Tag Archives: Neuropathy

With Diabetes Assuming Epidemic Proportions, Foot Doctors Look For A Leg Up

PODIATRISTS, tenders of corns, bunions and other troubles of the humble foot, are classified as second-class citizens in the medical world – a rung below full-fledged M.D.s. But with the surge in people with diabetes, they’re playing a particularly vital role these days in preventing amputations. And there’s a move afoot to boost their official status as well, reports Jan Ferris of the Sacramento Bee.

Dr Jon A. Hultman

“We kind of see ourselves as the profession that keeps people walking,” said Dr. Jon Hultman, executive director of the California Podiatric Medical Association.

Obesity is the primary culprit for the boom in cases of type 2, or adult-onset, diabetes. As the numbers rise, so does the need for early treatment – especially of foot sores or ulcers that can quickly threaten the lower limbs. Sixty percent of all non-traumatic amputations in the U.S. are due to diabetes, according to the American Diabetes Association.

Indeed, podiatry (foot care) for people with diabetes is one of the most overlooked aspects of diabetes management. Reviewing the community discussion regarding podiatry and particularly for visiting podiatrists reveals that many people with diabetes are entirely unaware that they need to take special care of their feet and visit a podiatrist at once if problems arise. Higher levels of blood glucose can damage the nerve endings in many areas of the body and organs, which is why tight blood glucose control is an essential aspect of diabetes care.

But here’s the thing: Though podiatrists can operate on the foot and ankle, give injections and provide other medical care, they aren’t licensed doctors of medicine, or M.D.s. As such, Hultman and others maintain, the state’s 1,800 doctors of podiatric medicine (DPMs) are hamstrung by law from treating many of the 7.5 million Californians insured through Medi-Cal (due to a 2009 state budget cut), partnering fully in the hospital care of diabetic patients and gaining access to first-rate residencies in their podiatric training.

“We’ve evolved over the last 30 or 40 years. What hasn’t changed is this limited license,” Hultman said. “We’re treated differently even though the way we practice is essentially the same.”

Indeed, on a given day with the Sutter Medical Group, 30-year podiatrist Dr. Spencer Lockson treats the foot from several angles: dermatological, as in athlete’s foot and eczema; bone and joint issues, such as bunions, fractures and “hammer toe” deformities; and nerve conditions, which are often associated with diabetes. “We avoid amputations the best we can,” he said.

Foot Doctors Can Help Diabetics Avoid Amputation

Podiatrists have attracted an unlikely ally in the bid to boost their status: the California Medical Association. The powerful doctors’ lobbying group is notorious for its turf battles with chiropractors, nurse practitioners and others it defines as “mid-level practitioners and other allied health professionals.”

But this time around, the CMA is playing the opposite role. It’s teaming up with the California Podiatric Medical Association and the California Orthopaedic Association to consider putting the training of foot specialists on par with M.D. standards, according to CMA Chief Executive Officer Dustin Corcoran.

The three groups are creating a task force to review the curriculum at California’s two podiatry schools and, depending on the outcome, appeal jointly to the national Liaison Committee on Medical Education to reclassify the licensing for podiatrists.

Dr. Lawrence Harkless, a podiatrist and dean of the Pomona-based College of Podiatric Medicine at the Western University of Health Sciences, believes the move makes good sense. “I don’t have an M.D., but I practice medicine every day. If I’m that close, why not just be it?” he said.

The first two years of podiatric training are similar to those for full-fledged physicians, with the emphasis on anatomy, physiology, pathology and other core subjects. Podiatry students jump into more specialized training the next two years, then generally spend the last two or three years as hospital residents. Training for licensed medical doctors generally takes several years longer, with the length for residencies determined by the specialty.

At his first hospital internship in Texas in the 1970s, Harkless worried he’d be less prepared than his M.D. peers. “After two months, I knew I learned more than anybody about feet,” said Harkless, considered a national pioneer in the field of diabetic limb salvage. “But if you have a different degree, they want to make you feel less than.”

Corcoran of the California Medical Association agrees the perception is not always favorable. He and Hultman are expecting pushback on the collaboration to bring podiatry into the medical mainstream. “There will be a freak-out, those naysayers, who say, ‘They’re just the foot guys and will always just be the foot guys’,” said Corcoran. But this is really how scope of practice should be decided.”

Shortage Of Vascular Surgeons In India Costs 80,000 Limbs Every Year

With a physician shortage in California, and the aging baby boomers’ growing need for care, podiatry may become a more attractive option if granted M.D. status, he added.

Franklin High School graduate Brittany Rice just completed her first year at the California Podiatric School of Medicine at Samuel Merritt University in Oakland. She is used to frequently explaining that podiatry is a credible medical field. “I know people in society put the M.D. on a higher pedestal. They don’t take us seriously,” said Rice, who is considering specializing in diabetes care. “Not that (a change in licensing) would affect what I do, just how people perceive the profession.”

Sacramento podiatrist Kevin Kirby isn’t convinced. He chose podiatry school in the 1980s, in part because of its “efficient” focus on the foot and a postgraduate commitment of six years instead of eight or nine. If new requirements called for additional training, he wonders if students would just choose a different branch of medicine.

