Monthly Archives: May 2010

Diabetes Management Made Easy

Having Diabetes requires good diabetes blood sugar control to minimize the damage to your body. From the time you become diagnosed as a diabetic, it becomes important to take a focussed awareness of most things you eat and do in life.

There are natural ways to control and normalize your blood sugar levels that definitely work.

Effectively managing type 2 diabetes is imperative since most people know there is no cure for diabetes. Given that we are now a decade into the 2000’s this may seem like a failing, that the Medical Researchers and doctors haven’t yet come up with an absolute cure for diabetes, especially when you consider the degree to which diabetes is becoming a problem around the world.

However the word ‘cure’ is probably a little off putting, because whilst it may be technically true that no diabetic will ever be cured of the disease, it can reach a stage where for all intents and purposes, you can be ‘cured’ meaning that your blood sugars become consistently within the normal range, and you are completely symptom free, and require no medication or insulin. That’s the ideal goal for all type 2 diabetics. There are several well respected and proven methods advocated as to how best to achieve (as close as possible) this goal.

To begin effectively managing Type 2 diabetes, you should begin by visiting your doctor, finding out as much as you can about diabetes, ensuring you understand what led to it, and knowing how your body is best able to respond to the measures you decide to put into place to control your type 2 diabetes. All diabetes management begins with controlling the glucose cycle.

Diabetes is effectively the inability by your body to deal with the glucose that enters your bloodstream from the foods you digest. Normally this glucose would be dealt with by your body’s insulin, and the blood glucose levels would then normalize.

However in diabetics this becomes difficult due to either poor insulin productivity, or insulin sensitivity, consequently your body cannot get rid of the glucose in the blood effectively. Over time this constant high blood sugar levels damages nerves, and vital organs, often resulting in adverse health problems like stroke, kidney damage, blindness, and loss of circulation and feeling in extremities, (leading to possible amputation)

It, therefore becomes imperative for managing type 2 diabetes to control the production of glucose in the body through careful choice of the correct foods (Low glycemic index foods) as well as the consumption of the glucose by the body, hence why regular exercise is strongly advocated for type 2 diabetics, as this helps to burn up the available glucose in the bloodstream.

Proper type 2 diabetes management often requires a complete lifestyle change and this in turn can require frequent, sometimes multi-daily checks of glucose in the blood. This is often achieved with the use of a personal blood glucose meter.

Glucose meters are readily available and are quite easy to use with a little practice and patience. A prick to a finger and a drop of blood will reveal whether or not the user know requires a dose of insulin.

With proper type2 diabetes control and management and a diabetes diet plan, eating the right diabetic foods, and exercise, a type 2 diabetic sufferer should have many years of healthy living ahead of them.

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Needle Anxiety? New Short Needle Removes Fear Of Diabetes Injections

While Belonephobia (needle phobia) is a relatively rare condition, many people have needle anxiety and find injections intimidating. This can have a profound effect on the treatment of those with diabetes.

Patients with Type 1 diabetes, the result of inheriting bad genes, need insulin injections to survive. Obesity is responsible for 90 percent of those with Type 2 diabetes. Initially, they can be treated with oral medication, but eventually 39% of these patients over 18 years of age require insulin. This is when the challenge begins for those with needle anxiety.

Needle anxiety often starts early in life when as children they were injected with what looked more like horse needles. Small wonder that they shy away from needle injections.

The goal in treating diabetes is to maintain a normal blood sugar level day after day. This is easier said than done due to human error. But it’s now possible for doctors to know whether or not patients are adhering to their treatment. A blood test called A1C indicates how well glucose (sugar) is adherent to red blood cells over a long period of time. Doctors know that if the test is abnormal, patients are getting careless and skipping injections.

Now there’s less reason for patients to be careless. Today, needles used for insulin injection, given with insulin pens, may be as short as 4 millimeters (4 mm), and as fine as a 32 gauge needle (G-, a medical term for the diameter of the needle) This is a far cry from the glass syringes and much bulkier needles which were used decades ago.

At a recent International meeting in Athens, Greece specialists in diabetic care stressed that the technique of injection is critical to the successful use of insulin. Researchers reported that some doctors are not always aware of the “hows and whys” of proper needle technique. In effect, there’s more to insulin injection than simply jabbing a needle through the skin.

For instance, using MRI and Ultrasound studies, researchers have been able to measure the thickness of skin and fat at several injection sites. They found that skin is rarely thicker than 2.5 mm. And that fat thickness is much thinner than previously believed, particularly in the thigh and outer areas of the abdominal wall.

This means that overweight adults and children can use short 4 mm needles, rather than the longer 12 mm ones. A short needle also increases the chance that insulin will be injected into subcutaneous tissue beneath the skin, rather than into muscles.

