GIRL SCOUT TROOP 66586 HAVE MADE THE BDC PEDS CLINIC THEIR “HOMETOWN HEROES.”

During "Cookie Season" every Colorado Girl Scout troop chooses a "Hometown Hero"- a local organization they wish to show appreciation for in the form of cookies. This year the girls in Broomfield troop 66586 chose the Barbara Davis Center, where two of their troopmates receive care, as their HTH. Jasmine and Evelyn are patients at the Barbara Davis Center and have shared parts of their diabetes stories with the troop. The girls delivered donated cookies to BDC on behalf of themselves and their troopmates.

The 15th edition of the Center’s book Understanding Diabetes became available in December, 2022 (available at Gaven@ChildrensDiabetesFoundation.org or childrensdiabetesfoundation.org). New editions are required every three to five years because changes in care are advancing so rapidly. Some of the changes in the new edition are outlined below:

Revisions in Sick-Day Management (Chapter 16) include new suggestions for changes in insulin dosages related to blood/CGM sugar levels, ketones and food intake when sick (see Table 4). Help is also provided in relation to when to call the diabetes care-provider. The section on the management of vomiting has been enlarged (see Table 5).

Continuous Glucose Monitors (CGM) have been updated in Chapter 29. The FreeStyle Libre3 and the Dexcom G7 systems were made available in 2022 and provide up to 14 days of continuous glucose readings. These systems have been approved by the FDA for insulin dosing so that finger stick blood sugars are not needed. The new CGM metrics include “Time in Range” (TIR) and “Time Above Range” (TAR) which are now being used in clinical management (see Table 4). More than two-thirds of our clinic patients now use CGMs, so this has been a major change in clinical management.

The Artificial Pancreas (AP) systems are again updated in Chapter 30. The Tandem t:slim X2 insulin pump with Control-IQ Technology and the Omnipod 5 Automated Delivery Systems have both been shown to reduce the time spent in hypoglycemia and to increase the time spent “in-range” Both systems use the Dexcom CGM (the Omnipod only with a compatible phone). The MiniMed 780G system is included in the chapter as it is expected to be available in 2023.

Type 2 Diabetes (T2D) information has been updated in Chapter 4 with new goals for blood sugar and HbA1c levels. The many new medications for the treatment of T2D are now included in Table 2 (page 41). The SGLT-2 inhibitors are particularly important as they may help to prevent or reverse early kidney damage from diabetes.

The Behavioral/Emotions chapters all have new suggestions. For example, Chapter 20 on teenagers now suggests using a “code-word” for the teen to use when they need the parent to give them space to handle things (page 218). Chapter 17 on Family and Behavioral Concerns has a new section promoting a positive attitude about diabetes (page 193). Chapter 10 on Initial Feelings and Emotions at Diabetes Onset has expanded sections such as about the feeling of grief when a person is newly diagnosed (page 102).

Treatment of Hypoglycemia with the use of Intranasal Glucagon (Baqsimi®) is discussed in Chapter 6. Its use may be particularly important when people are not available who are skilled at giving injectable glucagon (e.g., at many schools). It works just as fast as the injectable glucagon and requires only one step for administration, the depression of the plunger.

Chapter 13 on Exercise has a newly developed Table 3 to help choose supplemental foods to prevent high or low blood/CGM sugar levels with aerobic or anaerobic exercise. Figure 4 in this chapter is also new and suggests insulin and carb-intake changes when using either an insulin pump or with injections. Once again, youth are recommended to have at least 60 minutes of exercise daily and adults should have at least 150 minutes of moderate to vigorous intensity aerobic activity weekly

Chapter 11 on Normal Nutrition suggests limiting carbs to 40-45 percent of daily calories rather than the previous 45 to 50 percent. Protein intake is proportionally increased. Weight management is now discussed in Chapter 11 (page 114), Chapter 12 (page 134) and in Chapter 4 (page 34). As increased weight adds to insulin-resistance, there strategies are important for people with type 1 or type 2 diabetes.