“I never had the feeling that I was a lesser doctor because I had a DPM,” said Kirby, who is on staff at two Sacramento hospitals and shares his practice with an orthopedic surgeon. “For me, I don’t lose any sleep over this. I’m plenty busy. I do a lot of good for people.”

Courtesy: Sacramento Bee

Advertisements

New Guidelines on Best Treatments for Diabetic Nerve Pain

The American Academy of Neurology (AAN) issued a new guideline yesterday on the most effective treatments for diabetic nerve pain, the burning or tingling pain in the hands and feet that affects millions of people with diabetes.

The recommendations of this guideline will serve as the foundation for a new set of tools the AAN is creating for doctors to measure the quality of care they provide people with nerve pain. The measures will be released in 2012.

The guideline ‒ published yesterday in the online issue of Neurology and presented at the American Academy of Neurology’s Annual Meeting in Honolulu ‒ was developed in collaboration with the American Association of Neuromuscular and Electrodiagnostic Medicine and the American Academy of Physical Medicine and Rehabilitation.

Nerve pain is different from other types of pain, like pain from a muscle ache or sprained ankle. Common pain medicines like aspirin may not work for nerve pain. Nerve pain is unique and feels different than muscle pain. Since all pain is not the same and nerve pain treatment is different from muscle pain treatment, it’s important to understand the source of your pain.

Unfortunately, nerve pain can be one of the most intense pains that people feel. And Diabetic Nerve Pain can make normal daily activities more difficult.

When a person has pain that is caused by nerve damage from diabetes, it is simply called painful Diabetic Peripheral Neuropathy (pDPN). The most common cause of pDPN or Diabetic Nerve Pain is poorly controlled blood sugar levels. Over time, high blood sugar levels can result in nerve damage. Controlled blood sugar levels may help prevent, stabilize, and delay further nerve damage.

All Eyes on Research That May Provide Cure for Diabetic Neuropathy

According to the guideline, strong evidence shows the seizure drug pregabalin (Lyrica) is effective in treating diabetic nerve pain and can improve quality of life; however, doctors should determine if it is appropriate for their patients on a case-by-case basis.

In addition, the guideline found that several other treatments are probably effective and should be considered, including the seizure drugs gabapentin (Gabarone) and valproate (Depacon), antidepressants such as venlafaxine (Effexor XR), duloxetine (Cymbalta) and amitriptyline (Elavil, Endep) and painkillers such as opioids and capsaicin. Transcutaneous electric nerve stimulation (TENS), a widely used pain therapy involving a portable device, was also found to be probably effective for treating diabetic nerve pain.

“We were pleased to see that so many of these pain treatments had high-quality studies that support their use,” said Vera Bril who is with the University of Toronto and a member of the AAN. “Still, it is important that more research be done to show how well these treatments can be tolerated over time since diabetic nerve pain is a chronic condition that affects a person’s quality of life and ability to function.”

Diabetes: Autonomic Neuropathy Far Worse Than ‘Pins & Needles’ in the Feet

To recap, the most common type of diabetic neuropathy is peripheral neuropathy (burning, throbbing, or painful tingling in your hands or feet). In the early stages of peripheral neuropathy, some people have no signs. Some may have numbness or tingling in the feet. Because nerve damage can occur over several years, these cases may go unnoticed. The patient may only become aware of neuropathy if the nerve damage gets worse and becomes painful.

It is estimated that diabetic nerve pain affects 16 percent of the more than 25 million people living with diabetes in the United States and is often unreported and more often untreated, with an estimated two out of five cases not receiving care.

According to one survey, about 50% of people with diabetes have some form of nerve damage known as diabetic neuropathy; 64% of Diabetic Nerve Pain sufferers report that their pain interferes with the daily activities that matter to them; 71% of sufferers say their pain interferes with the daily activities and makes it hard for them to fall asleep; 49% of diabetics had not had a discussion with their doctor about Diabetic Nerve Pain or its symptoms in the last 12 months and 65% say the pain decreases their general motivation.

In short, Diabetic Nerve Pain may make it hard to do what is needed to manage your diabetes. It can create a cycle where one problem just leads to another problem, which makes the first problem even worse. Pain may make it difficult to stay physically active and focus on other areas of diabetes care.

Diabetic Neuropathy: No Clear Answers

If you are not physically active and focusing on diabetes care, it may be hard to keep your blood sugar levels close to the normal range. In turn, if your blood sugar levels are raised for long periods of time (many months or years), you may be more likely to develop more health problems. This may include more nerve damage. Finally, people with Diabetic Nerve Pain also have more risk for symptoms of depression, which can further lower the drive to focus on the day-to-day parts of good diabetes care.

The Nervous System

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. Diabetic Nerve Pain may make it hard to do what is needed to manage your diabetes. It can create a cycle where one problem just leads to another problem, which makes the first problem even worse.

