Month: March 2020

March 31, 2020

The COVID-19 pandemic is a very worrisome time for everyone, especially those with additional health concerns. To support and inform the T1D community, JDRF Canada consulted a panel of Canadian endocrinologists (listed below) to provide answers to some of your most frequently asked questions.

First and foremost, the importance of good hygiene and social distancing in reducing the risk of infection or spreading infection to others cannot be stressed enough.   

Each person with T1D is different, and we would encourage you to discuss your needs with your healthcare team – the answers below should not be taken in place of medical advice. In addition, the situation with COVID-19 is changing rapidly, with new evidence emerging every day. This information is current as of March 25th, 2020.

Q: Are people with T1D at higher risk of being infected with the virus that causes COVID-19?

There is no evidence that people with T1D are at increased risk of being infected by SARS-CoV-2, the virus that causes COVID-19. Reports from other countries that have implied that people with diabetes may be at higher risk of coming down with COVID-19 might be explained by the fact that people with diabetes had more frequent interactions with other patients and healthcare providers early during the outbreak, when the importance of social distancing was not yet known.

Q: Why do people with diabetes have a worse prognosis when they get COVID-19?

Based on what is known about other viral infections, if a person with T1D comes down with COVID-19, the consequences might be more severe, particularly if they have other health concerns or complications from diabetes (such as heart disease, heart failure, kidney disease) and/or are above the age of 70. In addition, managing blood glucose during an infection is difficult and adds an additional layer of complexity to treatment. If someone with T1D is struggling with illness management when sick with COVID-19, they could be at increased risk of ketosis and diabetic ketoacidosis (DKA), of other (bacterial) infections if they have very high blood sugar, or of hypoglycemia.

A large proportion of people who have died from COVID-19 in China had diabetes – but most of these were likely people with type 2 diabetes, who are on average older than people with type 1 diabetes. It is also not yet clear whether diabetes itself causes worse outcomes, or whether worse outcomes are seen because people with diabetes often have other medical conditions (such as heart or kidney disease) that increase risk. Research in progress will hopefully provide more information on these uncertainties soon. As with any disease, each individual is different, and we encourage you to consult your healthcare team to discuss your risks.

Q: Do people with T1D need to take extra precautions to avoid getting COVID-19, above and beyond those recommended for the general population?

Social distancing is crucial at this time to protect yourself and others from exposure. We all have a part to play in minimizing the impact of the COVID-19 outbreak in Canada, and each of us can set a good example: stay home as much as possible, use virtual options for work or socializing, ask a delivery service or a friend to bring groceries, and keep 2 m away from others if you must go out. For clinic visits, please check with your healthcare team about options for video or phone visits, and delay routine lab work unless there is a clear and urgent need.

If you struggle with your glucose control and have a complication such as heart or kidney disease, or if you are older (~60 years or older), we would encourage you to consider taking all steps possible to minimize potential exposure. If you have high HbA1c (>9%), you may also wish to monitor blood sugar closely and work with your healthcare team (by phone or video) to safely reduce this over the coming weeks when COVID-19 may remain a problem, as lowering your HbA1c could mean a lesser impact of COVID-19 if you do become sick.

Q: My child has T1D – is he or she at high risk compared with a child who does not have T1D?

In general, children who become sick with COVID-19 have mild disease. There is still no published evidence about COVID-19 in children with T1D, but anecdotal evidence from Europe suggests that children with T1D who become ill usually have mild disease and that many children can be managed safely at home with appropriate management of illness.

However, children and youth are not immune to serious illness and in this situation it is important to prevent possible DKA (a serious and life-threatening condition), severe hypoglycemia, and dehydration. During times of illness, it is important to monitor blood glucose and ketones as indicated, follow guidelines as well as connect with your local diabetes team as needed. We recommend ensuring that ketone testing supplies (urine and/or blood strips) have not expired, and being ready to give extra rapid-acting insulin, if required, if your child has elevated glucose and ketones  ̶ as often as every 3-4 hours if indicated. Following illness management guidelines through your diabetes clinic is recommended. For example, here is a useful link to information on illness management from Ontario’s Provincial Council for Maternal and Child Health. Additional details in English and French can be also accessed here.

Q: Is our insulin supply in Canada under threat? How about diabetes supplies or devices?

