grams of fat, 3 grams of protein, and 4 grams of fiber — with only 11 grams of carbs (22Trusted Source).
You can eat it on its own or include it in numerous desserts. A dark chocolate bar keeps for up to 4 months in your pantry, but freezing it extends its shelf life.
15. High protein pasta
High protein pasta are usually made from legumes, such as black beans or chickpeas, instead of wheat.
Legumes contain carbs but boast more fiber and protein than wheat, making high protein pastas a better choice for people with diabetes (23Trusted Source, 24Trusted Source).
You can replace regular pasta with a high protein variety in any recipe. It lasts dry for up to 6 months.
16. Protein powder
Most protein powders are low in carbs and added sugars while providing hefty doses of protein. They’re also quick and convenient.
Whey protein is derived from cow’s milk, so if you prefer a plant-based option, you can use soy or pea protein powder.
Protein powder is a great addition to smoothies, protein shakes, and desserts. It typically lasts for up to 1 year if sealed and stored in a cool, dry place.
Shelf-stable milk, whether dairy or plant-based, is always good to have on hand.
Although cow’s milk is slightly higher in carbs than some nondairy alternatives, it has protein and fat — unless it’s skim — that reduce its effects on your blood sugar. Alternatively, some plant-based milk like unsweetened almond milk contain few carbs to begin with (25Trusted Source, 26Trusted Source).
If you opt for plant milk, make sure to buy varieties without added sugar.
Both shelf-stable and plant-based milks can be used in various recipes, such as protein-rich smoothies, soups, and baked goods. They last unopened for several months but should be refrigerated after opening.
Olive oil is rich in anti-inflammatory compounds, and consuming it regularly may help you manage your blood sugar levels (27Trusted Source).
Olive oil is pure fat, so it contains no carbs to affect your blood sugar levels. However, it’s high in calories, so you should use it in moderation (28Trusted Source).
It’s a popular cooking oil and ideal for vinaigrettes, dressings, and dips.
Meal planning tips
Keeping blood sugar levels consistent is an important consideration for people with diabetes.
Since carbs affect your blood sugar levels more than protein and fats, your meals and snacks should all contain roughly the same number of carbs.
The number of carbs that you need or can tolerate depends on many factors, including your body size, activity level, insulin sensitivity, and calorie needs.
While the best way to determine the right amount for your needs is to consult a knowledgable healthcare provider, here are some examples of a single serving of some carb-rich foods (29Trusted Source):
1/3 cup (about 50 grams) of rice or pasta
1/2 cup (117 grams) of oatmeal or grits
1 slice of bread
1 small tortilla or dinner roll
6 crackers
1/2 cup (80 grams) of potatoes or sweet potatoes, cooked
1 piece of fruit or 1 cup (144 grams) of berries
1 cup (240 mL) of milk
Try to include protein and fat in each meal or snack to help keep you full and prevent your blood sugar levels from rising quickly (30Trusted Source).
Before making any large changes to your diet, consult your healthcare provider so that they can properly adjust your medications and insulin dosages if needed.
SUMMARY
If you have diabetes, you should try to keep your carb intake consistent across all your meals and snacks.
Sample meals
Here is a sample 3-day meal plan using the non-perishable foods featured in this article.
Day 1
Breakfast: morning quinoa with chia seeds and frozen berries
Lunch: soup with chickpeas and canned tomatoes
Snack: dark chocolate and pistachios
Dinner: high protein pasta with chicken, plus sauce made from canned tomatoes, spinach, and mushrooms
Day 2
Breakfast: protein shake with whey powder, shelf-stable milk, and peanut butter
Lunch: chicken salad with seed crackers
Snack: roasted chickpeas
Dinner: salmon patties, quinoa, and green beans
Day 3
Breakfast: savory cauliflower “oatmeal” with spinach and mushrooms, plus 1 cup (240 mL) of milk
Lunch: high protein pasta tossed with olive oil, chickpeas, and spinach
Snack: smoothie with berries, shelf-stable milk, and peanut butter
The concern began after a study in The LancetTrusted Source stated that ibuprofen boosts the angiotensin-converting enzyme 2 (ACE2), which may facilitate and worsen COVID-19.
The World Health Organization warned most patients to stick with acetaminophen. Now they say they do not advise against using ibuprofen.
Could people on certain medications for hypertension, cardiovascular disease, and diabetes be at risk for experiencing COVID-19 more severely?
