‘HIV and Diabetes’ on December’s Diabetes Late Nite podcast

We’re excited to announce our December edition of Diabetes Late Nite. Sara (Dr. Mandy) Wilson Reece, PharmD, CDE, BC-ADM is Vice-Chair and Associate Professor in the Department of Pharmacy Practice and will stop by the studio to talk about HIV and Diabetes while Kelly Clarkson provides musical inspiration.  Join us here on Tuesday, December 4, 2018  from 6 – 7:30 PM.

Wrapped In RedKelly Clarkson’s holiday album, inspires us to talk about all things ‘red’ such as the iconic red ribbon worn as a symbol for the solidarity of people living with HIV/AIDS. People with HIV are more likely to have type 2 diabetes than people without HIV and some HIV medicines may increase blood glucose levels and lead to type 2 diabetes.
World AIDS Day is December 1, a fitting occasion to speak with Dr. Mandy about the link between HIV medications and diabetes prior to our podcast interview.  

Q: I’ve read that some HIV medicines may increase blood glucose levels and lead to type 2 diabetes. Can you explain why could happen? 

Dr. Mandy Reece: Some HIV medication cause insulin resistance with insulin deficiency which increases risk for Type 2 diabetes. Specifically, nucleoside reverse transcriptase inhibitors (NRTIs) (zidovudine, stavudine and didanosine) and protease inhibitors (indinavir and lopinavir/ritonavir) increase risk for Type 2 diabetes.

Q: Do you feel people taking HIV medicines should check their blood glucose? If so, what do you recommend? 

Dr. Mandy Reece: Yes, they should check their blood glucose before they start their medication and then every few months as recommended by the U.S. Department of Health.

According to U.S. Department of Health and Human Services, it is recommended to have either fasting blood glucose or hemoglobin A1c when entering into care for HIV, initiating or modifying antiretrovial therapy and annually if glucose or A1c were in target range at least measurement. Target range is < 5.7% for hemoglobin A1c and <126 mg/dL fasting blood glucose.  It is advised to have fasting blood glucose or hemoglobin A1c tested every 3 – 6 months if above target range at last measure. 

(Guidelines for Use of Antiretrovial Agents in Adults and Adolescents Living with HIV. U.S. Department of Health and Human Services. https://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv/3/tests-for-initial-assessment-and-follow-up. Updated October 25, 2019. Accessed November 18, 2018.

Q:Dealing with two or more chronic conditions could be complicated and time consuming. What medication organizing tips can you recommend to help make life more manageable?  

Dr. Mandy Reece: Personally, my favorite tool for organizing medications is a pill box where medication is stored by day and time of day.  It is easy to identify visually if medication has been taken.  Many pharmacies have medical refill reminder calls which work wonderfully if you get all of your medications from the same pharmacy. Pharmacies can utilize a medication synchronization system which allows for your getting all refills at same time.  Additionally, there various apps such as Round Health, Medisafe -Pill & Med Reminder and Pill Reminder – All in One would provide digital reminder system.  Services such as PillPack sorts and organizes medication by dose and timing each dose with monthly delivery. 

Q: With the holidays quickly approaching what advice can you give to people about managing their medications during this busy time of year? 

Dr. Mandy Reece: Taking time to get organized is absolutely key.  An easy way to get organized is to using a pill box or service such PillPack to organize your medications, and utilizing reminder system to follow through on taking medications.  Ensure that you have at least a 10 day supply of medication on hand at all times is essential.  Remember keeping your health a priority hence taking your medication during this busy season is key as it has lasting effects that you will not see or feel in the moment.

Q: Holiday travel can lead to long delays and/or missing luggage. What advice can you give to traveler’s 

Dr. Mandy Reece: Always pack all of your medications in your carry bag rather than checked luggage.  It is absolutely vital to have your medication available at all times. 