These studies also enabled researchers to determine what happens to insulin following injection. They discovered that injecting insulin frequently into the same area triggered the formation of what’s called lipos.

These repeatedly used injection sites look somewhat like sponge-cake and can slow down and cause erratic absorption of insulin. So it’s important for patients to frequently change injection sites.

Today with Type 2 diabetes reaching epidemic proportions, an increasing number of patients will be advised to use insulin injections for improved control of blood sugar. Fortunately, these short, four millimeter needles, so thin you may need glasses to see them, will make this transition easier.

Tiny needles will also help to discourage children and others from skipping injections.

Thank you Dr Gifford-Jones/Toronto Sun

Diabetes: What To Do If Hospitalised

I found this article in dLife and having undergone surgery twice, I can see why the author Therese Garnero stresses the need to manage hyperglcemia. In my case I was in hospital for 50 days all because I had high BS. Unfortunately the hospital’s endocrinologist failed to manage my sugar levels.

Facing surgery is a scary prospect in and of itself. For people who have never taken insulin, the thought of needles only adds to the fear. Plus, if you have heard some of the endless stories and myths circulating about insulin, it only makes matters worse.

You want to go into surgery feeling as confident and relaxed as possible, with minimal anxieties. I hope that after you read this column about the enormous negative impact high glucose levels (hyperglycemia) have on people who are hospitalized, and the incredible benefits of insulin, you’ll feel a little less nervous.

Imagine being hospitalized with a fever of 103 degrees and the hospital staff doesn’t give you any (or not enough) medication to reduce it. Too often, that is the case for people with hyperglycemia—it goes untreated, under-treated, or worse—undetected.

Until recently, it was felt that mild to moderate hyperglycemia didn’t really matter. Now we know better. The research evidence points very strongly to the importance of maintaining tight control of glucose levels when hospitalized. Meticulously controlling glucose improves recovery from illness, reduces mortality (death rate), post-surgical infections, and the length of time spent in the hospital—definitely good things!

How high is high? According to recommendations made by the American Diabetes Association (ADA) Diabetes in Hospitals Writing Committee, glucose levels should be maintained as follows:

# In the Intensive Care Unit (ICU), less than 110 mg/dl (6.11 mmol/l) at all times

# In non-critical care units (like the medical-surgical units), less than 110 before meals, and a maximum of 180 mg/dl (10.00 mmol/l)

# The lower limit for all areas, 80 mg/dl (4.44 mmol/l)

I first learned about these new national standards at the 2004 American Association of Diabetes Educator conference. I was, and still am, outraged. Did you know that at least 25% of all hospitalized adults have hyperglycemia and/or undiagnosed diabetes?

What can you do to combat hyperglycemia if you find yourself in your neighborhood hospital?

Inform the staff. Make sure they know you have diabetes.

Ask to have your glucose level taken regularly (typically done before meals and at bedtime, and more often based on values). I am amazed at how often glucose levels are not checked.

Bring your glucose monitor to the hospital. Some people find comfort in knowing they can check their glucose on a moment’s notice. Plus, if you feel up to it and the hospital allows, you could check your glucose as ordered by the doctor instead of using the hospital’s system (which can have painful lancets).

Realize that insulin is your friend. It has only been around since the 1920s. The Portland Protocol, which is a new national standard for insulin use in the hospital, is placing all people going into surgery, whether or not they have diabetes, on a low dose insulin drip because of its benefits.

Know that it is normal to be afraid of needles, at first. If you liked needles, we’d worry! Trade secret: the new insulin needles come in short, skinny sizes, and oftentimes hurt less than poking your finger with a lancet. For some, insulin might be needed for a short time during a hospital stay. For others, insulin is needed long term to keep glucose levels in check. Insulin is one of the best things we have to help control diabetes. It is not the problem—high glucose levels are the problem.

Request your surgery be done in the morning. If your surgery is later, your glucose levels might be harder to control. Even one reading above 200 can have an impact. Ask the surgical team (nurse, surgeon, physician, and/or anesthesiologist) about your medications for the day of surgery. Some medications should not be taken; others are split in half.

Bring an advocate. Who knows a lot about your diabetes and can stand up for you if need be? Studies show it is not uncommon for doctors and nurses to have a basic lack of knowledge and understanding about diabetes. You may have more knowledge about the best way to control your diabetes, but may be too ill to articulate that. So have a family member or friend step up to the plate.

Ask to see a diabetes educator. Not all hospitals have registered nurses, registered dietitians, and pharmacists who specialize in diabetes, but many do. If you need an advocate, a diabetes educator will do just that. You can also ask for an endocrinologist evaluation (a doctor who specializes in diabetes) if your diabetes is not in control.

Control pain. The old adage, “No pain, no gain” is hogwash. Pain raises glucose levels and interferes with healing. Try not to be tough. If you are in pain, let the nurse know.