The question raises more concerns about which medications may make COVID-19 worse in some people. It follows reports that ibuprofen could do more harm than good in patients with COVID-19.CORONAVIRUS UPDATESStay on top of the COVID-19 outbreak
The concern began after a study in The LancetTrusted Source stated that ibuprofen boosts the angiotensin-converting enzyme 2 (ACE2), which may facilitate and worsen COVID-19.
As a result, the World Health Organization (WHO) originally warned most patients to stick with acetaminophen, which is also known as paracetamol. Now they say they do not advise against using ibuprofen.
The study explained that COVID-19 binds to ACE2 in order to target cells. Patients likely have increased ACE2 expression if they’re treated with ACE inhibitors, angiotensin II type I receptor blockers (ARBs) and thiazolidinediones. Those drugs are commonly taken by those with cardiovascular disease, hypertension, and diabetes. Ibuprofen can also increase ACE2, the study noted.
Cardiovascular, diabetes drugs in question as well
While media reports focused on ibuprofen, many did not highlight the other drug warnings in the journal article.
“We therefore hypothesize that diabetes, cardiovascular disease, and hypertension treatment with ACE2-stimulating drugs increases the risk of developing severe and fatal COVID-19,” the authors wrote. They said patients with cardiac diseases, hypertension, or diabetes who use drugs that increase ACE2 could be at higher risk for severe COVID-19 and, therefore, should be monitored.
In a separate article, lead author Dr. Michael Roth-Chiarello, who heads up a pulmonary cell research unit at the University Hospital of Basel in Switzerland, said that there needs to be more research into the use of ACE inhibitors in those with COVID-19. He did not respond to a request for comment.
Doctors: Evidence lacking
So, are patients on some hypertension, cardiovascular disease, and diabetes drugs at risk for more severe COVID-19?
This speculation about the safety of ACE or ARB treatment in relation to COVID-19 “does not have a sound scientific basis or evidence to support it,” Jared Van Hooser, assistant professor in the department of pharmacy practice and pharmaceutical sciences at the University of Minnesota College of Pharmacy and a clinical pharmacist at St. Luke’s Mount Royal Medical Clinic, told Healthline.
“Should people be aware that there is a possibility COVID-19 could be more severe in those with hypertension, cardiovascular disease, or diabetes? Yes, they should be aware, but the research is not definitive,” Van Hooser said.
The Council on Hypertension of the European Society of Cardiology has stated there’s a lack of any evidence supporting harmful effects of ACE and ARB with regard to COVID-19.
“[We] strongly recommend that physicians and patients should continue treatment with their usual antihypertensive therapy because there is no clinical or scientific evidence to suggest that treatment with ACEi or ARBs should be discontinued because of the COVID-19 infection,” the organization said in a statement.
Further research is needed to evaluate interactions between ACE inhibitor drugs and the virus that causes COVID-19. Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, has expressed support for further research in this area.
“There have been worse COVID-19 in patients on treatment for some chronic diseases like hypertension, but it’s impossible right now to separate whether this is due to the underlying disease versus the drugs being used,” explained Dr. Otto O. Yang, a professor of infectious diseases at the David Geffen School of Medicine at UCLA, told Healthline.
Rory Remmel, Ph.D., a professor at the University of Minnesota College of Pharmacy, cited the BMJ report that said patients taking lisinopril or angiotensin receptor blocking agents such as losartan could have increased ACE2 Trusted Source in the lungs. ACE2, the study authors noted, could make COVID-19 worse.
But there’s a flip side.
“Interestingly, losartan is one of the medically approved drugs that is being tested for treatment of COVID-19 on the theory that it will block viral entry,” he told Healthline. The virus binds to ACE2, but losartan blocks ACE2 from entering cells — making it a potential therapy.
Dr. James Louis Januzzi, a cardiologist at Massachusetts General Hospital, said people need to be careful about getting medical advice from anyone other than their own doctors.
“Don’t believe the misinformation that is going on out there,” he said. “Everyone is scared and wants to provide rapid, useful information to people.”
“Unless and until prospective randomized data are available, people should not assume anything they read is true, and they should speak to their physician if they have questions,” Januzzi added.
Stay on your meds, doctors warn
Most cardiologists — including the American Heart Association, American College of Cardiology, and Heart Failure Society of America — advise patients to stay on their medications.
“People should not stop taking their medications unless directed by a healthcare professional,” Van Hooser said. “We want to avoid a knee-jerk reaction to something that does not have evidence or very limited evidence.”