With Diabetic Nerve Pain, decreasing your activity level is a problem, making it harder to manage your diabetes. (We all know it’s important to be physically active to keep your blood sugar level under control.) With nerve pain, your nerves repeatedly send extra electrical signals to the brain. These extra signals can cause pain when you do something that is not normally painful, e.g. putting on shoes. If this pain is not properly diagnosed and treated, it can cause difficulties with walking, working, or even being in social situations.

Pfizer’s Lyrica Tops Drugs Recommended for Diabetes Nerve Pain

Over time, elevated blood sugar levels could potentially lead to different diabetes complications, like kidney and eye (retinopathy) conditions besides leading to nerve damage, especially in the feet. Therefore annual foot exams are crucial to check for diabetic peripheral neuropathy. Indeed, regular examinations are important because a diabetes patient can have peripheral neuropathy without pain, especially in the early stages of the neuropathy.

To be sure, Diabetic Nerve Pain care is an important part of overall diabetes care. And it is a part you may be able to actively improve. With less pain, you’ll feel better and may even increase your physical activity level. This is a key component of good diabetes care.

If you have Diabetic Nerve Pain, it’s very important to keep your blood sugar levels as close to the normal range as possible. This may help stabilize and prevent further nerve damage. It’s also important to keep your pain under control. Then you may be able to return to activities that are important to you.

Diabetes: Sleep Apnea Increases Risk of Amputation, Blindness In Diabetics

PEOPLE with Type 2 diabetes who have obstructive sleep apnea (OSA) are more at risk of losing their sight due to severe retinopathy, as well as foot problems and possible amputation because of neuropathy, according to new research in the UK.

Retinopathy affects the blood vessels supplying the retina – the seeing part of the eye. Blood vessels in the retina of the eye can become blocked, leaky or grow haphazardly. This damage gets in the way of the light passing through to the retina and if left untreated can damage vision.

Neuropathy is nerve damage and a long term complication of diabetes that can lead to foot ulcers and slow-healing wounds which, if they become infected, can result in amputation.

Obstructive sleep apnea (OSA) is a condition that causes interrupted breathing during sleep. The onset of OSA is most common in people aged 35 to 54 years old, although it can affect people of all ages, including children. The condition often goes undiagnosed. Only one in four people with obstructive sleep apnea are diagnosed with the condition.

Dr Iain Frame, Director of Research at Diabetes UK, said: “We already know that there is a high prevalence of OSA in people with Type 2 diabetes. However, this is the first time that the link between OSA and retinopathy and neuropathy in people with Type 2 diabetes has been examined.

This research suggests that if someone with Type 2 diabetes also has this sleeping disorder they are more at risk of developing these serious complications compared to someone with the condition who does not have OSA.

“As being overweight is a risk factor for both OSA and Type 2 diabetes, this is yet another reason to highlight the importance of good weight management through a healthy diet and regular physical activity. In people with Type 2 diabetes, the increasing severity of OSA is associated with poorer blood glucose control and the treatment of sleep disorders (in this case by losing weight) has the potential to improve diabetes control and energy levels.”

Researchers from the University of Birmingham looked at 231 people with Type 2 diabetes of whom 149 had OSA, a sleep disorder caused by disturbed breathing. They found there were twice as many people with severe retinopathy (48 percent) in the group with OSA compared to the group without OSA (20 percent). Retinopathy is the leading cause of blindness in the UK’s working-age population.

In a separate study, the researchers found that OSA was also linked to neuropathy. They looked at 230 people with Type 2 diabetes of whom 148 had OSA. They found that 60 percent of the group with OSA also had neuropathy compared to 22 percent in the group without OSA.

In both studies, the association between OSA and the two diabetes complications in people with Type 2 diabetes was independent of age, gender, ethnicity, blood pressure, blood glucose levels, smoking and cholesterol.

Dr Abd Tahrani, who led the research, said: “Our work highlights several important issues. Our results emphasized what is already known – that OSA is very common in patients with Type 2 diabetes, much higher than OSA prevalence in the general population.

“Furthermore, our results suggest that OSA is not an innocent bystander in patients with Type 2 diabetes and might contribute to morbidities associated with this condition. Whether OSA treatment has any impact on these complications will need to be determined”

Source: Diabetes UK

Tags: Health, Living, Type 2 Diabetes, Retinopathy, Sleep Apnea, Neuropathy, Amputation, Nerve Damage

 

Diabetes Management: Killer Apps That Are Revolutionizing Diabetes Care

The advantages of the wireless world are finally being brought to use beyond socializing. For us diabetics, they’re being used as a means of communicating critical information about our health and the status of the conditions that can be mortally devastating and an expensive burden.

Of course, nothing replaces weight loss and proper diet. But, in the meantime, communications technology can be used as a means to inform, monitor and support patients.

Indeed, health care providers and medical companies are quickly learning how to leverage emerging communication and electronic technologies to make diabetes management more efficient, reducing hospitalizations and ultimately decreasing the cost of the disease to individuals and on society.

What’s more, the health care market is seeing a large influx of companies who are putting technology to use in a growing field of healthcare communications and health-record management. At a basic level, this means using technology to manage health records and share information with a patient’s physician or other approved health care providers and caregivers ‒ including family members.

