CGMs Lead to Cost Savings

For people with type 1 diabetes, access to Continuous Glucose Monitoring (CGM) technology, is considered a standard of care by most experts.

There is plenty of research that demonstrates CGM use is associated with not only improved A1c but significantly decreases time in hypoglycemic range and ketoacidosis rates.

Researchers wondered if this translates into cost savings?

YES.
According to a study presented at the Heart in Diabetes virtual meeting.

After three years of follow-up, the savings were substantial.

  • Multiple daily injection plus CGM users saved between $5,777 and $8,549.
  • CGM users with continuous subcutaneous insulin infusion saved between $2,732 and $4,753 per person, compared with non-CGM users.

“In this study, we showed that it didn’t make any difference how you deliver insulin,” Grunberger said. “This difference is in how you monitor glucose.”

George Grunberger, MD, FACP, MACE, Chairman Grunberger Diabetes Institute and more

Glucose Crises are Expensive

According to Grunberger, the cost of diabetes ketoacidosis (DKA) in the U.S. is over 5 billion dollars a year.

Having a CGM reduces DKA rates, hospitalization, and leads to cost savings.

A study in the United Kingdom showed that for 900 people using the Freestyle Libre (Abbott), DKA episodes were reduced by 80% within six months of using this device.

A study in Belgium followed 1,913 people with type 1 diabetes using the Freestyle Libre CGM.

Not only did they see a dramatic reduction in hospitalizations from DKA and hypoglycemia, but the researchers also observed a fifty percent drop in work absenteeism.

The data shows CGM’s are associated with cost savings due to less diabetes emergencies and decreased work absenteeism.

Full Story: Healio (free registration)/Endocrine Today (8/31) 


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AccreditationDiabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*  

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.

Glucagon Rescue Meds Options

What is Glucagon and How Does it Work?

Glucagon is a counter-regulatory hormone secreted by the pancreas when blood sugars are dipping or during periods of emotional or physical stress. This hormone liberates stored glycogen from the liver, causing an upward surge in circulating glucose.

When people become hypoglycemic, there is not enough circulating glucagon available to drive more glucose release. Glucagon rescue medications increase glucagon levels enough to stimulate further glucose release from glycogen stores in the body.

While administering glucagon is life saving, it also depletes the body of its glycogen reserves and can lead to further hypoglycemia if it is not replaced quickly. It is so important to replace glycogen stores by consuming carbohydrates as soon as it is safe.


3 Different Glucagon Rescue Options

When someone with diabetes is experiencing severe hypoglycemia and needs the assistance of another person, there are now 3 Glucagon options to choose from.

Here are some highlights of the currently available Glucagon Rescue Medications. Below, is our new Glucagon PocketCard that helps to compare and contrast the delivery system, dosing, age range, route and storage all in one card.

Nasal Glucagon – Baqsimi (Back-see-me)

Baqsimi is a nasal glucagon powder to treat severe hypoglycemia in people with diabetes ages four and older. This non-injectable form of glucagon is available as one pack or 2 pack.

It is approved for pediatrics over the age of four with type 1 diabetes and adults.

Baqsimi does not need to be inhaled, which means it can be effectively administered to a person who is unconscious due to severe hypoglycemia.

*Eligible commercially insured people with diabetes can pay $25 for up to two BAQSIMI devices (1 two-pack or 2 one-packs) with a savings card. This prescription is generally filled on an annual basis. For more info visit www.BAQSIMI.com or call The Lilly Answers Center at 1-800-LillyRx (1-800-545-5979).


Gvoke Pre-Filled Pen or HypoPen Auto-Injector

Xeris Pharmaceuticals offers a pre-filled liquid stable form of glucagon that is approved for use in people with diabetes, age 2 and older. They also have an HypoPen Auto-Injector.

The Xeris glucagon pen was created to simplify glucagon injections. This new Gvoke pen does not require any mixing since it is filled with liquid stable glucagon.