Concerned about taking these medications and getting COVID-19? Dr. Michael Miller, a cardiologist, and professor at the University of Maryland School of Medicine, said to stay on your medications and talk to your doctor about concerns.
“We are not recommending that our patients stop taking these medications,” he told Healthline.
The only way a doctor would recommend stopping the medication is if the patient has complications from COVID-19, Miller said.
“However, if they develop COVID-19 and have complications that result in significant hypotension, ACE inhibitors will almost invariably be temporarily discontinued,” he noted.
Stay on your medications, Januzzi echoed.
“It actually could be harmful to stop these meds abruptly,” Januzzi said. “To be explicitly clear, we have no good, prospective comparative data to suggest taking drugs like ACE inhibitors is harmful or beneficial relative to COVID-19 infection.”
As the entire world is combating an unprecedented outbreak of the viral respiratory disease COVID-19, you may be wondering if it’s safe to continue taking inhalable insulin. Could it compromise your lungs? Or be rendered ineffective if you become sick?
People may be concerned because research shows that respiratory infections are more severe in those with diabetes.
We queried some of the country’s top experts and learned a lot in the process.
The short answer is that there’s no reason not to use inhalable insulin unless you are ill to the point of experiencing “acute respiratory distress” that requires hospitalization.
But there’s a lot more to know on this topic as well — including what weakens your lungs most, information on the newest inhalable insulin product under development, and how inhalable medications might be key to fighting the COVID-19 outbreak.
MannKind’s Afrezza ‘not impacted’
There is currently only one brand of inhalable insulin on the market, Afrezza, from Southern California-based MannKind Corp. The drug has been shown to be extremely effective, and quite safe in both clinical trials and real-world use since its launch in 2015.
We asked Mike Castagna, CEO of MannKind, about the interplay of colds and flu with using the Afrezza inhaler. “We don’t have any evidence that there’s an issue with absorption, and there’s no evidence that it exacerbates respiratory issues. The powder is not sitting in the lungs, but rather goes through the lungs like oxygen,” he says.
Official word from the company is: “In clinical studies, absorption of Afrezza was not impacted by upper respiratory infection (which typically includes scratchy or sore throat, sneezing, cough and runny nose).”
While Afrezza users often experience a cough at the outset of use, Castagna says they regularly work through colds and flu without issues. Some Afrezza users who experience a lot of mucus, or an extreme cough, may opt to switch to injectable insulin during the worst part of their illness, but “that’s up to you and your doctor. We don’t see absorption issues in Afrezza in upper respiratory infections,” he says.
While the predictions for COVID-19 spread are scary — up to half the U.S. population may get the viral disease — thankfully the huge majority of those cases are expected to clear up after relatively mild symptoms, including runny nose, headache, fever, and diarrhea. Experts confirm that people with diabetes are no more or less likely to contract the illness. But if they do get sick, the consequences can be more severe and exceptional care needs to be taken to keep glucose levels under control.
“I don’t want to minimize the concerns people with diabetes may have. If you have good (glucose) control, most people will be fine. If you don’t have good control, that’s when we worry,” says Castagna.
He reminds us that we all need additional insulin when we’re sick, due to the stress on the body. But generally, he says, “We don’t recommend any changes to people’s insulin management due to coronavirus — unless you are in respiratory distress. Then you should contact your doctor and get into a clinic as soon as possible.”
An expert weighs in
John Patton, one of the nation’s premier experts in inhalable medication science, is a veteran of the team that developed the world’s first inhalable insulin, Exubera, from Pfizer. He is a co-founder and now board member of Aerami, a start-up developing a new formulation of inhaled insulin (details below).
“That’s actually the most common safety question on inhaled insulin — what happens when you get cold or flu?” Patton tells Diabetes Mine. “Pfizer actually ran trials where they gave people rhinovirus to do testing. We did not find that episodic lung diseases or infections were cause for concern.”
Once that first inhalable insulin product was out on the market, “all kinds of people got the flu and there was never a serious adverse event associated with having the flu. Of course, we don’t know how many people reverted to injections when they were sick,” he says.
(Note that Exubera was pulled from the market in 2007, for business reasons having nothing to do with negative health outcomes.)
Patton makes a point of noting that when sick, you need to manage blood glucose carefully, to avoid going into diabetic ketoacidosis (DKA).
Whose lungs are at highest risk?