The best place to play jeopardy is outside of the hospital. Ready? What can double the amount of time you spend in a hospital, increase your risk for a heart attack or stroke, increase your chance of an infection, or increase your chance of leaving this planet forever? Hyperglycemia!

You can minimize your risks and concerns by controlling hyperglycemia in the hospital setting. And luckily, advocates are there to help.

NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.

Thank you Theresa Garnero

Diabetes: The Perils Of Hypoglycemia

I came across this very good article on the perils of Hypoglycemia. While T1 cases are discussed, all of us insulin-dependent T2 types must also know the consequences of “tight control”.

I have always wondered why just about everyone insists that diabetics MUST have BS levels associated with non-diabetics! Indeed, my diabetologist says: “One incident of Hypoglycemia is worse than 10 days of Hyperglycemia.”

In my case, BS levels went haywire (plus 9 on the A1C scale) after intestinal surgery 2 years ago. I started a strict regimen and brought down A1C level to 7.2 in 3 months. However, my doctor was unimpressed!

According to him, his experience of 30 years showed that diabetics live healthy lives even if A1C levels are between 7-8. Less than that, frequent bouts of Hypoglycemia lead to more complications. His prognosis is that the body “learns to live with diabetes” by adjusting accordingly.

In fact, I have noted that obits of many famous people dying of “diabetes complications” involve individuals over 80!

While the jury is out on such an assertion, we know that most diabetics lead normal lives without attaining “optimal” BS scores.

In my own case, after 8 years of insulin dependence, I’m so far outside the danger zone vis-a-vis retinopathy, neuropathy, kidney malfunction, heart disease and foot complications.

Here are excerpts from the article by Robert J Tanenberg, MD, outlining the perils of Hypoglycemia:

Over 80 years ago, famed diabetologist Elliot Joslin said about the treatment of patients with type 1 diabetes: “Ketoacidosis may kill a patient, but frequent hypoglycemic reactions will ruin him.”

Unfortunately, hypoglycemia continues to be the most difficult problem facing most patients, families, and caregivers who deal with the management of type 1 diabetes on a daily basis.

Frequent hypoglycemia episodes not only can “ruin,” or adversely impact the quality of life for patients, but also, when severe, can cause seizures, coma, and even death.

One needs to first understand hypoglycemia as a biological event. When blood sugars fall below normal, there are two important consequences, which are identified by the blood sugar level at which they occur and the type of symptoms involved.

Mild and Moderate Hypoglycemia
The first consequence triggers a prompt release of hormones that work to raise the blood sugar.

These so-called counter-regulatory hormones include epinephrine (adrenaline), glucagon, cortisol, and growth hormone. The clinical responses to these hormones, which are well known to patients who have had hypoglycemic reactions, include sweating, palpitations, tremor, hunger, nervousness, and tingling sensations. These “fight, or flight” symptoms are often called sympathetic or adrenergic to emphasize their origin in the autonomic nervous system and from the adrenal gland. They are non-specific and may also occur in response to other stressors.

When hormones are released normally (in response to a low or rapid fall in blood sugar), patients experience the symptoms and usually take action by eating or drinking carbohydrates. Typically, the symptoms resolve within five minutes as the blood sugar rises.

Severe Hypoglycemia
However, if the hormones are not released and there are no warning symptoms, the blood sugar will continue to fall. As the blood sugar drops below 55 mg/dL, the second consequence of hypoglycemia occurs.

The brain becomes deprived of glucose and can no longer function normally. This condition, called neuroglycopenia, leads to cognitive dysfunction that presents as confusion. There is a slowing of reflexes, and the hypoglycemic individual loses the ability to comprehend and act appropriately. The patient is no longer able to treat the hypoglycemia himself.

The need for assistance from another person to treat the hypoglycemia fulfills the definition of severe hypoglycemia. When driving a car, for example, patients with severe hypoglycemia often become lost even in a familiar neighborhood. If they are not able to quickly recognize the insulin reaction and pull off the road, they may lose control of their vehicle, with potentially catastrophic consequences.

Loss of Protective Hormones
Several hormonal changes occur in patients with type 1 diabetes. Usually within a few years of the onset of the disease, the patient’s pancreas fails to secrete glucagon when the blood sugar falls below 70 mg/dL.

When this happens, only epinephrine is left to respond to the low blood sugar until it drops below 60 mg/dL. At that level, cortisol and growth hormone are secreted. Unfortunately, these hormones are “too little, too late” to help during the first 10 minutes of the insulin reaction.

Patients with both a diminished glucagon and a diminished epinephrine response have a 25-fold increase in the frequency of severe hypoglycemia.

Diabetes specialists use the term hypoglycemic unawareness to describe patients who have lost the ability to trigger the classic sympathetic symptoms. Sleep, which naturally suppresses epinephrine, makes the patient vulnerable to severe nocturnal hypoglycemia.