Gvoke Pre-Filled Syringe and HypoPen 2-PackTM is also available. Health care professionals can request a Gvoke HypoPen demo device by completing this request form or contacting your local sales representative. Read more about the Gvoke Glucagon Pen and auto-injector here.

Eligible commercially insured people with diabetes can pay as little at $0 by completing the Gvoke Copay Card* form. Visit this page to sign-up.


Glucagon Emergency Kit | Powder + diluent

Glucagon Emergency Kit by Lilly
GlucaGen Hypo Kit by NovoNordisk

Both Lilly and NovoNordisk manufacture this injectable glucagon that requires mixing glucagon powder in a vial with a diluent, then injecting either sub-q or IM. It can be administered to all ages, but give a half dose for children weighing less than 45kg.


Emergency Action Steps

Glucagon rescue medications raise blood sugar by at least 20 mg/dl and should start working within 15 minutes.

  • After administration, make sure to seek medical help and roll person on their side since glucagon can cause nausea and vomiting.
  • If no response after 15 minutes, administer a second dose.
  • After the person gains consciousness and can safely swallow, administer food or beverage containing at 15 -30 gms of carbohydrate until blood sugars are back in a safe range. Then follow-up with usual meal.

    15 gms of carbohydrate ideas:
    • 4-8 ounces of juice or sugary beverage;
    • A piece of fruit, a handful of raisins, tablespoons of honey or corn syrup;
    • 4 glucose tabs, glucose gel, or GU energy gel.

Glucagon PocketCard – FREE

When addressing severe hypoglycemia, fast and effective treatment is critical. Diabetes Specialists have a vital role in making sure those at risk of a hypoglycemic crisis have a glucagon rescue medication available.

Our new PocketCard provides a concise review of the 3 Glucagon Emergency treatment options.

This card can serve as a decision tool when discussing the pros and cons of the currently available rescue medications with providers and people living with diabetes.

Our new Glucagon PocketCard compares and contrasts the delivery system, dosing, age range, route, and storage of the currently available rescue meds all in one card.

Request a FREE Glucagon Pocket Card to be mailed to your door later this month.

We are offering a FREE copy of this laminated card to the first 50 requests (one per person please).


View it for FREE anytime our CDCES Coach App by clicking on the PocketCard Image on the home screen.


Download it FREE on our PocketCard Page.

Glucagon Rescue Medications require a prescription. Check expiration dates before using them. This information on the Glucagon PocketCard is for educational purposes only. Please consult package inserts for detailed instructions.

Teaching Resources

Hypoglycemia and Hyperglycemia Education Teaching Sheet » This handout is one of my favorites. Cartoon characters depict the signs and symptoms of low and high blood sugars and then detail steps to take.  

Medication Wallet Card PDF » pocket sized document that includes contact info, list of medications and critical health data.

Medication Wallet Card in WORD » Add your program’s logo and provide your clients with a useful, customized document that includes contact info, list of medications and critical health data.  

Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE!  Sign up below!

New Rapid Bolus Insulin Approved

This newly FDA approved rapid-acting insulin analog is aimed at reducing post-meal glucose spikes.

Lyumjev also known as insulin lispro-aabc, is approved for adults with Type 1 or Type 2 diabetes, can be taken before meals or even 20 minutes into the meal.

Insulin lispro-aabc (Lyumjev) by Lilly is comparable to Fiasp by Novo Nordisk since they are both very rapid-acting insulins that are detectable in the circulation within minutes of injection.

Insulin lispro-aabc (Lyumjev) appears in circulation approximately 1 minute after injection, peaks at 57 minutes and has an effective duration of about four to five hours. The safety and effectiveness of pediatrics with diabetes has not been established.

Description:

Insulin lispro-aabc (Lyumjev) is produced by recombinant DNA technology using a non-pathogenic strain of E coli. Insulin lispro-aabc differs from human insulin due to a switching of lysine and proline in the B28 and B29 position. Its chemical name is Lys(B28), Pro(B29) human insulin analog. See the package insert for more information.

