Diabetic Articles – Better Off Healthy
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Sleep Problems Tied to Diabetes in Men

Men who do not get enough sleep — or get too much — may have an increased risk for Type 2 diabetes, a new study suggests.

Researchers studied 788 healthy men and women participating in a larger health study, measuring their sleep duration using electronic monitors and testing them for markers of diabetes — how well pancreatic cells take up glucose and how sensitive the body’s tissues are to insulin. The study is in the Journal of Clinical Endocrinology & Metabolism.

The average sleep time for both men and women was about seven hours. As the men diverged from the average, in either direction, their glucose tolerance and insulin sensitivity decreased, gradually increasing the deleterious health effects. There was no such association in women.

The researchers weren’t sure why men but not women showed this association but caution that this was a cross-sectional study, a snapshot of one moment in time, and that they draw no conclusions about cause and effect.

The lead author, Femke Rutters, an assistant professor at the VU Medical Center in Amsterdam, said that it is easy to advise men to get regular and sufficient sleep, but because so many lifestyle and health factors may contribute to poor sleep, acting on that advice is much harder.

“There has been a lot of observational work on sleep, but trying to change it is difficult,” she said. “Ideally, men should try for regular sleep.”

Source: http://well.blogs.nytimes.com/2016/07/05/sleep-problems-tied-to-diabetes-in-men/?rref=collection%2Fsectioncollection%2Fhealth&_r=0

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Daily chocolate intake linked to lower risk of diabetes, heart disease

Could a doctor’s visit one day result in a prescription for chocolate? According to a new study, it is possible. Researchers suggest that consuming a small amount of chocolate every day may lower the risk of diabetes and heart disease.
Eating chocolate every day could lower the risk of diabetes and heart disease, say researchers.

Study co-author Prof. Saverio Stranges – visiting academic of the University of Warwick Medical School, United Kingdom, and scientific director of the Department of Population Health at the Luxembourg Institute of Health (LIH) – and colleagues publish their findings in the British Journal of Nutrition.

Chocolate is often perceived as a treat that should only be enjoyed from time to time. Given its high fat and sugar content, this is no surprise; overconsumption can lead to health problems, such as tooth decay and obesity.

However, studies are increasingly suggesting regular, moderate chocolate consumption may yield significant health benefits, particularly when it comes to dark chocolate.

Dark chocolate has the highest cocoa content, which means it has the highest levels of antioxidants – specifically, flavonoids – which are molecules that can prevent some forms of cell damage.

For their study, Prof. Stranges and colleagues analyzed the chocolate consumption of 1,153 people aged 18-69 who were part of the Observation of Cardiovascular Risk in Luxembourg (ORISCAV-LUX) study.

Data on chocolate intake were gathered from participants’ completion of a food frequency questionnaire.

The team set out to investigate whether chocolate intake is associated with insulin resistance – where the body’s cells do not effectively respond to insulin, raising the risk for type 2 diabetes and heart disease.

They also assessed how chocolate consumption affected liver enzyme levels, which is a measure of liver function.

Reduced insulin resistance with daily chocolate consumption

The researchers found that 81.8 percent of the study participants consumed chocolate, with an average consumption of 24.8 grams daily.

Compared with participants who did not eat chocolate every day, those who did were found to have reduced insulin resistance and improved liver enzyme levels. The effect was stronger the higher the chocolate consumption, the team reports.

The findings remained after accounting for participants’ age, sex, education, lifestyle, and dietary factors that could affect the results.

Dietary factors included intake of tea and coffee rich in the antioxidants polyphenols, which the researchers say have the potential to spur chocolate’s benefits for cardiometabolic risk.

Cardiometabolic risk refers to a person’s likelihood of developing diabetes, heart disease, or stroke.

Participants who ate chocolate were more physically active, younger, and more highly educated than those who did not eat chocolate, according to the authors.

Could dark chocolate be included in dietary recommendations?

Prof. Stranges and colleagues say their findings suggest that chocolate consumption may reduce the risk of developing cardiometabolic disorders by improving liver enzyme levels and protecting against insulin resistance.

“Given the growing body of evidence, including our own study, cocoa-based products may represent an additional dietary recommendation to improve cardiometabolic health; however, observational results need to be supported by robust trial evidence.

Potential applications of this knowledge include recommendations by healthcare professionals to encourage individuals to consume a wide range of phytochemical-rich foods, which can include dark chocolate in moderate amounts.”

Prof. Stranges

However, Prof. Stranges notes that it is important to distinguish the difference between chocolate that contains natural cocoa and processed chocolate; the latter is much higher in calories.

“Therefore, physical activity, diet and other lifestyle factors must be carefully balanced to avoid detrimental weight gain over time,” he adds.