Thus far, we are aware of no disruptions to the supply chain for medications including insulin, or for diabetes devices. For a list of notices from specific manufacturers, please visit www.jdrf.ca/t1d-and-covid-19/. However, the availability of some medicines (including insulin) in individual pharmacies is being affected as many consumers have been requesting more medicines than usual. We are continuing to monitor the situation and provide information and support. If you cannot obtain insulin, we encourage you to reach out directly to your insulin manufacturer’s customer care team.

Q: I’ve heard that certain blood pressure-lowering medications (ACEis and/or ARBs) might increase my risk of coming down with COVID-19. Is it safe to keep taking these medications?

There is no good evidence to tell us that these drugs worsen the risk of getting COVID-19 or the consequences once infected (see a statement from Hypertension Canada from March 13^th, 2020 here). If your doctor started one of these drugs to protect your heart or kidneys you should keep taking it, unless you have diarrhea, vomiting, or are dehydrated, in which case consult your healthcare team for advice.

Q: How about ibuprofen?

Despite some suggestions in the media that ibuprofen should be avoided with COVID-19, as of yet there is no evidence to suggest it is unsafe, although some health authorities (such as the NHS in the UK) are recommending acetaminophen as a first choice to treat a fever with suspected COVID-19. However, for anyone that takes ibuprofen for other conditions (such as arthritis), there is no need to stop at this time. Patients with advanced kidney damage should be cautious about using ibuprofen in general and this situation also applies to the current situation. Some CGM sensors (including Dexcom G4 and G5, Medtronic Enlite, and possibly others) are affected by acetaminophen and cause the sensor to show a higher reading than the true blood glucose level over the 3-4 hours after taking a typical dose. Thus, if you use one of these sensors and suspect you may have COVID-19, we encourage you to use a back-up glucose monitoring method (fingersticks) if taking acetaminophen.

Q: How can I support my family in learning about and preparing for COVID-19?

Families must find appropriate ways to speak to their children about the pandemic and teach or reinforce important health behaviours that lower risk of exposure. Each family must find their own solutions to adapt to restrictions such as social distancing or quarantine. A helpful resource can be found here.

Q: Should I avoid attending in-person medical appointments right now?

It’s best to contact your local healthcare team for advice. Many clinics are offering appointments by phone or video call to minimize the risk of contracting COVID-19, as well as delaying routine lab work. Rest assured, if there is an urgency to be seen, your teams will be able to see you. It is just not wise to have large groups of people congregating at health care facilities right now.

For additional information on preventing COVID-19, being prepared, and what to do if you think you might have symptoms of COVID-19, please visit jdrf.ca/coronavirus.

We sincerely thank Dr. Farid Mahmud (Associate Professor, Pediatrics, Endocrinology, Hospital for Sick Children), Dr. Remi Rabasa-Lhoret (Professor of Medicine and Nutrition at the L’Institut de recherches cliniques de Montréal (IRCM) and Le Centre hospitalier de l’université de Montréal (CHUM)), Dr. Bruce Perkins (Professor of Medicine, Endocrinology, University of Toronto), and Dr. Peter Senior (Professor of Medicine, Division of Endocrinology, University of Alberta) for offering insights.

March 26, 2020

 

Dear JDRF family,

Over the last few weeks, I have been blown away by the strength, resilience and generosity demonstrated by you, our JDRF family. I am reminded of how privileged we are to have your continued support. Thank you for everything you do.

Because of you, JDRF is providing people living with type 1 diabetes (T1D) resources and support to navigate these challenging times. Here’s what has been done so far:

• We have set up an information page about T1D and COVID-19, as well as a mechanism to answer your questions via email.
• We are hosting regular online events so you can ask experts your questions about T1D and COVID-19. Check out our Facebook Live with one of our researchers, endocrinologist Dr. Rémi Rabasa-Lhoret.
• We are working with industry partners to ensure people with T1D can continue to get the diabetes supplies they need.
• We have created a panel of medical experts from coast-to-coast to consult on the virus and T1D.

While we all do our part to stop the spread of COVID-19, the day-to-day challenges of living with T1D remain. Our commitment to better health and quality of life for people living with T1D is stronger than ever and, with your help, we will continue to champion the short and long term needs of people living with T1D and their families.

In a time when social distancing is required, it is more important than ever to feel connected. We are working to find the best ways to remain engaged with you during this exceptional time. We are here for you and thinking of you.

