The obesity epidemic is taking a toll on our national health. All those extra pounds cause wear and tear on the body and set the stage for serious medical conditions, from diabetes to stroke.
Obesity takes a huge toll on the body and put you at risk of serious health conditions, ranging from sleep apnea to diabetes to stroke. Losing weight can reverse many of the problems that obesity creates.
Understanding how major health conditions are associated with obesity is often the first step in recognizing the value of losing even some of the extra weight you’re carrying.
Obesity, Heart Disease, and Stroke
Obesity is linked to cardiovascular diseases, such as heart disease and stroke, in 70 percent of diagnosed cases. Hardening of the arteries, also called atherosclerosis, is 10 times more frequent in people who are obese. Heart-related issues connected to obesity include:
High cholesterol. Studies have shown that the higher your body mass index (BMI), the higher the levels of total cholesterol; this is particularly true in women, but is also the case for men. Cholesterol levels rise even more for people who carry most of their excess weight in their belly. Eating an unhealthy diet leads to obesity and often high cholesterol levels.
Stroke. Too much fat in the body, especially saturated fat and cholesterol, builds up plaque in the arteries and can lead to stroke, explains registered dietitian Jim White, RD, spokesperson for the American Dietetic Association, and owner of Jim White Fitness & Nutrition Studios in Virginia Beach, Va.
Hypertension. Obesity doubles the risk of hypertension, or high blood pressure. Also related to heart disease, hypertension occurs in 26 percent of obese individuals. Obesity creates more cells and tissues that need blood and oxygen — and your heart and circulatory system must work harder to deliver them. This extra effort can increase blood pressure, leading to hypertension. Losing weight and maintaining a healthy diet can undo much of the damage caused by these conditions.
Obesity and Other Serious Health Conditions
Obesity has been associated with many other illnesses, either as a cause or a trigger for worsening symptoms:
Diabetes. Obesity is strongly correlated with diabetes. Nearly 90 percent of type 2 diabetics are overweight, as too much weight can lead to insulin resistance. Losing weight can help to manage and even prevent type 2 diabetes by making it easier for the body to use the insulin that it produces and regulate blood glucose levels.
Cancer. Research shows strong evidence of a relationship between some cancers and obesity, such as colon cancer, endometrial cancer, and breast cancer. As many as 51 percent of new cancer cases diagnosed in women are linked to obesity; the number is 14 percent for men. Although it's not understood how obesity increases the risk of developing certain cancers, evidence does show that losing weight can help to prevent many cancers.
Sleep apnea. This is a dangerous condition that causes breathing to temporarily stop during sleep. A big risk factor for sleep apnea is obesity, as excess weight taxes the respiratory system and makes breathing more difficult. Losing just 10 percent of your body weight can cut down on pauses in breathing during sleep.
Osteoarthritis. Arthritis risk increases as much as 13 percent with every two pounds gained. The increase of developing osteoarthritis is increased four times for women who are overweight; men who are overweight have five times the risk. Obesity places excess strain on the joints, leading to additional wear and tear and ultimately osteoarthritis.
Gallbladder disease. As many as 30 percent of all gallbladder surgeries are attributed to obesity. Obesity "causes disruption in the whole gallbladder," says White, by forcing it to work harder to process more fat. Obesity also leads to excess cholesterol, which boosts the risk for gallstones. Less weight puts less strain on the gallbladder.
Fatty liver disease. The specific connection between obesity and fatty liver disease isn't really understood, so it's hard to know how many cases are linked to obesity. But those with diabetes and pre-diabetics are at an increased risk of fatty liver disease. Maintaining a healthy body weight can manage blood sugar for those with diabetes and also reduce fat build-up in the liver.
GERD. Overeating doesn’t just contribute to obesity, but also to gastroesophageal reflux disease (GERD), says White. Excess weight increases pressure inside the stomach, which can push acids up into the esophagus and worsen GERD symptoms — although it doesn't actually cause GERD. Losing weight can reduce pressure and minimize GERD symptoms.
Gout. Gout is a condition in which uric acid (waste that the body produces) builds up in the joints and tissues in the body. Obesity increases the risk of gout simply because there are more cells and tissues producing uric acid, which can lead to the build-up. Getting rid of excess weight can reduce uric acid production and manage gout.
Depression. Depressed individuals are at double the risk of obesity of their non-depressed peers. People who are overweight or obese can have self-esteem issues, says White. They may feel bad about themselves for overeating and ashamed or embarrassed, all leading to depression. Getting regular exercise, eating a healthy diet, and losing weight can ease symptoms of depression.
Losing just a few pounds — even 5 percent of your body weight — can have a significant impact on your health by reducing your risk of developing many of these diseases.
Showing posts with label diabetes. Show all posts
Showing posts with label diabetes. Show all posts
Wednesday, February 15, 2012
Wednesday, October 12, 2011
Diabetes Doubles Alzheimer's Risk
People with diabetes are at increased risk of having a heart attack or stroke at an early age. But that’s not the only worry: Diabetes appears to dramatically increase a person’s risk of developing Alzheimer’s disease or other types of dementia later in life, according to a new study conducted in Japan.
In the study, which included more than 1,000 men and women over age 60, researchers found that people with diabetes were twice as likely as the other study participants to develop Alzheimer’s disease within 15 years. They were also 1.75 times more likely to develop dementia of any kind.
“It’s really important for the public health to understand that diabetes is a significant risk factor for all of these types of dementia,”says Rachel Whitmer, PhD, an epidemiologist in the research division of Kaiser Permanente Northern California, a nonprofit health-care organization based in Oakland, Calif.
Whitmer, who studies risk factors for Alzheimer’s but wasn’t involved in the new research, stresses that many questions remain about the link between diabetes and dementia. The new study was “well done” and provides“really good evidence that people with diabetes are at greater risk,” she says,“but we really need to look at other studies to find out why.”
What Factors Increase the Risk?
Diabetes could contribute to dementia in several ways, which researchers are still sorting out. Insulin resistance, which causes high blood sugar and in some cases leads to type 2 diabetes, may interfere with the body’s ability to break down a protein (amyloid) that forms brain plaques that have been linked to Alzheimer’s. High blood sugar (glucose) also produces certain oxygen-containing molecules that can damage cells, in a process known as oxidative stress.
In addition, high blood sugar—along with high cholesterol—plays a role in the hardening and narrowing of arteries in the brain. This condition, known as atherosclerosis, can bring about vascular dementia, which occurs when artery blockages (including strokes) kill brain tissue.
“Having high glucose is a stressor to the nervous system and to the blood vessels,” says David Geldmacher, MD, a professor of neurology at the University of Alabama at Birmingham. “The emerging information on Alzheimer’s disease and glucose shows us that we do need to remain vigilant on blood sugar levels as we get older.”
New and Improved Research
Studies dating back to the late 1990s have suggested that people with diabetes are more likely to develop Alzheimer’s disease and other types of dementia, but the research has been marred by inconsistent definitions of both diabetes and dementia.
The authors of the new study, led by Yutaka Kiyohara, MD, an environmental medicine researcher at Kyushu University, in Fukuoka, sought to address this weakness by using the gold standard of diabetes diagnosis, an oral glucose tolerance test. This involves giving a person a sugar-loaded drink after they have fasted for at least 12 hours, and then measuring how much glucose remains in their blood two hours later.
At the beginning of the study, the tests showed that 15% of the participants had full-fledged diabetes, while 23% had prediabetes, also known as impaired glucose tolerance.
During the next 15 years, 23% of the participants received a dementia diagnosis. Slightly less than half of those cases were deemed to be Alzheimer’s disease, with the remainder roughly split between vascular dementia and dementia due to other causes. (The diagnoses were confirmed with brain scans of living patients and brain autopsies in deceased patients.)
The link between diabetes and dementia risk persisted even after the researchers took into account several factors associated with both diabetes and dementia risk, such as age, sex, blood pressure, and body mass index.
The next step in the research, Whitmer says, will be to understand whether controlling blood sugar and reducing risk factors for type 2 diabetes also reduces dementia risk. She and her colleagues have several studies underway investigating these questions.
In the study, which included more than 1,000 men and women over age 60, researchers found that people with diabetes were twice as likely as the other study participants to develop Alzheimer’s disease within 15 years. They were also 1.75 times more likely to develop dementia of any kind.
“It’s really important for the public health to understand that diabetes is a significant risk factor for all of these types of dementia,”says Rachel Whitmer, PhD, an epidemiologist in the research division of Kaiser Permanente Northern California, a nonprofit health-care organization based in Oakland, Calif.
Whitmer, who studies risk factors for Alzheimer’s but wasn’t involved in the new research, stresses that many questions remain about the link between diabetes and dementia. The new study was “well done” and provides“really good evidence that people with diabetes are at greater risk,” she says,“but we really need to look at other studies to find out why.”
What Factors Increase the Risk?
Diabetes could contribute to dementia in several ways, which researchers are still sorting out. Insulin resistance, which causes high blood sugar and in some cases leads to type 2 diabetes, may interfere with the body’s ability to break down a protein (amyloid) that forms brain plaques that have been linked to Alzheimer’s. High blood sugar (glucose) also produces certain oxygen-containing molecules that can damage cells, in a process known as oxidative stress.
In addition, high blood sugar—along with high cholesterol—plays a role in the hardening and narrowing of arteries in the brain. This condition, known as atherosclerosis, can bring about vascular dementia, which occurs when artery blockages (including strokes) kill brain tissue.
“Having high glucose is a stressor to the nervous system and to the blood vessels,” says David Geldmacher, MD, a professor of neurology at the University of Alabama at Birmingham. “The emerging information on Alzheimer’s disease and glucose shows us that we do need to remain vigilant on blood sugar levels as we get older.”
New and Improved Research
Studies dating back to the late 1990s have suggested that people with diabetes are more likely to develop Alzheimer’s disease and other types of dementia, but the research has been marred by inconsistent definitions of both diabetes and dementia.
The authors of the new study, led by Yutaka Kiyohara, MD, an environmental medicine researcher at Kyushu University, in Fukuoka, sought to address this weakness by using the gold standard of diabetes diagnosis, an oral glucose tolerance test. This involves giving a person a sugar-loaded drink after they have fasted for at least 12 hours, and then measuring how much glucose remains in their blood two hours later.
At the beginning of the study, the tests showed that 15% of the participants had full-fledged diabetes, while 23% had prediabetes, also known as impaired glucose tolerance.
During the next 15 years, 23% of the participants received a dementia diagnosis. Slightly less than half of those cases were deemed to be Alzheimer’s disease, with the remainder roughly split between vascular dementia and dementia due to other causes. (The diagnoses were confirmed with brain scans of living patients and brain autopsies in deceased patients.)
The link between diabetes and dementia risk persisted even after the researchers took into account several factors associated with both diabetes and dementia risk, such as age, sex, blood pressure, and body mass index.
The next step in the research, Whitmer says, will be to understand whether controlling blood sugar and reducing risk factors for type 2 diabetes also reduces dementia risk. She and her colleagues have several studies underway investigating these questions.
Wednesday, March 30, 2011
The Lowdown on Glycemic Load
Carbohydrates are controversial when it comes to diet these days. But what separates the good from the bad is a food's glycemic load, which has a big impact on blood sugar levels.
Every food you eat affects your body differently, and not just in terms of your long-range health, but also in the way it is processed and the effect it has on your energy level and blood sugar.
Glycemic Load and Diet: The Basics
The glycemic load is a classification of different carbohydrates that measures their impact on the body and blood sugar. The glycemic load details the amount of carbohydrates a food contains and its glycemic index, a measurement of its impact on blood sugar. “The glycemic index ranks foods based on how quickly they're digested and get into the bloodstream," says Sandra Meyerowitz, MPH, RD, a nutritionist and owner of Nutrition Works in Louisville, Ky. “Its glycemic load takes into consideration every component of the food as a whole, so it's a different number. It changes everything."
Because the glycemic load of a food looks at both components, the same food can have a high glycemic index, but an overall low glycemic load, making it better for you than it originally might have appeared.
Glycemic Load and Diet: The Effect on Your Health
Foods with a low glycemic load keep blood sugar levels consistent, meaning that you avoid experiencing the highs and lows that can be caused by blood sugar that jumps too high and quickly drops — the candy bar effect.
There's more content below this advertisement. Jump to the content.
Watching the glycemic load of the foods you eat can have a big impact on your health in many ways. A diet focused on foods with a low glycemic load can:
Make it easier to lose weight and avoid the dreaded diet plateau
Keep blood sugar levels more consistent
Burn more calories
Help prevent insulin resistance and diabetesLower heart disease risk
"It makes more sense to use the glycemic load because when you eat a food you don’t just eat one food by itself — you eat a whole bunch of foods together," says Meyerowitz. Looking at the total picture of foods you eat, rather than just the individual pieces, gives you a clearer and more accurate picture of the foods that make up your diet.