 

Source: http://www.medicalnewstoday.com/articles/309741.php

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Just because you leave the doctor’s office empty-handed, it doesn’t mean you have a clean bill of health

An Alarming Number Of Adults Have Prediabetes—and Doctors Aren’t Doing Anything About It

Here’s why this serious common condition shouldn’t go unchecked

Just because you leave the doctor’s office empty-handed, it doesn’t mean you have a clean bill of health: Most people with prediabetes aren’t given treatment for the disease, new research from the University of Florida found.In the study, 34 percent of people ages 45 and older were found to meet the criteria for prediabetes.

That means their levels on the A1C test—a measure of your average blood sugar levels over the past two to three months—were between 5.7 and 6.4 percent.In comparison, a normal reading is below 5.7 percent, and a level of 6.5 percent or higher indicates full-fledged diabetes.

But of the people who had blood sugar levels in the prediabetes range, only 23 percent of them received any kind of treatment for it.

“The doctors may be more focused on treating diabetes, not something that may lead to diabetes,” says study author Arch Mainous, Ph.D.

That’s bad news, because treating prediabetes—either with drugs like metformin or through a weight loss program incorporating healthy eating and exercise—is very successful at preventing or delaying the development of diabetes, he says.

And by preventing diabetes from occurring, you can stave off the serious implications of the disease, including damage to your kidneys, nerves, eyes, and heart, he says.

Your move, then, is to take a more active role in your own health.

Current guidelines by the United States Preventive Services Task Force recommend that all adults over 40 who are overweight or obese get their blood sugar tested.

If you fall into that category, ask your doctor for a test. And when the results come in, follow up with him or her—don’t just sit back if your hear “everything is fine.”

Instead, inquire ask about what your levels actually are. If they fall into the prediabetes range, ask your doctor point-blank what you should be doing to get your levels back to normal, says Mainous.

You don’t necessarily need to jump right to meds, either. Your doctor can start you on a diet and exercise plan—a mixture of cardio and resistance training for 150 minutes a week is best—to see if that brings your levels down enough first, he says.

 

Source: http://www.menshealth.com/health/why-prediabetes-goes-untreated?cid=soc_Men%27s%20Health%20-%20MensHealth_FBPAGE_Men%27s%20Health__

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Service dog saves sleeping boy with type 1 diabetes

A loyal service dog saved his 7-year-old ward when the boy’s blood sugar levels dropped quickly while he was sleeping.

In a Facebook post that’s gained over  330,000 likes, mom Dorrie Nuttal shared the story and a photo of the dog, black Labrador Jedi guarding over her son, Luke, who has type 1 diabetes.

“This is a picture of Jedi saving his boy. Saving him from highs and lows and from ever feeling alone,” Dorrie wrote in the March 3 post.

Five minutes before the photo was taken, Dorrie wrote, the family was asleep. Then Jedi jumped on and off the bed where Luke, 7, was sleeping and lay on Dorrie until she woke up. Jedi then bowed—his alert that Jedi’s glucose was too low.

Dorrie checked her son’s glucose monitor, and it read at 100, which was normal. Jedi still refused to get off of the bed. Suddenly, Dorrie realized the seriousness of the situation and pricked her son’s finger— the reading was 57, too low for the boy, who was recovering from a stomach bug.

“Luke was laying right next to me, just inches from me, and without Jedi I would have had no idea that he was dropping out of a safe range. He has never woken up on his own for a low in over 4 and a half years,” she wrote.

As  a diabetic “alert dog,” Jedi has been trained for the last three years to detect a high or low level or blood sugar and notify humans. Owing to their sharp sense of smell, certain dog breeds that are fit for detecting bombs are also good at sniffing out hard-to-detect scents emitted by people who lack insulin, the Wall Street Journal reported.

Type 1 diabetes affects fewer than 5 percent of people with the disease, according to the American Diabetes Association. Individuals are unable to produce insulin, a hormone the body uses to get glucose from the bloodstream into the body’s cells.

Dorrie took the photo in a moment after giving Luke a glucose tab to raise his blood sugar.

“…because if we don’t share our stories how would anybody ever know that this is what my son and millions of others go through every single day,” she wrote. “We need awareness about a disease that most of the world doesn’t understand, we need to help show the world why we so desperately need a cure.”

 

Source: http://www.foxnews.com/health/2016/03/09/service-dog-saves-sleeping-boy-with-type-1-diabetes.html

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New findings could boost type 1 diabetes treatment

For six weeks seven-year-old Bethan Westcott-Storer was feeling listless and losing weight, worrying parents Lizzie and Dean. Now aged nine, she’s the picture of health, having been diagnosed with type 1 diabetes in November 2014, since when she’s been treating herself via an omnipod pump that delivers insulin via a cannula under her skin.