But, for treating diabetes patients in particular, the use of technology has been slow. When killer apps for iPhone and iPad are out in the market days after the devices are released, it is quite ironic that given the ever-changing condition of diabetes ‒ by its very nature we could benefit from up-to-the minute capabilities that technology brings ‒ diabetes management technology remained rooted in the last century. But that’s changing.

At long last, technology is coming to the rescue of diabetics, trying to make diabetes management easier. In fact, just in the past few years, there finally has been marvelous progress in diabetes care. This isn’t just with insulin pumps and home blood glucose monitoring systems. The technologies available now and those at the cusp of development are really encouraging and exciting.

Wireless Technology Improves Patient Care For Marginalized Communities

Of my favorites is an innovative use of wireless technology will help underserved communities improve diabetes care and prevention in Tijuana. Using 3G mobile technologies, the Dulce Wireless Tijuana project helps patients in remote areas both monitor and treat their diabetic condition. The Dulce Wireless Tijuana system, announced by Qualcomm Incorporated in October last year, combines mobile applications, web applications, mobile phones, netbooks, laptops, diabetes educational content and health care worker and patient training. Service delivery is available to diabetes patients and their caregivers wirelessly through Qualcomm’s 3G technology network.

Dulce Wireless Tijuana patients now will have access to the system and technology, including primary care diabetes services and disease management programs. The project stands as an example of how wireless technology can improve patient care for marginalized communities — not just in Mexico, but throughout the world.

Goodbye Bariatric Surgery!

Then there is a matchbox-sized gadget called DIAMOND (Diabetes Improvement and Metabolic Normalization Device) ‒ a.k.a. TANTALUS™ ‒ developed by German medical device maker MetaCure. The system is implanted under the skin on the abdomen, and stimulates the stomach muscles when the patient is eating. This tricks brain into thinking more food has entered the stomach than the person has actually eaten. To deal with this supposedly large meal, the brain boosts insulin production as well as triggering the release of hormones that suppress appetite.

This means that the patient feels full much sooner than normal. A wireless charger system allows the patient to recharge the device at home by placing the charger over the abdomen for 45 minutes, once a week. The result is an improvement in blood glucose levels, which is often accompanied by weight loss, and reduction of blood pressure, waist circumference and blood lipid level. Goodbye bariatric surgery!

Over 200 patients are using the DIAMOND system to date, many of them for over two years, and many for over four years. Trials at the Medical University of Vienna showed the device reduced blood glucose levels by a quarter over three months and the DIAMOND has been shown to significantly reduce blood glucose levels and blood pressure levels. Goodbye bariatric surgery!

Diabetes Management System Could Be iTunes of Diabetes Care

A UK-based medical device company, Cellnovo develops and manufactures an innovative mobile diabetes management system. Comprised of a mobile connected micropump, mobile touchscreen controller, blood glucose meter and applications, the Cellnovo system provides intuitive operation, wireless Internet connectivity and real-time activity tracking – all industry firsts. Cellnovo offers extensive experience gained at the world’s premier medical device and wireless companies, including Medtronic, DuPont, Novo Nordisk, Abbott, AT&T Lucent, and other industry leaders.

The Cellnovo system’s advanced micropump technology enables people with diabetes to more efficiently manage their life-saving therapies while benefiting from greater personalization and portability.  This mobile-connected, disease management approach to diabetes removes the burden of keeping journals and pushes information to healthcare professionals so they always have a real-time view of this information

Treating High Blood Pressure With Radio Waves

The Symplicity Catheter System developed in Australia is used to perform a procedure termed renal denervation (RDN). In a straightforward endovascular procedure, similar to an angioplasty, the physician inserts the small, flexible Symplicity Catheter into the femoral artery in the upper thigh and threads it into the renal artery. Once in place within the renal artery, the device delivers low-power radio frequency (RF) energy to deactivate the surrounding renal sympathetic nerves. This, in turn, reduces hyper-activation of the sympathetic nervous system, which is often the cause of chronic hypertension. The one-time procedure aims to permanently reduce blood pressure. RDN may also allow patients to reduce or eliminate the need for lifelong antihypertensive medications.

The procedure is highly effective with 84 per cent of patients who underwent renal denervation experiencing a reduction in systolic blood pressure by more than 10 mmHg. The study also found that the therapy was safe, with no serious device or procedure-related events, no cardiovascular complications and no kidney-related complications.

Removing Pain From Diabetes Management

A quick and painless way to measure blood sugar is highly sought-after by diabetes sufferers, who currently have to prick their fingers to draw blood several times a day. Now, researchers in the US may have found a solution – a device that works by simply shining a light on skin.

An MIT team has developed an algorithm to relate blood glucose to interstitial glucose levels. “We’ve incorporated a mass-transfer model into the overall Raman spectroscopic algorithm, which allows us to seamlessly transform between blood and interstitial fluid glucose,” explains Ishan Barman, lead author of the research.

Using an early version of the device, the team tested the blood-sugar levels of some human volunteers and found that the accuracy and precision of the test was just as good as conventional finger-prick tests. In addition, the new algorithm allows the test to predict impending episodes of high or low blood sugar (hyperglycemia and hypoglycemia) by extrapolating the rate of change of sugar concentration.

