The number of Americans who have type 2 diabetes has risen to nearly 26 million, federal officials announced today.
In addition, about 79 million U.S. adults have "prediabetes," a condition in which blood sugar levels are higher than normal but not high enough to be diagnosed as diabetes, according to the federal Centers for Disease Control and Prevention. Prediabetes raises a person's risk of type 2
diabetes, heart disease and stroke.
In 2008, CDC estimated that 23.6 million Americans had diabetes and an additional 57 million adults had prediabetes.
"These distressing numbers show how important it is to prevent type 2 diabetes and to help those who have diabetes manage the disease to prevent serious complications such as kidney failure and blindness," said the CDC's Ann Albright in a statement. "We know that a structured lifestyle program that includes losing weight and increasing physical activity can prevent or delay type 2 diabetes."
About 7 million Americans do not know they have the disease.
The increase was caused by a number of factors, including:
-- More people are developing diabetes. Obesity, which has been increasing, is a leading cause of diabetes.
-- Medical advances are enabling many people to live longer with diabetes.
-- A test known as hemoglobin A1c is now being used to diagnose diabetes.
Type 2 diabetes, which is most common form of the disease, occurs when the body gradually loses the ability to control blood sugar levels. Risk factors include older age, obesity, family history and being sedentary. African Americans, Hispanics and American Indians are among those at increased risk.
Diabetes is the seventh leading cause of death in the United States. People with diabetes are more likely to have heart attacks, strokes, high blood pressure, kidney failure, blindness and require amputations. Diabetes costs $174 billion annually, according to the CDC.
By Rob Stein
Friday, April 29, 2011
Wednesday, April 27, 2011
Cause of Blood Vessel Damage in People with Diabetes Discovered
Researchers have identified a key mechanism that appears to contribute to blood vessel damage in people with diabetes....
The researchers said studies in mice show that the damage appears to involve two enzymes, fatty acid synthase (FAS) and nitric oxide synthase (NOS) that interact in the cells that line blood vessel walls. First author Xiaochao Wei said, "We already knew that in diabetes there's a defect in the endothelial cells that line the blood vessels."
"People with diabetes also have depressed levels of fatty acid synthase. But this is the first time we've been able to link those observations together."
Wei studied mice that had been genetically engineered to make FAS in all of their tissues except the endothelial cells that line blood vessels. These so-called FASTie mice experienced problems in the vessels that were similar to those seen in animals with diabetes. "It turns out that there are strong parallels between the complete absence of FAS and the deficiencies in FAS induced by lack of insulin and by insulin resistance," said Clay F. Semenkovich, the Herbert S. Gasser Professor of Medicine, professor of cell biology and physiology and chief of the Division of Endocrinology, Metabolism and Lipid Research, Washington University in St. Louis, Missouri.
Comparing FASTie mice to normal animals, as well as to mice with diabetes, Wei and Semenkovich determined that mice without FAS, and with low levels of FAS, could not make the substance that anchors nitric oxide synthase to the endothelial cells in blood vessels. "We've known for many years that to have an effect, NOS has to be anchored to the wall of the vessel," Semenkovich said.
"Xiaochao discovered that fatty acid synthase preferentially makes a lipid that attaches to NOS, allowing it to hook to the cell membrane and to produce normal, healthy blood vessels." In the FASTie mice, blood vessels were leaky, and in cases when the vessel was injured, the mice were unable to generate new blood vessel growth.
The actual mechanism involved in binding NOS to the endothelial cells is called palmitoylation. Without FAS, the genetically engineered mice lose NOS palmitoylation and are unable to modify NOS so that it will interact with the endothelial cell membrane. That results in blood vessel problems.
It's a long way, however, from a mouse to a person, so the researchers next looked at human endothelial cells, and they found that a similar mechanism was at work.
"Our findings strongly suggest that if we can use a drug or another enzyme to promote fatty acid synthase activity, specifically in blood vessels, it might be helpful to patients with diabetes," Wei said.
Journal of Biological Chemistry. Jan. 2011
The researchers said studies in mice show that the damage appears to involve two enzymes, fatty acid synthase (FAS) and nitric oxide synthase (NOS) that interact in the cells that line blood vessel walls. First author Xiaochao Wei said, "We already knew that in diabetes there's a defect in the endothelial cells that line the blood vessels."
"People with diabetes also have depressed levels of fatty acid synthase. But this is the first time we've been able to link those observations together."
Wei studied mice that had been genetically engineered to make FAS in all of their tissues except the endothelial cells that line blood vessels. These so-called FASTie mice experienced problems in the vessels that were similar to those seen in animals with diabetes. "It turns out that there are strong parallels between the complete absence of FAS and the deficiencies in FAS induced by lack of insulin and by insulin resistance," said Clay F. Semenkovich, the Herbert S. Gasser Professor of Medicine, professor of cell biology and physiology and chief of the Division of Endocrinology, Metabolism and Lipid Research, Washington University in St. Louis, Missouri.
Comparing FASTie mice to normal animals, as well as to mice with diabetes, Wei and Semenkovich determined that mice without FAS, and with low levels of FAS, could not make the substance that anchors nitric oxide synthase to the endothelial cells in blood vessels. "We've known for many years that to have an effect, NOS has to be anchored to the wall of the vessel," Semenkovich said.
"Xiaochao discovered that fatty acid synthase preferentially makes a lipid that attaches to NOS, allowing it to hook to the cell membrane and to produce normal, healthy blood vessels." In the FASTie mice, blood vessels were leaky, and in cases when the vessel was injured, the mice were unable to generate new blood vessel growth.
The actual mechanism involved in binding NOS to the endothelial cells is called palmitoylation. Without FAS, the genetically engineered mice lose NOS palmitoylation and are unable to modify NOS so that it will interact with the endothelial cell membrane. That results in blood vessel problems.
It's a long way, however, from a mouse to a person, so the researchers next looked at human endothelial cells, and they found that a similar mechanism was at work.
"Our findings strongly suggest that if we can use a drug or another enzyme to promote fatty acid synthase activity, specifically in blood vessels, it might be helpful to patients with diabetes," Wei said.
Journal of Biological Chemistry. Jan. 2011
Tuesday, April 26, 2011
Understanding the 2010 Consensus Recommendations for Diabetic Foot Ulcer Care
Note to the Reader: These articles summarize the "Consensus Recommendations on Advancing the Standard of Care for Treating Neuropathic Foot Ulcers in Patients with Diabetes," authored by Robert J. Snyder et al., published as a supplement to Ostomy Wound Management in April 2010.
Published as a supplement to the April 2010 issue of Ostomy Wound Management was a pivotal reference paper titled, "Consensus Recommendations on Advancing the Standard of Care for Treating Neuropathic Foot Ulcers in Patients with Diabetes."1 The authors are a recognized group of leading experts in the field who convened the consensus panel.
The world's population with diabetes will increase from 171 million to 366 million by 2025.2 In the U.S., there are an estimated 24 million people with diabetes. Up to 25% of those with diabetes will develop a foot ulcer in their lifetimes.3 That translates roughly to 1-2% of the diabetic patients per year.
Diabetic foot ulcers (DFU) and lower extremity amputations (LEA) are a costly problem. In 2007, it was estimated that $30 billion was spent for the care of those two conditions.4
The recommendations from the consensus panel are important because they help to update the standard of care based on a review of 111 studies. The recommendations are divided into three categories: Assessment, Treatment, Advanced Therapies.
In this issue we will look at recommendations on assessment of the diabetic foot ulcer.
Recommendations on Assessment of the Diabetic Foot Ulcer
The team approach to assessment and management of the DFU is recognized as the standard of care. No physician "is an island", and the co-morbidities within the diabetic foot cross multiple physician disciplines. A thorough history should be performed. Since wound healing delays can occur with anemia, renal insufficiency, and uncontrolled blood sugar, a CBC and HbA1c should be performed at baseline. If osteomyelitis is suspected, erythrocyte sedimentation rate (ESR) and (CRP) should be ordered.
The patient's nutritional status should be assessed by history and serum pre-albumin. Historical concerns are unintentional weight loss, chronic alcohol use, and problems chewing or swallowing. Smoking is a risk factor for peripheral arterial disease (PAD) and delays wound healing. One should remember the four A's of smoking cessation: Ask about smoking, Advise to quit, offer Assistance, Arrange follow-up.
Neurologic screening should consist of 10 gram monofilament and 128-Hz tuning fork tests. Vascular evaluation is more complicated. There is no single test that can completely evaluate vascular health. Palpation of pulses or ante brachial index (ABI) cannot be relied upon in this population. The absence of pulses is a good indicator of poor flow, but the presence of pulses cannot rule out arterial insufficiency. The toe brachial index (TBI) is less susceptible to false readings due to diabetic arterial calcification. Skin perfusion pressure (SPP) measures capillary pressure in the skin and is very sensitive at uncovering vascular disease in diabetics as well as predicting wound healing. Transcutaneous oximetry (TCPO2) can validate referral for hyperbaric oxygen. Vascular imaging tests should be performed by an appropriate specialist if there is reasonable suspicion of underlying vascular disease.
The foot examination should include assessment of dermatologic changes, musculoskeletal deformities, and ulcer evaluation. Dermatologic changes can show inflammation by thermometry or thermography. Also, it can reveal ischemia by the presence of purpura, fat atrophy, loss of hair growth, or taut skin. The podiatrist is a key member of the team for understanding the biomechanical abnormalities that lead to ulceration. Range of motion of the ankle and first metatarsophalangeal joints should be assessed for restriction in dorsi-flexion. Inspect for deformities associated with Charcot joint disease.