The Latest Versions of Insulin and Available Forms are presented in a new Table 4 in Chapter 9. Likewise, the new more rapid-acting forms of Humalog and Novolog, Apidra and Fiasp, are included for the first time in Table 1 of Chapter 8. The basal insulins are now divided between long-acting and ultra-long-acting.

The Three Stages of Type 1 Diabetes are included for the first time. The new Figure 1 in Chapter 3 defines the three stages of beta cell loss. This is particularly important as a medicine (Teplizumab) has now been approved for treatment of stage 2 to try to delay the onset of type 1 diabetes. The new Figure 2 in this chapter shows the expected changes in CGM glucose levels for the three stages.

The “Core Content Areas” listed at the start of each of the chapters have been completely updated to follow the more “user-friendly” education guidelines from the American Diabetes Association (ADA). These “Core Content Areas” give the main topics covered in each chapter and ensure that this book can be used as a comprehensive diabetes curriculum for diabetes centers throughout the U.S. (including our Center). A clearly defined curriculum is an important aspect of ADA accreditation for diabetes centers and is also often required by health insurance companies to ensure quality of care.

This book is approximately three-times the length of the companion book, A First Book for Understanding Diabetes. It is intended for people of all ages who want to have a more in-depth understanding of the topics. In contrast, the “First Book” is often used initially A combined total of the English and Spanish editions of the “First Book” went to over 40,000 families in 2022. It is available in five languages, while Understanding Diabetes is only available in English.

Children’s Diabetes Advisory Board Members and Guild Presidents

THE GUILD PRESIDENTS:

Founding President, Amy Davis

Mrs. Gina Abou-Jaoude

Mrs. Christy Alberts

Mrs. Jamie Angelich

Mrs. Karen Aylsworth

Mrs. Linda Broughton

Mrs. Tangy Buchanan

Mrs. Joy Burns

Dr. Bonita Carson

Mrs. Lisa Corley

Mrs. Nancy Cowee

Mrs. Dalyla Creaghe

Mrs. Norma D’Amico

Ms. Donna Douglas

Mrs. Margy Epke

Mrs. Lori Finch

Mrs. Chris Foster

Mrs. Helenn Franzgrote

Mrs. Sally Frerichs

Mrs. Debbie Gradishar

Mrs. Katie Grassby

Mrs. Helen Hanks

Mrs. Georgia Imhoff

Mrs. Marty Jensen

Mrs. Gail Johnson

Mrs. Sharon Kamen

Mrs. Janet Knisely

Mrs. Cheryl Lebsock

Mrs. Suzy Love vMrs. Shelley Lucas

Mrs. Judy McNeil

Mrs. Sally Newcomb

Mrs. Barb Oberfeld

Mrs. Gretchen Pope

Mrs. Carol Roger

Mrs. Kay Stewart

Mrs. Diane Sweat

Ms. Charlotte Tucker

Mrs. Loretta Tucker

Mrs. Melissa Tucker

Mrs. Jane Weingarten

ADVISORY BOARD:

Sir Michael Caine

Mrs. Lisa Corley

Mr. and Mrs. Robert A. Daly

The Honorable Diana DeGette, U.S. House of Representatives, Colorado

Mr. Neil Diamond

Mr. Placido Domingo

Mr. John Elway

Mr. David Foster

Mr. Kenny G

Mr. David Geffen

Mr. Magic Johnson

Mr. Quincy Jones

Ms. Sherry Lansing

Mr. Jay Leno

Mr. Lionel Richie

Mrs. Adrienne Ruston Fitzgibbons

Mr. George Schlatter

Ms. Maria Shriver

Ms. Brenda Richie

Ms. Barbera Thornhill

Miss Joan van Ark

Mrs. Cindy Wells

Mr. Gary L. Wilson

Mr. Stevie Wonder

See complete list at ChildrensDiabetesFoundation.org