Glycemic Load and Diet: Glycemic Loads in Favorite Foods
It's tough to figure out on your own if a food has a high or a low glycemic load, but as a general guideline, the more fiber a food has the better. Here is a glycemic load reference list with many common foods to let you know which are low, medium, and high.
Foods with a low glycemic load of 10 or less:
Kidney, garbanzo, pinto, soy, and black beans
Fiber-rich fruits and vegetables, like carrots, green peas, apples, grapefruit, and watermelon
Cereals made with 100 percent bran
Lentils
Cashews and peanuts
Whole-grain breads like barley, pumpernickel, and whole wheat
Whole-wheat tortillas
Tomato juice
Milk
Foods with a medium glycemic load of 11 to 19:
Whole-wheat pasta and some breads
Oatmeal
Rice cakes
Barley and bulgur
Fruit juices without extra sugar
Brown rice
Sweet potato
Graham crackers
Foods with a high glycemic load of 20 or more:
High-sugar beverages
Candy
Sweetened fruit juices
Couscous
White rice
White pasta
French fries and baked potatoes
Low-fiber cereals (high in added sugar)
Macaroni and cheese
Pizza
Raisins and dates
Focusing on the glycemic load of foods is particularly important for people with diabetes to help maintain a steady blood sugar, but everyone can benefit from understanding and monitoring the glycemic load in their diet.
By Diana Rodriguez
Medically reviewed by Christine Wilmsen Craig, MD
Every food you eat affects your body differently, and not just in terms of your long-range health, but also in the way it is processed and the effect it has on your energy level and blood sugar.
Glycemic Load and Diet: The Basics
The glycemic load is a classification of different carbohydrates that measures their impact on the body and blood sugar. The glycemic load details the amount of carbohydrates a food contains and its glycemic index, a measurement of its impact on blood sugar. “The glycemic index ranks foods based on how quickly they're digested and get into the bloodstream," says Sandra Meyerowitz, MPH, RD, a nutritionist and owner of Nutrition Works in Louisville, Ky. “Its glycemic load takes into consideration every component of the food as a whole, so it's a different number. It changes everything."
Because the glycemic load of a food looks at both components, the same food can have a high glycemic index, but an overall low glycemic load, making it better for you than it originally might have appeared.
Glycemic Load and Diet: The Effect on Your Health
Foods with a low glycemic load keep blood sugar levels consistent, meaning that you avoid experiencing the highs and lows that can be caused by blood sugar that jumps too high and quickly drops — the candy bar effect.
There's more content below this advertisement. Jump to the content.
Watching the glycemic load of the foods you eat can have a big impact on your health in many ways. A diet focused on foods with a low glycemic load can:
Make it easier to lose weight and avoid the dreaded diet plateau
Keep blood sugar levels more consistent
Burn more calories
Help prevent insulin resistance and diabetesLower heart disease risk
"It makes more sense to use the glycemic load because when you eat a food you don’t just eat one food by itself — you eat a whole bunch of foods together," says Meyerowitz. Looking at the total picture of foods you eat, rather than just the individual pieces, gives you a clearer and more accurate picture of the foods that make up your diet.
Glycemic Load and Diet: Glycemic Loads in Favorite Foods
It's tough to figure out on your own if a food has a high or a low glycemic load, but as a general guideline, the more fiber a food has the better. Here is a glycemic load reference list with many common foods to let you know which are low, medium, and high.
Foods with a low glycemic load of 10 or less:
Kidney, garbanzo, pinto, soy, and black beans
Fiber-rich fruits and vegetables, like carrots, green peas, apples, grapefruit, and watermelon
Cereals made with 100 percent bran
Lentils
Cashews and peanuts
Whole-grain breads like barley, pumpernickel, and whole wheat
Whole-wheat tortillas
Tomato juice
Milk
Foods with a medium glycemic load of 11 to 19:
Whole-wheat pasta and some breads
Oatmeal
Rice cakes
Barley and bulgur
Fruit juices without extra sugar
Brown rice
Sweet potato
Graham crackers
Foods with a high glycemic load of 20 or more:
High-sugar beverages
Candy
Sweetened fruit juices
Couscous
White rice
White pasta
French fries and baked potatoes
Low-fiber cereals (high in added sugar)
Macaroni and cheese
Pizza
Raisins and dates
Focusing on the glycemic load of foods is particularly important for people with diabetes to help maintain a steady blood sugar, but everyone can benefit from understanding and monitoring the glycemic load in their diet.
By Diana Rodriguez
Medically reviewed by Christine Wilmsen Craig, MD
Tuesday, March 8, 2011
Diabetic socks: More than meets the toe
With so much emphasis placed on proper diabetic footwear, especially for those who suffer from peripheral neuropathy, patients with diabetes may not realize how crucial the size, fit, fiber, and construction of socks also are. Since socks are an integral part of treatment, the following do’s and don’ts may help practitioners educate patients about proper sock selection and wear.
Do’s
Do prescribe specially constructed, seamless socks that have a soft, flexible, and stretchy toe area where the material is joined.
Do advise patients of the dangers of wearing socks with any irregularities, including darned socks or socks with holes. A seam, wrinkling, or a tiny fold can generate friction, creating microtrauma that can lead to ulceration and worse.
Do prescribe socks made of high quality fibers. They will last longer and wear evenly, instead of leaving thin spots where friction can occur.
Do look for socks made of stretchy synthetics with moisture-wicking properties to minimize the risk of infection and blisters. Any natural fibers should be blended with synthetics and make up a small portion of the total fiber content.
Do choose socks with antibacterial properties. Socks made with silver and copper fibers have been shown to decrease bacteria and combat foot odor.
Do pay attention to fit. Good diabetic socks conform to the foot and resist wrinkling inside the shoe. The best therapeutic socks fit no more than two shoe sizes and offer a range of four or five sizes to choose from.
Do prescribe therapeutic socks with silicone padding to reduce plantar pressure in patients with neuropathy. The padded socks are also a good choice for diabetic patients with rheumatoid arthritis. Double padding can be achieved by wearing two pairs of the socks, one inside the other. To accommodate the extra thickness, the shoe size needs to increase by at least 1/2 size, or suggest the patient wear the socks with extra-depth shoes.
Do make sure patients buy an adequate number of pairs to avoid the temptation to wear the same socks twice or revert to nondiabetic socks.
Do ensure that socks are not causing callus buildup or corns. The presence of a callus or corn on the surface of the foot should be a warning sign that abnormal skin shear is occurring.
Do tell patients how socks fit into their preventive care plan. Patients who find themselves in the high-risk category for ulcers and amputations should know that wearing properly sized prescription shoes and socks as well as visually inspecting and washing feet every day are all necessary to avoid infection.
Do tell patients who develop an infection not to wear socks until they’ve laundered them with bleach or another disinfectant.
Do stress the importance of regulating blood glucose, exercising, and quitting smoking to minimize the risk of foot ulceration and improve healing.
Don’ts
Don’t prescribe socks that are too tight for patients with poor circulation. If the patient has vascular disease as well as neuropathy, the socks need to have the capability of expanding as the foot and ankle swell.
Don’t prescribe socks that are too loose. They may bunch up, causing friction.
Don’t use socks with metallic fibers to treat infections or ulcers. Just because the sock itself resists bacterial growth does not mean it has been demonstrated to reduce infections on the surface of the foot.
Do’s
Do prescribe specially constructed, seamless socks that have a soft, flexible, and stretchy toe area where the material is joined.
Do advise patients of the dangers of wearing socks with any irregularities, including darned socks or socks with holes. A seam, wrinkling, or a tiny fold can generate friction, creating microtrauma that can lead to ulceration and worse.
Do prescribe socks made of high quality fibers. They will last longer and wear evenly, instead of leaving thin spots where friction can occur.
Do look for socks made of stretchy synthetics with moisture-wicking properties to minimize the risk of infection and blisters. Any natural fibers should be blended with synthetics and make up a small portion of the total fiber content.
Do choose socks with antibacterial properties. Socks made with silver and copper fibers have been shown to decrease bacteria and combat foot odor.
Do pay attention to fit. Good diabetic socks conform to the foot and resist wrinkling inside the shoe. The best therapeutic socks fit no more than two shoe sizes and offer a range of four or five sizes to choose from.
Do prescribe therapeutic socks with silicone padding to reduce plantar pressure in patients with neuropathy. The padded socks are also a good choice for diabetic patients with rheumatoid arthritis. Double padding can be achieved by wearing two pairs of the socks, one inside the other. To accommodate the extra thickness, the shoe size needs to increase by at least 1/2 size, or suggest the patient wear the socks with extra-depth shoes.
Do make sure patients buy an adequate number of pairs to avoid the temptation to wear the same socks twice or revert to nondiabetic socks.
Do ensure that socks are not causing callus buildup or corns. The presence of a callus or corn on the surface of the foot should be a warning sign that abnormal skin shear is occurring.
Do tell patients how socks fit into their preventive care plan. Patients who find themselves in the high-risk category for ulcers and amputations should know that wearing properly sized prescription shoes and socks as well as visually inspecting and washing feet every day are all necessary to avoid infection.
Do tell patients who develop an infection not to wear socks until they’ve laundered them with bleach or another disinfectant.
Do stress the importance of regulating blood glucose, exercising, and quitting smoking to minimize the risk of foot ulceration and improve healing.
Don’ts
Don’t prescribe socks that are too tight for patients with poor circulation. If the patient has vascular disease as well as neuropathy, the socks need to have the capability of expanding as the foot and ankle swell.
Don’t prescribe socks that are too loose. They may bunch up, causing friction.
Don’t use socks with metallic fibers to treat infections or ulcers. Just because the sock itself resists bacterial growth does not mean it has been demonstrated to reduce infections on the surface of the foot.
Thursday, March 3, 2011
A Closer Look At New Developments In Diabetes
The prevalence of diabetes is increasing rapidly and is expected to reach epidemic proportion over the next decade. Recent research estimates that the number of people diagnosed with diabetes will rise from 23.7 million to 44.1 million between 2009 and 2034.1 The Centers for Disease Control and Prevention (CDC) further predict that up to one-third of U.S. adults could have diabetes by 2050 if Americans continue to gain weight and avoid exercise.2
Diabetes is associated with a myriad of complications with foot ulcerations being the most common. An estimated 15 percent of all patients with diabetes will develop foot ulcers.3 About half of these ulcers become infected and 20 percent of those patients will end up with some form of lower extremity amputation.3 With the prevalence of diabetes dramatically increasing, billions of dollars are spent in the field of diabetes research for the early diagnosis, prevention and management of this disease.
With that said, here is a closer look at current research in the field of diabetes and emerging methods of disease management.
What You Should Know About Biomarkers For Diabetes
Researchers are constantly studying biomarkers to help predict the possibility of developing certain diseases. Biomarkers can indicate a change in the expression or state of a protein that correlates with the risk or progression of a disease, or with the susceptibility of the disease to a given treatment.
Recently, researchers from the United Kingdom have reported that microRNA (MiR) can help identify people who are likely to develop type 2 diabetes even before the onset of symptoms.4 MicroRNAs are classes of approximately 22 non-coding nucleotide regulatory ribonucleic acid (RNA) molecules that play important roles in controlling the developmental and physiological processes.5 Specifically, microRNAs regulate gene expression including differentiation and development by either inhibiting translation or inducing target degradation. MicroRNAs can also help serve as diagnostic markers to identify those who are at high risk of developing coronary and peripheral arterial disease.
In a study of 822 people, researchers identified five specific microRNA molecules with an abnormally low concentration in blood in people with diabetes and in those who subsequently went on to develop the disorder.6 One molecule in particular, microRNA 126 (MiR-126), was among the most reliable predictors of current and future diabetes. MiR-126 is known to help with angiogenesis and regulate the maintenance of vasculature. Healthy blood vessel cells are able to release substantial quantities of MiR-126 into the bloodstream.
However, when endothelial damage occurs, the cells retain MiR-126 and subsequently release less MiR-126 into the bloodstream. A decrease in plasma MiR-126 can therefore be an indicator of blood vessel damage and cardiovascular disease. Researchers also found that levels of MiR were lower when they gave large amounts of sugar to mice with a genetic propensity to develop diabetes.6 The MiR test can directly assess vascular endothelial damage secondary to diabetes and has a fairly low cost at around $3 per test. Clinicians may possibly be able to use this in conjunction with conventional tests in the near future.
Plasma thrombin activatable fibrinolysis inhibitor (TAFI) antigen is another biomarker that may participate in arterial thrombosis in cardiovascular diseases and may be involved in the mechanism of vascular endothelial damage in patients with diabetes.
Erdogan and colleagues investigated the association of plasma TAFI antigen level in the development of diabetic foot ulcers in people with type 2 diabetes.7 Specifically, researchers determined TAFI antigen levels in plasma samples in 50 patients with diabetic foot ulcers, 34 patients with diabetes but without diabetic foot ulcers, and 25 healthy individuals. The diabetic foot ulcer group and the diabetic non-ulcer group were similar in terms of mean age and sex distribution.
The researchers found TAFI levels to be significantly elevated in patients with diabetes with or without foot ulcers in comparison to the healthy controls. However, there was no difference in TAFI levels between the diabetic foot ulcer group and diabetic non-ulcer group, or between diabetic foot ulcer stages.
As research in this arena continues, a new class of blood markers may give additional insight to screen people who are at a higher risk of developing diabetes and intervene before the symptoms and the broad spectrum of associated complications occur.
Can An Artificial Pancreas System Enhance Glucose Control?
The artificial pancreas is a technology that is best described as a closed loop glucose management system that is intended to afford patients with diabetes better glucose control while averting the hypoglycemic state.8 With the advancement of technologies, newer artificial pancreas systems consist of a real-time continuous glucose monitoring (CGM) system. This system transmits information every one to five minutes from an under the skin sensor to a handheld receiver that can be integrated into a pump. The device also has an insulin pump with a pre-programmed algorithm that calculates appropriate insulin dosages based on the glucose ratings.
A potential imperfection to this CGM system is that the system reads glucose levels from the patient’s interstitial fluid as opposed to the actual blood glucose levels. The interstitial compartment has a lag time of eight to ten minutes and can affect the glucose readings, especially postprandial readings.
The insulin pump is a beeper-sized device that is flexibly attached via a tube in the tissue just under the skin and will release as per patient requirement. Some partial “half-loop” solutions are available in Europe and the FDA has recently approved three of the closed loop systems. Meticulous testing is still needed before the system can go on the market.9
Emerging Insights On Stem Cell Advances
With islet cell transplantation research quickly on the rise to help regenerate the disordered islet cells of the pancreas, we have seen much promise in stem cell research. Ideally, the in vitro generation of insulin-producing cells from stem or progenitor cells presents a promising approach to overcome the scarcity of donor pancreases for cell replacement therapy in people with diabetes.10
In an ongoing study, researchers at the Diabetes Research Institute are assessing the effects of biohybrid devices, also known as “scaffolds,” to house and protect the transplanted insulin producing cells.11 These “scaffolds” are designed to mimic the pancreatic environment and are being tested in different areas of the body that include the abdominal pouch, muscle tissue or subcutaneously. Furthermore, the “scaffolds” are also being tested to deliver favorable agents that may help promote the growth and viability of the transplanted islet cells.
Current studies are very optimistic in showing that these “scaffolds” co-transplanted with mesenchymal stem cell regenerative islet cells can help accelerate angiogenesis, which prolongs the longevity and functionality of islet cell regeneration.12
Encouraging Patient Adherence: What Recent Studies Reveal
Patient adherence is one of the many challenges in the treatment and management of diabetes. For years, physicians have been researching new methods in tracking patient adherence to glucose monitoring and management, and to pressure mitigation devices.
In an article published in the Annals of Family Medicine, researchers looked at the participation levels of patients with type 2 diabetes in their primary care check-up visits.13 Several offices sent questionnaires to these patients regarding their treatment goals and plans at the initial visit as well as follow-up visits. Researchers found that the more patients participated in their treatment decisions and management, the better they adhered to the prescribed medications and treatment. This resulted in better control of their diabetes.
Another study compared the efficacy of a reciprocal peer support program with that of nurse care management in 244 men with diabetes in two Veterans Affairs healthcare facilities.14 Researchers matched patients in the reciprocal peer support group with another age-matched peer patient and were encouraged to talk via telephone and participate in optional group sessions. Patients in the nurse care management group attended a 1.5-hour educational session and were assigned to a nurse care manager.
After six months, the mean hemoglobin A1C level for patients in the peer support program decreased from 8.02% to 7.73% while it increased from 7.93% to 8.22% in the nurse care management group.14 This was statistically significant.
Both studies support the notion that some patient empowerment in their treatment decisions and management may translate into better long-term outcomes.
In Conclusion
Diabetes is estimated to impose more than $174 billion dollars per year on United States healthcare. This astounding financial toll is expected to continue to rise as more and more people are diagnosed with this debilitating disease.2 In addition to being aware of the plethora of current research, patient education and preventative care are important strategies to emphasize. It is through innovative research, teamwork and preventative strategies that we continue to gain successful outcomes and improvement in the prevention and management of diabetes and its complications.
VOLUME: 24 PUBLICATION DATE: Jan 01 2011
Author(s):David A. Farnen, BS, and Stephanie C. Wu, DPM, MSc
Diabetes is associated with a myriad of complications with foot ulcerations being the most common. An estimated 15 percent of all patients with diabetes will develop foot ulcers.3 About half of these ulcers become infected and 20 percent of those patients will end up with some form of lower extremity amputation.3 With the prevalence of diabetes dramatically increasing, billions of dollars are spent in the field of diabetes research for the early diagnosis, prevention and management of this disease.
With that said, here is a closer look at current research in the field of diabetes and emerging methods of disease management.
What You Should Know About Biomarkers For Diabetes
Researchers are constantly studying biomarkers to help predict the possibility of developing certain diseases. Biomarkers can indicate a change in the expression or state of a protein that correlates with the risk or progression of a disease, or with the susceptibility of the disease to a given treatment.
Recently, researchers from the United Kingdom have reported that microRNA (MiR) can help identify people who are likely to develop type 2 diabetes even before the onset of symptoms.4 MicroRNAs are classes of approximately 22 non-coding nucleotide regulatory ribonucleic acid (RNA) molecules that play important roles in controlling the developmental and physiological processes.5 Specifically, microRNAs regulate gene expression including differentiation and development by either inhibiting translation or inducing target degradation. MicroRNAs can also help serve as diagnostic markers to identify those who are at high risk of developing coronary and peripheral arterial disease.
In a study of 822 people, researchers identified five specific microRNA molecules with an abnormally low concentration in blood in people with diabetes and in those who subsequently went on to develop the disorder.6 One molecule in particular, microRNA 126 (MiR-126), was among the most reliable predictors of current and future diabetes. MiR-126 is known to help with angiogenesis and regulate the maintenance of vasculature. Healthy blood vessel cells are able to release substantial quantities of MiR-126 into the bloodstream.
However, when endothelial damage occurs, the cells retain MiR-126 and subsequently release less MiR-126 into the bloodstream. A decrease in plasma MiR-126 can therefore be an indicator of blood vessel damage and cardiovascular disease. Researchers also found that levels of MiR were lower when they gave large amounts of sugar to mice with a genetic propensity to develop diabetes.6 The MiR test can directly assess vascular endothelial damage secondary to diabetes and has a fairly low cost at around $3 per test. Clinicians may possibly be able to use this in conjunction with conventional tests in the near future.
Plasma thrombin activatable fibrinolysis inhibitor (TAFI) antigen is another biomarker that may participate in arterial thrombosis in cardiovascular diseases and may be involved in the mechanism of vascular endothelial damage in patients with diabetes.
Erdogan and colleagues investigated the association of plasma TAFI antigen level in the development of diabetic foot ulcers in people with type 2 diabetes.7 Specifically, researchers determined TAFI antigen levels in plasma samples in 50 patients with diabetic foot ulcers, 34 patients with diabetes but without diabetic foot ulcers, and 25 healthy individuals. The diabetic foot ulcer group and the diabetic non-ulcer group were similar in terms of mean age and sex distribution.
The researchers found TAFI levels to be significantly elevated in patients with diabetes with or without foot ulcers in comparison to the healthy controls. However, there was no difference in TAFI levels between the diabetic foot ulcer group and diabetic non-ulcer group, or between diabetic foot ulcer stages.
As research in this arena continues, a new class of blood markers may give additional insight to screen people who are at a higher risk of developing diabetes and intervene before the symptoms and the broad spectrum of associated complications occur.
Can An Artificial Pancreas System Enhance Glucose Control?
The artificial pancreas is a technology that is best described as a closed loop glucose management system that is intended to afford patients with diabetes better glucose control while averting the hypoglycemic state.8 With the advancement of technologies, newer artificial pancreas systems consist of a real-time continuous glucose monitoring (CGM) system. This system transmits information every one to five minutes from an under the skin sensor to a handheld receiver that can be integrated into a pump. The device also has an insulin pump with a pre-programmed algorithm that calculates appropriate insulin dosages based on the glucose ratings.
A potential imperfection to this CGM system is that the system reads glucose levels from the patient’s interstitial fluid as opposed to the actual blood glucose levels. The interstitial compartment has a lag time of eight to ten minutes and can affect the glucose readings, especially postprandial readings.
The insulin pump is a beeper-sized device that is flexibly attached via a tube in the tissue just under the skin and will release as per patient requirement. Some partial “half-loop” solutions are available in Europe and the FDA has recently approved three of the closed loop systems. Meticulous testing is still needed before the system can go on the market.9
Emerging Insights On Stem Cell Advances
With islet cell transplantation research quickly on the rise to help regenerate the disordered islet cells of the pancreas, we have seen much promise in stem cell research. Ideally, the in vitro generation of insulin-producing cells from stem or progenitor cells presents a promising approach to overcome the scarcity of donor pancreases for cell replacement therapy in people with diabetes.10
In an ongoing study, researchers at the Diabetes Research Institute are assessing the effects of biohybrid devices, also known as “scaffolds,” to house and protect the transplanted insulin producing cells.11 These “scaffolds” are designed to mimic the pancreatic environment and are being tested in different areas of the body that include the abdominal pouch, muscle tissue or subcutaneously. Furthermore, the “scaffolds” are also being tested to deliver favorable agents that may help promote the growth and viability of the transplanted islet cells.
Current studies are very optimistic in showing that these “scaffolds” co-transplanted with mesenchymal stem cell regenerative islet cells can help accelerate angiogenesis, which prolongs the longevity and functionality of islet cell regeneration.12
Encouraging Patient Adherence: What Recent Studies Reveal
Patient adherence is one of the many challenges in the treatment and management of diabetes. For years, physicians have been researching new methods in tracking patient adherence to glucose monitoring and management, and to pressure mitigation devices.
In an article published in the Annals of Family Medicine, researchers looked at the participation levels of patients with type 2 diabetes in their primary care check-up visits.13 Several offices sent questionnaires to these patients regarding their treatment goals and plans at the initial visit as well as follow-up visits. Researchers found that the more patients participated in their treatment decisions and management, the better they adhered to the prescribed medications and treatment. This resulted in better control of their diabetes.
Another study compared the efficacy of a reciprocal peer support program with that of nurse care management in 244 men with diabetes in two Veterans Affairs healthcare facilities.14 Researchers matched patients in the reciprocal peer support group with another age-matched peer patient and were encouraged to talk via telephone and participate in optional group sessions. Patients in the nurse care management group attended a 1.5-hour educational session and were assigned to a nurse care manager.
After six months, the mean hemoglobin A1C level for patients in the peer support program decreased from 8.02% to 7.73% while it increased from 7.93% to 8.22% in the nurse care management group.14 This was statistically significant.
Both studies support the notion that some patient empowerment in their treatment decisions and management may translate into better long-term outcomes.
In Conclusion
Diabetes is estimated to impose more than $174 billion dollars per year on United States healthcare. This astounding financial toll is expected to continue to rise as more and more people are diagnosed with this debilitating disease.2 In addition to being aware of the plethora of current research, patient education and preventative care are important strategies to emphasize. It is through innovative research, teamwork and preventative strategies that we continue to gain successful outcomes and improvement in the prevention and management of diabetes and its complications.
VOLUME: 24 PUBLICATION DATE: Jan 01 2011
Author(s):David A. Farnen, BS, and Stephanie C. Wu, DPM, MSc
Sunday, January 23, 2011
Flaxseed and Diabetes
Q: Is flaxseed beneficial for people with type 2 diabetes? Does it help my prostate gland as well?
– Frank, Mid-West
A: Yes, flaxseed may help lower your sugar levels, and it plays a role in the prevention of prostate cancer as well. However, the strength of the evidence is too weak to permit definitive recommendations. Nonetheless, flaxseed is rich in alpha-linolenic acid (ALA), an essential fatty acid that appears to be beneficial in preventing heart disease and related illnesses. Flaxseed contains the right ratio of omega-3 to omega-6 fatty acids, is high in fiber, and provides a phytoestrogen called lignan, which may have antioxidant properties that protect against certain cancers.
There is some evidence that eating flaxseed reduces blood sugar levels after a meal and increases insulin levels because of its high content of soluble fiber. (It is 28 percent fiber, of which two-thirds is soluble.) Indeed, flaxseed carbohydrate (what remains after the oil is removed) was used in a study that showed a beneficial effect. Although this result was not duplicated in other studies, flaxseed has been shown to improve insulin sensitivity. An interesting, yet unproven, potential benefit may be the prevention of type 1 and type 2 diabetes; in animal models, flaxseed has been shown to delay the onset of the disease.
Flaxseed might help your prostatic health as well. In fact, the American National Cancer Institute has singled out flaxseed as one of six foods that deserve extensive research. Why? Because flaxseed contains a large amount of phytonutrients that serve as antioxidants, as well as those omega-3 fatty acids, which seem to play a role in preventing the formation of abnormal cells in the body. In terms of your specific question, flaxseed may reduce the prostate-specific antigen (PSA), a protein produced by the cells of the prostate gland that is often used as a marker for cancer. Also, men whose prostatic fluids contain high levels of lignan (the phytoestrogen found in flaxseed) seem to have a low risk of prostate cancer, though study results of this were not conclusive.
One word of warning: Flaxseed is high in calories. Here's an idea of how much you might need to consume to obtain its beneficial effects — 1 tablespoon of flaxseed has 5 grams of fat and weighs 12 grams. You need to take 40 to 50 grams of flaxseed, which is equal to about 4 tablespoons and has a total of 20 grams of fat. Milled flax has 36 calories per tablespoon; flax oil has 124 calories per tablespoon. (Flaxseeds are more nutritious than their oil.) These caloric considerations are important in the control of your glucose level.
Stay tuned, as I am sure there will be more studies that will guide us better in using flaxseed to stay healthy.
– Frank, Mid-West
A: Yes, flaxseed may help lower your sugar levels, and it plays a role in the prevention of prostate cancer as well. However, the strength of the evidence is too weak to permit definitive recommendations. Nonetheless, flaxseed is rich in alpha-linolenic acid (ALA), an essential fatty acid that appears to be beneficial in preventing heart disease and related illnesses. Flaxseed contains the right ratio of omega-3 to omega-6 fatty acids, is high in fiber, and provides a phytoestrogen called lignan, which may have antioxidant properties that protect against certain cancers.
There is some evidence that eating flaxseed reduces blood sugar levels after a meal and increases insulin levels because of its high content of soluble fiber. (It is 28 percent fiber, of which two-thirds is soluble.) Indeed, flaxseed carbohydrate (what remains after the oil is removed) was used in a study that showed a beneficial effect. Although this result was not duplicated in other studies, flaxseed has been shown to improve insulin sensitivity. An interesting, yet unproven, potential benefit may be the prevention of type 1 and type 2 diabetes; in animal models, flaxseed has been shown to delay the onset of the disease.
Flaxseed might help your prostatic health as well. In fact, the American National Cancer Institute has singled out flaxseed as one of six foods that deserve extensive research. Why? Because flaxseed contains a large amount of phytonutrients that serve as antioxidants, as well as those omega-3 fatty acids, which seem to play a role in preventing the formation of abnormal cells in the body. In terms of your specific question, flaxseed may reduce the prostate-specific antigen (PSA), a protein produced by the cells of the prostate gland that is often used as a marker for cancer. Also, men whose prostatic fluids contain high levels of lignan (the phytoestrogen found in flaxseed) seem to have a low risk of prostate cancer, though study results of this were not conclusive.
One word of warning: Flaxseed is high in calories. Here's an idea of how much you might need to consume to obtain its beneficial effects — 1 tablespoon of flaxseed has 5 grams of fat and weighs 12 grams. You need to take 40 to 50 grams of flaxseed, which is equal to about 4 tablespoons and has a total of 20 grams of fat. Milled flax has 36 calories per tablespoon; flax oil has 124 calories per tablespoon. (Flaxseeds are more nutritious than their oil.) These caloric considerations are important in the control of your glucose level.
Stay tuned, as I am sure there will be more studies that will guide us better in using flaxseed to stay healthy.
Wednesday, January 19, 2011
Managing Diabetes With a Cold or Flu
Got the sniffles? Here's what you need to know when managing diabetes and fighting off a cold or the flu. Sick days bring everyone down. But if you have type 2 diabetes, you have some special considerations when you are burdened with a cold or the flu — for example, choosing the right cold medicine or checking in with your doctor to find out about changes in the dosing of your medications.
Diabetes care means being prepared for the days when you would rather not drag yourself out of bed for a glucose check or a snack.
Pick the Right Cold Medicine
“A lot of [cold and flu] medications, particularly cough syrup, are high in glucose,” says internist Danny Sam, MD, the program director of the residency program at Kaiser Permanente in Santa Clara, Calif. His practice specializes in adult diabetes.
If you have diabetes, your best bet is a medicine that is clearly labeled sugar-free. Almost every major pharmacy has a store brand of sugar-free cold or cough medicine, says Dr. Sam. If you have questions, ask your pharmacist for help.
Check Blood Sugar Often
There's more content below this advertisement. Jump to the content.
“Diabetes is not as well controlled when you are sick,” observes Sam. This is because when your body fights infection, it releases a chemical cascade that can alter your body’s glucose and insulin response. As a result, you may need to check your blood sugar more often than you usually do. People with type 2 diabetes may need to check their blood sugar four times a day, and should check their urine for ketones anytime their blood sugar level is higher than 300 mg/dL.
Other medications you may need to take when you are sick can affect your blood sugar levels:
Aspirin may lower blood sugar levels
Certain antibiotics may decrease blood sugar levels in those taking some oral diabetes medicationsDecongestants may raise blood sugar levels
Adjust Your Plan
“You have to monitor your blood sugar more frequently and you may have to adjust your meds,” Sam says. Some people may find their blood sugar spiking more frequently, while other people, especially those plagued by stomach flu or diarrhea, may be facing hypoglycemia, or low blood sugar. Either way, you need to know how to respond to these unusual dips and spikes in blood sugar.
“Touch base with your doctor to get instructions on how to adjust medications,” says Sam. This is especially important if your blood sugar readings stay higher than 240 mg/dL for more than 24 hours.
Alternatively, before cold and flu season sets in, you can talk to your diabetes care team about how to make medication dose decisions if you should get sick. Find out what the acceptable range of blood sugar change is — and exactly when you should call your doctor. Write these instructions down in a notebook so that you can easily refer to them when you do get sick.
But there are some things you shouldn’t change: Unless your diabetes care team or doctor has instructed otherwise based on your blood sugar levels, keep taking your diabetes medications as prescribed.
Feeling Better Without Meds
Remember, as miserable as you feel right now, colds and the flu do not last forever. If you want to feel better, take care of yourself. That means:
Stay hydrated. Drink lots of fluids. Small sips can help you stay hydrated even if you are vomiting frequently.
Snack. You may not feel like it, but you should eat regularly. Snack on fluids like soup or milk, or small portions of easy-to-digest foods like applesauce, crackers, and vanilla wafers. It’s also a good idea to keep written track of the medications you take, both for diabetes and cough and cold symptoms, as well as the results of your blood sugar tests and other details of your illness.
Illness Prevention Strategies
We’d all like to avoid getting a cold or the flu. If you have type 2 diabetes, your best bet for avoiding sickness is to keep your disease under control. “Control blood sugar when well,” advises Sam.
Out-of-control blood sugar makes it harder for your body to fight off infections, including those that lead to colds and the flu. If you can keep your blood sugar under control during your healthy days, you will have fewer sick days and, when you do get sick, your body will be able to bounce back faster.
It’s also a good idea to get your annual flu shot and other vaccinations that are recommended for your age range.
By Madeline Vann, MPH
Medically reviewed by Lindsey Marcellin, MD, MPH
Diabetes care means being prepared for the days when you would rather not drag yourself out of bed for a glucose check or a snack.
Pick the Right Cold Medicine
“A lot of [cold and flu] medications, particularly cough syrup, are high in glucose,” says internist Danny Sam, MD, the program director of the residency program at Kaiser Permanente in Santa Clara, Calif. His practice specializes in adult diabetes.
If you have diabetes, your best bet is a medicine that is clearly labeled sugar-free. Almost every major pharmacy has a store brand of sugar-free cold or cough medicine, says Dr. Sam. If you have questions, ask your pharmacist for help.
Check Blood Sugar Often
There's more content below this advertisement. Jump to the content.
“Diabetes is not as well controlled when you are sick,” observes Sam. This is because when your body fights infection, it releases a chemical cascade that can alter your body’s glucose and insulin response. As a result, you may need to check your blood sugar more often than you usually do. People with type 2 diabetes may need to check their blood sugar four times a day, and should check their urine for ketones anytime their blood sugar level is higher than 300 mg/dL.
Other medications you may need to take when you are sick can affect your blood sugar levels:
Aspirin may lower blood sugar levels
Certain antibiotics may decrease blood sugar levels in those taking some oral diabetes medicationsDecongestants may raise blood sugar levels
Adjust Your Plan
“You have to monitor your blood sugar more frequently and you may have to adjust your meds,” Sam says. Some people may find their blood sugar spiking more frequently, while other people, especially those plagued by stomach flu or diarrhea, may be facing hypoglycemia, or low blood sugar. Either way, you need to know how to respond to these unusual dips and spikes in blood sugar.
“Touch base with your doctor to get instructions on how to adjust medications,” says Sam. This is especially important if your blood sugar readings stay higher than 240 mg/dL for more than 24 hours.
Alternatively, before cold and flu season sets in, you can talk to your diabetes care team about how to make medication dose decisions if you should get sick. Find out what the acceptable range of blood sugar change is — and exactly when you should call your doctor. Write these instructions down in a notebook so that you can easily refer to them when you do get sick.
But there are some things you shouldn’t change: Unless your diabetes care team or doctor has instructed otherwise based on your blood sugar levels, keep taking your diabetes medications as prescribed.
Feeling Better Without Meds
Remember, as miserable as you feel right now, colds and the flu do not last forever. If you want to feel better, take care of yourself. That means:
Stay hydrated. Drink lots of fluids. Small sips can help you stay hydrated even if you are vomiting frequently.
Snack. You may not feel like it, but you should eat regularly. Snack on fluids like soup or milk, or small portions of easy-to-digest foods like applesauce, crackers, and vanilla wafers. It’s also a good idea to keep written track of the medications you take, both for diabetes and cough and cold symptoms, as well as the results of your blood sugar tests and other details of your illness.
Illness Prevention Strategies
We’d all like to avoid getting a cold or the flu. If you have type 2 diabetes, your best bet for avoiding sickness is to keep your disease under control. “Control blood sugar when well,” advises Sam.
Out-of-control blood sugar makes it harder for your body to fight off infections, including those that lead to colds and the flu. If you can keep your blood sugar under control during your healthy days, you will have fewer sick days and, when you do get sick, your body will be able to bounce back faster.
It’s also a good idea to get your annual flu shot and other vaccinations that are recommended for your age range.
By Madeline Vann, MPH
Medically reviewed by Lindsey Marcellin, MD, MPH
Saturday, January 1, 2011
Sugar Substitutes: What's Their Real Value?
About 15 percent of Americans use sugar substitutes to cut calories, control diabetes, or prevent cavities. Yet just how much is safe to consume?
Sugar-free foods and drinks are lower in calories than their full sugar alternatives, but are they good options for weight loss? While sugar substitutes are generally safe, the debate about how they should be used continues.
Sugar Substitutes: A Short and Sweet History
The first sugar substitute, saccharin, was discovered in the late 1800s and gained prominence in manufacturing during the World Wars, when sugar was rationed. The business of sugar-free foods and drinks began to boom in the 1960s when clinicians realized the importance of controlling weight gain in the management of diabetes.
Since then, as people became more health-conscious and wanted to shun sugar, manufacturers responded with a host of sugar substitutes. They are:
• Aspartame, approved in 1981 by the U.S. Food and Drug Administration (FDA) and now in more than 6,000 foods and drinks
• Acesulfame-K, FDA-approved in 1988
• Sucralose (Splenda, SucraPlus), approved in 1998 for limited use and in 1999 for general use
• Neotame, approved in 2002
Other sugar substitutes are being developed, and many products contain a mix of sugar substitutes to enhance flavor. Each sugar substitute is several thousand times sweeter than sugar, but has a slightly different flavor. Whether you reach for the pink, blue, or yellow packet to sweeten your coffee is a matter of personal taste. Sugar substitutes are now so common that many people use them without consciously considering their use as a weight-loss strategy.
Sugar Substitutes: Their Role in Your Diet
As part of an overall healthy diet, sugar substitutes are believed to reduce calories and the risk of cavities. Interestingly, controlled studies that compare weight loss between people who use sugar substitutes and those who consume sugar show very little difference in weight loss between the two groups, although over the long term, sugar substitutes can help maintain weight loss.
Conscious calorie-cutting strategies can include sugar-free products. Replacing a sugary drink with a sugar-free drink will reduce your calorie intake, and cutting back by just one full sugar soda a day could result in losing over 1.4 pounds in 18 months. The key to losing weight using sugar-free products is to use them strategically.
Sugar Substitutes: How Much Can You Have?
A big question surrounding sugar substitutes is how much diet soda is safe to drink. Though you might never consider consuming this much in a day, the FDA says these are the maximum amounts allowable for daily consumption, listed by type of sugar substitute:
• Aspartame: 18 to 19 cans of diet soda
• Saccharin: 9 to 12 packets
• Acesulfame-K: 30 to 32 cans of diet soda
• Sucralose: 6 cans of diet soda
Sugar Substitutes: Reality Check
A realistic use of sugar-free products looks quite different.
A regular amount for a sugar substitute is two servings a day, says dietitian Liz Weinandy, RD, MPH, a dietitian in the non-surgical weight-loss program at Ohio State University Medical Center in Columbus. “My concern comes when people do multiple servings, like a six-pack of diet pop a day. Many times they are trying to use a sugar substitute in place of food. Some are very nutritious, like light yogurt, but while sugar-free soda doesn’t have calories, it also doesn’t have stuff in it that’s good for you.”
Further, consuming a lot of sugar-free drinks could hurt your weight-loss strategy. Studies show that when a sugar substitute is added to a product that has no other nutritional content (such as water), it increases hunger. This is true regardless of the type of sugar substitute used. Sugar substitutes in foods do not have this effect.
Sugar Substitutes: Who Should Avoid Them
While sugar substitutes are generally considered safe, Weinandy advises against giving children sugar-free foods and drinks — unless a doctor has said otherwise — and says pregnant women also should be cautious. “Drink water or fruit juice during pregnancy,” Weinandy suggests. “Limit diet pop to one per day at most.”
Additionally, people who have the disease phenylketonuria need to avoid aspartame, which contains phenylalanine, one of the amino acids in protein. Phenylketonuria is a genetic disorder in which the body cannot fully break down phenylalanine. If levels of it get too high in the blood, mental retardation could result.
For most people, sugar substitutes are a safe alternative to sugar. They may be helpful, in reasonable amounts, with weight loss and weight management when they are part of a balanced, healthy diet.
By Madeline Vann, MPH
Medically reviewed by Pat F. Bass III, MD, MPH
Sugar-free foods and drinks are lower in calories than their full sugar alternatives, but are they good options for weight loss? While sugar substitutes are generally safe, the debate about how they should be used continues.
Sugar Substitutes: A Short and Sweet History
The first sugar substitute, saccharin, was discovered in the late 1800s and gained prominence in manufacturing during the World Wars, when sugar was rationed. The business of sugar-free foods and drinks began to boom in the 1960s when clinicians realized the importance of controlling weight gain in the management of diabetes.
Since then, as people became more health-conscious and wanted to shun sugar, manufacturers responded with a host of sugar substitutes. They are:
• Aspartame, approved in 1981 by the U.S. Food and Drug Administration (FDA) and now in more than 6,000 foods and drinks
• Acesulfame-K, FDA-approved in 1988
• Sucralose (Splenda, SucraPlus), approved in 1998 for limited use and in 1999 for general use
• Neotame, approved in 2002
Other sugar substitutes are being developed, and many products contain a mix of sugar substitutes to enhance flavor. Each sugar substitute is several thousand times sweeter than sugar, but has a slightly different flavor. Whether you reach for the pink, blue, or yellow packet to sweeten your coffee is a matter of personal taste. Sugar substitutes are now so common that many people use them without consciously considering their use as a weight-loss strategy.
Sugar Substitutes: Their Role in Your Diet
As part of an overall healthy diet, sugar substitutes are believed to reduce calories and the risk of cavities. Interestingly, controlled studies that compare weight loss between people who use sugar substitutes and those who consume sugar show very little difference in weight loss between the two groups, although over the long term, sugar substitutes can help maintain weight loss.
Conscious calorie-cutting strategies can include sugar-free products. Replacing a sugary drink with a sugar-free drink will reduce your calorie intake, and cutting back by just one full sugar soda a day could result in losing over 1.4 pounds in 18 months. The key to losing weight using sugar-free products is to use them strategically.
Sugar Substitutes: How Much Can You Have?
A big question surrounding sugar substitutes is how much diet soda is safe to drink. Though you might never consider consuming this much in a day, the FDA says these are the maximum amounts allowable for daily consumption, listed by type of sugar substitute:
• Aspartame: 18 to 19 cans of diet soda
• Saccharin: 9 to 12 packets
• Acesulfame-K: 30 to 32 cans of diet soda
• Sucralose: 6 cans of diet soda
Sugar Substitutes: Reality Check
A realistic use of sugar-free products looks quite different.
A regular amount for a sugar substitute is two servings a day, says dietitian Liz Weinandy, RD, MPH, a dietitian in the non-surgical weight-loss program at Ohio State University Medical Center in Columbus. “My concern comes when people do multiple servings, like a six-pack of diet pop a day. Many times they are trying to use a sugar substitute in place of food. Some are very nutritious, like light yogurt, but while sugar-free soda doesn’t have calories, it also doesn’t have stuff in it that’s good for you.”
Further, consuming a lot of sugar-free drinks could hurt your weight-loss strategy. Studies show that when a sugar substitute is added to a product that has no other nutritional content (such as water), it increases hunger. This is true regardless of the type of sugar substitute used. Sugar substitutes in foods do not have this effect.
Sugar Substitutes: Who Should Avoid Them
While sugar substitutes are generally considered safe, Weinandy advises against giving children sugar-free foods and drinks — unless a doctor has said otherwise — and says pregnant women also should be cautious. “Drink water or fruit juice during pregnancy,” Weinandy suggests. “Limit diet pop to one per day at most.”
Additionally, people who have the disease phenylketonuria need to avoid aspartame, which contains phenylalanine, one of the amino acids in protein. Phenylketonuria is a genetic disorder in which the body cannot fully break down phenylalanine. If levels of it get too high in the blood, mental retardation could result.
For most people, sugar substitutes are a safe alternative to sugar. They may be helpful, in reasonable amounts, with weight loss and weight management when they are part of a balanced, healthy diet.
By Madeline Vann, MPH
Medically reviewed by Pat F. Bass III, MD, MPH
Thursday, December 30, 2010
Healthy Drink Suggestions Not Just for Diabetics
Coffee and tea are healthy gifts brimming with antioxidants and flavonoids. Research has shown that coffee may lower the risk of type 2 diabetes, Parkinson’s disease, liver disease, and cirrhosis, while green tea is believed to possibly reduce the risk of heart disease. The Republic of Tea and Celestial Seasonings sell several different varieties of green tea, including flavored, full-leaf, and decaffeinated. A gift of wine is a great way to toast the season and can be healthy, too. It’s believed moderate alcohol use (one drink per day for women, one to two drinks per day for men) may slightly increase HDL, the so-called good cholesterol
Tuesday, December 21, 2010
Does Medicare Cover Therapeutic Shoes?
Yes, Medicare will cover the cost of one pair of therapeutic shoes (diabetic shoes) and inserts for people with diabetes if you have a medical need for them. The Medicare payment for therapeutic shoes is subject to the requirement that they are necessary and reasonable for protection of insensitive feet or neuropathy (nerve damage in the feet). To ensure that Medicare pays for your shoes, you must follow the steps below:
Your treating doctor must complete a certificate of medical necessity for the therapeutic shoes and document the need in your medical records. So, do not order anything until you have visited your doctor - no matter what the sales person tells you.
The shoes and inserts must be prescribed by a podiatrist or other qualified doctor and provided by a podiatrist, orthotist, prosthetist, or pedorthist.
The supplier must receive the order before Medicare is billed and must keep it on file.
If you receive your Medicare through a Medicare Advantage Plan (like a HMO, PPO) it is likely you will have to follow the plan's steps for approval and purchase. Make a point of calling your plan's customer service number and ask about their steps for coverage of diabetic shoes.
Medicare will cover one of the following per calendar year:
One pair of depth-inlay shoes and three pairs of inserts or;
One pair of custom molded shoes (including inserts) and two additional pairs of inserts. This option is only available if you cannot wear depth-inlay shoes due to a foot deformity.
In certain cases, Medicare may also cover separate inserts or shoe modifications instead of inserts.
Medicare will not cover deluxe features: A deluxe feature is one that does not contribute to the shoe's therapeutic function - for example, a custom style, color or custom material.
Your treating doctor must complete a certificate of medical necessity for the therapeutic shoes and document the need in your medical records. So, do not order anything until you have visited your doctor - no matter what the sales person tells you.
The shoes and inserts must be prescribed by a podiatrist or other qualified doctor and provided by a podiatrist, orthotist, prosthetist, or pedorthist.
The supplier must receive the order before Medicare is billed and must keep it on file.
If you receive your Medicare through a Medicare Advantage Plan (like a HMO, PPO) it is likely you will have to follow the plan's steps for approval and purchase. Make a point of calling your plan's customer service number and ask about their steps for coverage of diabetic shoes.
Medicare will cover one of the following per calendar year:
One pair of depth-inlay shoes and three pairs of inserts or;
One pair of custom molded shoes (including inserts) and two additional pairs of inserts. This option is only available if you cannot wear depth-inlay shoes due to a foot deformity.
In certain cases, Medicare may also cover separate inserts or shoe modifications instead of inserts.
Medicare will not cover deluxe features: A deluxe feature is one that does not contribute to the shoe's therapeutic function - for example, a custom style, color or custom material.
Wednesday, December 15, 2010
Obese Adolescents at Greatest Risk of Becoming Severely Obese Adults
Obese adolescents are 16 times more likely to become severely obese by age 30 than their healthy weight or even overweight peers, according to a new study....
Public health researchers found that nearly 40 percent of obese adolescents are expected to become severely obese by age 30, compared to only 2.5 percent of healthy weight and overweight teenagers.
It is believed to be the first longitudinal study to examine the persistence and development of severe obesity over the transition from the teenage to adult years.
The link found between adolescent obesity and adult severe obesity suggests intervention programs might be most effective during childhood or adolescence, before the worst weight gain occurs, said senior study author Penny Gordon-Larsen, Ph.D., associate professor of nutrition in the University of North Carolina Gillings School of Global Public Health and a fellow of the Carolina Population Center.
"Severe obesity can lead to life-threatening complications, including diabetes, hypertension, hyperlipidemia, asthma and arthritis, as well as substantial reductions in life expectancy," she said. "It's critical that we identify who is most at risk for this condition, and when they are most vulnerable to it. Then we'll have better evidence for when and how to effectively intervene."
Current weight loss drugs are either minimally effective or come with a high risk of side effects, while people who have bariatric surgery, or "stomach stapling" operations, can suffer major potential complications, said Natalie The, Ph.D., postdoctoral research associate and lead author of the study. Therefore, preventing severe obesity may be the most effective strategy to avoid obesity-related health risks, she said.
Researchers defined adult severe obesity as a body mass index (BMI) of greater than or equal to 40, and being overweight and obese as a BMI greater than 25. The study found that while 1.2 percent of males and 2.4 percent of females who were normal weight as adolescents became severely obese as adults, 37 percent of males and 51 percent of females who were obese as adolescents became severely obese as adults. The risk of becoming severely obese was highest in black females.
"While we know that the transition from the teenage years to the adult years is one of high risk for weight gain, few studies have tracked individuals over time to understand the risk of developing severe obesity."
To measure the association between obesity in adolescence and severe obesity in adulthood, researchers studied data from the U.S. National Longitudinal Study of Adolescent Health. More than 8,800 people aged 12-21 in 1996 were followed into adulthood (ages 24-33 in 2007-2009).
Results showed that across all weight, sex and racial and ethnic groups, 7.9 percent of these teenagers who were not severely obese as adolescents became severely obese as young adults 13 years later. On the other hand, 70 percent of the teens who were severely obese remained so as they aged.
On average, over the period of the study, a teenage female of 5 feet 4 inches tall weighing 130 pounds who never developed severe obesity gained about 30 pounds; however a female of the same height who did become severely obese gained about 80 pounds.