Radiography is useful to help uncover osteomyelitis or deformities. The foot should be x-rayed at baseline and it is appropriate to perform bilateral x-rays for comparison.
The wound assessment and documentation includes size, depth, shape, probing, undermining, condition of the wound bed, and condition of the periwound area. One should use a standard wound classification scheme. The consensus panel recommends use of the University of Texas Classification.5
Infection is devastating to the diabetic foot and its evaluation is primarily clinical. Heat, redness, pain, and swelling are the classic symptoms. The diabetic neuropathic patient does not always exhibit all those signs, so one should be aware of secondary signs like exudate, delayed healing, discolored granulation tissue, and malodor. Culture should only be taken if the clinician suspects infection.
Published as a supplement to the April 2010 issue of Ostomy Wound Management was a pivotal reference paper titled, "Consensus Recommendations on Advancing the Standard of Care for Treating Neuropathic Foot Ulcers in Patients with Diabetes."1 The authors are a recognized group of leading experts in the field who convened the consensus panel.
The world's population with diabetes will increase from 171 million to 366 million by 2025.2 In the U.S., there are an estimated 24 million people with diabetes. Up to 25% of those with diabetes will develop a foot ulcer in their lifetimes.3 That translates roughly to 1-2% of the diabetic patients per year.
Diabetic foot ulcers (DFU) and lower extremity amputations (LEA) are a costly problem. In 2007, it was estimated that $30 billion was spent for the care of those two conditions.4
The recommendations from the consensus panel are important because they help to update the standard of care based on a review of 111 studies. The recommendations are divided into three categories: Assessment, Treatment, Advanced Therapies.
In this issue we will look at recommendations on assessment of the diabetic foot ulcer.
Recommendations on Assessment of the Diabetic Foot Ulcer
The team approach to assessment and management of the DFU is recognized as the standard of care. No physician "is an island", and the co-morbidities within the diabetic foot cross multiple physician disciplines. A thorough history should be performed. Since wound healing delays can occur with anemia, renal insufficiency, and uncontrolled blood sugar, a CBC and HbA1c should be performed at baseline. If osteomyelitis is suspected, erythrocyte sedimentation rate (ESR) and (CRP) should be ordered.
The patient's nutritional status should be assessed by history and serum pre-albumin. Historical concerns are unintentional weight loss, chronic alcohol use, and problems chewing or swallowing. Smoking is a risk factor for peripheral arterial disease (PAD) and delays wound healing. One should remember the four A's of smoking cessation: Ask about smoking, Advise to quit, offer Assistance, Arrange follow-up.
Neurologic screening should consist of 10 gram monofilament and 128-Hz tuning fork tests. Vascular evaluation is more complicated. There is no single test that can completely evaluate vascular health. Palpation of pulses or ante brachial index (ABI) cannot be relied upon in this population. The absence of pulses is a good indicator of poor flow, but the presence of pulses cannot rule out arterial insufficiency. The toe brachial index (TBI) is less susceptible to false readings due to diabetic arterial calcification. Skin perfusion pressure (SPP) measures capillary pressure in the skin and is very sensitive at uncovering vascular disease in diabetics as well as predicting wound healing. Transcutaneous oximetry (TCPO2) can validate referral for hyperbaric oxygen. Vascular imaging tests should be performed by an appropriate specialist if there is reasonable suspicion of underlying vascular disease.
The foot examination should include assessment of dermatologic changes, musculoskeletal deformities, and ulcer evaluation. Dermatologic changes can show inflammation by thermometry or thermography. Also, it can reveal ischemia by the presence of purpura, fat atrophy, loss of hair growth, or taut skin. The podiatrist is a key member of the team for understanding the biomechanical abnormalities that lead to ulceration. Range of motion of the ankle and first metatarsophalangeal joints should be assessed for restriction in dorsi-flexion. Inspect for deformities associated with Charcot joint disease.
Radiography is useful to help uncover osteomyelitis or deformities. The foot should be x-rayed at baseline and it is appropriate to perform bilateral x-rays for comparison.
The wound assessment and documentation includes size, depth, shape, probing, undermining, condition of the wound bed, and condition of the periwound area. One should use a standard wound classification scheme. The consensus panel recommends use of the University of Texas Classification.5
Infection is devastating to the diabetic foot and its evaluation is primarily clinical. Heat, redness, pain, and swelling are the classic symptoms. The diabetic neuropathic patient does not always exhibit all those signs, so one should be aware of secondary signs like exudate, delayed healing, discolored granulation tissue, and malodor. Culture should only be taken if the clinician suspects infection.
Saturday, April 23, 2011
Should I Be Concerned About Varicose Veins?
Q: I am 64 years old and have only recently started developing varicose veins in my legs. I'm using compression stockings, but they're uncomfortable during the warm months. What other options do I have to deal with them? Aside from the increased risk of a blood clot, do they pose any serious health risks? Will the varicose veins start to look worse as I get older?
A: Varicose veins can be very unpleasant, particularly from a cosmetic point of view. These enlarged and tortuous veins usually show up in the legs; they are subject to high pressure when you’re upright and therefore likely to be uncomfortable and perhaps even painful while you're standing or walking. Varicose veins can also sometimes itch, and scratching them can cause ulcers. Ulcers that infect your veins can lead to blood clots — this is a condition known as superficial thrombophlebitis and is usually isolated to superficial veins. In rare cases, these blood clots can extend into deep veins, becoming a more serious problem. Still, varicose veins very rarely bring on serious complications. More than anything else, they are considered to be a cosmetic problem, which, unfortunately, can worsen as you grow older.
One of the options you might wish to consider to reduce the appearance of your varicose veins is surgical intervention. Vein stripping is one particular surgical treatment that can help. There are also newer, less-invasive treatments such as ultrasound-guided foam sclerotherapy, radiofrequency ablation, and endovenous laser treatment, each of which has its own pros and cons. Nonsurgical treatment options include elastic stockings, elevating the legs, and exercise.
A: Varicose veins can be very unpleasant, particularly from a cosmetic point of view. These enlarged and tortuous veins usually show up in the legs; they are subject to high pressure when you’re upright and therefore likely to be uncomfortable and perhaps even painful while you're standing or walking. Varicose veins can also sometimes itch, and scratching them can cause ulcers. Ulcers that infect your veins can lead to blood clots — this is a condition known as superficial thrombophlebitis and is usually isolated to superficial veins. In rare cases, these blood clots can extend into deep veins, becoming a more serious problem. Still, varicose veins very rarely bring on serious complications. More than anything else, they are considered to be a cosmetic problem, which, unfortunately, can worsen as you grow older.
One of the options you might wish to consider to reduce the appearance of your varicose veins is surgical intervention. Vein stripping is one particular surgical treatment that can help. There are also newer, less-invasive treatments such as ultrasound-guided foam sclerotherapy, radiofrequency ablation, and endovenous laser treatment, each of which has its own pros and cons. Nonsurgical treatment options include elastic stockings, elevating the legs, and exercise.
Friday, April 22, 2011
Controlling Diabetes With Exercise
Exercise can be an effective way to get your blood sugar under control. Get motivated to start — and stick to — an exercise plan.
By Krisha McCoy, MS
Medically reviewed by Pat F. Bass III, MD, MPH Print Email Exercise is important for everyone, but it can be especially important for your health if you have diabetes. People who exercise regularly are better able to control their diabetes, thereby reducing their risk of diabetes complications.
Diabetes and Exercise: Why It’s Important to Stay Fit
If you have diabetes, you have an increased risk of developing certain health conditions, including heart attack, stroke, kidney disease, and nerve problems. By following your doctor's recommendations for keeping your blood glucose levels under control, you can reduce your risk of developing these complications.
Researchers have found that people who exercise regularly have:
Lower blood glucose levels
Lower blood pressure
Better cholesterol levels
Improved ability to use insulin
Decreased risk of stroke
Decreased risk of heart diseaseStronger bones
Less chance of falling
Easier weight loss
Less body fat
More energy
Reduced stress levels
In addition, if you use insulin to treat your diabetes, exercise can be part of the daily schedule that you and your diabetes health care team develop to control your blood glucose levels.
Diabetes and Exercise: Getting Started
Talk with your diabetes health care team before you begin an exercise program. They can help you design an exercise program that is safe and effective for you. Make sure to ask about any limitations. If you have heart disease, kidney disease, eye problems, or foot problems, there may be some physical activities that you should not do.
To get started with an exercise program:
Find physical activities you like. Choose activities that you enjoy doing and that are convenient. Try new activities, such as walking, dancing, swimming, or bicycling, until you find one you like.Schedule your workouts. Make exercise part of your schedule, just like work and doctor appointments. Aim to work out for at least half an hour on most or all days of the week.Slowly increase your time and intensity. Don't start out doing too much, or you may get burned out. Begin with just a few minutes, and add a little time, distance, or intensity to your workouts each week.Find an exercise partner. Ask a friend or neighbor to join you in your exercise plan. For many people, having a person who is counting on you will make you less likely to skip a workout. Keep a workout journal. Each time you exercise, write down what you did and what your blood glucose levels were. That way you can keep track of your progress and see how activity affects your diabetes control. Diabetes and Exercise: A Note about Hypoglycemia
Although exercise is an excellent way to help control your blood glucose levels, it is not without its risks. One of the most serious risks of exercising when you have diabetes is a condition called hypoglycemia.