“I felt very weak and tired all the time, and if my friends in the playground said ‘do you want to play It?’ or something, I’d just feel like ‘ohh, not really,” Bethan told Reuters during a check-up at the University of Exeter Medical School.

According to her mother, “we noticed that she’d become quite thin, she’d lost a lot of weight, but she didn’t have all of the signs that other children normally have with type 1 – she didn’t have the excess thirst and urinating. Just lost a lot of weight, so she’s been diagnosed for 15 months now.”

Exeter scientists have revealed that children diagnosed before the age of seven develop a more aggressive form of the disease than that seen in teenagers. Their research could open up new, differing, treatments for both teenagers and young children. It could even help scientists develop a vaccine that prevents children developing diabetes.

Working alongside scientists from the University of Oslo, the team, led by Professor Noel Morgan and Dr Sarah Richardson, analyzed 100 pancreas samples from people diagnosed with type 1 diabetes shortly before their death. The samples are housed at the Exeter Archival Diabetes Biobank, the world’s largest pancreas collection.

According to Richardson, a JDRF career development fellow, “those samples are extremely important because we do not understand the underlying disease process that goes on in these individuals and it’s that recent diagnosis that’s critical for us to actually look inside the pancreas and see what is going wrong, and the pancreas itself is an extremely inaccessible organ.”

The study shows that children diagnosed with type 1 diabetes before the age of seven suffer from insulitis, an inflammatory process which kills off almost all the insulin-producing beta cells in their pancreas. By contrast, those diagnosed as teenagers or older retain unexpectedly large numbers of beta cells, albeit malfunctioning.

“The significance of these findings is that we find that the individuals who are diagnosed young have a very different disease profile to those that are diagnosed older, and that has important implications for potential treatments in that those individuals that are diagnosed young might benefit more from immunotherapeutic therapies, whereas those that are diagnosed older we might need to look at different therapies that reactivate their sleeping beta cells at the same time as applying immunotherapeutic drugs to prevent any reactivation of an immune response,” said Richardson.

Morgan told Reuters “it’s always been thought that when people get type 1 diabetes they’ve lost as many as 90 percent of their insulin producing cells from their pancreas. What we’ve found is that while that might be the case for the younger children it certainly doesn’t appear to be true for those that are older. They have quite a considerable reserve of cells left. That’s a new insight and it might mean that if we could reactivate those cells we could help them to cope better with their illness.”

The team’s discovery also has implications for the younger group. “We might even be able to stop people getting the illness who otherwise might,” said Morgan. “That’s our real hope, that we might have a way of stopping children from becoming diabetic by understanding the process and targeting it more specifically.”

He added: “We’re trying to understand what the trigger is and it may be possible to use a vaccine to stop the triggering process, but it might also be able to use a different kind of vaccine to target the specific immune cells that are causing the illness, and that’s where the excitement lies.”

According to type 1 diabetes charity JDRF (formerly known as the Juvenile Diabetes Research Foundation), which part funded the research, a child diagnosed with type 1 diabetes at the age of five faces up to 19,000 insulin injections and 50,000 finger-prick blood tests before they are 18.

Bethan Westcott-Storer hopes the Exeter team will succeed. “One day in the future they find a cure lots and lots of people are going to be really happy,” she said.

The research, which received European Union backing, was published online in the journal Diabetes.

 

Source: http://www.reuters.com/article/us-diabetes-treatment-idUSKCN0W21FZ

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Years of taking popular diabetes drug tied to risk of B12 deficiency

People taking metformin, a common type 2 diabetes medication, for several years may be at heightened risk of vitamin B12 deficiency and anemia, according to a new analysis of long-term data.

Metformin helps to control the amount of sugar, or glucose, in the blood by reducing how much glucose is absorbed from food and produced by the liver, and by increasing the body’s response to the hormone insulin, according to the National Institutes of Health.

“Metformin is the most commonly used drug to treat type 2 diabetes, so many millions of people are taking it, usually for a prolonged period (many years),” said senior study author Dr. Jill P Crandall of Albert Einstein College of Medicine in New York City, by email.

“Smaller numbers of people take metformin for prevention of diabetes or treatment of polycystic ovary syndrome,” Crandall told Reuters Health.

The researchers used data from the Diabetes Prevention Program and the Diabetes Prevention Program Outcomes Study, which followed participants at high risk for type 2 diabetes for more than 10 years.

The study began with more than 3,000 people age 25 years and older with high blood sugar. The participants were randomly assigned to receive either 850 milligrams of metformin twice daily, placebo medication or an intensive lifestyle program than did not include medication. For the new analysis only those taking placebo or metformin were considered, and about 50 participants were excluded after having weight-loss surgery, which would affect their diabetes outcomes.