The vision is to create a laptop-sized device that could be kept at home or carried around. Rather than having to pierce the skin to obtain blood samples, the device measures sugar levels by simply placing a scanner against the skin. Because measurement is fast and easy, it is hoped that the device may encourage people with diabetes to check their blood sugar more often, giving them better control over their condition.

This research addresses a real problem and appears to provide an important means for improving the calibration of non-invasive sensors. It may also be helpful in the development of a so-called ‘artificial pancreas’ – where insulin can be dispensed automatically in response to sugar levels.

High-Tech Tattoo For Monitoring Blood Sugar

Another MIT team has given people with diabetes one more reason to join the tattoo craze: a special tattoo under development could help them monitor their blood sugar. The team is developing a glucose “tattoo” that could give people with diabetes a visual track of their blood sugar, and reduce the need for the painful finger pricks required for traditional monitors. The glucose tattoo ink, which would be injected under the skin, would be made from a substance that can reflect infrared light back through the skin to a watch-sized monitor that the person with diabetes wears over the ink.

By having this special ink injected under their skin, and by consistently checking the small monitor worn over it, people with diabetes can get a “real-time” feed on their glucose. They can note and take action when they see their blood sugar climbing or dropping; they don’t have to wait until they can get to a convenient place to conduct a finger prick or, worse, until they start to feel ill. The device also opens up an avenue of thought: if special ink can alert people with diabetes to dropping glucose levels, could an automatic, implanted glucose dispenser or pump be far behind?

Shed a Tear to Test Blood Sugar

On diabetes forum like TuDiabetes, diabetics are forever discussing lancet devices, painful pricks, first drop of blood, and callused fingertips. Now a team of researchers at the Arizona State University in collaboration with the Mayo Clinic is developing a new sensor that could make the lives of diabetes patients much easier. The team has come up with a sensor that would enable patients to take tear fluid from their eye to test their glucose levels. The researchers claim the tear sample would give just as accurate a reading as a blood test does.

Team members assessed how current devices were working – or failing – and how others have attempted to solve monitoring problems. They came up with a device that can be dabbed in the corner of the eye, absorbing a small amount of tear fluid like a wick that can then be used to measure glucose. Because of its potential impact on health care, the technology has drawn interest from BioAccel, an Arizona nonprofit that works to accelerate efforts to bring biomedical technologies to the marketplace,

Improving Compliance

A number of companies have developed continuing blood glucose monitoring and insulin injection products with the goal of improving compliance in diabetic patients. Today’s children with diabetes also have the opportunity for better blood glucose control than any generation before.

A research study reported in Pediatric Diabetes showed that, compared to multiple daily insulin shots, children on insulin pump therapy for 12 months significantly and consistently lowered their A1C levels. In fact, insulin pump therapy has been shown to significantly decrease severe hypoglycemia in youth. Recent studies showed that adolescents and young children on insulin pump therapy had over 50 percent fewer episodes.

To encourage compliance in diabetic children, Bayer Diabetes Care recently released its Didget blood glucose monitor, which connects to the Nintendo DS and DS Lite. The meter provides children with an adventure game that rewards consistent testing with points, which can be used to unlock new game levels. The product was approved by the FDA in April.

Bioject Medical Technologies markets a needle-free injection system that is approved for delivering subcutaneous or intramuscular injections. The system forces liquid medication through a tiny opening held against the skin, creating an ultra-fine high-pressure stream that penetrates the skin. The technology can be used for a variety of applications, including diabetes, malaria and influenza.

Echo Therapeutics has developed a wireless, transdermal glucose monitoring system for patients with diabetes. The Symphony tCGM System uses a skin permeation device, called Prelude, to painlessly remove the outermost layer of skin in approximately three to five seconds, allowing the transdermal biosensor to read glucose levels through the remaining layers of skin.

OrSense has developed a noninvasive continuous glucose monitor that utilizes a patented technology called Occlusion Spectroscopy. A ring-like sensor temporarily closes off (occludes) blood flow in the patient’s finger, creating new blood dynamics that generate a unique optical signal. Clinicians can analyze the signal to obtain measurements of glucose levels and other blood parameters.

Online Diabetes Resources

Then there are new computer programs that support the analysis of home blood glucose data. Insulin pens are finally the norm and diabetes sufferers are using not just more convenient and expedient methods of insulin administration ‒ they are now using more accurate methods because of technologies that provide improved measurement and monitoring. The idea of subcutaneous glucose sensors were a dream only a decade ago and now they’re an everyday part of diabetes care.

Bethesda-based Telcare, a Bethesda-based company that has developed blood glucose monitoring technology that combines a glucose meter with wireless connectivity to Telcare’s “cloud” server. The electronic device keeps an open two-way communication between a patients and caregivers ‒ those that are loved ones and those that are professionals such as the nurses and doctors.