Please stay safe,

Dave Prowten
President & CEO
JDRF Canada

March 24, 2020

Sponsored Content by Ei Lilly Canada 

Eli Lilly Canada is pleased to announce the approval and availability of Baqsimi^TM, a new rescue treatment for severe hypoglycemia, demonstrating Lilly’s commitment to simplifying the management of severe hypoglycemia through medicines and patient solutions. The formulation was invented in Canada and is changing the lives of people with diabetes around the world. Baqsimi (glucagon nasal powder 3 mg) was approved by Health Canada with ethical status, making it available at the pharmacy with or without a prescription. Baqsimi is indicated for the treatment of severe hypoglycemic reactions when impaired consciousness precludes oral carbohydrates, which may occur in the management of insulin-treated patients with diabetes mellitus, whether type 1 or type 2.ⁱ Baqsimi is a compact nasal spray that is portable and does not require reconstitution. It is indicated in children 4 years and above and is now widely available in pharmacies across Canada.

For Canadians who have diabetes and who are treated with insulin, the fear of going ‘low’ (hypoglycemia) never goes away. When an individual has a severe low (severe hypoglycemia), they are unable to treat themselves, and they need help from someone else to recover. For people with type 1 or type 2 diabetes who are on medications like insulin, there can be many causes of severe hypoglycemia. These include not eating enough, over-exercising, drinking alcohol, or even using diabetes medications incorrectly.ii

“The daily worry of a ‘severe low’ and the complexity of using injectable glucagon creates an emotional toll for both the person living with diabetes and their caregivers,” says Dave Prowten, President and CEO at JDRF Canada. “Having a new rescue option that is easy to administer with a single nasal puff by a caregiver will alleviate a significant burden, and it has the potential to save lives.”

Baqsimi is a ready-to-use form of glucagon, which requires no reconstitution or priming. It is administered in a single fixed dose that is sprayed in the nose, where it is passively absorbed. Baqsimi does not need to be refrigerated and can be stored at temperatures up to 30°C/86°F in its shrink-wrapped tube.

For more information about Baqsimi and how you can be prepared for an unexpected severe hypoglycemic event, please visit, www.baqsimi.ca.

REFERENCES

March 5, 2020

Type 1 diabetes (T1D) is an autoimmune disorder that is often difficult to manage. Despite recent advances in innovative medical devices and educational tools, many people with T1D often experience blood sugar swings that can put them at risk of complications including hypoglycemia and hyperglycemia. Adding adjunct therapy to existing insulin treatment regimens could soon change that.

The artificial pancreas (also known as a closed-loop) is a promising technology consisting of a system of devices that closely mimics the glucose-regulating function of a healthy pancreas. It comprises a continuous glucose monitor (CGM), an insulin pump, and a computer algorithm that enables these devices to communicate and automate insulin delivery according to a person’s needs in real time. The artificial pancreas systems that are currently available automate basal insulin, and still require the user to give manual boluses via their insulin pump, but research working to develop a fully automated system. One approach towards a fully automated system is incorporating additional hormones or drugs.

Drs. Ahmad Haidar, Laurent Legault, Michael Tsoukas and Jean-Franҫois Yale are a team of JDRF-funded researchers at McGill University (Montreal) who are the first to test the addition of pramlintide (a synthetic form of amylin, which is a hormone co-secreted with insulin by the healthy pancreas) to an artificial pancreas system – a combined treatment they hypothesize would help patients achieve optimal glucose control during the day. Previous studies have shown that pramlintide prevents blood sugar spikes following a meal through affecting digestion and the release of other hormones. Pramlintide – which is already approved and available in the USA – can be taken by injection, but is rarely used. In this study, the researchers set out to test the effects of pramlintide when delivered together with insulin in an artificial pancreas system.

Blood sugar levels in people wearing an artificial pancreas (AP) with insulin alone vs an AP with insulin + pramlintide.

Starting blood sugars were 5-10 mmol/L. Adapted from Haidar et al, Diabetes Care 2020; 43: 597-606.

To test their hypothesis, the researchers conducted a clinical trial in adults with T1D who wore artificial pancreas systems with or without pramlintide during inpatient visits at the Research Institute of McGill University Health Centre. The results of the trial showed that adding pramlintide to rapid-acting insulin in an artificial pancreas system improved glucose control compared to rapid-acting insulin alone, without increasing hypoglycemia. In the next stage of their research, Dr. Haidar and his team are conducting another clinical trial to test whether the insulin-plus-pramlintide artificial pancreas system can eliminate the need for carb-counting in adolescents and adults with T1D.