If the blood sugar drops falls below 30 mg/dL, it may lead to seizures, coma, and ultimately death (as it did in our patient). Occasionally, patients with tightly controlled type1 diabetes (e.g., A1c under 6.5%) may be reasonably lucid with blood sugars below 40 mg/dL.

Apparently, the brain has a capability to lower the natural clinical set point. This situation places the patient in great danger. The only treatment is to back off on glycemic control (in other words, raise the target blood sugars), which should raise the set point back to normal. In fact, it is well known that each episode of severe hypoglycemia increases the possibility of a future episode occurring at an even lower blood glucose level.

Causes of Hypoglycemia
In type 1 diabetes, the most common cause of hypoglycemia is a mismatch of insulin, food intake, and physical activity. Whenever there is a change in the amount of food or exercise in a nondiabetic individual, the body adjusts by changing the hormones to keep the glucose as close to normal as possible.

This is why people without diabetes rarely become hypoglycemic when fasting or running marathons. In patients taking insulin, however, vigorous physical activity may cause hypoglycemia both during the activity and for several hours afterward. In fact, late afternoon exercise is a well known cause of nocturnal hypoglycemia.

Regimens using the newer analogue insulins (e.g., glargine and lispro) reduce the incidence of hypoglycemia compared to those using regular and NPH insulin. But any insulin, even when dosed correctly, can cause severe hypoglycemia. If patients taking insulin increase their physical activity, they must either eat more or reduce the insulin dose before and after their activity.

Similarly, patients on insulin who eat much less than usual need to reduce their insulin dose to prevent hypoglycemia. Furthermore, the indiscriminate use of alcohol can also lead to severe hypoglycemia.

Treatment of Hypoglycemia
Mild hypoglycemia should be treated with 15 grams of fast-acting carbohydrate, such as four ounces of juice or three to four dextrose tablets. If the blood sugar is still low in 10 to 15 minutes another 15 grams of carbohydrate should be given (known as the Rule of 15).

Moderate hypoglycemia typically responds to oral carbohydrates, but may take as long as 30 minutes to fully resolve. Frequent fingerstick blood glucose testing is mandatory to be sure the glucose does not continue to fall.

Patients with severe hypoglycemia who are not yet comatose may respond to liquid or buccal oral carbohydrates, but injectable glucagon is the best treatment in the home setting. Since glucagon may not raise the glucose levels to normal, giving fast-acting carbohydrates after the patient becomes more responsive is essential.

Rescue squads and emergency room physicians administer 50-percent dextrose intravenously, which usually reverses the condition very quickly. In some cases, repeated doses of intravenous dextrose are needed.

Prevention of Severe Hypoglycemia
To help prevent severe hypoglycemia, diabetes specialists recommend the following:

* For physically active persons, it is important to check fingerstick blood sugars after exercise in anticipation of possible hypoglycemia. It is especially important to check at bedtime and 3:00 am if the activity is after 4:00 pm.
* Bedtime insulin should be decreased after exercise.
* Physicians should be cautious about recommending near-normal blood glucose control and A1c targets to patients with type 1 diabetes and a history of hypoglycemia, particularly if they sleep alone.
* If severe hypoglycemia occurs, the physician should raise the glucose targets immediately to prevent another episode.
* Patients with nocturnal hypoglycemia, hypoglycemic unawareness, and/or a history of seizures are candidates for the newer real-time subcutaneous sensors with low glucose alarms.

Final Thoughts
We want to better inform physicians and patients of this potential danger. Severe hypoglycemia, in very rare cases, can lead to death while driving a car, swimming in the ocean, or even sleeping in ones’ own bed.

If patients who take insulin learn nothing else, they should learn to always test their blood sugar at bedtime, before driving, and any time there is a change in activity or food intake.

Early treatment of mild hypoglycemia must be emphasized so that progression to more severe consequences can be avoided. As physicians and diabetes educators learn more about the hazards of nocturnal hypoglycemia, they will educate their patients to anticipate and prevent it.

Thank you Robert J. Tanenberg, MD

Diabetes Lowers Prostate Cancer Risk

While us diabetics lead very complicated lives managing the disease, there are moments now and then that give us reason to cheer. The latest bit of heartening news that diabetics are less prone to prostate cancer!

Hey, that’s one less threat to worry about!

The news agency UPI has reported German, Swedish and US researchers said they found a lower rate of prostate cancer among people with diabetes.

Study leader Kari Hemminki at Helmholtz Association of German Research Centres in Heidelberg said the researchers could only speculate about the causes.

“Possibly, a lower level of male sex hormones in diabetics may be among the factors that are responsible for this,” Hemminki said in a statement.