During follow-up, the participants provided blood samples at the five- and 13-year points.

Using these blood samples, the researchers found that at year five, average B12 levels were lower in the metformin group than the placebo group, and B12 deficiency was more common, affecting 4 percent of those on metformin compared to 2 percent of those not taking the drug.

Borderline low B12 levels affected almost 20 percent of those on metformin and 10 percent of those taking placebo.

Average vitamin B12 levels were higher by year 13 than in year five, but B12 deficiency was also more common in both the metformin and placebo groups, as reported in the Journal of Clinical Endocrinology and Metabolism.

Vitamin B12 deficiency may lead to nerve damage which can be severe and may be irreversible, Crandall said.

“Severe and prolonged B12 deficiency has also been linked to impaired cognition and dementia,” she said. “It can also cause anemia (low red blood cell count) – fortunately, this condition is reversible with treatment.”

More people in the metformin group were also anemic at year five than in the placebo group.

There are more than three million cases of vitamin B12 deficiency each year in the U.S., which can be caused by diet or certain medical conditions. Symptoms include fatigue, and numbness or tingling.

Humans do not make vitamin B12 and need to consume it from animal sources or supplements. Vegetarians may get enough from eating eggs and dairy products, but vegans need to rely on supplements or fortified grains.

Doctors who prescribe metformin to patients long-term for type 2 diabetes, gestational diabetes, polycystic ovarian syndrome or other indications should consider routine measurement of vitamin B12 levels, the authors conclude.

“The FDA and organizations such as the American Diabetes Association do not have any formal recommendations for B12 monitoring for people taking metformin,” Crandall said. “That said, our study (and others) suggests that a small but significant number of people may develop deficiency.”

“People who are taking metformin should ask their doctor about measuring their B12 level,” she said.

Restoring healthy B12 levels is easy to accomplish with pills or monthly injections, she added.

“The risk of B12 deficiency should not be considered a reason to avoid taking metformin,” Crandall said.

 

Source: http://www.reuters.com/article/us-health-metformin-b12-deficiency-idUSKCN0WC211

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New diabetes patch analyzes sweat to detect blood sugar levels

A stick-on patch that tracks, and even regulates, blood sugar levels could be used by people with diabetes one day, according to a new study.

Unlike finger pricking — the traditional method of monitoring levels of the blood sugar glucose — the new patch detects the levels of glucose in a person’s sweat. Research has shown that glucose levels in sweat accurately reflect glucose levels in the blood, the researchers said.

The researchers also showed that the patch can deliver the diabetes drug metformin through the skin and that it can reduce high blood glucose levels in mice with diabetes.

The researchers are very interested in making the patch commercially available, and are talking about it with several companies in Korea, said study co-author Hyunjae Lee, of the Institute for Basic Science in Seoul, South Korea.

But more research is needed before the patch can be used in people with diabetes, the researchers said.

Scientists have been looking for a noninvasive way to monitor the levels of glucose in people with diabetes, because finger pricking can be painful and some patients are unwilling to do it, the researchers said.

To make the new patch, the researchers combined gold particles and graphene  — a type of material that shows promise for use in wearable electronics because it is flexible, and can be transparent, soft and very thin, the researchers said.

The patch consists of wearable sensors that detect the levels of glucose in sweat, as well as an integrated system with micro-needles that deliver the glucose-regulating drug metformin. When the sensors detect a high level of glucose in the sweat, heaters embedded in the patch prompt the micro-needles to release the drug and lower the glucose level.

In the study, the researchers tested the new patch’s ability to detect glucose levels in two men without diabetes, and found that it accurately detected changes in their glucose levels after they ate a meal. The scientists also tested the patch’s ability to regulate glucose levels in mice with diabetes through the use of micro-needles and metformin, and found that it helped to lower these levels.

However, the drug-delivery system in the patch needs to be improved further before it can be tested in human patients with diabetes, the researchers said in the new study, published today (March 21) in the journal Nature Nanotechnology.

“Some important questions still need to be answered before the technology can be translated into practical use,” Richard Guy, a professor of pharmaceutical sciences at the University of Bath in the United Kingdom, wrote in an editorial accompanying the new study in the journal.

For example, it is not clear whether the glucose-detecting sensors would work continuously for long periods of time, or whether the patch would work well if the wearer sweated a lot due to exercise, said Guy, who was not involved in the new study.

 

Source: http://www.livescience.com/54110-graphene-patch-detects-blood-sugar-levels-in-sweat.html

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Genetic test aims to improve diabetes diagnosis

Radiographer Paul Martin was wrongly diagnosed with type 2 diabetes in April 2013. After months of taking two medications that failed to improve his condition, Martin visited a consultant who subsequently diagnosed him correctly with type 1.