This exciting research into insulin adjunct therapy brings us closer to less burdensome management of T1D and a better quality of life.

March 4, 2020

On March 11, 2020, advocates living with type 1 diabetes (T1D) will share with Manitoba Members of the Legislative Assembly their experience living with T1D and the importance of extending insulin pump coverage to people of all ages. Currently, in Manitoba, to qualify under the current insulin pump program, you must be under the age of 18.

Our Manitoba Lobby Day has been fundamental in securing government funding for T1D research and raising awareness. The delegates raise their voices as advocates, representing the millions of people living with T1D, and are empowered to continue to use their voice to make change. 

We’re so happy to share our 8 finalists with you – meet our 2020 Manitoba Lobby Day Delegates!

Click to view video submission	Tyler Polonuk Age: 17 From: East Saint Paul, MB
	Ashlynn Argo​ Age: 16 From: Sunnyside, MB
Click to view video submission	Julia Hird Age: 19 From: Winnipeg, MB
	Ellen Karr Age: 71 From: Winnipeg, MB
Click here to view video submission	Leah Wiebe Age: 54 From: Steinbach, MB
	Jenna Basson Age: 34 From: The Pas, MB
	Spencer Christie Age: 19 From: Winnipeg, MB
Click here to view video submission	Noah Silvaggio Age: 17 From: Winnipeg, MB

Take part in our lobby days by signing up to become a JDRF Advocate. Your voice will help advocate for T1D research and raise awareness about the T1D community.

For more information about JDRF 2020 Manitoba Lobby Day visit jdrf.ca/advocacy

March 3, 2020

*Note: as of March 3, JDRF Canada welcomes the release of the Standing Committee on Finance’s report and its recommendations to address the diabetes epidemic. Read the press release here*

JDRF President and CEO Dave Prowten testified recently in front of the Standing Committee on Finance as part of their 2020 Pre-Budget Consultations. Also appearing on JDRF’s behalf was Angie Sullivan, parent of a child with type 1 diabetes (T1D).

The pair delivered a powerful and compelling testimony in support of our 2020 budget recommendations as well as a new CIHR proposal from the Canadian Institutes of Health Research (CIHR) to celebrate the 2021 anniversary of the discovery of insulin by creating a $100 million diabetes research fund.

Check out their testimonies below!

March 4, 2020

She was the youngest person in the room, and her presentation was met with resounding applause from the entire audience. Fourteen-year old Anne Pettigrew made an impressive and compelling presentation at last month’s Ontario pre-budget consultations in Scarborough.

Anne presented JDRF’s #AccessforAll recommendation to the Minister of Finance Rod Philips,  Minister for Seniors and Accessibility Raymond Cho, and local Member of Provincial Parliament Aris Babikian by telling her story of how the continuous glucose monitor (CGM) has saved her life on more than one occasion. 

“My family is able to make sacrifices to choose to afford this [device] for me. But not everybody has that luxury. Type 1’s who cannot make the sacrifices still need the technology, still need health security and still deserve life. And CGM’s save lives.”

What is the pre-budget submission process and why is it important?

Ahead of the Budget cycle each year, Ontarians are invited to submit their thoughts, ideas, and recommendations to inform the provincial budget. The government provides several opportunities where individuals, businesses, and organizations can engage in this process. Written submissions, oral presentations, survey responses, and general comments are accepted in late Fallearly Winter, before the official Budget is released in the Spring. This is an important opportunity to tell the government directly about what matters most to the over 96,000 people who live with T1D in the province.

Recognizing this as an opportunity to have our collective voice heard, JDRF also submitted a written recommendation to ensure our request is considered.

Anne’s remarks not only indicated the importance of how advanced glucose monitors help people live better, but how this investment makes financial sense for the government as well. Severe hypoglycemia alone costs our Ontario health care system more than $5 million annually, adding to the hallway health care problem. Funding these technologies addresses an unmet medical need and is crucial to ending hallway medicine by reducing the economic burden that diabetes imposes on our healthcare system.

Anne’s full presentation below.

Now it’s your turn. Tell your representative how provincial funding for CGM and FGM devices will help people with type 1 diabetes live healthier, easier, safer lives. Click here to send them a message now – and join the movement.