Hemminki and colleagues studied the cancer incidence in 125,126 Swedish citizens hospitalized due to type 2 diabetes complications as well as those of the general population in Sweden.

They also found higher risks of several cancers in those with type 2 diabetes — very significantly for pancreatic cancer and liver cell cancers.

Diabetics also had double the risks of cancers of the kidneys, thyroid, esophagus, small intestine and nervous system.

The study, published in The Oncologist, also looked at whether the risk was higher in hospitalized diabetic patients because their tumors were found earlier due to routine diagnostics. The researchers separately analyzed how many cancers occurred in study participants after one and five years, respectively, following their hospital stays. This revealed a slightly lower risk elevation, but, the researchers concluded, the trend was the same.

Diabetes and Surgery

A lot of individuals are afraid of having operations carried out on them, more so those with diabetes. It is a fact of life that people with diabetes who have had surgery are at a higher risk than non diabetics of having severe infection and reduced healing rate following the operation.

The reduced ability of wounds to heal in people with diabetes is due to factors like delayed response of their body to the injury, reduced functioning of their white blood cells which are the soldiers of the body and reduced production of certain cells in the body called fibroblasts that aid wound healing. Older people with diabetes, those that are malnourished and those with damaged their blood vessels and nerves generally heal less well after surgery.

The question thus needs to be asked that, if someone with diabetes requires having a surgery done; can such an operation be carried out safely? The answer is a resounding yes! The operation can range from relatively minor ones like a tooth extraction to major ones like hip replacement or one that will require opening up of the abdomen. If the preparation for the operation is carefully made, the operation will likely be successful and the recovery good.

When people with diabetes know the steps they should take so that they will emerge from their surgery safe and sound, then the fear of having operations will wane considerably. Surgery can either be elective or emergency. In elective cases, both the surgeon and the patient have time on their hands to ensure that all needed preparations are made.

In the person with diabetes, this will importantly include the need to ensure a good blood sugar level control prior to the operation. The surgery should not be carried out until the blood sugar level is under control. In elective cases, the outcome is better most times than in emergency cases when both the surgeon and the patient do not have enough time on their hands to make near foolproof preparations.

In preparing for the surgery, the person with diabetes will have to work closely with his or her Physician in order to avoid too low or too high blood sugar levels in the days preceding the surgery. This will also make for easy blood sugar control during the operation and also reduces the risk of infections and helps to enhance healing.

The need to stop tablets used to treat diabetes and probable substitution with insulin injections a few days before the operation will also be discussed. Prior to surgery, there will be a proper evaluation of the nerves of the individual undergoing the operation as nerve damage resulting from long-term diabetes can lead to catastrophically low blood pressure levels during the operation.
The likely duration, type and extent of the surgery, the type of anaesthetic agent to be used, where it will administered, for how long and the possible side effects should also be discussed with the managing physicians. Complications that may follow the surgery and what time of the day the surgery will be scheduled for should also be discussed.

Also, the person undergoing the surgery has a right to ask about the expertise of the surgeon carrying out the operation and that of the supporting staff. People with diabetes generally have their surgeries carried out in the mornings and are generally put on top of the operating list.

On the day of the operation, indeed from at least eight hours prior to the operation, all oral intakes will be restricted. A glucose infusion containing insulin will be started early in the morning of the operation and will continue until oral intake can be started hours after the surgery.

During the operation, blood sugar levels will be checked every hour and the glucose- insulin infusion will then be adjusted as needed. Insulin injections are generally advised until the wound from the surgery is fully healed.

Thank you Dr Olubiyi Adesina

Diabetes: Contribution Of Toxins In The Body

Unraveling how toxins contribute to disease has long been a murky matter. Now researchers at the Stanford University School of Medicine have developed a quick new method for figuring out which foreign chemicals in the body coincide with complex diseases, and used it to examine the increasingly prevalent type 2 diabetes.

“The whole inspiration was to do for the environment what has been done for genetics,” said Atul Butte, pediatrician and computer scientist at Stanford Medical School and an author of the study published online Thursday in the open-access journal PLOS One.

To find potential genetic causes of a disease, researchers typically look for genetic markers common to people with the disease but rare for others. Instead of testing for one genetic marker at a time, they search for any such traits.

The new method, developed by Butte, his graduate student Chirag Patel, and Stanford professor of medicine Jayanta Bhattacharya, mimics that approach for environmental factors.

Using data collected by the Centers for Disease Control and Prevention, the team correlated each anonymous test subject’s fasting blood sugar level — a sign of type 2, or adult onset, diabetes — with the levels of 266 chemicals detected in blood and urine. The CDC tested people from different age groups and ethnic backgrounds to gauge the overall health of children and adults.

“The data’s just been sitting there, waiting for an analysis like this,” Butte said. “Every day we encounter something new, but we still don’t know what this means for our health,” Patel said.