“They put me on tablets – metformin and glycoside – and then I was able to just continue taking those for months until I saw a consultant who then said that my diabetes had got worse. So I was actually diagnosed as type 1 then and introduced to insulin,” he explained.

Martin is one of a number of patients diagnosed with the wrong type of diabetes, which differ markedly in causation and treatment. Type 1 diabetes, which accounts for less than ten percent of patients, occurs when the body’s immune system destroys the cells that release insulin. Without insulin, patients’ bodies cannot absorb sugar. Most type 1 diabetics are diagnosed young.

Type 2 diabetes is often linked with obesity and can be developed at any age. In those cases patients’ bodies are unable to use insulin correctly and can suffer damage to their pancreas, although the condition can sometimes be managed through improved diet and weight loss.

Correctly diagnosing which type a patient has is crucial, and in a small minority of cases the wrong diagnosis can be fatal. But in an age of growing obesity in the western world, diagnosis is becoming increasingly difficult for doctors.

According to diabetes expert Dr Richard Oram, from the University of Exeter Medical School, clinical diagnosis is currently based almost entirely on age at diagnosis and whether a patient is obese.

So Oram has come up with a new, relatively inexpensive, genetic test for the disease, which he thinks will help doctors.

“This is a genetic test which essentially means that it measures genetic risk factors for type 1 diabetes and it measures very simply and cheaply in a way that’s easy to do, and it means that when a patient presents with diabetes we could measure that genetic risk and if the genetic risk is higher for type 1 diabetes it means they’re very likely to have autoimmune type-1 diabetes, and if the genetic risk is low for type 1 diabetes then they’re much more likely to have type 2 diabetes, the kind of diabetes associated with obesity,” he told Reuters.

Oram’s team devised a test which measures 30 genetic variants in DNA and combines all the risks associated with them in a single score, acting as a summary of genetic risk for type 1 diabetes. If a person’s score is high they are likely to have type 1 diabetes. If the score is low they may have type 2. A further commonly used test which measures anti-bodies would then be undertaken to complete individual diagnosis.

Oram says early diagnosis is crucial. “If you get this wrong, if you label someone who actually has type 2 diabetes as type 1 they’ll be left on insulin for the rest of their life when they don’t need it. Even worse, if someone with type 1 diabetes is mislabelled as having type 2 diabetes then they may not be treated with the insulin they need and they may suffer life threatening complications,” he said.

A National Institute for Health Research Clinical Lecturer and specialist in Diabetes and Nephrology, Oram says his test will also benefit patients’ understanding and attitude towards their condition.

In the short term the University of Exeter Medical School, a leading centre in genome-wide association studies, could test genetic samples sent by patients from hospitals across the UK. Oram’s team is also working to develop a bench-side test that any clinical laboratory could run cheaply and quickly.

“If someone could have a blood sample taken it would be sent to our lab here and have the genetic risk score tested,” Oram said. “What we think is better for people with diabetes both in the UK and around the rest of the world is if their local hospital could do this test on a bench-side machine.”

The research was supported by the UK’s National Institute for Health Research (NIHR) and the Wellcome Trust, an independent, global charitable foundation dedicated to improving health. It’s also been backed by research charity Diabetes UK.

The latter’s regional manager Claire Gordon called the research “excellent.” She added: “They’re looking at making it a very cheap process, so people can literally have a phone app that will help them determine whether it’s type 1 or type 2, and it will be cheap enough that you can do it universally, so one of the problems with lots of research is that things cost a lot of money. This is really great because it identifies what the risk of type 1 and type 2 are and means you’re much more likely to get the right diagnosis quickly.”

Paul Martin agrees, and says his health has improved markedly since his correct diagnosis two years ago. “Basically my blood sugars have come right down. I don’t seem to be as tired as I used to be,” he said.

Oram’s team published its research in peer-reviewed journal Diabetes Care last November.

 Source: http://www.reuters.com/article/us-genetics-diabetes-idUSKCN0WP22O
A Novo Nordisk employee controls a machine at an insulin production line in a plant in Kalundborg November 4, 2013. Picture taken November 4, 2013. 
REUTERS/Fabian Bimmer

Bypass surgery better at alleviating diabetes than diet and exercise

After one year, gastric bypass surgery did a better job of bringing type 2 diabetes into remission than an intensive diet and exercise regimen, according to results of a small trial among obese patients.

Gastric bypass surgery precipitates weight loss and also triggers hormonal and metabolic mechanisms that work against diabetes specifically, beyond just weight loss, said lead author Dr. David E. Cummings of the University of Washington in Seattle.

“The new thinking is might we begin to see surgery as a way to treat diabetes primarily,” Cummings told Reuters Health.