Telcare monitor users can access all of their glucose data, as well as offering additional electronic logbook capabilities such as manual recording, nutrition recording, weight management, exercise regimens, medication amounts, and blood pressure statistics. Most impressive is that Telcare provides a cross-platform social community where people with diabetes and healthcare professionals can interact, share stories, discuss the diabetes technology that they use, and learn from one another.

Many diabetes-related health problems ‒ such as eye, kidney and heart disease ‒ are the result of high levels of blood glucose affecting organs over time. So doctors are encouraged that today’s young diabetes patients can achieve consistent, lower blood sugar levels from an early age that can continue for a lifetime. For example, Roche makes the ACCU-CHEK® Spirit insulin pump system.

These pumps are milestones above the traditional method of treating fluctuating glucose levels. These pumps can deliver 480 basal doses of insulin each day. But here’s where technology comes in: A Palm device and the ACCU-CHEK Pocket Compass software with a bolus calculator determines a patient’s bolus doses and even creates pie charts and other graphs to track a patient’s progress. This software application can be loaded onto smartphones.

Another company is PositiveID Corp, a growth-stage micro-cap known for their digital personal health records technology. The company unveiled its new ‘iglucose’ technology at the Cellular Technology Industry Association (CTIA) annual conference in Orlando, Florida last week. It is a wireless communication device for the automatic transmission of blood glucose readings from market leading, data-capable glucometers to the iglucose database.

PositiveID’s iglucose technology is making great strides in the advancement of diabetes management and control by allowing patients to wirelessly track blood glucose levels. It connects to the patient’s existing glucometer and, using M2M (machine-to-machine) technology, collects, records and transmits a patient’s blood glucose data to the iglucose database.

From there, it can be shared automatically via text message, email or fax with family members and health care professionals in real-time. In doing so, iglucose helps eliminate the burden of keeping journals and empowering individuals with diabetes to be more engaged in the self-management of their condition.

Cure for Diabetic Neuropathy

Neuropathy is typically measured by taking skin biopsies from the foot and running a series of specialized tests that can take up to a week to complete. In many cases, this debilitating condition is not identified until serious, and irreparable, damage has already been done.

But in a profound and important breakthrough, Nathan Efron, an Australian optometrist, has discovered that the nerves affected by neuropathy are an exact match to nerves found in front of the eye, and is testing whether looking at their level of degeneration in these nerves over a period of time would match the nerve degeneration found in arms and legs.

Quick and non-invasive eye tests would deliver results in a matter of minutes. In short, the importance of Efron’s discovery lies in the fact that since the eye is a transparent structure, it is the only place in the body where you can look directly at nerves and their degeneration over time.

There are multiple benefits of being able to measure the onset of neuropathy, one being that there are drugs in development that aim to cure diabetic neuropathy. When these drugs are ready to come onto the market the method would be able to detect nerve degeneration early and then hopefully cure it.

For the tests, patients would receive a drop of anesthetic in the eye. A corneal confocal microscope would then capture a 20 second “movie” of their eye for analysis. Two more eye tests will look at the effect of nerve degeneration on the retina.

Efron hopes his discoveries will lead to early testing for diabetic neuropathy that will motivate sufferers to better manage their disease. Testing could be carried out at the same time as diabetes patients are tested for other eye problems caused by the disease. The test has been used to monitor nerve regeneration in patients who have undergone kidney and pancreas transplants, and it could help track the effects of new treatments.

It’s interesting to ponder how technology – much of which already exist for other uses – can help us maybe not cure diseases like diabetes, but at least treat them in a way that takes the burden off the patient. There’s more to come…What ideas do you have?

With inputs from Huffington Post

Mystery Mechanism Protects Some Diabetics From Developing Complications

WHY are some diabetics free of complications? Researchers are now asking the question the other way around. They want to know why some diabetic patients do not develop complications. What is protecting them? It seems some people with diabetes possess yet-unidentified factors that reduce the risk for and even prevent them from developing diabetes-related complications, despite living with the disease for decades.

If researchers can identify the mechanisms protecting these individuals ‒ who are clearly different because something protects them from devastating complications ‒ then it might be possible to develop drugs that can do the same thing.

I had reported end January that what current research provides is an admission that the fundamental mechanisms that create the environment for the development of diabetes complications are still very much unknown.

One aspect of the disease though that is very well documented is the damage that the disease wreaks on an individual’s blood vessels. Diabetes does not kill the individual but the complications often do.

Among the top of the list of complications is cardiovascular disease, as diabetics have three times of the risk compared to non-diabetics. The small blood vessels are also damaged. Nearly 70 percent of patients would have suffered from kidney damage leading to end stage renal failure. Many others suffer from eye complications, with nearly two percent of these diabetics going blind eventually.

Still, despite decades of intensive research on diabetes complications, the fundamental mechanisms are not yet fully known. Neither it is possible to prevent or treat the damage of the blood vessels that affects a majority of all diabetics.