Lys(B28), Pro(B29) human insulin lispro-aabc

Pricing:
Insulin lispro-aabc (Lyumjev) will be offered at the same price as lispro (Humalog). Lilly will also offer Lyumjev at $35 per month for people who are uninsured or have commercial insurance through its Insulin Value Program. The $35 cap applies regardless of the number of insulin doses required.

How supplied:
Insulin lispro-aabc (Lyumjev) comes in two strengths: U-100 (100 units per milliliter) and U-200 (200 units per milliliter) and a variety of delivery options, including the Junior KwikPen® which allows for 0.5 unit dosing increments.

Lyumjev Injection: 100 units/mL (U-100) available as:
• 10 mL multiple-dose vial
– 3 mL 300 unit KwikPen® (5 pens)
• 3 mL 300 unit Junior KwikPen® 0.5 unit dose increment (5 pens)
• 3 mL 300 unit Tempo Pen™ (5 pens)
• 3 mL 300 unit cartridges (5 cartridges)

Lyumjev Injection: 200 units/mL (U-200) available as:
• 3 mL KwikPen® (2 pens with 600 units each)

Storage:
Discard opened or unopened insulin lispro-aabc (Lyumjev) vials, pens, and cartridges stored at room temperature below 86°F (30°C) after 28 days.

Stay tuned for more new insulin approvals and updates to our Insulin PocketCards!


We are expanding our Online University. Check out our new bundle!

Level 3 | Boot Camp + Expert Team Bundle
Join us live starting September 16th!

When you join our DiabetesEd Certification Boot Camp, it’s like having your own online coaching staff.

?In each webinar, either Coach Beverly, Dr. Isaacs, or Ms. Armstrong, highlight the critical content of each topic area, so you can focus your study time most efficiently. They also launch multiple poll questions to help participants focus on key concepts and assess their knowledge while learning the best test-taking strategies. 

Mastery of this content is critical to ensure certification exam success and to improve clinical outcomes.

Click here to download Level 3 + Expert Bundle flyer Enroll Today!


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AccreditationDiabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*  

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.

New Glucagon Pocket Card

Our new Glucagon PocketCards are available for Pre-order or FREE Download

There are 3 glucagon rescue medications to choose from! Our two-sided Glucagon Pocketcard, designed by Coach Beverly Thomassian, is a perfect decision aid and teaching tool designed for sharing with colleagues and people with diabetes alike.

This card can serve as a decision tool when discussing the pros and cons of the currently available rescue medications with providers and people living with diabetes.

Plus, this card highlights prevention and treatment options for hypoglycemia. It is also an excellent study tool for certification exam preparation.

  • Glucagon Pocket Card
    • Front side: Our new Glucagon PocketCard compares and contrasts the delivery system, dosing, age range, route, and storage of the currently available rescue meds all in one card. 
  • Teaching Tool 
    • Backside: This teaching tool provides step-wise instruction on how to identify, treat, and prevent hypoglycemia.  It also describes the 3 levels of hypoglycemia and includes a list of factors that can increase the risk of hypoglycemia. 

This Diabetes Glucagon PocketCard is perfect for all Diabetes Care and Education Specialists.

Get yours today!


View or Download Glucagon PocketCard


View it for FREE anytime on our CDCES Coach App! Access by clicking on the PocketCard on our apps home screen.




Download Glucagon PocketCard for FREE on our PocketCard Page.


Glucagon Rescue Medications require a prescription. Check expiration dates before using them. This information on the Glucagon PocketCard is for educational purposes only. Please consult package inserts for detailed instructions.


What is Glucagon and How Does it Work?

Glucagon is a counter-regulatory hormone secreted by the pancreas when blood sugars are dipping or during periods of emotional or physical stress. This hormone liberates stored glycogen from the liver, causing an upward surge in circulating glucose.

When people become hypoglycemic, there is not enough circulating glucagon available to drive more glucose release. Glucagon rescue medications increase glucagon levels enough to stimulate further glucose release from glycogen stores in the body.