The people who appear to be at “enormous risk” of developing worst-case-scenario COVID-19 are smokers, whose lungs are filled with high loads of tar, Patton says.
Vaping is also suspected to make COVID-19 cases worse, although there is no solid data on this yet.
A gender gap is also emerging, where more men are being infected and dying of COVID-19 than women. One theory is that this is tied to significantly higher rates of smoking among men than women across the world. But the LA Times reports that other factors may be at play, such as a theory that the hormone estrogen may have “specific protective powers” against this virus.
Access to Afrezza should remain smooth
MannKind is also not expecting any product shortages due to the outbreak, despite the fact that they manufacture the product in Connecticut, which is currently 12th on the list of hardest-hit states.
“We have months of inventory on hand. We’re making another batch as we speak,” Castagna tells DiabetesMine. “We’re taking measures to secure safety, of workers and the product, at our factories.”
A company alert issued on March 25 reminds patients and doctors that “pharmacies can order additional supplies from wholesalers with expected delivery within 1-2 days, as usual.” They also note that patients can receive Afrezza by mail-order, and that many insurance companies are allowing 90-day refills during this time.
A healthy market for Afrezza?
The company has had difficulty gaining traction with Afrezza, because so many doctors and patients still just don’t know it’s an option, Castagna says. They currently have a user base of 6,000 to 7,000 individuals, half with type 1 diabetes and half with type 2. They don’t have specific stats on age groups but do know that 20 percent of their users are on Medicare, so presumed older; and 80 percent are on Medicaid or private insurance, which implies younger users.
Although they started out targeting type 2s, they’re now shifting almost 100 percent of their energy towards the type 1 market, a decision that was made in January 2020. Castagna points out that they now have 20 to 30 people on staff who live with type 1 diabetes themselves.
Basically, they want to prioritize their resources where they can have the most impact, he says. And people with type 1 are most keenly tuned in to achieving better time-in-range, fewer hypoglycemic episodes, and less sleep disruption. Data presented at the February 2020 ATTD international diabetes technology conference showed a 1.6 percent reduction in A1C and significant reduction of hypos using Afrezza versus injected insulins.
Castagna says they’re seeing increased demand for the product every week, “and we don’t anticipate any slowdown, other than the fact that people won’t be seeing their doctors in the coming weeks, so that will slow down prescriptions overall.”
They’re apparently achieving 70 percent approval on prior authorizations “within hours,” he says, as their CoverMyMeds program has been quite effective.
As far as COVID-19 concerns go, Castagna adds:” We’ve had zero calls as of last week from HCPs (healthcare providers) on this issue. But our reps are equipped to answer questions.”
“We don’t want people running around scared, saying, ‘I’ve got to get off my Afrezza.’ We don’t see any indication for that… A large majority of people will get COVID-19 but a large majority will not have symptoms strong enough to warrant a change in their insulin.”
If you use Afrezza and have questions, you can contact their Customer Service at 818-661-5047 or guide@mannkindcorp.com.
New inhalable insulin from Aerami
Aerami Therapeutics
We also connected with North Carolina-based Aerami Therapeutics (formerly Dance Pharmaceuticals), which is working on a next-generation inhalable insulin product.
Theirs is a fine mist aerosol formulation instead of a powder, delivered by their new inhaler device called AFINA. It will have built-in Bluetooth capability to track data and integrate with apps and platforms. The company has completed seven early stage trials to date and is now looking for a partner for their phase 3 study design with the Food and Drug Administration.
They are also working on an inhalable GLP-1 drug, which would be the first needle-free option for that type 2 diabetes drug.
About the new coronavirus, Aerami COO Timm Crowder says: “We’re seeing acute respiratory issues now with this virus which are pretty unique. It’s probably not something people have put a lot of thought into. Is this the new normal…?”
But he says their inhalable drug formulation should be perfectly safe and effective for those with “normal” cold and flu symptoms — perhaps even more so than Afrezza.
“Ours is a soft liquid, that’s shown no cough, and been very gentle on the lungs in trials. Our high peripheral deposition (HPD) insulin droplets go into the deepest part of the lungs. Even with congestion, you’re not typically going to see mucus in that part of the lung,” Crowder explains.
The AFINA inhaler is a small black square device outfitted with a light that blinks to alert the user as to how effective their inhalation technique is. It comes with a small dropper vial full of insulin mist, which has to be used to fill the inhaler before each mealtime (bolus-only) dose.