“The blood vessels and other organs of the body are sugar coated and become stiff. It is reminiscent of a premature biological aging,” says Peter Nilsson of the Lund University Diabetes Centre in Sweden who isstudying diabetics with no complications in Sweden.

just-published study conducted by the Joslin Diabetes Center on people who have lived with type 1 diabetes for more than 50 years presents a strong case for the existence of a protective mechanism in some individuals that allows them to live relatively free of the problems typically associated with long-term duration of diabetes. These mechanisms, the study found, may be different for microvascular (such as kidney, nerve and eye disease) than macrovascular complications (such as heart disease).

press release issued by the American Diabetes Association yesterday quotes lead researcher George King, Chief Scientific Officer of the Joslin Diabetes Center and Professor of Medicine at Harvard Medical School saying: “If we can identify what constitutes this protective mechanism, we have the potential to induce such protections in others living with diabetes…That’s huge.”

The Joslin researchers looked at 351 U.S. residents known as the “Medalist” cohort and found that a subgroup of people who had lived with type 1 diabetes for more than 50 years remained free from such complications as proliferative diabetic retinopathy (PDR), a serious eye disease that can lead to blindness (42.6 percent of them); nephropathy, or kidney damage (86.9 percent of them); neuropathy, or nerve damage (39.4 percent); and cardiovascular disease (51.5 percent). Of those who did not develop PDR, 96 percent with no retinopathy progression in the first 17 years of their disease never experienced a worsening of symptoms, meaning that they likely possessed some type of protection specific to this complication.

Surprisingly, glycemic control was not a factor in providing this protective mechanism.

“That doesn’t mean of course that glycemic control doesn’t help to prevent complications. Numerous other studies have shown that it unquestionably does. In this case, it means only that there is a separate, protective mechanism in play that is not related to glycemic control that also helps to protect against diabetes-related problems. We are still working on identifying just what that is,” King said.

It’s important to note that most of the people in this study developed type 1 diabetes before strict glycemic control was even possible or used as the standard of medical care, the researchers write. The people in this study likely lived for several decades, therefore, without maintaining strict control.

The study also found that those with high plasma carboxyethyl-lysine and pentosidine, or advanced glycation end products (AGEs), were 7.2 times more likely to have some kind of complication than those who had low levels of this combination of AGEs. (AGEs are compounds that develop in the body after long exposure to high glucose levels and have generally been regarded as playing a role in diabetes-related complications.)

However, those with other types of AGE molecules exhibited protective features. Thus, this study suggests that not all AGEs are alike in their actions and raises the exciting possibility that some AGEs may be markers for protection against one or more diabetic complications.

In an accompanying editorial titled The Question Is, My Dear Watson, Why Did the Dog Not Bark?, Dr. Aaron Vinik, Director, Eastern Virginia Medical School Diabetes Research Center, writes that “the accumulation of AGEs may be one of the important factors in metabolic memory,” a phenomenon in which an initial period of good glycemic, lipid and blood pressure control results in a prolonged period of health benefits that last beyond the period of control.

However, while it is clear that for some there is a protective mechanism at play, it’s unclear whether metabolic memory is playing a role because glycemic control was not considered important until 1993, long after the study began.

What’s most interesting, Vinik points out, is that sRAGE (the circulating soluble receptor for AGEs) is deficient in those who have the most severe complications, and is present at high levels in those with the most longevity. “If this is the missing link, it is huge for the possible emergence of a new biomarker and the potential for therapy that might increase circulating sRAGE or sRAGE itself,” he said.

Diabetics Shouldn’t Take High Doses of Vitamin B

Diabetics with kidney disease who are taking high doses of B vitamins in an effort to forestall heart attacks should stop taking them immediately because they are potentially very harmful, Canadian researchers reported in the Journal of the American Medical Association.

Rather than reducing the risk of heart attack and stroke, the vitamins appear to actually increase it, the researchers said in April.

It is thought that at least 40 percent of diabetics develop diabetic nephropathy, in which the function of the kidneys is impaired. Diabetics typically have above-normal levels of the amino acid homocysteine in their blood, and elevated levels are associated with an increased risk of heart disease. B vitamins normally reduce homocysteine levels, and researchers had also thought they would improve kidney function.

A team headed by Dr. David Spence of the University of Western Ontario in London (Canada) organized a clinical trial in which researchers hoped to demonstrate a benefit from the supplement. They enrolled 238 diabetic patients at five Canadian medical centers. Half received a daily dose of 2.5 milligrams of folic acid, 25 milligrams of vitamin B6 and 1 milligram of vitamin B12 and half received a placebo.

After an average of 32 months, the researchers found that those taking the vitamins had a significantly higher decrease in kidney function, as measured by the ability to filter toxic wastes from the bloodstream. Moreover, eight people taking the vitamins suffered a heart attack, compared with four taking the placebo; and six taking the vitamins suffered a stroke, compared to one taking the placebo.

Spence said he was greatly surprised by the results and initially thought that researchers had mixed up the data. He noted that the vitamins are normally excreted in urine and speculated that kidney damage produced by the diabetes led to a toxic buildup of the supplement in the patients. The B vitamins included in multivitamin supplements should not be a problem, he added.

He said that researchers would have to find a different way to reduce homocysteine levels.