While administering glucagon is life-saving, it also depletes the body of its glycogen reserves and can lead to further hypoglycemia if it is not replaced quickly. It is so important to replace glycogen stores by consuming carbohydrates as soon as it is safe.

Emergency Action Steps

Glucagon rescue medications raise blood sugar by at least 20 mg/dl and should start working within 15 minutes.

  • After administration, make sure to seek medical help and roll person on their side since glucagon can cause nausea and vomiting.
  • If no response after 15 minutes, administer a second dose.
  • After the person gains consciousness and can safely swallow, administer food or beverage containing at 15 -30 gms of carbohydrate until blood sugars are back in a safe range. Then follow-up with the usual meal.

    15 gms of carbohydrate ideas:
    • 4-8 ounces of juice or sugary beverage;
    • A piece of fruit, a handful of raisins, tablespoons of honey or corn syrup;
    • 4 glucose tabs, glucose gel, or GU energy gel.

Teaching Resources

Hypoglycemia and Hyperglycemia Education Teaching Sheet » This handout is one of my favorites. Cartoon characters depict the signs and symptoms of low and high blood sugars and then detail steps to take.  

Medication Wallet Card PDF » pocket sized document that includes contact info, list of medications and critical health data.

Medication Wallet Card in WORD » Add your program’s logo and provide your clients with a useful, customized document that includes contact info, list of medications and critical health data.  


Meds Management for Type 2 | Live Stream Webinar

Meds Management for Type 2 | Live Stream Webinar

June 25, 2020, at 11:30 am (PST) 
1.5 CE | $29.00 or No CEsFree

Have you heard a novel insulin formulation was FDA approved this week? What is all the news about metformin? How do we know which diabetes medication to start or add next?

Join Coach Beverly RN, MPH, CDCES, BC-ADM for an intensive live course that weeds out fact from fiction while detailing the latest diabetes medications and management algorithms.

During this live stream webinar, we will discuss diabetes medication benefits, considerations and critical information to share with people with diabetes and providers.

Coach Beverly will highlight the key elements of the latest Medication Guidelines by AACE and ADA. We will explore clinical factors to consider when determining the best strategy to improve glucose management in people with type 2 diabetes and discuss new medications.

Topics include:

  • Overview of classes and actions of diabetes medications
  • Medication updates and new recommendations
  • Using the ADA/AACE algorithms to improve diabetes care and outcomes

Webinar Join Options to view Level 2 Courses

  • Earn 1.5 CE for $29 | This option includes the video presentation, podcast, practice test, and additional resources. To register for some or all of our Level 2 Courses, click here.
  • Join for Free (no CEs) | Coach Beverly wants to increase access and opportunities for the DiabetesEd Community to benefit from this valuable information. This option is available for those who want to join the course(s), but don’t need CEs. Click here.
  • Already purchased the course? View courses in your DiabetesEd Online University Student Center. See the FAQ information below.

Register for FREE live stream webinar (no CEs).


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AccreditationDiabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*  

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.

Medicare Caps Monthly Insulin Costs at $35

In March of this year, the Centers for Medicare and Medicaid Services (CMS) approved a $35 dollar monthly cap for Medicare Part D enrollees starting in 2021.

According to an ADA Survey, more than 1/3 of Medicare enrollees self-reported that cost limits their ability to purchase insulin.

In an attempt to make insulin more affordable for those enrolled in Medicare part D, CMS has agreed to limit the amount paid for monthly to no more than $35 per month. Insulins covered by participating plans will not be subject to the deductible or donut hole phases of Part D coverage.

Under this new option, Medicare enrollees with diabetes will pay $35 per each 30-day supply of a covered insulin prescription until they reach the catastrophic coverage phase, during which they will pay 5% co-insurance.

As beneficiaries have more consistent, predictable access to the prescription drugs they need, the model projects that health will improve and the total cost of care will decline for our nation’s senior population.

Medicare D Enrollment Cost

In exchange for these additional benefits, enhanced plans have slightly higher premiums, which are paid for by beneficiaries or through other means, such as a Medicare Advantage plan.