Sara (Dr. Mandy) Wilson Reece, PharmD, CDE, CDE, BC-ADM, vice-chair and associate professor in the Department of Pharmacy Practice. ‘Dr. Mandy’ shares practical information about medications for people living with diabetes on her blog, Reece’s Pieces. Follow her on Twitter @ReecesPiecesDi and Instagram ReecesPiecesDI

Don’t miss December’s Diabetes Late Nite podcast featuring music from Kelly Clarkson’s Wrapped In Red album courtesy of SONY Music on Tuesday, December 4, 2018, 6 PM, EST.

Kelly Clarkson’s inspiring us to lend our ‘voice’ to  topics such as the link between HIV medications and type 2 diabetes, how the homeless manage diabetes, great gift ideas for loved ones with diabetes, and how you can lose weight during holidays (!). Plus, one lucky listener tries their luck during Mr. Divabetic’s Wrapped In Red’ Health Game challenge. Guests include Poet Lorraine Brooks, Kathy Gold  RN, MSN, CDE, FAADE, Glucose Delivery Necklace co-creator Kris Maynard, Dr. Sara (Mandy) Reece, PharmD, CDE, BC=ADM, BCACP, FAADE, Maria Sakowitz, MS, RDN, LDN, CLT, Mama Rose Marie and the Charlie’s Angels of Outreach.

Diabetes Late Nite is a fast-paced, full-filled hour of diabetes education and wellness advice that encourages listeners to “laugh a little, learn a  lot.”

‘Homeless With Diabetes’ On December’s Diabetes Late Nite podcast

We’re excited to announce our December edition of Diabetes Late Nite. Kathleen Gold, RN, MSN, CDE, will stop by the studio to share her experience working with homeless people and Kelly Clarkson will provide musical inspiration from her holiday album, Wrapped in Red.  Join us here on Tuesday, December 4, 2018  from 6 – 7:30 PM.

One of the Diabetes Late Nite featured songs this month is Kelly Clarkson’s “I’ll be Home for Christmas.” This is a poignant inspiration song to gain perspective from Kathy prior to our podcast interview on the biggest obstacles homeless people face who are living with diabetes.

As a diabetes advocate for over 20 years at Unity Health Care Clinic at the Community for Creative Nonviolence, a shelter in Washington, D.C., Kathy helped homeless people check blood glucose logs, made referrals to specialists, and discussed ways to best manage their health. “What I try to do is spend as much time with them as they need,” Gold said in an interview for Diabetes Forecast. “We touch on other issues, not just diabetes: food, food stamps, depression. … They really are very motivated, and they try to make good choices.”

Q: I would think that for homeless people with diabetes the stress of living with so much uncertainty every day must play a big factor in managing their diabetes. What do you advise?

Kathy Gold RN, MSN, CDE: Yes, this is a major problem. They frequently don’t know when or if they will get their next meal or where they may be sleeping that night. I first try to address their living situation. Locating a shelter and a place to receive meals on a consistent basis is the main priority. Until these needs are met you can’t address their diabetes or their healthcare needs.

Q: What type of meal planning advice do you give to homeless people with diabetes who are relying on food stamps, the kindness of others, and prepackaged foods to carry them through the day?

Kathy Gold RN, MSN, CDE: I connect them with various food kitchens and food banks, so they know where to access food. Also, we discuss options for how to spend their food stamp dollars wisely. I help them create a shopping list of non-perishable items they could always have available. We also discuss portion control. I encourage them always to choose vegetables, whole grains and fruit if available. In DC the primary food bank offers a “diabetes meal” which provided an extra serving of vegetables.

Q: How do you advise homeless people with diabetes to create and/or adhere to a daily diabetes management routine if they don’t have a set schedule? 