Environmental factors
The method has several challenges that genetic testing does not, which makes it difficult to clearly establish cause and effect. For instance, a disease can be the reason certain toxins accumulate in the body instead of those toxins being among the causes of the disease. Also, the CDC tests only for compounds that are stable in blood and urine, but misses thousands of compounds that disintegrate quickly.

Still, using the new method, researchers uncovered several chemicals of interest for type 2 diabetes. Surprisingly, a form of vitamin E found in oil and nuts — gamma tocopherol — was related to elevated fasting blood sugar levels. And higher concentrations of polychlorinated biphenyls, pollutants banned in the United States in 1979, often coincided with higher fasting blood sugar levels. Some PCBs have previously been linked to type 2 diabetes.

“It’s reassuring that we found some correlations that we were expecting to find,” Butte said. But “there were many more surprises than reassurances.”

The method also found similar results for heptachlor epoxide, a chemical that animals and plants derive from an insecticide that was banned in the 1980s.

Heptachlor persists in the water and soil, can accumulate in the tissues of animals, and can be passed from mothers to infants through breast milk.

Much testing remains before the researchers can establish which environmental factors cause or deter type 2 diabetes.

“Before we start telling people what to eat, which plastic bottles to throw away, I would like to see these things replicated,” said Mark Cullen, a professor of internal medicine at the medical school who has worked with Patel.

Valuable Approach
Next, the team hopes to reproduce the type 2 diabetes results in another independent population. The next step after that will be to track people with elevated levels of gamma tocopherol and heptachlor epoxide to see whether they develop diabetes. The long-term payoff for the method will one day allow medical science to search for environmental risk factors for other complex diseases, such as obesity, heart disease and cancer.

“This is a very valuable first approach,” said Rochelle Long, program director of the National Institute of General Medical Sciences (NIGMS), which supported the research. “It will need to be replicated. One caveat is that you can only discover factors that are present in the data set to begin with.”

In addition to NIGMS, the work was funded by the National Library of Medicine, the National Institute on Aging, the Lucile Packard Foundation for Children’s Health and the Howard Hughes Medical Institute.

The CDC survey is a laborious task that involves running a battery of tests on each subject. Patel and Butte hope to inspire California biotech companies to develop new chips for quickly testing for hundreds of relevant compounds. Studying environmental factors in disease is a more uplifting task than studying genetic factors, they said.

For instance, the factors most highly linked to type 2 diabetes that their method uncovered have already been banned.

“The public can make a difference,” Butte said. “Genes — you can’t do anything about those.”

Thank you Olga Kuchmen/Mercury News

Diabetic Neuropathy: No Clear Answers

Do high glucose levels cause neuropathy? That’s an issue that worries most diabetics. And unfortunately there are no clear answers.

Experts think of blood glucose values as a spectrum of numbers with no clear cutoff between nondiabetic and diabetic. In similar manner, there is a gray area of blood glucose that defines pre-diabetes. Many people use blood sugar and blood glucose interchangeably.

The definition of diabetes has changed over time. The numbers you quote might very well be considered diagnostic of diabetes today whereas they were not 20 years ago. In 1997, the American Diabetes Association definition of normal blood glucose decreased from 120 to 110 mg/dL (6.1 mmol/L). In 2002, the American Diabetes Association defined a normal fasting blood glucose as less than 100 mg/dL (5.6 mmol/L).

Today we consider fasting blood sugars of 100 mg/dl to 125mg/dl to be in the realm of glucose intolerance which is sometimes called pre-diabetes. These patients are at increased risk for developing frank diabetes. Several fasting glucose levels over 125 or a single random glucose over 200 mg are considered diagnostic of diabetes.

There are other tests used to make the diagnosis of pre-diabetes or diabetes. Pre-diabetes is defined as a blood sugar of 140 to 199 mg/dL (7.8 to 11.0 mmol/L) two-hour after drinking 75 grams of an oral glucose solution. The diagnosis of diabetes is confirmed with a blood sugar of 200 mg/dL or greater, two hours after ingestion of the glucose solution.

Hemoglobin A1C is a blood test that gives an estimate of blood sugar levels over the previous three months. Persons with a value of 5.7 to 6.4 percent are thought to have pre-diabetes. Those with a value of 6.5 percent or higher are considered diabetic.

About 30 percent of patients with frank diabetes for more than a decade have some neuropathy. It usually presents as numbness, itching or tingling in the legs but can also be pains. It can even present as digestive problems such as difficulty digesting food or diarrhea due to problems with nerves in the bowels.

Most diabetic neuropathy is caused by peripheral artery disease, in which the small blood vessels are obstructed or partially obstructed and cannot carry oxygenated blood to areas of the body. These areas have pain or other difficulties due to the lack of oxygen.