With hypoglycemia, increased activity causes your blood glucose to fall to dangerously low levels. This can happen while you are exercising or even many hours later. Hypoglycemia can make you feel shaky, weak, and confused. If your blood glucose levels drop low enough, hypoglycemia could cause you to faint or have a seizure.
Talk with your doctor about strategies for preventing hypoglycemia. You may need to have a snack before you exercise or closely monitor your blood glucose levels before, during, and after exercising.
In addition to eating healthfully and taking insulin or other diabetes medications, exercise is a valuable tool for keeping you healthy. Commit to a regular exercise program, and you will not only have better control over your diabetes, but you will also gain more self-confidence and a better sense of well-being.
By Krisha McCoy, MS
Medically reviewed by Pat F. Bass III, MD, MPH Print Email Exercise is important for everyone, but it can be especially important for your health if you have diabetes. People who exercise regularly are better able to control their diabetes, thereby reducing their risk of diabetes complications.
Diabetes and Exercise: Why It’s Important to Stay Fit
If you have diabetes, you have an increased risk of developing certain health conditions, including heart attack, stroke, kidney disease, and nerve problems. By following your doctor's recommendations for keeping your blood glucose levels under control, you can reduce your risk of developing these complications.
Researchers have found that people who exercise regularly have:
Lower blood glucose levels
Lower blood pressure
Better cholesterol levels
Improved ability to use insulin
Decreased risk of stroke
Decreased risk of heart diseaseStronger bones
Less chance of falling
Easier weight loss
Less body fat
More energy
Reduced stress levels
In addition, if you use insulin to treat your diabetes, exercise can be part of the daily schedule that you and your diabetes health care team develop to control your blood glucose levels.
Diabetes and Exercise: Getting Started
Talk with your diabetes health care team before you begin an exercise program. They can help you design an exercise program that is safe and effective for you. Make sure to ask about any limitations. If you have heart disease, kidney disease, eye problems, or foot problems, there may be some physical activities that you should not do.
To get started with an exercise program:
Find physical activities you like. Choose activities that you enjoy doing and that are convenient. Try new activities, such as walking, dancing, swimming, or bicycling, until you find one you like.Schedule your workouts. Make exercise part of your schedule, just like work and doctor appointments. Aim to work out for at least half an hour on most or all days of the week.Slowly increase your time and intensity. Don't start out doing too much, or you may get burned out. Begin with just a few minutes, and add a little time, distance, or intensity to your workouts each week.Find an exercise partner. Ask a friend or neighbor to join you in your exercise plan. For many people, having a person who is counting on you will make you less likely to skip a workout. Keep a workout journal. Each time you exercise, write down what you did and what your blood glucose levels were. That way you can keep track of your progress and see how activity affects your diabetes control. Diabetes and Exercise: A Note about Hypoglycemia
Although exercise is an excellent way to help control your blood glucose levels, it is not without its risks. One of the most serious risks of exercising when you have diabetes is a condition called hypoglycemia.
With hypoglycemia, increased activity causes your blood glucose to fall to dangerously low levels. This can happen while you are exercising or even many hours later. Hypoglycemia can make you feel shaky, weak, and confused. If your blood glucose levels drop low enough, hypoglycemia could cause you to faint or have a seizure.
Talk with your doctor about strategies for preventing hypoglycemia. You may need to have a snack before you exercise or closely monitor your blood glucose levels before, during, and after exercising.
In addition to eating healthfully and taking insulin or other diabetes medications, exercise is a valuable tool for keeping you healthy. Commit to a regular exercise program, and you will not only have better control over your diabetes, but you will also gain more self-confidence and a better sense of well-being.
Tuesday, April 19, 2011
How to Reduce After Breakfast Blood Sugars 40%
A high-protein, low-carbohydrate snack before breakfast attenuates post-breakfast hyperglycemia....
Previous studies have shown a considerable reduction in hyperglycemia after the second meal of the day, provided that breakfast had been taken. The preservation of this effect in Type 2 diabetes was not confirmed until recently. Postprandial hyperglycemia acts as an independent risk factor for cardiovascular disease, a major cause of death in subjects with Type 2 diabetes. It was hypothesized that post-breakfast hyperglycemia in subjects with Type 2 diabetes could be improved non-pharmacologically by using a high-protein, low-carbohydrate prebreakfast snack.
Researchers studied 10 men and women with diet- and/or metformin-controlled Type 2 diabetes. Metabolic changes after breakfast were compared between 2 days: breakfast taken only and soya-yogurt snack taken prior to breakfast.
The results showed that there was a significant lower rise in plasma glucose on the snack day. The incremental area under the glucose curve was 450 ± 55 mmol · min/l on the snack day compared with 699 ± 99 mmol · min/l on the control day (P = 0.013). The concentration of plasma free fatty acids immediately before breakfast correlated with the increment in plasma glucose (r = 0.50, P = 0.013).
This study demonstrated for the first time that the provision of a practical, high-protein, low-carbohydrate snack prior to breakfast reduced by 40% the postprandial plasma glucose increment in people with Type 2 diabetes. These findings confirm a potent expression of the second-meal effect in people with Type 2 diabetes. The importance of the present observation is that a more practical means of improving glucose tolerance could potentially be of therapeutic benefit in people with Type 2 diabetes.
Researchers observed no effect of the prior snack on insulin secretion after breakfast. The mechanism underlying the second-meal effect has been shown to be due to suppression of plasma FFA, allowing greater storage of glucose as muscle glycogen. They had previously demonstrated a strong negative correlation between the decrease of preprandial plasma FFA levels and the postmeal glucose increment. In the present study, a significant positive correlation was found between prebreakfast plasma FFA and the rise in postprandial plasma glucose concentration.
The snack used in the present study was empirically designed. It will be important to optimize both the composition of the snack and the interval before breakfast to maximize the benefit of this approach. In everyday life, the gap between snack and breakfast would have to be accommodated, for instance, by delaying breakfast until mid-morning. Although the snack induced a small increase in plasma glucose, it was minimal and unlikely to contribute to the hyperglycemic burden. The sample size was dictated by prior power calculation (80% power with 10 subjects).
The study demonstrated that a high-protein, low-carbohydrate snack before breakfast attenuates postbreakfast hyperglycemia and further studies must determine whether long-term use is associated with improvement in A1c.
Previous studies have shown a considerable reduction in hyperglycemia after the second meal of the day, provided that breakfast had been taken. The preservation of this effect in Type 2 diabetes was not confirmed until recently. Postprandial hyperglycemia acts as an independent risk factor for cardiovascular disease, a major cause of death in subjects with Type 2 diabetes. It was hypothesized that post-breakfast hyperglycemia in subjects with Type 2 diabetes could be improved non-pharmacologically by using a high-protein, low-carbohydrate prebreakfast snack.
Researchers studied 10 men and women with diet- and/or metformin-controlled Type 2 diabetes. Metabolic changes after breakfast were compared between 2 days: breakfast taken only and soya-yogurt snack taken prior to breakfast.
The results showed that there was a significant lower rise in plasma glucose on the snack day. The incremental area under the glucose curve was 450 ± 55 mmol · min/l on the snack day compared with 699 ± 99 mmol · min/l on the control day (P = 0.013). The concentration of plasma free fatty acids immediately before breakfast correlated with the increment in plasma glucose (r = 0.50, P = 0.013).
This study demonstrated for the first time that the provision of a practical, high-protein, low-carbohydrate snack prior to breakfast reduced by 40% the postprandial plasma glucose increment in people with Type 2 diabetes. These findings confirm a potent expression of the second-meal effect in people with Type 2 diabetes. The importance of the present observation is that a more practical means of improving glucose tolerance could potentially be of therapeutic benefit in people with Type 2 diabetes.
Researchers observed no effect of the prior snack on insulin secretion after breakfast. The mechanism underlying the second-meal effect has been shown to be due to suppression of plasma FFA, allowing greater storage of glucose as muscle glycogen. They had previously demonstrated a strong negative correlation between the decrease of preprandial plasma FFA levels and the postmeal glucose increment. In the present study, a significant positive correlation was found between prebreakfast plasma FFA and the rise in postprandial plasma glucose concentration.
The snack used in the present study was empirically designed. It will be important to optimize both the composition of the snack and the interval before breakfast to maximize the benefit of this approach. In everyday life, the gap between snack and breakfast would have to be accommodated, for instance, by delaying breakfast until mid-morning. Although the snack induced a small increase in plasma glucose, it was minimal and unlikely to contribute to the hyperglycemic burden. The sample size was dictated by prior power calculation (80% power with 10 subjects).
The study demonstrated that a high-protein, low-carbohydrate snack before breakfast attenuates postbreakfast hyperglycemia and further studies must determine whether long-term use is associated with improvement in A1c.
Monday, April 18, 2011
Thermometer to save diabetics losing limbs
A new handheld device could greatly reduce the number of ulcers and limb amputations in people with diabetes.
The device provides early warning of complications which, if left untreated, can lead to the limb becoming so damaged it needs to be removed.
Around 100 Britons a week undergo an amputation as a result of diabetes. The disease can cause significant damage to the nerves and blood vessels — possibly because they are exposed to such high levels of blood sugar.
Nerve damage: Red areas highlight possible inflammation
Nerve damage can lead to loss of feeling in the feet, meaning sufferers might not feel a cut, blister or sore. Left untreated, such injuries can develop into serious ulcers and infections.
Poor circulation exacerbates the problem — reduced blood and oxygen supply to the area makes healing difficult.