Kathy Gold RN, MSN, CDE: This is a big struggle as the timing of meals is such a difficult thing to predict. It is important to use medications cautiously if the individual does not have access to meals at a predictable time. Oatmeal is always a lifesaver because all they need is a cup of hot water and they have instant nourishment. Educating the homeless about how and when their medications work to avoid a low blood sugar reaction is very important and ties in with the appropriate use of food stamps. The newer insulins make a huge difference in controlling blood glucose levels as they can be taken with meals. It is much more difficult if individuals are forced to use the older insulins where there is little flexibility.

Q: What kind of medical services and supplies are available to homeless people with diabetes?

Kathy Gold RN, MSN, CDE: A lot depends on where they live and if and how they are covered under Medicaid. Not all Medicaid plans cover the newer medications. In DC we are fortunate that all patients could have a meter and strips to test their blood glucose and our medication formulary was quite extensive. This is not the case in all states. Education is key. I found that if patients were educated, their expenses dropped, and the risk of complications greatly decreased. At the Homeless Shelter we saw significant savings and complication reductions but not everyone has access and that’s sad.

Q: Do you feel homeless people with diabetes are more likely to develop health-related complications? If so, can you share some insight into the types of health complications homeless people with diabetes are more likely to develop.

Kathy Gold RN, MSN, CDE: Many homeless individuals have a history of alcohol or drug abuse which places them at risk of many health issues besides diabetes. Kidney disease is a major complication, since many individuals also suffer from hypertension. Mental illness is widespread, and it is difficult to manage these individuals because they frequently don’t take their medications. Diabetic neuropathy, depression and feeling overwhelmed are very prevalent in this population. Hypoglycemia is also a frequent complication because of their inability to eat on time, which can cause them to be unresponsive, confused and/or disoriented. Severe hyperglycemia, if they stop taking their medications, can lead to ketoacidosis or a very elevated blood glucose level. It is necessary to deal with these health issues first, so they can manage their diabetes.

I found that people who overcame with addictions were very successful in managing their diabetes because they had the tools to make behavior change.

Q: I have read that homeless people with diabetes may sell their supplies in order to afford basic living needs. What’s your experience? 

Kathy Gold RN, MSN, CDE: There is a black market for strips and meters. In DC these supplies were provided, so we didn’t see as much of it. But there were some people who constantly “lost” their meters and they may have been selling them. People get desperate.

Q: How can our Diabetes Late Nite listeners help?

Kathy Gold RN, MSN, CDE: If you donate food, please stick to healthy foods such as vegetables and fresh fruit. Volunteer at a homeless shelter and prepare healthy meals. Whole grain cereals, oatmeal, peanut butter for protein and nuts for a good snack are good options. Avoid sugared cereals, processed foods that are high in salt, sugar, and fat.  Arrange with local restaurants or farmers markets to donate their foods to a homeless shelter. Offer to teach a simple cooking class at a food bank or a shelter. Donate brown rice instead of white rice and include some recipes that use foods you donated. Donate to the National Health Care for the Homeless Council https://www.nhchc.org/

Don’t miss December’s Diabetes Late Nite podcast featuring music from Kelly Clarkson’s Wrapped In Red album courtesy of SONY Music on Tuesday, December 4, 2018, 6 PM, EST.

Kelly Clarkson’s inspiring us to lend our ‘voice’ to  topics such as the link between HIV medications and type 2 diabetes, how the homeless manage diabetes, great gift ideas for loved ones with diabetes, and how you can lose weight during holidays (!). Plus, one lucky listener tries their luck during Mr. Divabetic’s ‘Wrapped In Red’ Health Game challenge. Guests include Poet Lorraine Brooks, Kathy Gold  RN, MSN, CDE, FAADE, Glucose Delivery Necklace co-creator Kris Maynard, Dr. Sara (Mandy) Reece, PharmD, CDE, BC=ADM, BCACP, FAADE, Maria Sakowitz, MS, RDN, LDN, CLT, Mama Rose Marie and the Charlie’s Angels of Outreach.

Diabetes Late Nite is a fast-paced, full-filled hour of diabetes education and wellness advice that encourages listeners to “laugh a little, learn a  lot.”