The researchers assigned 23 obese adults ages 25 to 64 years with type 2 diabetes to receive gastric bypass, in which surgeons reduce the size of the stomach and also bypass a portion of the intestines. Another 20 similar patients instead received an intensive lifestyle intervention that included at least 45 minutes of aerobic exercise five days per week, a dietitian-directed weight and blood sugar lowering diet as well as diabetes medical treatment for one year.

Eleven participants withdrew before completing the trial, so 15 in the surgery group and 17 in the lifestyle intervention group remained to be studied after one year.

Researchers measured participants’ fasting blood sugar and insulin levels, sensitivity to insulin, body weight, waist circumference, body composition, blood pressure, cholesterol, aerobic fitness, medication usage and quality of life before the study began, after six months and after 12 months.

At the one year point, 60 percent of those in the gastric bypass group had lowered their blood sugar into the non-diabetic range, compared to 6 percent of those in the diet and exercise group. Less than 30 percent of participants in the gastric bypass group were using insulin after one year compared to 41 percent of the lifestyle change group, as reported in Diabetologia.

Surgical patients were also using fewer blood pressure medications after one year than lifestyle-change patients.

Body weight, waist circumference, waist-to-hip ratio and percent body fat mass decreased in both groups over time, although surgical patients lost more weight and fat mass.

Cardiorespiratory fitness, measured by peak oxygen consumption during exercise, increased for the diet and exercise group but did not change for the surgery group.

“The uniqueness of this study lies in the fact that the lifestyle intervention control group used what was considered to be the most strict program practical for such patients with diabetes that was patterned after the well-known Diabetes Prevention Program and Look Ahead trials,” and patients were recruited from a broad population within a healthcare system, said Nathan D. Wong, director of the Heart Disease Prevention Program at the University of California, Irvine.

Clearly surgery is much more effective than intensive lifestyle change for causing remission of diabetes, but surgery should still be the last option, Wong told Reuters Health by email.

“Patients with pre-diabetes (and even before that) should be more conscious of their lifestyle and what they can do to prevent diabetes as the Diabetes Prevention Program and other similar studies have clearly shown modest weight loss and exercise can go a long way towards preventing diabetes,” he said. “Healthcare providers (and insurers alike) need to provide better support and resources to effect intensive lifestyle intervention.”

In current practice, patients are not generally given the long-term lifestyle programs that should be tried before surgery, he said.

“In those with severe or morbid obesity where multiple lifestyle intervention attempts have been unsuccessful, gastric bypass surgery is felt to be a good option by many experts,” Wong said. “There are always potential risks with such surgeries such as excessive bleeding, clotting, or infections, and surgery of course is not reversible.”

 

Source: http://www.reuters.com/article/us-health-diabetes-gastric-bypass-idUSKCN0WP2QF

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What is Diabetes?

Diabetes, often referred to by doctors as diabetes mellitus, describes a group of metabolic diseases in which the person has high blood glucose (blood sugar), either because insulin production is inadequate, or because the body’s cells do not respond properly to insulin, or both. Patients with high blood sugar will typically experience polyuria (frequent urination), they will become increasingly thirsty (polydipsia) and hungry (polyphagia).

Fast facts on diabetes

Here are some key points about diabetes. More detail and supporting information is in the main article.

  • Diabetes is a long-term condition that causes high blood sugar levels.
  • In 2013 it was estimated that over 382 million people throughout the world had diabetes
  • Type 1 Diabetes – the body does not produce insulin. Approximately 10% of all diabetes cases are type 1.
  • Type 2 Diabetes – the body does not produce enough insulin for proper function. Approximately 90% of all cases of diabetes worldwide are of this type.
  • Gestational Diabetes – this type affects females during pregnancy.
  • The most common diabetes symptoms include frequent urination, intense thirst and hunger, weight gain, unusual weight loss, fatigue, cuts and bruises that do not heal, male sexual dysfunction, numbness and tingling in hands and feet.
  • If you have Type 1 and follow a healthy eating plan, do adequate exercise, and take insulin, you can lead a normal life.
  • Type 2 patients need to eat healthily, be physically active, and test their blood glucose. They may also need to take oral medication, and/or insulin to control blood glucose levels.
  • As the risk of cardiovascular disease is much higher for a diabetic, it is crucial that blood pressure and cholesterol levels are monitored regularly.
  • As smoking might have a serious effect on cardiovascular health, diabetics should stop smoking.
  • Hypoglycemia – low blood glucose – can have a bad effect on the patient. Hyperglycemia – when blood glucose is too high – can also have a bad effect on the patient.

This information hub offers detailed but easy-to-follow information about diabetes. Should you be interested in the latest scientific research on diabetes, please see our diabetes news section.