It is very possible for someone with numbers that are considered pre-diabetes to have some of the complications of diabetes This is especially true of big vessel disease such as myocardial infarction (heart attack), stroke and peripheral vascular disease. Retinopathy, neuropathy and kidney disease are rarer in pre-diabetics but can occur, especially in someone who has pre-diabetes and hypertension (high blood pressure).

The condition of pre-diabetes combined with hypertension is often referred to as the “metabolic syndrome.” Elevated cholesterol and triglyceride combined with diabetes and hypertension increases risk of neuropathy even further. Of note, there are some nondiabetics with neuropathy and peripheral vascular disease caused by elevated cholesterol and triglycerides only.

It is prudent that you have a relationship with a physician who will measure not just blood sugar, but cholesterols, triglycerides and blood pressure. He or she may decide that lowering your blood sugars through diet or medication or both might be beneficial for your long-term health. Lowering blood sugar can sometimes even better the pain of diabetic neuropathy.

Many pre-diabetics and diabetic patients are also treated for cholesterol and triglyceride problems and get a baby aspirin daily to decrease risk of heart disease. There are also a number of treatments for pain caused by neuropathy.

In addition to having the above tests, people with pre-diabetes and diabetes should get an annual eye examination to rule out early diabetic retinopathy. Diabetic retinopathy is treatable and is the most common cause of blindness.

It is also prudent to examine the feet for wounds that the patient might not appreciate due to loss of sensation as a part of diabetic neuropathy. Assessment of kidney function and some studies of the heart and vascular system may also be called for.

By the way, there are other causes of peripheral neuropathy. Not uncommon are amyloidosis, which is a disease in which excess protein is deposited in nerve tissue, and vasculitic neuropathy, a rheumatologic disease in which the patient has inflammation near the nerve.

Also we must consider alcoholic neuropathy in someone with an extreme drinking history and even lead poisoning as a possible cause. Patients who have been treated with chemotherapy for cancer and some rheumatologic diseases can also get some painful neuropathies.

Thank you Dr Otis Brawley

World Diabetes Day: 6 Months To Go

(This is a message from the International Diabetes Federation)

Let’s take control of diabetes. Now.
2010 marks the second year of the five-year focus on ‘Diabetes education and prevention”, the theme selected by the International Diabetes Federation and the World Health Organization for World Diabetes Day 2009-2013.

The campaign slogan for this year is: “Let’s take control of diabetes. Now.”

For the general public and people at high risk of diabetes, the focus will be on raising awareness of diabetes and disseminating tools for the prevention of diabetes.

For people with diabetes, the focus will be on disseminating tools to improve knowledge of diabetes in order to better understand the condition and prevent complications.

For governments and policy-makers, efforts will focus on advocacy aimed at communicating the cost-effective implications of diabetes prevention strategies and promoting diabetes education as a core component of diabetes management and treatment.

The key messages of the campaign, developed for our different target groups, are:

* Are you at risk? Take the blue circle test.
* Know the signs and symptoms of diabetes. Early diagnosis saves lives.
* Diabetes prevention and treatment is simple and cost-effective. Put it on top of the agenda.
* Your child could be affected. Know the warning signs. See your doctor to measure the risk.
* Enjoy an active life and prevent complications.

A special video, shot in the IDF Executive Office in Brussels, has been produced explaining the 2010 campaign. View the video.
2009: A Global Success Story
Thanks to the efforts of IDF member associations and the wider global diabetes community, the first year of our five-year campaign on ‘Diabetes education and prevention’ was a resounding success.

People all over the world were mobilized and engaged around our messages aimed at communicating the importance of knowing the warning signs and risk factors of type 1 and type 2 diabetes, and knowing how to take control and reduce their risk. Achievements included:

* 1650 events and activities, including blue lightings, human blue circles, walks, and screenings, in over 115 countries, registered on http://www.worlddiabetesday.org.
* 1800 campaign-related pictures submitted to http://www.worlddiabetesday.org and the WDD virtual museum.
* 225,000 virtual candles lit.
* 3 million visits to and 1 million page views on http://www.worlddiabetesday.org.
* World Diabetes Day logo and campaign posters translated and made available in 65 and 16 languages respectively.

The pictures received told the global story of a remarkable shared experience. We are very grateful to all those who contributed to the success of the day, and look forward to building upon the achievements in 2010.

2010 Campaign News

Blue Circle Online and Offline Test
This year we’re adding an exciting, new dimension to the World Diabetes Day campaign. We’ll be launching a new initiative that will allow people around the world to learn if they are at risk of type 2 diabetes, and start taking control of their lifestyle.

The “Blue Circle Test” will consist of an online and offline component:
The online tool will showcase the risk factors of type 2 diabetes and display the positive actions that can be taken to reduce a person’s risk. Users will be confronted with one or more fictitious characters at high risk of developing type 2 diabetes.

The aim will be to reduce a character’s risk by eliminating risk factors and adding positive actions. With each action, the user will be informed in an informal way on the hows and whys.

The offline version will consist of a special blue World Diabetes Day measuring tape for use in World Diabetes Day grassroots activities all over the world. The tape will include information on the links between waist circumference and the risk of type 2 diabetes.

Blue Monuments and Exercise
Last year confirmed the popularity of the blue lighting of landmark buildings and sites as a key component of World Diabetes Day celebrations around the world. The initiative will continue this year, and we aim to strengthen the link between the lightings and diabetes by encouraging the global diabetes community to use the blue lightings as the venue for all World Diabetes Day-related grassroots activities and events.

Particular focus will be placed on activities promoting physical activity, with the aim of stimulating participation, particularly of people with diabetes, and interactivity in order to convey a positive and empowering message.

If you have already managed to secure a lighting in your area, please send the name of the confirmed monument to lorenzo.piemonte@idf.org. In our next newsletter, we will begin the count with the list of building and sites confirmed so far.

Whatever the event you plan to organize for World Diabetes Day this year, please register your event on the World Diabetes Day website.

Tailored, Adaptable Materials
We have designed new visuals to illustrate the campaign slogan and key messages described above. There will be custom posters for people at risk of diabetes, health professionals, decision-makers, and people with diabetes. Our aim is for the material to be flexible and adaptable to fit different target groups and cultures.

A practical handbook will also be produced with all the information needed to mark World Diabetes Day in your area.

See these videos: http://www.youtube.com/watch?v=B-yZLZfAWnU&feature=channel

Diabetes & Yoga Make Good Dialectics!

Yoga is an ancient Vedic practice of various physical postures and breathing techniques to reduce stress and improve health. Yoga has been derived from a Sanskrit word ‘yoke’ which means union.

Yoga is the age old science, art and philosophy of uniting the human mind, body and soul in a single chord. This union is for creating a balance between these three prime elements. There are various yoga forms including Hatha yoga, Raja yoga, Kundalini yoga, Ashtanga yoga, Jnana yoga, Vinyasa yoga, and Bikram Yoga to mention a few.

All these yoga forms aim to reach a higher level of awareness by overcoming the limitations of the mind, body and soul. Apart from spiritual upliftment, yoga also promises a better life and sound physical and mental health.

Practicing yoga on a daily basis ensures myriad health benefits. Many yoga practitioners have found that their yoga practice is deepened and improved by incorporating soothing yoga music into their practice.

Soothing spiritual music or meditation music helps to create a strong sacred vibration and sets up the proper state of mind required for yoga or meditation by relaxing the mind and the body. When the mind and body are relaxed, it helps support the immune system and automatically lessens the chance of illness.

Yoga has even been known to cure various serious ailments and diseases including heart disease, muscle and joint debilitation, depression and many, many more ailments. Diabetes is another disease which has been seen to resolve with a regular yoga practice.

Diabetes or Diabetes Mellitus is a chronic polygenic disease where the glucose level in the blood is abnormally high. It is a type of metabolic disorder characterized by the body’s inability regulate and produce insulin.

The main function of insulin is converting sugar, starches or other food items into energy. When the body stops producing insulin, the sugar circulation in blood increases unchecked, which leads to serious disorders of the nervous system, the vascular system, the circulatory system, obesity, even loss of limbs.

Diabetes is a growing world-wide epidemic that even the most advanced medical doctors are continuously losing the battle against. An increasing number of people in their middle age are facing the stark reality of diabetes due to unbalanced diet and insufficient activity levels.

Yoga and a balanced diet paired together have been seen to show marked steps towards curing diabetes and balancing blood sugar. Regular practice of yoga also reduces the chances of the onset of diabetes and keeps it in control by changing lifestyle patterns.

If you are interested in trying out yoga as a beginner, you can use a good yoga DVD in the privacy of your own home and receive proper guidance in yoga practicing from an excellent yoga teacher.

There are various yoga poses which can be effective in warding off diabetes. Sun salutation or Surya Namaskar is a very powerful and helpful yoga exercise for people suffering from diabetes. This exercise tends to improve the blood circulation throughout the body and hence a better level of insulin administration throughout the body.

After becoming more familiar with Sun Salutations, one can practice other yoga asanas including Paschimottanasana, Dhanurasana, Ardhamatsyendrasana, Kapalbhati, Anuloma-Viloma, Vajrasana, Shankha Prakshalana and Savasana.

Pranayama or the breathing techniques are also very good for controlling and purifying the blood. In addition, practicing meditation can also be helpful in the treatment of diabetes.

Regular meditation has actually been known to have a regulative effect on sugar levels. Gentle meditation music can be of great while practicing pranayama as it helps one to concentrate more on the breathing.

Thank you Raj Malhotra

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