In 2020, average monthly premiums in Part D are $32.09 for a basic plan and $49.32 for an enhanced plan.

Affordability continues to be a barrier for people living with diabetes’ access to insulin. We hope that these changes are a step in the right direction for making insulin affordable for all.

Click ADA Website here to read more.

See CMS.gov Newsroom announcement here.


We want to hear from you!

As changes like this happen, we find that feedback from our community helps us better understand how these changes apply to real-life situations. We want to know, how have these CMS changes impacted the people you work with? Fill out our quick survey to let us know!


Insulin Cost Savings |
Resources for Diabetes Specialists

“The cost of insulin is a real problem. It can lead to insulin rationing and at its worst, people have died due to a lack of insulin,” explains Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES & ADCES 2020 Diabetes Educator of the year.

Read our article Insulin Cost Savings | Resources for Diabetes Specialists for insulin cost-saving resources.


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Metformin XR Warning due to NDMA impurity

Some brands of long acting Metformin are being recalled since they contain higher than acceptable levels of NDMA (see list below).

The U.S. Food and Drug Administration has recommended recalls of certain metformin products that may contain the impurity N-nitrosodimethylamine (NDMA) above the acceptable intake limit.

Patients taking recalled metformin should continue taking it until a doctor or pharmacist gives them a replacement or a different treatment option. It could be dangerous for patients with type 2 diabetes to stop taking their metformin without first talking to their health care professional.

Remind patients not to stop medication until they check with their provider.

Find more info on the FDA Website here

Recalled Products

  • The agency is also asking all manufacturers of extended release versions of metformin to evaluate their risk of excessive NDMA and to test at-risk product before each batch is released onto the U.S. market. If testing shows NDMA above the acceptable intake limit, the manufacturer must inform the agency and should not release the batch to the U.S. market.
  • FDA’s testing has shown elevated levels of NDMA in some extended release (ER) metformin formulation but not in the immediate release (IR) formulation or in the active pharmaceutical ingredient.

For a complete listing of diabetes medications and insulin, download our DiabetesEd Medication PocketCards


Join Meds Management for Type 2 Webinar with Coach Beverly

Purchase 1.5 CE | $29.00 or No CEsFree

Medication Pocketcards Update | Free Resource Friday

We have updated our Medication Pocketcards!

Our four-sided medication accordion Pocketcards were designed by Coach Beverly Thomassian to assist in clinical practice and exam preparation. One of our best sellers, the Diabetes Medication PocketCard is perfect for all Diabetes Care and Education Specialists.

New June 2020 Updates:

  • Added Trijardy (new triple combo oral medication)
  • Deleted Insulin combo Ryzodeg (not available in the U.S.)
  • Deleted oral combo med Avandamet (no longer available)
  • Deleted warning for Dapagliflozin since no longer on package insert (Do not use in pts with bladder cancer)

Included in the Pocketcards:

  • Insulin Pocket Card
    • Front side: current insulins, including action times, dosing info
    • Backside: concentrated and Inhaled insulins 
  • GLP-1 Receptor Agonists, Injectables / Insulin + GLP-1 Combo
    • Front side: GLP-1 Receptor Agonists and Injectables 
    • Backside: Injectable/Insulin Combinations 
  • Oral Diabetes Medications – Complete listing of the 4 common oral medications including dosing range and considerations.
  • Other Oral  and Combo Oral Medications   
    • Front Side: Less commonly used oral medications
    • Backside: Complete listing of all the combined oral medications including doses available

Upcoming Live Streaming Webinar
Next Webinar Airs June 25, 2020, from 11:30 am to 1:00 (PST)

Our Level 2 Standards of Care Intensive Series is designed to engage students in deciphering and exploring the ADA Standards of Care from top to bottom. This straight forward program will provide you with information you can use in your clinical setting and also provides critical content for the diabetes educator exam.

Mastery of this content is critical to ensure certification exam success and to improve clinical outcomes.


Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE!  Sign up below!


AccreditationDiabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*  

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.