The big differentiators for this product are its precise delivery, those small droplets that go into the deep lungs, and “breath actuation,” meaning the ability to let users know how well they are absorbing the product, Crowder says.
“With our device, the aerosol droplets are only generated when the inhalation is in target range, shown by the flow sensor on the device — in other words, only when the patient inhales properly. If they’re not inhaling appropriately, the device will glow yellow, showing that no dose is being delivered. They either need to slow down or speed up their inhalation technique.”
“Also, our dosing is extremely targeted. We can control precisely where the droplets go,” he adds.
They’re not yet providing a projected launch date, and are still determining basics like whether a spirometry lung capacity test will be required to get a prescription for this inhaler (as is the case with Afrezza), or whether they will mainly target type 1 or type 2 diabetes. Human clinical trials will determine all that, Crowder says.
Despite the current worldwide respiratory virus crisis, the overall promise of inhalable medications to effectively treat conditions free of needles is huge, Crowder says.
Inhalable treatments for COVID-19?
It’s important to note that on March 17, Afrezza maker MannKind announced that the company will be shifting its pipeline to also work on three potential COVID-19 treatments with development partners. These aim to reduce replication of the virus in the lungs and delay the “inflammation cascade” that leads to acute respiratory distress syndrome. These will be in the form of dry powder inhalers that deliver the medication directly into the lungs.
Expert Patton, who is now also co-founder of iPharma, an “International Inhalation Center of Excellence” that helps develop and test new medical inhalation products, tells us that with the current COVID-19 pandemic, “people with ideas for therapies are coming out of the woodwork.”
Patton points to a paper just published by the University of California, San Francisco and international scientists listing 72 molecules that could have an impact on treating the novel coronavirus. (Among the substances listed is the diabetes drug metformin, we noticed.) Patton lauds this as “remarkable work” but cautions that this may lead to a potentially dangerous explosion of off-label use of these molecules: “People aren’t going to wait for clinical trials.”
Case in point: Just a few days ago, a man died in Arizona after self-medicating with what he thought was an experimental substance that could combat the new coronavirus that causes COVID-19.
Patton also notes that most of the ideas for new COVID-19 therapies are oral or injection prototypes, which could have toxic properties. “Ideally, they should be inhaled,” he says.
“Local lung delivery has always had extraordinarily strong potential. It offers targeted delivery, that can lower overall dose and raise the effect on the cells you want to target.”
A classic example is newer inhaled steroids used for asthma or COPD; he says. Oral or injected steroids can be quite toxic, especially in children. “They’re essentially going through the whole body. But with inhaled medications, you get targeted treatment, that only impacts the affected cells. It’s like with some drugs that can kill cancer, but they will also kill you,” Patton explains.
The benefits of inhaled steroids are enabling a high concentration of the drugs to reach only the impacted areas of the body, reducing adverse side effects and allowing for smaller, more effective dosing.
Patton is not alone in believing that inhalation devices can have a huge impact on improving healthcare.
But of course, with the cautionary note: “If you have irritated lungs or lungs that are sensitive, there’s just a physical irritation that happens with anything — even good things that are not toxic, like mother’s milk.”
The bottom line, according to Patton, is: “If you are really sick and coughing, you may not want to inhale anything.” But if your lungs are otherwise healthy, there’s no inherent danger in it
Call your primary care provider and discuss symptoms before visiting a healthcare facility or click below to find a local provider. If this is an emergency, call 911, and tell the operator you have COVID-19.
Given that diabetes is characterized by high blood sugar levels, following a healthy diet that helps manage blood sugar is essential to treatment (1Trusted Source).
However, that can be easier said than done, and people with diabetes may find it difficult to decide which foods to eat and avoid.
Mushrooms are low in carbs and sugar and considered to have anti-diabetic properties.
This article explains why mushrooms are an excellent choice if you have diabetes.
Nutrition
There are many types of mushrooms, including the traditional button or white mushroom, shiitake, portobello, and oyster mushrooms to name a few.
Despite their varying appearance and taste, they all have similar nutritional profiles, which are characterized by low sugar and fat contents.