Four out of ten people with diabetes are thought to have lost some feeling in their feet, and nearly half will suffer a foot wound or ulceration in their lifetime.
In some cases, wounds can remain open for months or even years, vastly increasing the risk of life-threatening infection.
If an infection sets in deeply, or affects the bone, antibiotics alone might not be enough. Gangrene can set in and amputation might be the only course of action.
Even if patients don’t end up so drastically affected, they can still suffer from ulcerations, infections and the foot can become deformed.
Diabetes affects 2.8 million people in the UK, with more than one million thought to be undiagnosed. It is caused by too much sugar — glucose — in the blood. There are two variants of the condition, type one and type two.
Type one can be present from birth and is caused by the destruction of insulin-producing cells.
However, around 90 per cent of those who suffer with diabetes have type two, which is triggered by obesity.
In this case, the body is unable to produce enough insulin. The condition can be controlled by following a healthy lifestyle.
The new device — a battery-powered thermometer — has been developed by U.S.-based Dibetica Solutions to be used at home by people with diabetes and some existing nerve damage.
It uses infrared light to measure changes in foot temperature — a rise in temperature is a sign of inflammation and damage. The readings can help alert a patient that a sore or ulcer is developing, before it even breaks the surface of the skin. They can then seek medical attention.
The gadget is designed to be used daily — the patient measures six sites on each foot and compares the temperatures.
If this temperature difference is more than four degrees Fahrenheit (2C), for two days or more, a problem might be brewing and they need to contact their doctor.
Previous studies have shown the device cut ulcer rates by a third, compared to people who didn’t use the gadget.
Now a larger, clinical trial is under way at Oslo University Hospital, in Norway, to see whether the device can prevent future foot ulcers in patients who have previously suffered with this complaint.
Cathy Moulton, clinical adviser at the charity Diabetes UK, says the device could be successful as long as patients are vigilant in taking their temperature every morning: ‘There is evidence showing that temperature changes could identify signs of neuropathy (nerve damage).
‘To reduce the risk of ulcers which could lead to amputations, Diabetes UK recommends that people with diabetes regularly check their feet looking for discolouration, damage to the skin, swollen areas, and if the foot feels very hot or cold.
‘If there are any changes such as these, they should see their doctor as soon as possible.
‘It is also vital that people with diabetes have access to a podiatrist and specialist care if any foot problems do develop.’
The device provides early warning of complications which, if left untreated, can lead to the limb becoming so damaged it needs to be removed.
Around 100 Britons a week undergo an amputation as a result of diabetes. The disease can cause significant damage to the nerves and blood vessels — possibly because they are exposed to such high levels of blood sugar.
Nerve damage: Red areas highlight possible inflammation
Nerve damage can lead to loss of feeling in the feet, meaning sufferers might not feel a cut, blister or sore. Left untreated, such injuries can develop into serious ulcers and infections.
Poor circulation exacerbates the problem — reduced blood and oxygen supply to the area makes healing difficult.
Four out of ten people with diabetes are thought to have lost some feeling in their feet, and nearly half will suffer a foot wound or ulceration in their lifetime.
In some cases, wounds can remain open for months or even years, vastly increasing the risk of life-threatening infection.
If an infection sets in deeply, or affects the bone, antibiotics alone might not be enough. Gangrene can set in and amputation might be the only course of action.
Even if patients don’t end up so drastically affected, they can still suffer from ulcerations, infections and the foot can become deformed.
Diabetes affects 2.8 million people in the UK, with more than one million thought to be undiagnosed. It is caused by too much sugar — glucose — in the blood. There are two variants of the condition, type one and type two.
Type one can be present from birth and is caused by the destruction of insulin-producing cells.
However, around 90 per cent of those who suffer with diabetes have type two, which is triggered by obesity.
In this case, the body is unable to produce enough insulin. The condition can be controlled by following a healthy lifestyle.
The new device — a battery-powered thermometer — has been developed by U.S.-based Dibetica Solutions to be used at home by people with diabetes and some existing nerve damage.
It uses infrared light to measure changes in foot temperature — a rise in temperature is a sign of inflammation and damage. The readings can help alert a patient that a sore or ulcer is developing, before it even breaks the surface of the skin. They can then seek medical attention.
The gadget is designed to be used daily — the patient measures six sites on each foot and compares the temperatures.
If this temperature difference is more than four degrees Fahrenheit (2C), for two days or more, a problem might be brewing and they need to contact their doctor.
Previous studies have shown the device cut ulcer rates by a third, compared to people who didn’t use the gadget.
Now a larger, clinical trial is under way at Oslo University Hospital, in Norway, to see whether the device can prevent future foot ulcers in patients who have previously suffered with this complaint.
Cathy Moulton, clinical adviser at the charity Diabetes UK, says the device could be successful as long as patients are vigilant in taking their temperature every morning: ‘There is evidence showing that temperature changes could identify signs of neuropathy (nerve damage).
‘To reduce the risk of ulcers which could lead to amputations, Diabetes UK recommends that people with diabetes regularly check their feet looking for discolouration, damage to the skin, swollen areas, and if the foot feels very hot or cold.
‘If there are any changes such as these, they should see their doctor as soon as possible.
‘It is also vital that people with diabetes have access to a podiatrist and specialist care if any foot problems do develop.’
Friday, April 15, 2011
Just 2000 Steps a Day Keeps Diabetes Risk Away
Walking not only prevents weight gain in middle age but also helps prevent or delay diabetes....
Terry Dwyer, AO, MD, MPH, of the Murdoch Children's Research Institute in Melbourne, Australia, found that middle-age Australians who increased their daily step count over five years maintained significantly higher insulin sensitivity at the end of that period than those who didn't boost their steps (P=0.03). This effect appeared largely due to lower adiposity and was independent of calories consumed, the group reported.
If causal, sedentary individuals who change their habits to walk an extra 2,000 steps (about one mile) a day might expect to shave 0.16 kg/m2 off their body mass index and boost insulin sensitivity by 2.76 units, the researchers estimated.
A relatively inactive person who gets to the goal of 10,000 steps (about five miles) per day could expect their BMI to drop 0.83 kg/m2 and their insulin sensitivity to rise 13.85 units -- a 12.8% increase from the mean for men and 11.5% for women.
Thus, sedentary individuals who reach 10,000 steps (about five miles) per day might expect a three-fold improvement in HOMA insulin sensitivity compared with increasing steps to a recent recommendation of 3,000 steps five days a week, the investigators projected.
Prior trials had suggested that exercise interventions fight insulin resistance, but Dwyer's group said their results suggest that real-world efforts to step-up physical activity are effective as well.
The researchers studied a group of 592 nondiabetic adults in the state of Tasmania who provided pedometer data for two days in both 2000 and 2005 as part of the population-based AusDiab Study, designed to determine the prevalence of diabetes and related risk factors in Australia.
At the beginning of the study, the average age was 51.4 for men and 50.3 for women.
Many participants were already overweight (57.4% of men, 36.9% of women) or obese (17.7% of men, 16.0% of women) at the outset and then gained further weight over the five year period.
Most got more sedentary as well with 65% showing a decline in step counts from 2000 to 2005, although another 35.5% increased their step counts.
Each additional 1,000 steps added to the daily count at the end of the five-year period was independently associated with 0.08 kg/m2 lower BMI (95% confidence interval 0.04 to 0.12) and 0.15 cm lower waist-to-hip ratio (95% CI 0.07 to 0.23).
Insulin sensitivity was also 1.38 HOMA units (95% CI 0.14 to 2.63) higher per 1,000 extra steps in 2005 versus 2000. The mean HOMA insulin sensitivity was 108.0 units for men and 120.4 for women in 2005.
The effect on insulin sensitivity dropped to insignificance after adjustment for body mass index in 2005, suggesting that change in adiposity with higher step activity was the mediator.
The researchers noted that their study couldn't determine the timing of changes in number of steps taken and likely missed some activity undertaken by study participants since pedometers only capture up-and-down motion.
Also, the actual energy expenditure associated with a certain step count varies by age, sex, height, leg length, and gait, they pointed out.
Terry Dwyer, AO, MD, MPH, of the Murdoch Children's Research Institute in Melbourne, Australia, found that middle-age Australians who increased their daily step count over five years maintained significantly higher insulin sensitivity at the end of that period than those who didn't boost their steps (P=0.03). This effect appeared largely due to lower adiposity and was independent of calories consumed, the group reported.
If causal, sedentary individuals who change their habits to walk an extra 2,000 steps (about one mile) a day might expect to shave 0.16 kg/m2 off their body mass index and boost insulin sensitivity by 2.76 units, the researchers estimated.
A relatively inactive person who gets to the goal of 10,000 steps (about five miles) per day could expect their BMI to drop 0.83 kg/m2 and their insulin sensitivity to rise 13.85 units -- a 12.8% increase from the mean for men and 11.5% for women.
Thus, sedentary individuals who reach 10,000 steps (about five miles) per day might expect a three-fold improvement in HOMA insulin sensitivity compared with increasing steps to a recent recommendation of 3,000 steps five days a week, the investigators projected.
Prior trials had suggested that exercise interventions fight insulin resistance, but Dwyer's group said their results suggest that real-world efforts to step-up physical activity are effective as well.
The researchers studied a group of 592 nondiabetic adults in the state of Tasmania who provided pedometer data for two days in both 2000 and 2005 as part of the population-based AusDiab Study, designed to determine the prevalence of diabetes and related risk factors in Australia.
At the beginning of the study, the average age was 51.4 for men and 50.3 for women.
Many participants were already overweight (57.4% of men, 36.9% of women) or obese (17.7% of men, 16.0% of women) at the outset and then gained further weight over the five year period.
Most got more sedentary as well with 65% showing a decline in step counts from 2000 to 2005, although another 35.5% increased their step counts.
Each additional 1,000 steps added to the daily count at the end of the five-year period was independently associated with 0.08 kg/m2 lower BMI (95% confidence interval 0.04 to 0.12) and 0.15 cm lower waist-to-hip ratio (95% CI 0.07 to 0.23).
Insulin sensitivity was also 1.38 HOMA units (95% CI 0.14 to 2.63) higher per 1,000 extra steps in 2005 versus 2000. The mean HOMA insulin sensitivity was 108.0 units for men and 120.4 for women in 2005.
The effect on insulin sensitivity dropped to insignificance after adjustment for body mass index in 2005, suggesting that change in adiposity with higher step activity was the mediator.
The researchers noted that their study couldn't determine the timing of changes in number of steps taken and likely missed some activity undertaken by study participants since pedometers only capture up-and-down motion.
Also, the actual energy expenditure associated with a certain step count varies by age, sex, height, leg length, and gait, they pointed out.
Thursday, April 14, 2011
American Diabetes Association's New Clinical Practice Recommendations Promote A1c as Diagnostic Test for Diabetes and Pre-Diabetes
Faster, easier test could help reduce number of undiagnosed with diabetes and pre-diabetes.
The American Diabetes Association's (ADA) new Clinical Practice Recommendations being published as a supplement to the January issue of Diabetes Care call for the addition of the A1c test as a means of diagnosing diabetes and identifying pre-diabetes. The test has been recommended for years as a measure of how well people are doing to keep their blood glucose levels under control.
"We believe that use of the A1c, because it doesn't require fasting, will encourage more people to get tested for Type 2 diabetes and help further reduce the number of people who are undiagnosed but living with this chronic and potentially life-threatening disease. Additionally, early detection can make an enormous difference in a person's quality of life," said Richard M. Bergenstal, MD, President-Elect, Medicine & Science, ADA.
"Unlike many chronic diseases, Type 2 diabetes actually can be prevented, as long as lifestyle changes are made while blood glucose levels are still in the pre-diabetes range."
A1c is measured in terms of percentages. The test measures a person's average blood glucose levels over a period of up to three months and previously had been used only to determine how well people were maintaining control of their diabetes over time. A person without diabetes would have an A1c of about 5 percent.
Under the new recommendations, which are revised every year to reflect the most current available scientific research, an A1c of 5.7 -- 6.4 percent would indicate that blood glucose levels were in the pre-diabetic range, meaning higher than normal but not yet high enough for a diagnosis of diabetes. That diagnosis would occur once levels rose to an A1c of 6.5 percent or higher.
The ADA recommends that most people with diabetes maintain a goal of keeping A1c levels at or below 7 percent in order to properly manage their disease. Research shows that controlling blood glucose levels helps to prevent serious diabetes-related complications, such as kidney disease, nerve damage and problems with the eyes and gums.
The A1c would join two previous diagnostic tests for diabetes, Fasting Plasma Glucose (FPG) and the Oral Glucose Tolerance Test (OGTT), both of which require overnight fasting. Because the A1c is a simple blood test and does not require fasting, allowing patients this option could increase willingness to get tested, thereby reducing the number of people who have Type 2 diabetes but don't yet know it.
According to the Centers for Disease Control and Prevention, one-fourth of all Americans with diabetes, or 5.7 million people, don't realize they have it. Another 57 million have pre-diabetes and 1.6 million new diagnoses are made every year.
The American Diabetes Association's (ADA) new Clinical Practice Recommendations being published as a supplement to the January issue of Diabetes Care call for the addition of the A1c test as a means of diagnosing diabetes and identifying pre-diabetes. The test has been recommended for years as a measure of how well people are doing to keep their blood glucose levels under control.
"We believe that use of the A1c, because it doesn't require fasting, will encourage more people to get tested for Type 2 diabetes and help further reduce the number of people who are undiagnosed but living with this chronic and potentially life-threatening disease. Additionally, early detection can make an enormous difference in a person's quality of life," said Richard M. Bergenstal, MD, President-Elect, Medicine & Science, ADA.
"Unlike many chronic diseases, Type 2 diabetes actually can be prevented, as long as lifestyle changes are made while blood glucose levels are still in the pre-diabetes range."
A1c is measured in terms of percentages. The test measures a person's average blood glucose levels over a period of up to three months and previously had been used only to determine how well people were maintaining control of their diabetes over time. A person without diabetes would have an A1c of about 5 percent.
Under the new recommendations, which are revised every year to reflect the most current available scientific research, an A1c of 5.7 -- 6.4 percent would indicate that blood glucose levels were in the pre-diabetic range, meaning higher than normal but not yet high enough for a diagnosis of diabetes. That diagnosis would occur once levels rose to an A1c of 6.5 percent or higher.
The ADA recommends that most people with diabetes maintain a goal of keeping A1c levels at or below 7 percent in order to properly manage their disease. Research shows that controlling blood glucose levels helps to prevent serious diabetes-related complications, such as kidney disease, nerve damage and problems with the eyes and gums.
The A1c would join two previous diagnostic tests for diabetes, Fasting Plasma Glucose (FPG) and the Oral Glucose Tolerance Test (OGTT), both of which require overnight fasting. Because the A1c is a simple blood test and does not require fasting, allowing patients this option could increase willingness to get tested, thereby reducing the number of people who have Type 2 diabetes but don't yet know it.
According to the Centers for Disease Control and Prevention, one-fourth of all Americans with diabetes, or 5.7 million people, don't realize they have it. Another 57 million have pre-diabetes and 1.6 million new diagnoses are made every year.
Tuesday, April 12, 2011
What Are These Dry Patches on My Face?
Q: When my diabetes acts up, I notice that dry patches break out on my face. Why might this happen, and what could it be?
A: I need more information to answer your question definitively, but it could be either tinea versicolor or tinea corporis, two types of fungal infection. Unfortunately, neither really fits your description. High blood sugar levels, however, can contribute to the development of fungal infections, which are treated with antifungal creams. Next time you experience an outbreak, see your doctor for a visual diagnosis, a comprehensive examination, and treatment. Other types of rashes associated with diabetes are Acanthosis nigricans, which usually appears as a darkening around the neck and other skin folds, and Necrobiosis lipoidica, which occurs as patches that turn into yellowish plaques on the legs.
A: I need more information to answer your question definitively, but it could be either tinea versicolor or tinea corporis, two types of fungal infection. Unfortunately, neither really fits your description. High blood sugar levels, however, can contribute to the development of fungal infections, which are treated with antifungal creams. Next time you experience an outbreak, see your doctor for a visual diagnosis, a comprehensive examination, and treatment. Other types of rashes associated with diabetes are Acanthosis nigricans, which usually appears as a darkening around the neck and other skin folds, and Necrobiosis lipoidica, which occurs as patches that turn into yellowish plaques on the legs.
Clijsters injures herself while dancing at nephew’s wedding
A tip for all women's tennis players: Don't go to Western Europe and expect to make it out healthy.
For the second time in nine months, a top-ranked women's player suffered a freak accident in a Western European country that will force her to miss a major part of the tennis season. Serena Williams stepped on a piece of broken glass before an exhibition match in Munich last July and hasn't been on the court since. Recently, Kim Clijsters was dancing at the wedding of her nephew and turned her ankle, an injury which could force her out of next month's French Open.
Clijsters revealed the news on her website (translated from Dutch):
At the wedding party of her cousin Tim, Kim injured her ankle severely. The consequences are rather dire. After a visit to the doctor, echo and NMR the diagnosis is a severe strain of both the medial and lateral ligaments of the right ankle and a torn ligaments, a torn capsule of the ankle joint, a hematoma and torn tendon sheath.
The statement goes on to say that Clijsters' foot is immobilized and that she'll miss six weeks. Her presence at Roland Garros is "very uncertain." The four-time Grand Slam champion is also said to be recovering from a previous wrist injury.
That must have been one funky chicken.
What is it about that part of the map that puts our biggest stars into walking boots when they leave? Is there some sort of national conspiracy to get Yanina Wickmayer to the top of the rankings? Is there a Walloon-Flemish beef that I don't know about?
You'd have to figure that Clijsters is pretty good on her feet, given that she's a champion tennis player with flawless footwork. If me and my herky-jerk, Elaine-style dance moves can make it through a wedding unscathed, imagine the bad luck Clijsters had to get her hurt. Also, how bad do you feel for her nephew?
"How was your wedding, Tim?"
"Oh, pretty good. Other than my aunt suffering a catastrophic injury that might alter the course of her career. Got a cool waffle maker, though."
For the second time in nine months, a top-ranked women's player suffered a freak accident in a Western European country that will force her to miss a major part of the tennis season. Serena Williams stepped on a piece of broken glass before an exhibition match in Munich last July and hasn't been on the court since. Recently, Kim Clijsters was dancing at the wedding of her nephew and turned her ankle, an injury which could force her out of next month's French Open.
Clijsters revealed the news on her website (translated from Dutch):
At the wedding party of her cousin Tim, Kim injured her ankle severely. The consequences are rather dire. After a visit to the doctor, echo and NMR the diagnosis is a severe strain of both the medial and lateral ligaments of the right ankle and a torn ligaments, a torn capsule of the ankle joint, a hematoma and torn tendon sheath.
The statement goes on to say that Clijsters' foot is immobilized and that she'll miss six weeks. Her presence at Roland Garros is "very uncertain." The four-time Grand Slam champion is also said to be recovering from a previous wrist injury.
That must have been one funky chicken.
What is it about that part of the map that puts our biggest stars into walking boots when they leave? Is there some sort of national conspiracy to get Yanina Wickmayer to the top of the rankings? Is there a Walloon-Flemish beef that I don't know about?
You'd have to figure that Clijsters is pretty good on her feet, given that she's a champion tennis player with flawless footwork. If me and my herky-jerk, Elaine-style dance moves can make it through a wedding unscathed, imagine the bad luck Clijsters had to get her hurt. Also, how bad do you feel for her nephew?
"How was your wedding, Tim?"
"Oh, pretty good. Other than my aunt suffering a catastrophic injury that might alter the course of her career. Got a cool waffle maker, though."
Friday, April 8, 2011
How Body Shape Affects Diabetes Risk
Where do you carry your excess fat? The answer may have implications for your type 2 diabetes risk.
Apple or pear? The question may imply a healthy snack — or an important distinction between body shapes that affects type 2 diabetes risk.
In general, people whose fat collects on their abdomen — making them resemble apples over time — are at greater risk for type 2 diabetes. But the good news is, you can escape your shape.
Being overweight is a significant risk factor for diabetes, no matter your shape. “Patients who have a higher body mass index have a higher risk [of diabetes],” says Danny Sam, MD, an internal medicine physician with Kaiser Permanente in Santa Clara, Calif., who specializes in the treatment of adult diabetes. Body mass index (BMI) is calculated by comparing weight and height.
But while any overweight person is at increased risk for diabetes, those who carry a lot of that extra weight over the belly are at particular risk. The apple shape not only predisposes you to diabetes but to poor heart health as well.
Identifying Your Type 2 Diabetes Body Type
Body shapes determined by fat deposits seem to predict your type 2 diabetes risk. It may be helpful to know the terms for the body shape categories:
Apple. People whose fat collects around their waistline may end up looking more like apples than any other fruit. This body type is also called “android” and the fat collection is sometimes referred to as “central adiposity.”Pear. In women especially, fat can be drawn to the buttocks and thighs. The good news is that this type of fat distribution is less likely than abdominal fat to lead to insulin resistance or type 2 diabetes. This is also called the “gynecoid” body shape or “gluteo-femoral” fat.Overall. Some people collect fat everywhere at a fairly even rate. But because being overweight or obese, regardless of your body shape, increases type 2 diabetes risk over being normal weight, the fact that you don’t fall into either apple or pear shape doesn’t completely let you off the hook when it comes to preventing type 2 diabetes and other chronic health conditions.
Measure Your Waist
Some people can tell by sight if they are apple- or pear-shaped. But if your risk of diabetes isn’t clear from a glance in the mirror, there is one important measurement that can help you determine your risk of diabetes and heart disease: your waist. If you are a woman and your waistline is greater than 35 inches, you are at increased risk for type 2 diabetes. For a man, the magic number is 40 inches. If your tape measure reveals you are at or above these numbers, it’s time for a little waist whittling.
Escape Your Shape
The good news is that your body shape is not your disease destiny. There is one way to reduce your type 2 diabetes risk: weight loss to maintain a healthy body weight.
Here are the steps you can take:
Be physically active. Sam emphasizes that physical activity has been shown to help prevent diabetes and will help you control your weight. Mix up your activities to include both aerobic activities, such as walking or swimming, and some weight training or core-strengthening so you get overall slimming benefits.Watch your weight. If you already know you are an apple or a pear, chances are you are also overweight. Getting back to a normal weight and staying there is your best bet for staving off diabetes. If you are having a hard time figuring out what your goal weight should be, talk to your doctor.Eat a healthy diet. A nutritious, varied diet full of lean protein, whole grain, fruits, and veggies is your best bet for long-term health. If you are pre-diabetic or have diabetes already, you must also control your blood sugar. Aim for low-fat menu planning as well, if you want to whittle down your waist. If the body shape you see in the mirror seems riskier than you want it to be, don’t despair. With some work you can beat your diabetes risk — while feeling and looking healthier.
Apple or pear? The question may imply a healthy snack — or an important distinction between body shapes that affects type 2 diabetes risk.
In general, people whose fat collects on their abdomen — making them resemble apples over time — are at greater risk for type 2 diabetes. But the good news is, you can escape your shape.
Being overweight is a significant risk factor for diabetes, no matter your shape. “Patients who have a higher body mass index have a higher risk [of diabetes],” says Danny Sam, MD, an internal medicine physician with Kaiser Permanente in Santa Clara, Calif., who specializes in the treatment of adult diabetes. Body mass index (BMI) is calculated by comparing weight and height.
But while any overweight person is at increased risk for diabetes, those who carry a lot of that extra weight over the belly are at particular risk. The apple shape not only predisposes you to diabetes but to poor heart health as well.
Identifying Your Type 2 Diabetes Body Type
Body shapes determined by fat deposits seem to predict your type 2 diabetes risk. It may be helpful to know the terms for the body shape categories:
Apple. People whose fat collects around their waistline may end up looking more like apples than any other fruit. This body type is also called “android” and the fat collection is sometimes referred to as “central adiposity.”Pear. In women especially, fat can be drawn to the buttocks and thighs. The good news is that this type of fat distribution is less likely than abdominal fat to lead to insulin resistance or type 2 diabetes. This is also called the “gynecoid” body shape or “gluteo-femoral” fat.Overall. Some people collect fat everywhere at a fairly even rate. But because being overweight or obese, regardless of your body shape, increases type 2 diabetes risk over being normal weight, the fact that you don’t fall into either apple or pear shape doesn’t completely let you off the hook when it comes to preventing type 2 diabetes and other chronic health conditions.
Measure Your Waist
Some people can tell by sight if they are apple- or pear-shaped. But if your risk of diabetes isn’t clear from a glance in the mirror, there is one important measurement that can help you determine your risk of diabetes and heart disease: your waist. If you are a woman and your waistline is greater than 35 inches, you are at increased risk for type 2 diabetes. For a man, the magic number is 40 inches. If your tape measure reveals you are at or above these numbers, it’s time for a little waist whittling.
Escape Your Shape
The good news is that your body shape is not your disease destiny. There is one way to reduce your type 2 diabetes risk: weight loss to maintain a healthy body weight.
Here are the steps you can take:
Be physically active. Sam emphasizes that physical activity has been shown to help prevent diabetes and will help you control your weight. Mix up your activities to include both aerobic activities, such as walking or swimming, and some weight training or core-strengthening so you get overall slimming benefits.Watch your weight. If you already know you are an apple or a pear, chances are you are also overweight. Getting back to a normal weight and staying there is your best bet for staving off diabetes. If you are having a hard time figuring out what your goal weight should be, talk to your doctor.Eat a healthy diet. A nutritious, varied diet full of lean protein, whole grain, fruits, and veggies is your best bet for long-term health. If you are pre-diabetic or have diabetes already, you must also control your blood sugar. Aim for low-fat menu planning as well, if you want to whittle down your waist. If the body shape you see in the mirror seems riskier than you want it to be, don’t despair. With some work you can beat your diabetes risk — while feeling and looking healthier.
Thursday, April 7, 2011
Diabetes Tied to Poor Impulse Control
Patients with newly diagnosed Type 2 diabetes were significantly more likely to show poor impulse control in psychological testing than healthy people....
In the standard Go/NoGo test of impulse control, newly diagnosed diabetics made about 50% more errors of commission than normal controls, regardless of whether they were overweight.
The differences were not attributable to cognitive impairment, the researchers concluded, because diabetic patients performed as well as controls on the Wisconsin Card Sorting Test of executive function.
"Our results showed that middle-aged, newly diagnosed, and medication-free patients with Type 2 diabetes have a particular neuropsychological deficit in inhibitory control of impulsive response, which is an independent effect of diabetes apart from being overweight," Yasuhiko Iwamoto, MD, of Tokyo Women's Medical University in Japan, and colleagues wrote.
They suggested the findings could help explain why diabetic patients find it difficult to make the recommended lifestyle adjustments such as avoiding high-fat foods and maintaining daily exercise.
The researchers explained that decision-making about daily activities relies on brain functions in different cerebral regions, mixing predictions of future rewards and punishments, inhibition of impulsive responses, and executive functions.
Overeating, they explained, occurs when the prospect of immediate reward overwhelms inhibitions that derive from awareness of negative consequences. "In such conditions, rapid reward prediction or impulsive response to environmental stimuli prevails over the preparations by executive function," Iwamoto and colleagues asserted.
Earlier studies had indicated that reward predictions by overweight individuals tend to be higher than those of normal weight people, and their impulse control was generally lower. Consequently, the Japanese researchers sought to test diabetic patients for performance on psychological tests that measure these functions.
The Go/NoGo test for impulse control involved showing participants one of two letters, N or H, with instructions to press a button when they saw the N but not H. Pressing the button in response to H was an error of commission, and failing to press it when shown the N was an error of omission. The test also measured reaction times, including slowed responses that sometimes followed errors.
Prediction of future rewards was evaluated with so-called reversal and extinction tasks.
In the former, participants won points for correctly switching images on a computer screen that randomly replaced each other. The extinction task was structured the same way, except that participants stopped winning points for executing the reversal after nine correct responses; at that point, they received points for not responding to the stimulus.
As on a TV game show, correct responses were signaled with a pleasant chime sound, whereas errors were announced with a buzzer. Participants were also assessed for clinical depression and for standard laboratory measures of glycemia and insulin resistance. A total of 27 newly diagnosed Type 2 diabetic patients and 27 non-diabetic controls participated. All participants in both groups were men, and none of the diabetic patients were taking medications for diabetes. The diabetic group included 16 who were overweight (mean BMI 29.8). There were 11 overweight controls (mean BMI 27.6).
Response inhibition in the Go/NoGo test was significantly decreased in the diabetic patients, the researchers reported. In a combined measure of commission and omission errors, labeled d', diabetic patients had a mean value of 2.55 compared with 3.22 for controls (P=0.001).
The difference was most pronounced for errors of commission, with a mean of 10 for patients versus about 6 for controls (P=0.002).
The researchers found a significant interaction between Go/NoGo performance and glycated hemoglobin levels, with an r2 value of 0.287 for d' versus HbA1c (P=0.024). Scores did not differ significantly by weight, although there was a trend toward reduced impulse control in overweight participants. Diabetes did not affect reaction times, overall or after errors, but weight did affect them, with faster reaction times in overweight participants.
Iwamoto and colleagues also found that diabetes status did not affect scores on the reversal and extinction tests. Overweight participants made about 40% more errors on the extinction test compared with normal-weight individuals (P=0.029) but not on the reversal test.
Achievement scores on the Wisconsin Card Sorting Test were similar in all patient groups stratified by weight and diabetes status.
So-called perseverative errors (involving continuous repetition of a response) appeared more common in normal-weight diabetic participants, but rates of these errors varied widely among individuals and the group difference was not statistically significant.
"Our study included only newly diagnosed patients with Type 2 diabetes, suggesting the possibility that the neuropsychological deficits in response inhibition may contribute to the behavioral problems leading to chronic lifestyle-related diseases, such as Type 2 diabetes," they wrote.
However, they acknowledged that the causal arrow could point in the other direction -- that "metabolic changes with diabetes affect brain functions and cause neuropsychological deficits."
Indeed, the researchers observed, some earlier studies have found that metabolic improvements in diabetic patients lead to improved cognitive performance.
"Further longitudinal studies will be useful to detect progression or improvement of neuropsychological deficits associated with metabolic change," Iwamoto and colleagues wrote.
They also recommended more studies into the potential causal role of impulsivity in development of Type 2 diabetes. If confirmed, psychobehavioral interventions aimed at improving impulse control could be beneficial in preventing or treating the disease
In the standard Go/NoGo test of impulse control, newly diagnosed diabetics made about 50% more errors of commission than normal controls, regardless of whether they were overweight.
The differences were not attributable to cognitive impairment, the researchers concluded, because diabetic patients performed as well as controls on the Wisconsin Card Sorting Test of executive function.
"Our results showed that middle-aged, newly diagnosed, and medication-free patients with Type 2 diabetes have a particular neuropsychological deficit in inhibitory control of impulsive response, which is an independent effect of diabetes apart from being overweight," Yasuhiko Iwamoto, MD, of Tokyo Women's Medical University in Japan, and colleagues wrote.
They suggested the findings could help explain why diabetic patients find it difficult to make the recommended lifestyle adjustments such as avoiding high-fat foods and maintaining daily exercise.
The researchers explained that decision-making about daily activities relies on brain functions in different cerebral regions, mixing predictions of future rewards and punishments, inhibition of impulsive responses, and executive functions.
Overeating, they explained, occurs when the prospect of immediate reward overwhelms inhibitions that derive from awareness of negative consequences. "In such conditions, rapid reward prediction or impulsive response to environmental stimuli prevails over the preparations by executive function," Iwamoto and colleagues asserted.
Earlier studies had indicated that reward predictions by overweight individuals tend to be higher than those of normal weight people, and their impulse control was generally lower. Consequently, the Japanese researchers sought to test diabetic patients for performance on psychological tests that measure these functions.
The Go/NoGo test for impulse control involved showing participants one of two letters, N or H, with instructions to press a button when they saw the N but not H. Pressing the button in response to H was an error of commission, and failing to press it when shown the N was an error of omission. The test also measured reaction times, including slowed responses that sometimes followed errors.
Prediction of future rewards was evaluated with so-called reversal and extinction tasks.
In the former, participants won points for correctly switching images on a computer screen that randomly replaced each other. The extinction task was structured the same way, except that participants stopped winning points for executing the reversal after nine correct responses; at that point, they received points for not responding to the stimulus.
As on a TV game show, correct responses were signaled with a pleasant chime sound, whereas errors were announced with a buzzer. Participants were also assessed for clinical depression and for standard laboratory measures of glycemia and insulin resistance. A total of 27 newly diagnosed Type 2 diabetic patients and 27 non-diabetic controls participated. All participants in both groups were men, and none of the diabetic patients were taking medications for diabetes. The diabetic group included 16 who were overweight (mean BMI 29.8). There were 11 overweight controls (mean BMI 27.6).
Response inhibition in the Go/NoGo test was significantly decreased in the diabetic patients, the researchers reported. In a combined measure of commission and omission errors, labeled d', diabetic patients had a mean value of 2.55 compared with 3.22 for controls (P=0.001).
The difference was most pronounced for errors of commission, with a mean of 10 for patients versus about 6 for controls (P=0.002).
The researchers found a significant interaction between Go/NoGo performance and glycated hemoglobin levels, with an r2 value of 0.287 for d' versus HbA1c (P=0.024). Scores did not differ significantly by weight, although there was a trend toward reduced impulse control in overweight participants. Diabetes did not affect reaction times, overall or after errors, but weight did affect them, with faster reaction times in overweight participants.
Iwamoto and colleagues also found that diabetes status did not affect scores on the reversal and extinction tests. Overweight participants made about 40% more errors on the extinction test compared with normal-weight individuals (P=0.029) but not on the reversal test.
Achievement scores on the Wisconsin Card Sorting Test were similar in all patient groups stratified by weight and diabetes status.
So-called perseverative errors (involving continuous repetition of a response) appeared more common in normal-weight diabetic participants, but rates of these errors varied widely among individuals and the group difference was not statistically significant.
"Our study included only newly diagnosed patients with Type 2 diabetes, suggesting the possibility that the neuropsychological deficits in response inhibition may contribute to the behavioral problems leading to chronic lifestyle-related diseases, such as Type 2 diabetes," they wrote.
However, they acknowledged that the causal arrow could point in the other direction -- that "metabolic changes with diabetes affect brain functions and cause neuropsychological deficits."
Indeed, the researchers observed, some earlier studies have found that metabolic improvements in diabetic patients lead to improved cognitive performance.
"Further longitudinal studies will be useful to detect progression or improvement of neuropsychological deficits associated with metabolic change," Iwamoto and colleagues wrote.
They also recommended more studies into the potential causal role of impulsivity in development of Type 2 diabetes. If confirmed, psychobehavioral interventions aimed at improving impulse control could be beneficial in preventing or treating the disease
Sunday, April 3, 2011
Easy Steps to Reduce Diabetes Risk
From walking more to getting your blood sugar checked, you can reduce your chances of getting diabetes by following just a few easy steps.
Being overweight, not getting enough physical activity, and constantly being stressed out are all strong risk factors for type 2 diabetes. These are problems that many people face, but the good news is that you can make a few simple changes to your life to create a diabetes prevention program and reduce your diabetes risk.
Think diabetes prevention at the start of every day. “Eat a breakfast of protein and complex carbohydrates,” says Suzanne Steinbaum, DO, a cardiologist and director of Women and Heart Disease at Lenox Hill Hospital in New York City. “Eating a meal like this prevents the sugar highs and lows that often come with a breakfast of simple carbohydrates and sugars, like a bagel or a donut, which can cause those feelings of fatigue and lethargy that make you crave sugar again to increase your energy.”
Fred Pescatore, MD, an author and physician who practices nutritional medicine in New York City, says one of your best overall strategies for diabetes prevention is to steer clear of most foods that are white — white bread, white rice, and white pasta top the list. “These simple carbohydrates can cause blood sugar to spike even more than regular sugar,” he says. “This may lead to a blood sugar dip, resulting in additional sugar cravings. Avoiding white foods will help to stop this vicious cycle.”
One of the biggest causes of diabetes in this country is overeating that leads to obesity. A basic strategy for avoiding overeating is to reduce your portions by using smaller dishes than you usually would for all your meals, according to Dr. Steinbaum. “Rather than worrying about servings, pay attention to cups and tablespoons,” she says. “To help with this, instead of using a large dinner plate, use a salad plate for dinner.”
Most people think it’s okay to drink soda as long as they stick to diet soda instead of the regular sugary kind. But Steinbaum cautions that water might be the better choice for diabetes prevention. “Studies have shown that even diet soda can increase the incidence of metabolic syndrome, a pre-diabetic condition associated with insulin resistance,” she says.
A basic lifestyle strategy to assist with diabetes prevention is to keep a detailed food journal. You can use paper or a Web site or mobile phone application like My Calorie Counter, but whatever you choose, don’t spare any details. “If you write down everything you eat, you are less apt to overeat or to unconsciously pick at food or ‘graze,’” says Steinbaum. “It also lets you look back at what you’ve eaten, so you can more easily modify your behavior.”
Some people get frustrated by constantly monitoring a scale while trying to lose weight. Steven Joyal, MD, author of What Your Doctor May Not Tell You About Diabetes, says that measuring your waistline might be a better way to foster diabetes prevention. “Greater than 40 inches for men or greater than 35 inches for women means you’re at an increased risk,” he says.
Remember that inactivity is a diabetes cause and activity is a key to diabetes prevention. When it comes to exercise, some people use time constraints or other commitments as excuses not to work out. If you think that not doing a long workout means you shouldn’t bother at all, Dr. Joyal respectfully begs to differ. “A power-packed, yet short-duration exercise program of 12 minutes every other day can have a tremendous impact on your body,” he says.
Another simple way to fit more diabetes prevention strategies into your everyday, daily routine is to find ways to add more activity to everything you do. For example, when you pull into a parking lot, Dr. Pescatore suggests parking as far away from your destination as possible and walking the rest of the way. “Walking burns calories, builds muscle, and utilizes blood sugar,” he says. Other steps include taking the stairs instead of the elevator and doing sit-ups, push-ups, or even stretches while watching TV.
Stress is a risk factor for type 2 diabetes. So while focusing on eating less and exercising more, it’s important not to overlook stress reduction. “Take a yoga class, try meditation, and set boundaries around family and friends,” says Robyn Webb, MS, food editor of Diabetes Forecast magazine and author of 13 cookbooks published by the American Diabetes Association. “Seek professional therapy for issues in your life that you feel you need help with.”
Finally, if you have a family history of diabetes or are at risk, you should get your blood checked once a year to truly know your status. Pescatore says the two most important tests your doctor should perform are checking your hemoglobin A1C levels and your fasting insulin levels. If you commit to making all the previous suggestions, your efforts should show in your lab results.
Being overweight, not getting enough physical activity, and constantly being stressed out are all strong risk factors for type 2 diabetes. These are problems that many people face, but the good news is that you can make a few simple changes to your life to create a diabetes prevention program and reduce your diabetes risk.
Think diabetes prevention at the start of every day. “Eat a breakfast of protein and complex carbohydrates,” says Suzanne Steinbaum, DO, a cardiologist and director of Women and Heart Disease at Lenox Hill Hospital in New York City. “Eating a meal like this prevents the sugar highs and lows that often come with a breakfast of simple carbohydrates and sugars, like a bagel or a donut, which can cause those feelings of fatigue and lethargy that make you crave sugar again to increase your energy.”
Fred Pescatore, MD, an author and physician who practices nutritional medicine in New York City, says one of your best overall strategies for diabetes prevention is to steer clear of most foods that are white — white bread, white rice, and white pasta top the list. “These simple carbohydrates can cause blood sugar to spike even more than regular sugar,” he says. “This may lead to a blood sugar dip, resulting in additional sugar cravings. Avoiding white foods will help to stop this vicious cycle.”
One of the biggest causes of diabetes in this country is overeating that leads to obesity. A basic strategy for avoiding overeating is to reduce your portions by using smaller dishes than you usually would for all your meals, according to Dr. Steinbaum. “Rather than worrying about servings, pay attention to cups and tablespoons,” she says. “To help with this, instead of using a large dinner plate, use a salad plate for dinner.”
Most people think it’s okay to drink soda as long as they stick to diet soda instead of the regular sugary kind. But Steinbaum cautions that water might be the better choice for diabetes prevention. “Studies have shown that even diet soda can increase the incidence of metabolic syndrome, a pre-diabetic condition associated with insulin resistance,” she says.
A basic lifestyle strategy to assist with diabetes prevention is to keep a detailed food journal. You can use paper or a Web site or mobile phone application like My Calorie Counter, but whatever you choose, don’t spare any details. “If you write down everything you eat, you are less apt to overeat or to unconsciously pick at food or ‘graze,’” says Steinbaum. “It also lets you look back at what you’ve eaten, so you can more easily modify your behavior.”
Some people get frustrated by constantly monitoring a scale while trying to lose weight. Steven Joyal, MD, author of What Your Doctor May Not Tell You About Diabetes, says that measuring your waistline might be a better way to foster diabetes prevention. “Greater than 40 inches for men or greater than 35 inches for women means you’re at an increased risk,” he says.
Remember that inactivity is a diabetes cause and activity is a key to diabetes prevention. When it comes to exercise, some people use time constraints or other commitments as excuses not to work out. If you think that not doing a long workout means you shouldn’t bother at all, Dr. Joyal respectfully begs to differ. “A power-packed, yet short-duration exercise program of 12 minutes every other day can have a tremendous impact on your body,” he says.
Another simple way to fit more diabetes prevention strategies into your everyday, daily routine is to find ways to add more activity to everything you do. For example, when you pull into a parking lot, Dr. Pescatore suggests parking as far away from your destination as possible and walking the rest of the way. “Walking burns calories, builds muscle, and utilizes blood sugar,” he says. Other steps include taking the stairs instead of the elevator and doing sit-ups, push-ups, or even stretches while watching TV.
Stress is a risk factor for type 2 diabetes. So while focusing on eating less and exercising more, it’s important not to overlook stress reduction. “Take a yoga class, try meditation, and set boundaries around family and friends,” says Robyn Webb, MS, food editor of Diabetes Forecast magazine and author of 13 cookbooks published by the American Diabetes Association. “Seek professional therapy for issues in your life that you feel you need help with.”
Finally, if you have a family history of diabetes or are at risk, you should get your blood checked once a year to truly know your status. Pescatore says the two most important tests your doctor should perform are checking your hemoglobin A1C levels and your fasting insulin levels. If you commit to making all the previous suggestions, your efforts should show in your lab results.
Friday, April 1, 2011
Sore, Callous, and Cracked Feet
In the course of a day, your feet take plenty of pounding. An average day of walking puts a force equal to several hundred tons of pressure on your feet, according to the American Podiatric Medical Association. That's a big burden for the 26 small bones and hundred-plus tiny muscles and tendons that do all this work. That's why your feet are more subject to injury than any other part of your body. If your foot concern is sore, calloused, cracked heels, then your feet need a little pampering.
If you don’t moisturize your feet in the winter months you will end up with red, cracked, painful skin. This is a problem for many people because your feet sweat daily and all the extra moisture you have is removed. By not moisturizing your feet on a daily basis especially in the winter months you leave your feet vulnerable to crack which in turn leaves you exposed to infection.
“To treat your already sore, calloused, cracked feet, use a thick moisturizer that contains petrolatum, glycerin, or dimethicone to lock in moisture and decrease transepidermal water loss." says Dr. Benjamin Weaver. We recommend Gormel Cream for non-diabetics and Amerigel for diabetics. Be sure to avoid putting any type of moisturizer between your toes. The toes already hold plenty of moisture between them. Too much moisture is just as bad as not enough. Don’t forget to address the calluses on the bottom of the foot which can also cause the foot to crack. We recommend applying Calcylic Cream after you use the pumi bar in the shower. Apply just a small dab to your calluses on the ball of the foot, toes and heels. This will help to soften the skin and in turn the callous will not be so rough and painful.
If your feet are sore and tired help by elevating them at least 6 inches above your heart. Besides reducing the swelling you are helping to reduce the pain and tiredness of your feet. When you’re in the shower using a pumi bar will also help because you are removing the dried old skin from your feet. Your feet will feel energized again and not be as tired and sore. We sell a pumi bar in our office that dissolves itself as you use it. The primary reason you want a pumi bar over a pumi stone is simple. A pumi stone looses the grit the more you use it. After time you will rub harder trying to get your soft feet but what you end up doing is tearing up good skin. The goal behind using a pumi bar is to not create more calluses. By using a pumi bar in the shower, applying a small dab of Calyclic Cream to your calluses once your feet are thoroughly dried and using Gormel or Amerigel Lotion to your feet afterwards, you will help your feet to relax and decompress.
If you don’t moisturize your feet in the winter months you will end up with red, cracked, painful skin. This is a problem for many people because your feet sweat daily and all the extra moisture you have is removed. By not moisturizing your feet on a daily basis especially in the winter months you leave your feet vulnerable to crack which in turn leaves you exposed to infection.
“To treat your already sore, calloused, cracked feet, use a thick moisturizer that contains petrolatum, glycerin, or dimethicone to lock in moisture and decrease transepidermal water loss." says Dr. Benjamin Weaver. We recommend Gormel Cream for non-diabetics and Amerigel for diabetics. Be sure to avoid putting any type of moisturizer between your toes. The toes already hold plenty of moisture between them. Too much moisture is just as bad as not enough. Don’t forget to address the calluses on the bottom of the foot which can also cause the foot to crack. We recommend applying Calcylic Cream after you use the pumi bar in the shower. Apply just a small dab to your calluses on the ball of the foot, toes and heels. This will help to soften the skin and in turn the callous will not be so rough and painful.
If your feet are sore and tired help by elevating them at least 6 inches above your heart. Besides reducing the swelling you are helping to reduce the pain and tiredness of your feet. When you’re in the shower using a pumi bar will also help because you are removing the dried old skin from your feet. Your feet will feel energized again and not be as tired and sore. We sell a pumi bar in our office that dissolves itself as you use it. The primary reason you want a pumi bar over a pumi stone is simple. A pumi stone looses the grit the more you use it. After time you will rub harder trying to get your soft feet but what you end up doing is tearing up good skin. The goal behind using a pumi bar is to not create more calluses. By using a pumi bar in the shower, applying a small dab of Calyclic Cream to your calluses once your feet are thoroughly dried and using Gormel or Amerigel Lotion to your feet afterwards, you will help your feet to relax and decompress.
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