There are three types of diabetes:

1) Type 1 diabetes

The body does not produce insulin. Some people may refer to this type as insulin-dependent diabetes, juvenile diabetes, or early-onset diabetes. People usually develop type 1 diabetes before their 40th year, often in early adulthood or teenage years.

Type 1 diabetes is nowhere near as common as type 2 diabetes. Approximately 10% of all diabetes cases are type 1.

Patients with type 1 diabetes will need to take insulin injections for the rest of their life. They must also ensure proper blood-glucose levels by carrying out regular blood tests and following a special diet.

Between 2001 and 2009, the prevalence of type 1 diabetes among the under 20s in the USA rose 23%, according to SEARCH for Diabetes in Youth data issued by the CDC (Centers for Disease Control and Prevention). (Link to article)

More information on type 1 diabetes is available in our type 1 diabetes page.

2) Type 2 diabetes

The body does not produce enough insulin for proper function, or the cells in the body do not react to insulin (insulin resistance).

Approximately 90% of all cases of diabetes worldwide are type 2.

Measuring the glucose level in blood

Some people may be able to control their type 2 diabetes symptoms by losing weight, following a healthy diet, doing plenty of exercise, and monitoring their blood glucose levels. However, type 2 diabetes is typically a progressive disease – it gradually gets worse – and the patient will probably end up have to take insulin, usually in tablet form.

Overweight and obese people have a much higher risk of developing type 2 diabetes compared to those with a healthy body weight. People with a lot of visceral fat, also known as central obesity, belly fat, or abdominal obesity, are especially at risk. Being overweight/obese causes the body to release chemicals that can destabilize the body’s cardiovascular and metabolic systems.

Being overweight, physically inactive and eating the wrong foods all contribute to our risk of developing type 2 diabetes. Drinking just one can of (non-diet) soda per day can raise our risk of developing type 2 diabetes by 22%, researchers from Imperial College London reported in the journal Diabetologia. The scientists believe that the impact of sugary soft drinks on diabetes risk may be a direct one, rather than simply an influence on body weight.

The risk of developing type 2 diabetes is also greater as we get older. Experts are not completely sure why, but say that as we age we tend to put on weight and become less physically active. Those with a close relative who had/had type 2 diabetes, people of Middle Eastern, African, or South Asian descent also have a higher risk of developing the disease.

Men whose testosterone levels are low have been found to have a higher risk of developing type 2 diabetes. Researchers from the University of Edinburgh, Scotland, say that low testosterone levels are linked to insulin resistance.

For more information on how type 1 and type 2 diabetes compare, see our article: the difference between type 1 and type 2 diabetes.

More information on type 1 diabetes is available in our type 2 diabetes page.

3) Gestational diabetes

This type affects females during pregnancy. Some women have very high levels of glucose in their blood, and their bodies are unable to produce enough insulin to transport all of the glucose into their cells, resulting in progressively rising levels of glucose.

Diagnosis of gestational diabetes is made during pregnancy.

The majority of gestational diabetes patients can control their diabetes with exercise and diet. Between 10% to 20% of them will need to take some kind of blood-glucose-controlling medications. Undiagnosed or uncontrolled gestational diabetes can raise the risk of complications during childbirth. The baby may be bigger than he/she should be.

Scientists from the National Institutes of Health and Harvard University found that women whose diets before becoming pregnant were high in animal fat and cholesterol had a higher risk for gestational diabetes, compared to their counterparts whose diets were low in cholesterol and animal fats.

Diabetes symptoms

 

 

What is prediabetes?

The vast majority of patients with type 2 diabetes initially had prediabetes. Their blood glucose levels where higher than normal, but not high enough to merit a diabetes diagnosis. The cells in the body are becoming resistant to insulin.

Studies have indicated that even at the prediabetes stage, some damage to the circulatory system and the heart may already have occurred.

Diabetes is a metabolism disorder

Diabetes (diabetes mellitus) is classed as a metabolism disorder. Metabolism refers to the way our bodies use digested food for energy and growth. Most of what we eat is broken down into glucose. Glucose is a form of sugar in the blood – it is the principal source of fuel for our bodies.

When our food is digested, the glucose makes its way into our bloodstream. Our cells use the glucose for energy and growth. However, glucose cannot enter our cells without insulin being present – insulin makes it possible for our cells to take in the glucose.

Insulin is a hormone that is produced by the pancreas. After eating, the pancreas automatically releases an adequate quantity of insulin to move the glucose present in our blood into the cells, as soon as glucose enters the cells blood-glucose levels drop.

A person with diabetes has a condition in which the quantity of glucose in the blood is too elevated (hyperglycemia). This is because the body either does not produce enough insulin, produces no insulin, or has cells that do not respond properly to the insulin the pancreas produces. This results in too much glucose building up in the blood. This excess blood glucose eventually passes out of the body in urine. So, even though the blood has plenty of glucose, the cells are not getting it for their essential energy and growth requirements.

How to determine whether you have diabetes, prediabetes or neither

Doctors can determine whether a patient has a normal metabolism, prediabetes or diabetes in one of three different ways – there are three possible tests:

  • The A1C test
    – at least 6.5% means diabetes
    – between 5.7% and 5.99% means prediabetes
    – less than 5.7% means normal
  • The FPG (fasting plasma glucose) test
    – at least 126 mg/dl means diabetes
    – between 100 mg/dl and 125.99 mg/dl means prediabetes
    – less than 100 mg/dl means normal
    An abnormal reading following the FPG means the patient has impaired fasting glucose (IFG)
  • The OGTT (oral glucose tolerance test)
    – at least 200 mg/dl means diabetes
    – between 140 and 199.9 mg/dl means prediabetes
    – less than 140 mg/dl means normal
    An abnormal reading following the OGTT means the patient has impaired glucose tolerance (IGT)

Why is it called diabetes mellitus?

Diabetes comes from Greek, and it means a “siphon”. Aretus the Cappadocian, a Greek physician during the second century A.D., named the condition diabainein. He described patients who were passing too much water (polyuria) – like a siphon. The word became “diabetes” from the English adoption of the Medieval Latin diabetes.

In 1675, Thomas Willis added mellitus to the term, although it is commonly referred to simply as diabetes. Mel in Latin means “honey”; the urine and blood of people with diabetes has excess glucose, and glucose is sweet like honey. Diabetes mellitus could literally mean “siphoning off sweet water”.

In ancient China people observed that ants would be attracted to some people’s urine, because it was sweet. The term “Sweet Urine Disease” was coined.

Controlling diabetes – treatment is effective and important

All types of diabetes are treatable. Diabetes type 1 lasts a lifetime, there is no known cure. Type 2 usually lasts a lifetime, however, some people have managed to get rid of their symptoms without medication, through a combination of exercise, diet and body weight control.

Special diets can help sufferers of type 2 diabetes control the condition.

Researchers from the Mayo Clinic Arizona in Scottsdale showed that gastric bypass surgery can reverse type 2 diabetes in a high proportion of patients. They added that within three to five years the disease recurs in approximately 21% of them. Yessica Ramos, MD., said “The recurrence rate was mainly influenced by a longstanding history of Type 2 diabetes before the surgery. This suggests that early surgical intervention in the obese, diabetic population will improve the durability of remission of Type 2 diabetes.” (Link to article)

Patients with type 1 are treated with regular insulin injections, as well as a special diet and exercise.

Patients with Type 2 diabetes are usually treated with tablets, exercise and a special diet, but sometimes insulin injections are also required.

If diabetes is not adequately controlled the patient has a significantly higher risk of developing complications.

Complications linked to badly controlled diabetes:

Below is a list of possible complications that can be caused by badly controlled diabetes:

  • Eye complications – glaucoma, cataracts, diabetic retinopathy, and some others.
  • Foot complications – neuropathy, ulcers, and sometimes gangrene which may require that the foot be amputated
  • Skin complications – people with diabetes are more susceptible to skin infections and skin disorders
  • Heart problems – such as ischemic heart disease, when the blood supply to the heart muscle is diminished
  • Hypertension – common in people with diabetes, which can raise the risk of kidney disease, eye problems, heart attack and stroke
  • Mental health – uncontrolled diabetes raises the risk of suffering from depression, anxiety and some other mental disorders
  • Hearing loss – diabetes patients have a higher risk of developing hearing problems
  • Gum disease – there is a much higher prevalence of gum disease among diabetes patients
  • Gastroparesis – the muscles of the stomach stop working properly
  • Ketoacidosis – a combination of ketosis and acidosis; accumulation of ketone bodies and acidity in the blood.
  • Neuropathy – diabetic neuropathy is a type of nerve damage which can lead to several different problems.
  • HHNS (Hyperosmolar Hyperglycemic Nonketotic Syndrome) – blood glucose levels shoot up too high, and there are no ketones present in the blood or urine. It is an emergency condition.
  • Nephropathy – uncontrolled blood pressure can lead to kidney disease
  • PAD (peripheral arterial disease) – symptoms may include pain in the leg, tingling and sometimes problems walking properly
  • Stroke – if blood pressure, cholesterol levels, and blood glucose levels are not controlled, the risk of stroke increases significantly
  • Erectile dysfunction – male impotence.
  • Infections – people with badly controlled diabetes are much more susceptible to infections
  • Healing of wounds – cuts and lesions take much longer to heal

Source: What is Diabetes?


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