One cup (70 grams) of raw mushrooms provides the following (2Trusted Source):
Calories: 15
Carbs: 2 grams
Sugar: 1 gram
Protein: 2 grams
Fat: 0 grams
Vitamin B2, or riboflavin: 22% of the Daily Value (DV)
Vitamin B3, or niacin: 16% of the DV
Selenium: 12% of the DV
Phosphorus: 5% of the DV
Mushrooms are rich in selenium and certain B vitamins. B vitamins are a group of eight water-soluble vitamins that’s strongly linked to improved brain function. Meanwhile, selenium is a potent antioxidant that plays a key role in thyroid function (3Trusted Source, 4Trusted Source).
SUMMARY
Mushrooms are a low calorie, low carb food that can be enjoyed on a diabetes-friendly diet. They also provide high amounts of selenium and certain B vitamins.
Glycemic index and glycemic load of mushrooms
The glycemic index (GI) and glycemic load (GL) are two classification systems that help evaluate how carb-containing foods affect blood sugar.
Foods with a low GI will likely raise your blood sugar levels at a slower pace. In contrast, those with a high GI will cause them to spike.
Alternatively, foods can be categorized by their GL, which takes into account a food’s GI, as well as its carb content and serving size. It’s determined by multiplying the GI by the carb content of a specific serving size and dividing the result by 100 (9Trusted Source).
The GL system also classifies food into three categories (10Trusted Source):
low GL: 10 and under
medium GL: 11–19
high GL: 20 and above
Similarly, to GI, a low GL tells you that a portion of food only slightly affects your blood sugar levels, whereas a high GL indicates a more significant effect.
Although mushrooms are technically fungi, they are considered white vegetables — like onions and garlic — with a low GI of 10–15 and a GL of less than 1 per cup (70 grams), meaning that they won’t spike your blood sugar levels (11).
SUMMARY
Mushrooms are considered a low GI and low GL food, meaning that they won’t spike your blood sugar levels.
Research shows that consuming a diet rich in vegetables like mushrooms and other vitamin-rich foods may help protect against gestational diabetes, which affects approximately 14% of pregnancies worldwide and affects both the mother and child (12Trusted Source, 13Trusted Source, 14Trusted Source, 15Trusted Source).
Thanks to their high vitamin B content, mushrooms may also protect against decreased mental function and dementia in older adults with vitamin B deficiencies, as well as those with diabetes who take the drug metformin to control their blood sugar levels (16Trusted Source, 17Trusted Source).
In addition to B vitamins, the main bioactive compounds in mushrooms —polysaccharides — may have anti-diabetic properties.
Plus, the soluble fiber beta glucan — one of the types of polysaccharides found in mushrooms — slows digestion and delays the absorption of sugars, thus controlling your blood sugar levels after a meal (22Trusted Source, 23Trusted Source, 24Trusted Source).
That said, more research is needed to better understand how the B vitamins and polysaccharides in mushrooms may benefit people with diabetes.
SUMMARY
The B vitamins and polysaccharides in mushrooms may aid the management and prevention of diabetes and its complications. However, more human research is needed to confirm this.
Adding mushrooms to your diet
Given the wide variety of mushrooms, there are plenty of ways to add them to your diet, including eating them raw, grilled, roasted, sautéed, or in a sauce or soup.
If you’re looking for new and tasty ways to add them to your meals, try this low carb mushroom and cauliflower rice skillet.
For this recipe you need the following:
1.5 cups (105 grams) of mushrooms, sliced
1.5 cups (200 grams) of cauliflower rice
1 cup (30 grams) of spinach
1/4 cup (40 grams) of onion, chopped
1 tbsp of olive oil
1 celery stick, sliced
1 small garlic clove, minced
3 tbsp (45 ml) of vegetable broth
Salt, pepper, and soy sauce to taste
Place a large skillet over medium heat and add the olive oil. Add the onions and celery and cook for 5 minutes. Then add the garlic and cook for a few seconds.
Next, add the mushrooms and sauté until cooked. Then add the cauliflower rice and the rest of the ingredients — minus the spinach — and cook until soft. Lastly, add the spinach and season with salt and pepper before serving.
This recipe serves two and makes a great addition to your lunch or dinner.
SUMMARY
Mushrooms are a versatile and tasty ingredient and adding them to your meals allows you to take advantage of their benefits.
The bottom line
Mushrooms are safe to eat if you have diabetes, as their low GI and GL content won’t spike your blood sugar levels.
Also, their vitamin B and polysaccharide content may offer additional health benefits that are of relevance for people with diabetes, including improved blood sugar and cholesterol control.
Aside from their anti-diabetic properties, mushrooms can add flavor to your dishes without any extra carbs and calories