Foot Doctors Can Help Diabetics Avoid Amputation

Being treated by a podiatrist helps diabetes patients reduce their risk of amputation, research shows. Podiatrists, also called podiatric physicians, are medical specialists of the foot, ankle and lower leg.

“Podiatrists are detecting conditions that can lead to amputation. That’s just what we do,” study co-author Dr. James Wrobel, an associate professor of medicine at Rosalind Franklin University of Medicine and Science in North Chicago, said in a university news release.

The study of nearly 29,000 diabetes patients, aged 18 to 64, found that those who had had at least one visit with a podiatrist prior to receiving a foot ulcer diagnosis had a lower risk of amputation and hospitalization (nearly 15 percent and 17 percent, respectively).

The study findings were presented in July at a meeting of the American Podiatric Medical Association in Seattle.

The study is important as people with diabetes can develop many different foot problems. Even ordinary problems can get worse and lead to serious complications. Foot problems most often happen when there is nerve damage, also called neuropathy, which results in loss of feeling in your feet. Poor blood flow or changes in the shape of your feet or toes may also cause problems.

What is Neuropathy?
Although it can hurt, diabetic nerve damage can also lessen your ability to feel pain, heat, and cold. Loss of feeling often means you may not feel a foot injury. You could have a tack or stone in your shoe and walk on it all day without knowing. You could get a blister and not feel it. You might not notice a foot injury until the skin breaks down and becomes infected.

Nerve damage can also lead to changes in the shape of your feet and toes. Ask your health care provider about special therapeutic shoes, rather than forcing deformed feet and toes into regular shoes.

Skin Changes
Diabetes can cause changes in the skin of your foot. At times your foot may become very dry. The skin may peel and crack. The problem is that the nerves that control the oil and moisture in your foot no longer work.

After bathing, dry your feet and seal in the remaining moisture with a thin coat of plain petroleum jelly, an unscented hand cream, or other such products.

Do not put oils or creams between your toes. The extra moisture can lead to infection. Also, don’t soak your feet — that can dry your skin.

Calluses
Calluses occur more often and build up faster on the feet of people with diabetes. This is because there are high-pressure areas under the foot. Too much callus may mean that you will need therapeutic shoes and inserts.

Calluses, if not trimmed, get very thick, break down, and turn into ulcers (open sores). Never try to cut calluses or corns yourself – this can lead to ulcers and infection. Let your health care provider cut your calluses.

Do not try to remove calluses and corns with chemical agents. These products can burn your skin. Using a pumice stone every day will help keep calluses under control. It is best to use the pumice stone on wet skin. Put on lotion right after you use the pumice stone.

Foot Ulcers
Ulcers occur most often on the ball of the foot or on the bottom of the big toe. Ulcers on the sides of the foot are usually due to poorly fitting shoes. Remember, even though some ulcers do not hurt, every ulcer should be seen by your doctor right away. Neglecting ulcers can result in infections, which in turn can lead to loss of a limb.

What your doctor will do varies with your ulcer. He may take x-rays of your foot to make sure the bone is not infected. Then he may clean out any dead and infected tissue. You may need to go into the hospital for this. Also, the doctor may culture the wound to find out what type of infection you have, and which antibiotic will work best.

Keeping off your feet is very important. Walking on an ulcer can make it get larger and force the infection deeper into your foot. Your health care provider may put a special shoe, brace, or cast on your foot to protect it.

If your ulcer is not healing and your circulation is poor, your health care provider may need to refer you to a vascular surgeon. Good diabetes control is important. High blood glucose levels make it hard to fight infection.

After the foot ulcer heals, treat your foot carefully. Scar tissue under the healed wound will break down easily. You may need to wear special shoes after the ulcer is healed to protect this area and to prevent the ulcer from returning.

Poor Circulation
Poor circulation (blood flow) can make your foot less able to fight infection and to heal. Diabetes causes blood vessels of the foot and leg to narrow and harden. You can control some of the things that cause poor blood flow. Don’t smoke; smoking makes arteries harden faster. Also, follow your doctor’s advice for keeping your blood pressure and cholesterol under control.

If your feet are cold, you may be tempted to warm them. Unfortunately, if your feet cannot feel heat, it is easy for you to burn them with hot water, hot water bottles, or heating pads. The best way to help cold feet is to wear warm socks.

Some people feel pain in their calves when walking fast, up a hill, or on a hard surface. This condition is called intermittent claudication. Stopping to rest for a few moments should end the pain. If you have these symptoms, you must stop smoking. Work with your doctor to get started on a walking program. Some people can be helped with medication to improve circulation.

Exercise is good for poor circulation. It stimulates blood flow in the legs and feet. Walk in sturdy, good-fitting, comfortable shoes, but don’t walk when you have open sores.

Amputation
People with diabetes are far more likely to have a foot or leg amputated than other people. The problem? Many people with diabetes have artery disease, which reduces blood flow to the feet. Also, many people with diabetes have nerve disease, which reduces sensation. Together, these problems make it easy to get ulcers and infections that may lead to amputation.

So remember, most amputations are preventable with regular care and proper footwear. It is a good idea to wear soft shoes.

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

%d bloggers like this: