Coronavirus and diabetes

My parents are in their late 70s, early 80s, and they live on a chain of barrier islands in a tourist area. The islands closed to visitors this past Tuesday, but by then thousands of spring breakers and families from areas such as New York, where the incidence of the virus accounts for 5% of the world’s cases, were already on the island. My mom has type 2 diabetes and heart disease. What neither of us have acknowledged in our now daily phone conversations is that neither she nor my father would likely survive this virus or even receive needed medical care if doctors were forced to choose between caring for my parent or a younger person.

My mom is worried about my only son, who has Type 1 Diabetes. So am I. My son and I have been practicing social distancing for a week now. And by distancing, I mean he hasn’t been out of the house or yard, and I have been to the grocery store and physical therapy only. My husband, however, has had to work. He is an attorney, and while the VA Supreme Court has shuttered the courts until at least the end of the month, cases involving incarcerated individuals are to be heard. And some local courts are defying the closure orders and hearing all manner of cases, packing courtrooms daily. So this means my husband has traveled to three different courts in the last week and there were more than ten people in each court room. Because my husband is expected to defend his clients at bond hearings, criminal hearings, and the like, he has also had to conduct jail visits to interview his clients. This means my husband is a ticking time bomb. I feel it is not a question of if but when he will be exposed. And if he brings the virus into our house, our son is incredibly vulnerable because of his diabetes.

The virus is really a double whammy for those living with diabetes. Uncontrolled or poorly controlled blood glucose levels can make one more likely to catch the virus according to a physician who lives with type 1. Once someone with diabetes gets the virus, the symptoms and complications are the same as someone without diabetes. But on top of the scarring of lung tissue and difficulty breathing caused by the Coronavirus, it can also cause complications with diabetes, just like any virus that causes a fever. Fever leads to dehydration, which can lead to high blood glucose levels, which can lead to development of ketones, which can lead to diabetic keto acidosis. I won’t go further because we don’t talk about those other consequences in my house. It sounds like a slippery slope fallacy, except it isn’t. That is what happens when someone with Type 1 gets sick with anything other than a common cold. Those are the risks.

So I am feeling pretty uneasy these days. Every time my husband comes home, I make him shower before he sits down at the dinner table. We all take our body temperatures twice daily, and my son and I have been eating immunity boost vitamins like it is candy.

At some point, we will probably all know someone who has contracted the virus. I pray to god those we know all recover without severe complications. Please stay safe. Practice social distancing–take it beyond what the government has called for, which isn’t enough in my opinion–nor in the opinion of many of those in Italy where the death toll increased by almost 800 in the last 24 hour period. My son and my parents, your grandparents and loved ones, are depending on you.

Coronavirus

It is March 22, 2020. A little over a week ago, the World Health Organization declared the spread of the Novel Coronavirus, or COVID-19, had reached pandemic status. COVID-19 is a highly communicable respiratory virus that originated in Wuhan, China in early December 2019. The first case in the US was diagnosed in Washington state on Jan. 20. By March, Italy was experiencing widespread contagion. People were dying. A lot. At the university where I teach in Virginia, students left for Spring Break on March 6, excited for vacations and time at home with family. By week’s end, they were asked not to return. During the course of the week they were gone, cases of the potentially deadly virus had spread to the East coast with New York once again serving as ground zero. With students traveling on spring break, the University was concerned they’d bring the virus with them back to campus. Public schools also closed under order of the governor in an effort to halt the virus. These efforts have failed.

Rockingham County, where I live just five miles from Harrisonburg’s city center, saw its first diagnosed case of the virus this past week, but in reality, there are likely a hundred or more people carrying or suffering from the virus. The local hospital is testing only those who have had known contact with someone diagnosed or who traveled out of the country–even if they have symptoms. Test kits are in short supply, as is important medical equipment such protective masks and ventilators. We are in the midst of a public health crisis and our government, which has not taken any viable steps to stop spread and provide hospitals and clinics with needed tests and medical equipment, has failed us.

Finally…Meal Kits Reviews for the cook or family with T1D

IMG_0909Ever since my son was diagnosed with T1D five years ago, I have spent a lot of time in the kitchen. This has, of course, saved us bundles–we used to eat out at least 2-3 times a week before dx. But I have to admit that I grow tired of the same old meals pretty easily. Now that my son is on two swim teams, our schedules are hectic, meaning I don’t have a lot of time to spend in the kitchen. While various meal kit services such as Blue Apron have been around for several years, I had been hesitant to jump in because I worried about counting carbs and I hated the idea of committing weekly. But there have so many new entries in the field, I finally decided to jump in and give a few a try. Hope the ratings and reviews help you decide which meal kit service is right for your family!

* POOR ** GOOD *** EXCELLENT

HOME CHEF ***

How it works and what it costs: Home Chef offers 2 and 4 servings options and requires customers to order meals for a minimum of two days a week. Meals start at $9.99 per serving, with premium meals (eg. filet mignon) costing $11.99 per serving. Many meals offer customization to include alternative proteins, higher quality, or organic ingredients for a fee (usually $1.99 per serving). You can expect 12-14 meal options including at least two vegetarian options each week. Each week also features lunch options as add-ons for $7.99 per meal. UPDATE (6/19): Home Chef recently introduced two easy and quick options. Home Chef Express meals come with some preparation already completed and can be prepared in 15-20 minutes. Oven Ready options offer easy-to-assemble casserole meals that can be thrown in the oven in a matter of minutes. These usually take 20-30 minutes to bake.

In addition, each week a smoothie is available for an additional fee of $4.95 per serving. We are big smoothie fans, so we have ordered and enjoyed smoothies several times. In the summer months, Home Chef also offers grill packs of unseasoned chicken, burgers, or steaks, but I have never been compelled to try these.

Delivery is available in my area Wed-Friday. Delivery days can be changed every week, as can the number of servings based on even numbers (2, 4, 6). This is unfortunate for my family of three, but we usually save the extra serving for lunch the next day. Shipping is free with a $40 purchase.

UPDATE (6/19): This is one of the two kit services we stuck with and the one we use almost weekly. I love the variety of meals and the ease of prep and flavor puts it at the top of my recommended list.

Access to Nutrition information ***

Carb counts and other nutrition information are available on each recipe card and on the website. Meals were 35-100 carbs per serving. The lower carb meals seemed incomplete–pork egg roll in a bowl without rice? Fish cakes without buns? I ended up adding a healthy carb to three of the six meals we ate, which made this service less of a value. All this said, the serving sizes, even without the starchy vegetables, are always generous.

Taste ***

All the meals were tasty…Home Chef is definitely our favorite. We all raved about the coffee-rubbed pork and the caramelized onion and arugula flatbread. The entrees were compatible with the meals I already made, but different enough to taste new and fresh.

Ease of prep ***

Instructions were easy to follow and took the exact amount of time the card said it would. Great for beginner and novice cooks. Note, though, that the instructions are written for a kit that serves two. If the recipe says to add 1/2 cup of water, you should double that amount.

Freshness of ingredients * (UPDATE 6/19 ***)

When I signed up, we had to order three meals and the only delivery day was Thursday. They were shipped from Chicago and spent three days in transit. Unfortunately, a Thursday delivery did not fit well with our schedules that first week. Two of our three meals were to be used within two days according to the recipe cards and website, and since the kit arrived after 6 PM on Thursday, we couldn’t use the kits until the weekend, as we had plans Friday evening. We prepared the third meal on Tuesday, a full eight days after the kits were originally shipped. Needless to say, the fresh ingredients were not so fresh. The cilantro was slimy and wilted and the green bell peppers had black spots all over them. The meat and other ingredients seemed okay. This was so disappointing. UPDATE: Home Chef added a distribution center in Atlanta, Georgia and the mildly shorter distance has made a big difference. My meals are picked up from the distribution center after midnight on Sunday night and usually arrive by noon on Wednesday. Ingredients have been fresh without bruises, mold, or wilt.

Environmental friendliness **

Well, there’s an attempt to be environmentally conscientious. Freezer packs have instructions for recycling and the box insulation is made from recycled jeans. Some of the ingredients’ packaging is recyclable, and the plastic bottles for liquid ingredients can be reused–I use them in my family’s lunches frequently.  Still, if you do not live in an area with a liberal recycling program, you will be throwing out a lot of plastic, as each kit for two comes in a non-recyclable ziplock bag.

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HELLO FRESH * 1/2

How it works and what it costs: I will start by saying there is a lot to like about Hello Fresh–they are doing it right as far as environmental consciousness and they are one of the least expensive kits on the market with servings starting at $8.99 each. Meals for two or four people are available for two, three, or four days a week. You must select a plan from the Carb-smart plan, Classic plan or Family plan and you do not have freedom to mix or match the meals from different plans within a given week. Each plan offers vegetarian meals.

Like Home Chef, Hello Fresh offers a grilling box with a variety of meats to choose from and grilling sauces and rubs.

We tried Hello Fresh for two weeks and haven’t tried it again, so my review is based on limited experience with the service. Hello Fresh has been my least favorite meal kit service. The food tastes bland and I did not like to be locked into a plan that prevented me from selecting from any menu.

Access to Nutrition information ***

Carb counts are available on a separate sheet sent with the kits, but they are not available on the website. This made it difficult to use counts as a guide when selecting recipes. Each meal was 45-65 carbs per serving.

Taste * 1/2

While the meals sounded great, they were not as flavorful as the other services we tried. The Cauliflower mac ‘n cheese was particularly meh.

Ease of prep *

Instructions were not as easy to follow. The ingredients listed on each card included a column for 2 and a column for 4 servings, but it was unclear if the instructions were for 2 or 4. So, for example, if a recipe said to add 1/4 cup of water to a pan, I did not know if I needed to double that for a recipe for four servings. I made four meals total and never figured it out. Cooking times did not include washing vegetables, so they took longer than the recipe cards noted. And each step listed several tasks, some of which were unrelated to each other.

Freshness of ingredients **

Meals were shipped from New Jersey and spent two days in transit. Still, the vegetables were fresh and unblemished.

Environmental friendliness ***

All the packaging is recyclable. Individual kits come in paper bags with fresh ingredients loose in the bag. Freezer packs have instructions for recycling and the padding inside the box is made from recycled materials and can be further recycled. By far, Hello Fresh is doing it right when it comes to environmental responsibility.

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PLATED ***

How it works and what it costs: Plated is THE meal kit for those with a well-traveled pallet. Each week offers recipes from around the globe–Baharat Eggplant and Chick Peas, Middle Eastern-spiced Chicken, Gochujang Beef, Chicken Horiatiki–in addition to some American regional staples such as Shrimp and Grits, Southwestern Chicken Salad or Italian Sausage and Peppers Sliders. Meals take about 45 minutes to prepare and cost $9.99 per serving for families of three or four, or $11.99 per serving for a family of two. You can order two to six meals per week, but you will be paying $7.95 for shipping if ordering only two meals; three meals or more and shipping is free.

Plated also offers two desserts each week. We ordered chocolate chip scones one week (ate them for breakfast) and a fruit turnover another time. There were both easy to make and tasted great. Be forewarned, however, these desserts are splurges–the average calorie count for their desserts is 600-700 per serving.

Access to Nutrition information *

Carb counts and other nutrition information are available on the website only. This is a huge inconvenience at meal time. Meals are usually 50-65 carbs per serving.

Taste * * *

My family was in agreement that these meals were pretty tasty. There was one meal I didn’t care for, a southwestern burrito bowl, but the rest of my family loved it.  We have enjoyed so many new dishes and flavors because of Plated’s focus on globally-inspired cuisine.

Ease of prep * 1/2

Instructions were not easy to follow because there were multiple tasks in each step, and some you had to come back to after completing other steps, which made it super easy to forget or overlook something. I missed a step one time and ended up making chimichurri sauce with Kale, which was supposed to be added to the dish separately in larger pieces instead of being blended with the parsley. Gotta read closely! Also, it seemed like essential steps, such as peeling carrots, were omitted from instructions. ALL of the recipes took much longer to prepare than the card noted. I spent at least 45 minutes on each meal even though several recipes said 30-40 minutes.

Freshness of ingredients ***

By far, these were the freshest ingredients–way better than what I can get in my local grocery. Meats are generally sourced from hormone-free, organic and/or grain fed sources and you don’t have to pay a premium as you do with Home Chef. Meals are shipped from Charlotte, NC on Monday and arrived by 11am the next day.  You can select delivery Tuesday through Saturday.

Environmental friendliness 1/2 *

Plated does not even pretend to be environmentally friendly. Everything came bagged in plastic baggies and the meats were double wrapped in two layers of plastic. UPDATE: Plated has moved more in line with Home Chef in that packaging is labeled clearly as recyclable, but again, you’ll need a liberal program in your area if packaging is to stay out of the landfill.

Martha and Marley Spoon **

How it works and what it costs:  Marley Spoon operates similarly to Hello Fresh, offering several different meal plans, BUT you can select from among different plans each week. The plans are more for organization purposes, which helps because the service generally offers at least 20 different meals each week. Kits can be ordered for two or four people, with anywhere from two to four meals per week. Delivery is free, and  each serving costs $9.95 per meal.

I so wanted to love this meal kit service, but I just didn’t. Some of the meals took in excess of an hour to prepare and the cooking methods were more advanced than the other kit services. But bottom line is that I just didn’t like all the meals. This isn’t surprising, though. I have never been a huge fan of Martha Stewart’s recipes. That said, I have a colleague who lives by this service and orders it weekly.

Access to Nutrition information ***

Full nutrition information is printed on the recipe card and is available on the website.

Taste * *

I am a southern girl and Marley Spoon just isn’t for me. Some of the meals seem stuck in the 80s (Lemon Garlic Chicken Thighs) and some just didn’t have a lot of flavor (Butter Shrimp). Our favorite was a roasted vegetable stromboli, but it was something I could have easily made myself without a recipe. We gave the plan three weeks before calling it quits.

Ease of Prep * (my rating scale does not include 0)

Don’t believe the cards. Each meal took me at least an hour to prepare. This was quite an annoyance, as our busy schedule does not allow me to spend an hour in the kitchen each night. The one thing I liked is that the number of pots and pans used in prep, ironically, is minimal compared to Home Chef and Plated.

Freshness of ingredients **

The ingredients were fresh, but as I am writing this, I realize there weren’t a lot of vegetables in the meals we ordered except for the stromboli. The meats were all good quality.

Environmental friendliness ** 1/2

Like Hello Fresh, Marley Spoon is doing it right. Ingredients for the week are placed together in a paper bag and it is for you to separate them by meal. The meats are packaged in plastic or on a foam tray wrapped in plastic, and are bagged in a separate paper bag from the produce. The boxes, like other kits, are recyclable and the freezer packs are reusable.

Freshly * 1/2

How it works and what it costs: Freshly is a relative new comer to the market and it isn’t so much a meal KIT delivery service as it is a MEAL delivery service. Freshly offers prepared meals that are fully cooked and individually packaged. All you have to do is heat them up in the microwave for 2-3 minutes. What sets these meals apart from the t.v. dinners you’ll find in the freezer section of the grocery? These meals are not frozen. But at $8.99 to $12.99 per serving based on the number of meals per week ordered, this service will set you back a bit more than the grocery store. Customers must order 4, 6, 9 or 12 meals per week. And the choices are plentiful…but they didn’t seem to change week to week.

I should note that our shipment the first week we ordered was two days late arriving because the manufacturer ran out of ingredients…that’s according to the email I received early in the evening the day I expected my delivery.

Access to Nutrition Information **

Full nutrition information is printed on the paper sleeve around the meal and the website includes calorie and carb counts for each meal.

Taste * 1/2

My family and I liked several of these meals initially, but by week’s end, we felt like we were eating the same thing even though that was not the case. Despite the different dishes–roasted pork with collards and shrimp andouille paella–they all used the same spices and they all left a lingering taste in our mouths that we couldn’t quite place–garlicky? yes. but something else that none of us really cared for. By the end of the week, we were done. In fact, I froze several of the meals and still have one in my freezer because no one wants it!

Ease of Prep ***

Feels kind of like cheating comparing this meal service to the other kits, but hey, what can be easier than popping a meal in the microwave for three minutes.

Freshness of ingredients ***

Again, it is kind of unfair to compare this kit but from what I could tell eating the prepared meals, ingredients seemed good quality and fresh. Plus the company does not use any chemical preservatives or artificial ingredients, no hydrogenated oils and no added sugars. The food is au naturel, the way food should be.

Environmental friendliness ***

The meals are packaged in plastic trays that are labeled #1, which can be recycled in just about every locality. Each tray has a cardboard sleeve with nutrition info and directions, and it is made of recycled paper. The shipping container and freezer packs are reusable and recyclable. The choice is yours!

Note: The obvious absence here is Blue Apron, which was really the kit that started the craze. I found the menu plans too limiting and cancelled before I had a chance to order. The family plan consists of meals for a family of four, while the classic plan offers only meals for two. The meals on the classic plan are much more to our liking; the family meals catered too much to the palate of young children (think homemade chicken nuggets). When I tried to order two of the classic plan meals to feed my family the same meal, I was not permitted to do so, and when I contacted customer service, they said we were not allowed to double order a meal. I am not sure what kind of business strategy this is, but it lost them a customer.

Technology update: 90 day CGM

Researchers recently conducted a 180 day trial of an implantable sensor for continuous glucose monitoring. Adult participants had a small incision cut into their upper arm where the sensor, a small  cylinder less than half an inch long, was inserted. The incision was closed with sterile tape and a transmitter was worn in the arm where the sensor was inserted.

The results of the trial showed promise. The CGM caught 80% of participants’ low blood sugars. Only 10% reported discomfort with either insertion of the sensor or wearing the tube. And most liked the convenience of going three months between insertions. You can read more here.

This kind of technology is not a game changer by any means, but it does offer a step in the right direction–that being to make medical care for Type 1 as unobtrusive as possible.

Last year, I wrote about the insulin smart patch being developed by researchers at UNC. Stay tuned for an update on that soon!

Bad dog: the high cost of insulin

Over the weekend, my dog Ivy swiped a “just-opened” vial of insulin and promptly deposited it outside in a hole she dug. By the time I realized the vial was missing and went looking for it, I was too late. The insulin was outside overnight and the vial was upside down in the grass and dirt. There was no way I could draw insulin from it without the possibility of contamination. What really stinks is that we don’t have an extra stash of insulin, so I’ve had to call the insurance company, explain the problem and get approval for an early refill. I am pretty fortunate. Others in my situation may have had to purchase a vial of insulin without coverage from the insurance company, which could potentially set them back almost $300!

There has been a lot of media attention given to rising drug costs and insulin is no exception. The cost of Humalog, the short term insulin my son uses in his pump, has increased 150% since 2009.  It is not unusual for adults living with type 1 to use three or more vials of insulin a month, especially if they are pumping and rely only on the short acting insulin. But, as a Washington Post writer discovers in her investigative series on the cost of insulin, weighing the cost of insulin against the benefits of new formulas suggests the increasing cost may not be justified.

Read more about this issue in the Washington Post.

 

Type 1 and College…yikes!

Thankfully, I have six more years to adjust to my son starting college. Six years to stop hovering and to get used to the fact that he is growing up and can’t live at home forever. As a mom, it’s hard to let go, but as a Type 1 mom, I harbor a lot of fear–what if his BG goes low overnight and he doesn’t wake up? What if his roommate hates him and tosses out his insulin? What if he has to take back to back classes and can’t get lunch? What if his professors are jerks (trust me, I know they exist)? What if this or that? A million things can go wrong when you are diabetic.

This evening I came across this article about applying for disability services at college if you have Type 1. It in no way eases all my fears, but the article does help to know that my son can have at least some control over the many unknowns of going away to college when you live with Type 1.

Read the article here.

Diabetic patients lose in United Healthcare’s latest shenanigans

Yesterday, United Healthcare, one of the largest insurance providers in the country, struck a deal with Medtronic, making the latter’s insulin pump the preferred pump of the insurance carrier. This means that diabetics who are insured by United now have no choice in which insulin pump they use, as United will cover only Medtronic pumps and supplies. This is unfortunate, as not everyone (including my son) want to wear a pump with tubes–tubes mean less freedom and less glucose control, as any pump that uses tubes for insulin delivery must be disconnected before bathing or swimming. I am thankful our insurance provider is Anthem, but I fear Pandora’s box has been opened and it is inevitable for other insurance companies to follow suit. If that does happen, diabetic patients are the real losers in a game played at their expense. Here’s an article commenting on the decision.