"Obese adolescents are at considerably high risk for becoming adults with severe obesity," Gordon-Larsen said. "Given the rapid rise in severe obesity and its associated health risks, early prevention efforts are critically needed."
Public health researchers found that nearly 40 percent of obese adolescents are expected to become severely obese by age 30, compared to only 2.5 percent of healthy weight and overweight teenagers.
It is believed to be the first longitudinal study to examine the persistence and development of severe obesity over the transition from the teenage to adult years.
The link found between adolescent obesity and adult severe obesity suggests intervention programs might be most effective during childhood or adolescence, before the worst weight gain occurs, said senior study author Penny Gordon-Larsen, Ph.D., associate professor of nutrition in the University of North Carolina Gillings School of Global Public Health and a fellow of the Carolina Population Center.
"Severe obesity can lead to life-threatening complications, including diabetes, hypertension, hyperlipidemia, asthma and arthritis, as well as substantial reductions in life expectancy," she said. "It's critical that we identify who is most at risk for this condition, and when they are most vulnerable to it. Then we'll have better evidence for when and how to effectively intervene."
Current weight loss drugs are either minimally effective or come with a high risk of side effects, while people who have bariatric surgery, or "stomach stapling" operations, can suffer major potential complications, said Natalie The, Ph.D., postdoctoral research associate and lead author of the study. Therefore, preventing severe obesity may be the most effective strategy to avoid obesity-related health risks, she said.
Researchers defined adult severe obesity as a body mass index (BMI) of greater than or equal to 40, and being overweight and obese as a BMI greater than 25. The study found that while 1.2 percent of males and 2.4 percent of females who were normal weight as adolescents became severely obese as adults, 37 percent of males and 51 percent of females who were obese as adolescents became severely obese as adults. The risk of becoming severely obese was highest in black females.
"While we know that the transition from the teenage years to the adult years is one of high risk for weight gain, few studies have tracked individuals over time to understand the risk of developing severe obesity."
To measure the association between obesity in adolescence and severe obesity in adulthood, researchers studied data from the U.S. National Longitudinal Study of Adolescent Health. More than 8,800 people aged 12-21 in 1996 were followed into adulthood (ages 24-33 in 2007-2009).
Results showed that across all weight, sex and racial and ethnic groups, 7.9 percent of these teenagers who were not severely obese as adolescents became severely obese as young adults 13 years later. On the other hand, 70 percent of the teens who were severely obese remained so as they aged.
On average, over the period of the study, a teenage female of 5 feet 4 inches tall weighing 130 pounds who never developed severe obesity gained about 30 pounds; however a female of the same height who did become severely obese gained about 80 pounds.
"Obese adolescents are at considerably high risk for becoming adults with severe obesity," Gordon-Larsen said. "Given the rapid rise in severe obesity and its associated health risks, early prevention efforts are critically needed."
The Lowdown on Glycemic Load
Carbohydrates are controversial when it comes to diet these days. But what separates the good from the bad is a food's glycemic load, which has a big impact on blood sugar levels.
Every food you eat affects your body differently, and not just in terms of your long-range health, but also in the way it is processed and the effect it has on your energy level and blood sugar.
Glycemic Load and Diet: The Basics
The glycemic load is a classification of different carbohydrates that measures their impact on the body and blood sugar. The glycemic load details the amount of carbohydrates a food contains and its glycemic index, a measurement of its impact on blood sugar. “The glycemic index ranks foods based on how quickly they're digested and get into the bloodstream," says Sandra Meyerowitz, MPH, RD, a nutritionist and owner of Nutrition Works in Louisville, Ky. “Its glycemic load takes into consideration every component of the food as a whole, so it's a different number. It changes everything."
Because the glycemic load of a food looks at both components, the same food can have a high glycemic index, but an overall low glycemic load, making it better for you than it originally might have appeared.
Glycemic Load and Diet: The Effect on Your Health
Foods with a low glycemic load keep blood sugar levels consistent, meaning that you avoid experiencing the highs and lows that can be caused by blood sugar that jumps too high and quickly drops — the candy bar effect.
There's more content below this advertisement. Jump to the content.
Watching the glycemic load of the foods you eat can have a big impact on your health in many ways. A diet focused on foods with a low glycemic load can:
Make it easier to lose weight and avoid the dreaded diet plateau
Keep blood sugar levels more consistent
Burn more calories
Help prevent insulin resistance and diabetesLower heart disease risk
"It makes more sense to use the glycemic load because when you eat a food you don’t just eat one food by itself — you eat a whole bunch of foods together," says Meyerowitz. Looking at the total picture of foods you eat, rather than just the individual pieces, gives you a clearer and more accurate picture of the foods that make up your diet.
Glycemic Load and Diet: Glycemic Loads in Favorite Foods
It's tough to figure out on your own if a food has a high or a low glycemic load, but as a general guideline, the more fiber a food has the better. Here is a glycemic load reference list with many common foods to let you know which are low, medium, and high.
Foods with a low glycemic load of 10 or less:
Kidney, garbanzo, pinto, soy, and black beans
Fiber-rich fruits and vegetables, like carrots, green peas, apples, grapefruit, and watermelon
Cereals made with 100 percent bran
Lentils
Cashews and peanuts
Whole-grain breads like barley, pumpernickel, and whole wheat
Whole-wheat tortillas
Tomato juice
Milk
Foods with a medium glycemic load of 11 to 19:
Whole-wheat pasta and some breads
Oatmeal
Rice cakes
Barley and bulgur
Fruit juices without extra sugar
Brown rice
Sweet potato
Graham crackers
Foods with a high glycemic load of 20 or more:
High-sugar beverages
Candy
Sweetened fruit juices
Couscous
White rice
White pasta
French fries and baked potatoes
Low-fiber cereals (high in added sugar)
Macaroni and cheese
Pizza
Raisins and dates
Focusing on the glycemic load of foods is particularly important for people with diabetes to help maintain a steady blood sugar, but everyone can benefit from understanding and monitoring the glycemic load in their diet.
By Diana Rodriguez
Medically reviewed by Christine Wilmsen Craig, MD
Every food you eat affects your body differently, and not just in terms of your long-range health, but also in the way it is processed and the effect it has on your energy level and blood sugar.
Glycemic Load and Diet: The Basics
The glycemic load is a classification of different carbohydrates that measures their impact on the body and blood sugar. The glycemic load details the amount of carbohydrates a food contains and its glycemic index, a measurement of its impact on blood sugar. “The glycemic index ranks foods based on how quickly they're digested and get into the bloodstream," says Sandra Meyerowitz, MPH, RD, a nutritionist and owner of Nutrition Works in Louisville, Ky. “Its glycemic load takes into consideration every component of the food as a whole, so it's a different number. It changes everything."
Because the glycemic load of a food looks at both components, the same food can have a high glycemic index, but an overall low glycemic load, making it better for you than it originally might have appeared.
Glycemic Load and Diet: The Effect on Your Health
Foods with a low glycemic load keep blood sugar levels consistent, meaning that you avoid experiencing the highs and lows that can be caused by blood sugar that jumps too high and quickly drops — the candy bar effect.
There's more content below this advertisement. Jump to the content.
Watching the glycemic load of the foods you eat can have a big impact on your health in many ways. A diet focused on foods with a low glycemic load can:
Make it easier to lose weight and avoid the dreaded diet plateau
Keep blood sugar levels more consistent
Burn more calories
Help prevent insulin resistance and diabetesLower heart disease risk
"It makes more sense to use the glycemic load because when you eat a food you don’t just eat one food by itself — you eat a whole bunch of foods together," says Meyerowitz. Looking at the total picture of foods you eat, rather than just the individual pieces, gives you a clearer and more accurate picture of the foods that make up your diet.
Glycemic Load and Diet: Glycemic Loads in Favorite Foods
It's tough to figure out on your own if a food has a high or a low glycemic load, but as a general guideline, the more fiber a food has the better. Here is a glycemic load reference list with many common foods to let you know which are low, medium, and high.
Foods with a low glycemic load of 10 or less:
Kidney, garbanzo, pinto, soy, and black beans
Fiber-rich fruits and vegetables, like carrots, green peas, apples, grapefruit, and watermelon
Cereals made with 100 percent bran
Lentils
Cashews and peanuts
Whole-grain breads like barley, pumpernickel, and whole wheat
Whole-wheat tortillas
Tomato juice
Milk
Foods with a medium glycemic load of 11 to 19:
Whole-wheat pasta and some breads
Oatmeal
Rice cakes
Barley and bulgur
Fruit juices without extra sugar
Brown rice
Sweet potato
Graham crackers
Foods with a high glycemic load of 20 or more:
High-sugar beverages
Candy
Sweetened fruit juices
Couscous
White rice
White pasta
French fries and baked potatoes
Low-fiber cereals (high in added sugar)
Macaroni and cheese
Pizza
Raisins and dates
Focusing on the glycemic load of foods is particularly important for people with diabetes to help maintain a steady blood sugar, but everyone can benefit from understanding and monitoring the glycemic load in their diet.
By Diana Rodriguez
Medically reviewed by Christine Wilmsen Craig, MD
Monday, December 13, 2010
How Can Diabetes Hurt the Skin?
Diabetes can hurt your skin in two ways:
If your blood glucose is high, your body loses fluid. With less fluid in your body, your skin can get dry. Dry skin can be itchy, causing you to scratch and make it sore. Also, dry skin can crack. Cracks allow germs to enter and cause infection. If your blood glucose is high, it feeds germs and makes infections worse. You may get dry skin on your legs, feet, elbows, and other places on your body.
Drinking fluids helps keep your skin moist and healthy.
Nerve damage can decrease the amount you sweat. Sweating helps keep your skin soft and moist. Decreased sweating in your feet and legs can cause dry skin.
If your blood glucose is high, your body loses fluid. With less fluid in your body, your skin can get dry. Dry skin can be itchy, causing you to scratch and make it sore. Also, dry skin can crack. Cracks allow germs to enter and cause infection. If your blood glucose is high, it feeds germs and makes infections worse. You may get dry skin on your legs, feet, elbows, and other places on your body.
Drinking fluids helps keep your skin moist and healthy.
Nerve damage can decrease the amount you sweat. Sweating helps keep your skin soft and moist. Decreased sweating in your feet and legs can cause dry skin.
Saturday, December 11, 2010
Type 1 Diabetes Death Rate is Falling But….
Average rate is still 7 times higher in people with the disease vs. those without it....According to a new study, death rates have dropped significantly in people with Type 1 diabetes. Researchers also found that people diagnosed in the late 1970s have an even lower mortality rate compared with those diagnosed in the 1960s.
The study's senior author, Dr. Trevor J. Orchard, a professor of epidemiology, medicine and pediatrics in the Graduate School of Public Health at the University of Pittsburgh, Pennsylvania, stated that, "The encouraging thing is that, given good diabetes control, you can have a near-normal life expectancy."
But, the research also found that mortality rates for people with Type 1 still remain significantly higher than for the general population -- seven times higher, in fact. And some groups, such as women, continue to have disproportionately higher mortality rates: women with Type 1 diabetes are 13 times more likely to die than are their female counterparts without the disease.
Insulin replacement therapy isn't as effective as naturally-produced insulin. People with Type 1 diabetes often have blood sugar levels that are too high or too low, because it's difficult to predict exactly how much insulin you'll need. When blood sugar levels are too high due to too little insulin, it causes damage that can lead to long term complications, such as an increased risk of kidney failure and heart disease. On the other hand, if you have too much insulin, blood sugar levels can drop dangerously low, potentially leading to coma or death.
These factors are why Type 1 diabetes has long been associated with a significantly increased risk of death, and a shortened life expectancy.
However, numerous improvements have been made in Type 1 diabetes management during the past 30 years, including the advent of blood glucose monitors, insulin pumps, newer insulins, better medications to prevent complications and most recently continuous glucose monitors.
To assess whether or not these advances have had any effect on life expectancy, Orchard, along, with his colleagues, reviewed data from a Type 1 diabetes registry from Allegheny County, Pennsylvania. The registry contained information on almost 1,100 people under the age of 18 at the time they were diagnosed with Type 1 diabetes.
The children were sorted into three groups based on the year of their diagnosis: 1965 to 1969, 1970 to 1974 and 1975 to 1979. As of January 2008, 279 of the study participants had died, a death rate that is 7 times higher than would be expected in the general population.
When the researchers broke the mortality rate down by the time of diagnosis, they found that those diagnosed later had a much improved mortality rate. The group diagnosed in the 1960s had a 9.3 times higher mortality rate than the general population, while the early 1970s group had a 7.5 times higher mortality than the general population. For the late 1970s group, mortality had dropped to 5.6 times higher than the general population.
The mortality rate in women with Type 1 diabetes remained significantly higher, however, at 13 times the rate expected in women in the general population.
In addition, blacks with diabetes had a significantly lower 30-year survival rate than their white counterparts -- 57 percent versus 83 percent, according to the study.
Although Orchard said it isn't clear why women and blacks have higher-than-expected mortality, Barbara Araneo, director of complications therapies at the Juvenile Diabetes Research Foundation, said that both discrepancies have been found in other research, and that one theory is that blacks may have a greater genetic susceptibility to heart disease or high blood pressure. And, for women, she said previous research has shown that, "women with diabetes lose their innate protection against [heart disease], similar to the loss sustained in postmenopausal phases of life." But, she said, it's not clear how diabetes causes this loss.
The overall message of the study, however, is a positive one.
"The outcome of this study shows that diabetes care has improved in many ways over the last couple of decades, and as a result people with diabetes are living longer now," said Araneo, adding, "Managing and taking good care of your diabetes is the surest way to reduce the risk of developing complications later in life."
"What we're seeing now is incredibly encouraging, but it's not necessarily the full story yet," said Orchard, who noted that improvements in diabetes care should continue to lower mortality rates in people with Type 1 diabetes.
The study's senior author, Dr. Trevor J. Orchard, a professor of epidemiology, medicine and pediatrics in the Graduate School of Public Health at the University of Pittsburgh, Pennsylvania, stated that, "The encouraging thing is that, given good diabetes control, you can have a near-normal life expectancy."
But, the research also found that mortality rates for people with Type 1 still remain significantly higher than for the general population -- seven times higher, in fact. And some groups, such as women, continue to have disproportionately higher mortality rates: women with Type 1 diabetes are 13 times more likely to die than are their female counterparts without the disease.
Insulin replacement therapy isn't as effective as naturally-produced insulin. People with Type 1 diabetes often have blood sugar levels that are too high or too low, because it's difficult to predict exactly how much insulin you'll need. When blood sugar levels are too high due to too little insulin, it causes damage that can lead to long term complications, such as an increased risk of kidney failure and heart disease. On the other hand, if you have too much insulin, blood sugar levels can drop dangerously low, potentially leading to coma or death.
These factors are why Type 1 diabetes has long been associated with a significantly increased risk of death, and a shortened life expectancy.
However, numerous improvements have been made in Type 1 diabetes management during the past 30 years, including the advent of blood glucose monitors, insulin pumps, newer insulins, better medications to prevent complications and most recently continuous glucose monitors.
To assess whether or not these advances have had any effect on life expectancy, Orchard, along, with his colleagues, reviewed data from a Type 1 diabetes registry from Allegheny County, Pennsylvania. The registry contained information on almost 1,100 people under the age of 18 at the time they were diagnosed with Type 1 diabetes.
The children were sorted into three groups based on the year of their diagnosis: 1965 to 1969, 1970 to 1974 and 1975 to 1979. As of January 2008, 279 of the study participants had died, a death rate that is 7 times higher than would be expected in the general population.
When the researchers broke the mortality rate down by the time of diagnosis, they found that those diagnosed later had a much improved mortality rate. The group diagnosed in the 1960s had a 9.3 times higher mortality rate than the general population, while the early 1970s group had a 7.5 times higher mortality than the general population. For the late 1970s group, mortality had dropped to 5.6 times higher than the general population.
The mortality rate in women with Type 1 diabetes remained significantly higher, however, at 13 times the rate expected in women in the general population.
In addition, blacks with diabetes had a significantly lower 30-year survival rate than their white counterparts -- 57 percent versus 83 percent, according to the study.
Although Orchard said it isn't clear why women and blacks have higher-than-expected mortality, Barbara Araneo, director of complications therapies at the Juvenile Diabetes Research Foundation, said that both discrepancies have been found in other research, and that one theory is that blacks may have a greater genetic susceptibility to heart disease or high blood pressure. And, for women, she said previous research has shown that, "women with diabetes lose their innate protection against [heart disease], similar to the loss sustained in postmenopausal phases of life." But, she said, it's not clear how diabetes causes this loss.
The overall message of the study, however, is a positive one.
"The outcome of this study shows that diabetes care has improved in many ways over the last couple of decades, and as a result people with diabetes are living longer now," said Araneo, adding, "Managing and taking good care of your diabetes is the surest way to reduce the risk of developing complications later in life."
"What we're seeing now is incredibly encouraging, but it's not necessarily the full story yet," said Orchard, who noted that improvements in diabetes care should continue to lower mortality rates in people with Type 1 diabetes.
Friday, December 10, 2010
Half of U.S. Could Have Diabetes or Prediabetes within Ten Years
More than half of Americans will have diabetes or be prediabetic by 2020 at a cost to the U.S. health care system of $3.35 trillion if current trends go on unabated, according to analysis of a new report released last week by health insurer UnitedHealth Group Inc....
Diabetes and prediabetes will account for an estimated 10% of total health care spending by the end of the decade at an annual cost of almost $500 billion -- up from an estimated $194 billion this year, according to the report titled "The United States of Diabetes: Challenges and Opportunities in the Decade Ahead." (See this week's Tool for Your Practice.)
The average annual health care costs in 2009 for a person with known diabetes were about $11,700 compared with about $4,400 for non-diabetics, according to new data in the report drawn from 10 million United Healthcare members.
The average annual cost nearly doubles to $20,700 for a person with complications related to diabetes, the report said.
Diabetes, which is reaching epidemic proportions and is one of the fastest-growing diseases in the United States, currently affects about 26 million Americans. Another 67 million Americans are estimated to have prediabetes, with more than 60 million unaware that they have the condition, according to UnitedHealth.
The 52-page UnitedHealth report also focuses on the growing obesity epidemic as that condition is a leading cause of diabetes.
The authors of the report contend the skyrocketing cost forecasts are not inevitable but only if the crisis is tackled aggressively, including early intervention to prevent prediabetes from becoming diabetes.
"Because diabetes follows a progressive course, often starting with obesity and then moving to prediabetes, there are multiple opportunities to intervene early on and prevent this devastating disease before it's too late," Deneen Vojta, senior vice president of the UnitedHealth Center for Health Reform & Modernization, said in a statement.
The report also focuses on obesity and its relationship to diabetes. Being overweight or obese is one of the primary risk factors for diabetes, and with more than two-thirds of American adults and 17 percent of children overweight or obese, the risk is clearly rising. In fact, over half of adults in the U.S. who are overweight or obese have either prediabetes or diabetes, and studies have shown that gaining just 11-16 pounds doubles the risk of Type 2 diabetes and gaining 17-24 pounds nearly triples the risk.
"What is now needed is concerted, national, multi-stakeholder action," Simon Stevens, chairman of the UnitedHealth Center for Health Reform & Modernization, said in a statement. "Making a major impact on the prediabetes and diabetes epidemic will require health plans to engage consumers in new ways, while working to scale nationally some of the most promising preventive care models." Stevens added.
If solutions for tackling the epidemic offered in the report were adopted broadly and scaled nationally it could lead to cost savings of up to $250 billion over the next 10 years, according to the UnitedHealth analysis.
Diabetes and prediabetes will account for an estimated 10% of total health care spending by the end of the decade at an annual cost of almost $500 billion -- up from an estimated $194 billion this year, according to the report titled "The United States of Diabetes: Challenges and Opportunities in the Decade Ahead." (See this week's Tool for Your Practice.)
The average annual health care costs in 2009 for a person with known diabetes were about $11,700 compared with about $4,400 for non-diabetics, according to new data in the report drawn from 10 million United Healthcare members.
The average annual cost nearly doubles to $20,700 for a person with complications related to diabetes, the report said.
Diabetes, which is reaching epidemic proportions and is one of the fastest-growing diseases in the United States, currently affects about 26 million Americans. Another 67 million Americans are estimated to have prediabetes, with more than 60 million unaware that they have the condition, according to UnitedHealth.
The 52-page UnitedHealth report also focuses on the growing obesity epidemic as that condition is a leading cause of diabetes.
The authors of the report contend the skyrocketing cost forecasts are not inevitable but only if the crisis is tackled aggressively, including early intervention to prevent prediabetes from becoming diabetes.
"Because diabetes follows a progressive course, often starting with obesity and then moving to prediabetes, there are multiple opportunities to intervene early on and prevent this devastating disease before it's too late," Deneen Vojta, senior vice president of the UnitedHealth Center for Health Reform & Modernization, said in a statement.
The report also focuses on obesity and its relationship to diabetes. Being overweight or obese is one of the primary risk factors for diabetes, and with more than two-thirds of American adults and 17 percent of children overweight or obese, the risk is clearly rising. In fact, over half of adults in the U.S. who are overweight or obese have either prediabetes or diabetes, and studies have shown that gaining just 11-16 pounds doubles the risk of Type 2 diabetes and gaining 17-24 pounds nearly triples the risk.
"What is now needed is concerted, national, multi-stakeholder action," Simon Stevens, chairman of the UnitedHealth Center for Health Reform & Modernization, said in a statement. "Making a major impact on the prediabetes and diabetes epidemic will require health plans to engage consumers in new ways, while working to scale nationally some of the most promising preventive care models." Stevens added.
If solutions for tackling the epidemic offered in the report were adopted broadly and scaled nationally it could lead to cost savings of up to $250 billion over the next 10 years, according to the UnitedHealth analysis.
Monday, December 6, 2010
Depression, Diabetes Linked in Women
The link between diabetes and depression in women runs both ways....
According to Frank Hu, MD, PhD, of the Harvard School of Public Health, in a large prospective study, the risk of incident diabetes was increased for women with depressed mood, and the risk was higher if they were on antidepressant medications. Conversely, having diabetes increased the risk of incident depression over a decade of follow-up, and the risk rose with the severity of the disease.
The two-way association is partly explained by other known risk factors, such as adiposity and lifestyle variables, but is independent of them, Hu and colleagues reported.
The findings come from the Nurses' Health Study, a long-running cohort study started in 1976. For this analysis, the researchers looked at data from the participants starting in 1996, when questions related to clinical depression were first asked.
Hu and colleagues had information on 65,381 women, ages 50 to 75 in 1996, who were observed until 2006.
For the analysis of depression and incident diabetes, those with diabetes in 1996 or who were missing data on depression were excluded, leaving 57,880 women. For the study of diabetes and incident depression, 56,857 women were included, after leaving out those with depression at baseline, or who were either using or gave no information on antidepressant medications.
Hu and colleagues defined clinical depression as having diagnosed depression or using antidepressants, while depressed mood was either clinical depression or severe depressive symptoms, defined as a score of 52 or less on the five-item Mental Health Index. For the analysis, those with index scores of 86 through 100 were used as a reference group.
They confirmed self-reported diabetes using a supplementary questionnaire and medical record review. Participants without diabetes at baseline served as the reference group.
For depression and incident diabetes, they found:
There were 2,844 new cases of diabetes over the 10 years of follow-up.
Compared with the reference group, participants with Mental Health Index scores of 76 through 85, 53 through 75, or 52 and below had a monotonic elevated risk of developing diabetes, and the trend was significant at P=0.002 in the multivariate analysis.
Participants with scores of 52 or less had an adjusted relative risk of developing diabetes of 1.17, with a 95% confidence interval from 1.05 to 1.30.
Those using antidepressants were at higher relative risk after adjustment for covariates -- of 1.25, with a 95% confidence interval from 1.10 to 1.41.
On the other hand, the parallel analysis showed:
There were 7,415 new cases of clinical depression over the decade of follow-up.
Compared with the reference group, those with diabetes had a relative risk of developing clinical depression -- after controlling for covariates - of 1.29, with a 95% confidence interval from 1.18 to 1.40.
The relative risks rose with disease severity: 1.25 and 1.24 for those without medications or using oral hypoglycemic agents, respectively, and 1.53 for those on insulin. The associations remained significant after adjusting for diabetes-related comorbidities.
Hu and colleagues noted that the study's strengths include its large size and prospective design. On the other hand, much of the data was self-reported and the participants were registered nurses and most were white, so the results might not apply to different populations.
According to Frank Hu, MD, PhD, of the Harvard School of Public Health, in a large prospective study, the risk of incident diabetes was increased for women with depressed mood, and the risk was higher if they were on antidepressant medications. Conversely, having diabetes increased the risk of incident depression over a decade of follow-up, and the risk rose with the severity of the disease.
The two-way association is partly explained by other known risk factors, such as adiposity and lifestyle variables, but is independent of them, Hu and colleagues reported.
The findings come from the Nurses' Health Study, a long-running cohort study started in 1976. For this analysis, the researchers looked at data from the participants starting in 1996, when questions related to clinical depression were first asked.
Hu and colleagues had information on 65,381 women, ages 50 to 75 in 1996, who were observed until 2006.
For the analysis of depression and incident diabetes, those with diabetes in 1996 or who were missing data on depression were excluded, leaving 57,880 women. For the study of diabetes and incident depression, 56,857 women were included, after leaving out those with depression at baseline, or who were either using or gave no information on antidepressant medications.
Hu and colleagues defined clinical depression as having diagnosed depression or using antidepressants, while depressed mood was either clinical depression or severe depressive symptoms, defined as a score of 52 or less on the five-item Mental Health Index. For the analysis, those with index scores of 86 through 100 were used as a reference group.
They confirmed self-reported diabetes using a supplementary questionnaire and medical record review. Participants without diabetes at baseline served as the reference group.
For depression and incident diabetes, they found:
There were 2,844 new cases of diabetes over the 10 years of follow-up.
Compared with the reference group, participants with Mental Health Index scores of 76 through 85, 53 through 75, or 52 and below had a monotonic elevated risk of developing diabetes, and the trend was significant at P=0.002 in the multivariate analysis.
Participants with scores of 52 or less had an adjusted relative risk of developing diabetes of 1.17, with a 95% confidence interval from 1.05 to 1.30.
Those using antidepressants were at higher relative risk after adjustment for covariates -- of 1.25, with a 95% confidence interval from 1.10 to 1.41.
On the other hand, the parallel analysis showed:
There were 7,415 new cases of clinical depression over the decade of follow-up.
Compared with the reference group, those with diabetes had a relative risk of developing clinical depression -- after controlling for covariates - of 1.29, with a 95% confidence interval from 1.18 to 1.40.
The relative risks rose with disease severity: 1.25 and 1.24 for those without medications or using oral hypoglycemic agents, respectively, and 1.53 for those on insulin. The associations remained significant after adjusting for diabetes-related comorbidities.
Hu and colleagues noted that the study's strengths include its large size and prospective design. On the other hand, much of the data was self-reported and the participants were registered nurses and most were white, so the results might not apply to different populations.
Healthy Recipes Not Just for Diabetics
Healthy Recipes
Herbed Tomato Risotto Mix Recipe
Servings
Diabetes-Friendly
Nutritional Info (Per serving):
Calories: 80, Saturated Fat: 0g, Sodium: 276mg, Dietary Fiber: 2g, Total Fat: 0g, Carbs: 17g, Sugars: 0g, Cholesterol: 0mg, Protein: 3g
Exchanges: Starch: 1
Carb Choices: 1
Recipe Source:
Total Time: 10 mins
Ingredients
• 3 1/4 cup(s) rice, arborio, 2 12-ounce packages
• 3/4 cup(s) tomato(es), sun-dried, thin strips dried tomatoes or snipped (not oil-packed)
• 3 tablespoon minced onion, dried
• 1 tablespoon Italian seasoning, dried
• 1 teaspoon garlic, dried, minced
Preparation
1. In a medium bowl, combine uncooked rice, dried tomatoes, dried minced onion, Italian seasoning, and dried minced garlic. Divide mixture among 8 small resealable plastic bags (about 1/2 cup mixture per bag). Seal and label. Store at room temperature for up to 3 months.
To make Herb and Tomato Risotto:
In a heavy, medium saucepan, bring 1 1/2 cups reduced-sodium chicken broth to boiling. Add the contents of 1 bag of the Herb and Tomato Risotto Mix. Return to boiling; reduce heat. Cover and simmer for 20 minutes, adding 1 cup desired frozen mixed vegetables for the last 5 minutes of cooking. Remove from heat. Let stand, covered, for 5 minutes. After standing, rice should be tender but slightly firm. If desired, stir in 2 tablespoons grated Parmesan or Romano cheese. Season to taste with ground black pepper. Makes 4 side-dish servings.
Herbed Tomato Risotto Mix Recipe
Servings
Diabetes-Friendly
Nutritional Info (Per serving):
Calories: 80, Saturated Fat: 0g, Sodium: 276mg, Dietary Fiber: 2g, Total Fat: 0g, Carbs: 17g, Sugars: 0g, Cholesterol: 0mg, Protein: 3g
Exchanges: Starch: 1
Carb Choices: 1
Recipe Source:
Total Time: 10 mins
Ingredients
• 3 1/4 cup(s) rice, arborio, 2 12-ounce packages
• 3/4 cup(s) tomato(es), sun-dried, thin strips dried tomatoes or snipped (not oil-packed)
• 3 tablespoon minced onion, dried
• 1 tablespoon Italian seasoning, dried
• 1 teaspoon garlic, dried, minced
Preparation
1. In a medium bowl, combine uncooked rice, dried tomatoes, dried minced onion, Italian seasoning, and dried minced garlic. Divide mixture among 8 small resealable plastic bags (about 1/2 cup mixture per bag). Seal and label. Store at room temperature for up to 3 months.
To make Herb and Tomato Risotto:
In a heavy, medium saucepan, bring 1 1/2 cups reduced-sodium chicken broth to boiling. Add the contents of 1 bag of the Herb and Tomato Risotto Mix. Return to boiling; reduce heat. Cover and simmer for 20 minutes, adding 1 cup desired frozen mixed vegetables for the last 5 minutes of cooking. Remove from heat. Let stand, covered, for 5 minutes. After standing, rice should be tender but slightly firm. If desired, stir in 2 tablespoons grated Parmesan or Romano cheese. Season to taste with ground black pepper. Makes 4 side-dish servings.
Friday, December 3, 2010
"Knocking Socks Off" Saves Limbs and Lives, New Diabetes Study Shows
During Diabetes Awareness Month, the American Podiatric Medical Association encourages patients to see a podiatrist for regular foot examinations.
Bethesda, MD (Vocus) November 17, 2010
The number of Americans diagnosed with diabetes continues to rise toward record levels, with an estimated one in three adults predicted to have the disease by the year 2050 according to the Centers for Disease Control. Because many serious complications from diabetes present in the lower limbs, proper foot care for those with the disease is a vital step to keeping the disease in check. In fact, a new study on foot care for people with diabetes conducted by Thomson Reuters confirms that care by a podiatrist can drastically reduce the incidence of diabetes-related hospitalizations and amputations.
"During November's Diabetes Awareness Month, it's important to realize that simple lifestyle changes can go a long way toward staying healthy with diabetes. These include eating right, being active, monitoring blood glucose, and checking your feet daily," said Dr. Kathleen Stone, president of the American Podiatric Medical Association (APMA). "Diabetic foot complications are the leading cause of non-traumatic, lower-limb amputation in the U.S. Remembering to 'knock your socks off' at every doctor's visit will help to catch any potential lower limb complications early."
According to preliminary results from the Thomson Reuters study, those with diabetes who received care from a podiatrist had a nearly 29 percent lower risk of lower limb amputation, and 24 percent lower risk of hospitalization, than those who did not. APMA's "Knock Your Socks Off" campaign, running during Diabetes Awareness Month, aims to encourage everyone with diabetes and those at risk for the disease to remove their shoes and socks and inspect their feet and visit a podiatrist for a foot exam.
Feet should be checked regularly for signs and symptoms of diabetes to help prevent serious complications. Symptoms in the feet such as redness, tingling and cuts that are not healing can lead to diabetic ulcers and even possible amputation without prompt medical care.
"The Thomson Reuters study results show that just one visit to a podiatrist can drastically reduce the chance of a tragic diabetes-related amputation. There is now no question that a podiatrist must be a part of everyone's diabetes management team," Dr. Stone said. The APMA-sponsored study was conducted using Thomson Reuters' MarketScan Research Databases, which house fully integrated, de-identified health-care claims data extensively used by researchers to understand health economics and outcomes. Studies based on MarketScan data have been published in more than 130 peer-reviewed articles in the past five years.
Founded in 1912, the American Podiatric Medical Association (APMA) is the nation's leading and recognized professional organization for doctors of podiatric medicine (DPMs). DPMs are podiatric physicians and surgeons, also known as podiatrists, qualified by their education, training and experience to diagnose and treat conditions affecting the foot, ankle and structures of the leg. The medical education and training of a DPM includes four years of undergraduate education, four years of graduate education at an accredited podiatric medical college and two or three years of hospital residency training. APMA has 53 state component locations across the United States and its territories, with a membership of close to 12,000 podiatrists. All practicing APMA members are licensed by the state in which they practice podiatric medicine.
Bethesda, MD (Vocus) November 17, 2010
The number of Americans diagnosed with diabetes continues to rise toward record levels, with an estimated one in three adults predicted to have the disease by the year 2050 according to the Centers for Disease Control. Because many serious complications from diabetes present in the lower limbs, proper foot care for those with the disease is a vital step to keeping the disease in check. In fact, a new study on foot care for people with diabetes conducted by Thomson Reuters confirms that care by a podiatrist can drastically reduce the incidence of diabetes-related hospitalizations and amputations.
"During November's Diabetes Awareness Month, it's important to realize that simple lifestyle changes can go a long way toward staying healthy with diabetes. These include eating right, being active, monitoring blood glucose, and checking your feet daily," said Dr. Kathleen Stone, president of the American Podiatric Medical Association (APMA). "Diabetic foot complications are the leading cause of non-traumatic, lower-limb amputation in the U.S. Remembering to 'knock your socks off' at every doctor's visit will help to catch any potential lower limb complications early."
According to preliminary results from the Thomson Reuters study, those with diabetes who received care from a podiatrist had a nearly 29 percent lower risk of lower limb amputation, and 24 percent lower risk of hospitalization, than those who did not. APMA's "Knock Your Socks Off" campaign, running during Diabetes Awareness Month, aims to encourage everyone with diabetes and those at risk for the disease to remove their shoes and socks and inspect their feet and visit a podiatrist for a foot exam.
Feet should be checked regularly for signs and symptoms of diabetes to help prevent serious complications. Symptoms in the feet such as redness, tingling and cuts that are not healing can lead to diabetic ulcers and even possible amputation without prompt medical care.
"The Thomson Reuters study results show that just one visit to a podiatrist can drastically reduce the chance of a tragic diabetes-related amputation. There is now no question that a podiatrist must be a part of everyone's diabetes management team," Dr. Stone said. The APMA-sponsored study was conducted using Thomson Reuters' MarketScan Research Databases, which house fully integrated, de-identified health-care claims data extensively used by researchers to understand health economics and outcomes. Studies based on MarketScan data have been published in more than 130 peer-reviewed articles in the past five years.
Founded in 1912, the American Podiatric Medical Association (APMA) is the nation's leading and recognized professional organization for doctors of podiatric medicine (DPMs). DPMs are podiatric physicians and surgeons, also known as podiatrists, qualified by their education, training and experience to diagnose and treat conditions affecting the foot, ankle and structures of the leg. The medical education and training of a DPM includes four years of undergraduate education, four years of graduate education at an accredited podiatric medical college and two or three years of hospital residency training. APMA has 53 state component locations across the United States and its territories, with a membership of close to 12,000 podiatrists. All practicing APMA members are licensed by the state in which they practice podiatric medicine.
Thursday, December 2, 2010
How Will You Stop Diabetes®? The Future Is in Your Hands.
During the holidays, we joke that our belts are a little tight around the waist. But for PJ, his tight belt was no laughing matter.
"I kept thinking 'I ought to lose weight,'" he shared.
Returning home from a baseball game one day, PJ experienced tingling in his hands and feet. "I thought that was odd. So the next day, I checked my blood glucose and my jaw dropped because it was so high. I checked the next day in disbelief, and it was still elevated."
"Right then and there, I thought 'My toes at 60. There is NO WAY I was going to lose my toes at 60.'"
Once PJ was diagnosed with type 2 diabetes, the tight belt became the focus of his attention. "I sucked it up, started to exercise and eat right and lost 30 pounds over 4 months. My glucose dropped and has remained low for 5 years. I even had to put a new hole in my belt!"
"Now I watch my diet and exercise 4 days a week. Keeping my 30 pounds off is challenging. I hate it, but it works! I do it for my toes. I do it for my brain, heart, kidneys, eyes and ultimately, my family. I thank God for the kick in the butt to check my blood glucose that day."
Developing and maintaining a healthy lifestyle can be a challenge any time of the year, but especially during the holidays. During American Diabetes Month® this November, join the movement to Stop Diabetes® and download your very own Celebrations Survival Guide. Get tips to handle the holidays and avoid tight belts this Thanksgiving season.
"I kept thinking 'I ought to lose weight,'" he shared.
Returning home from a baseball game one day, PJ experienced tingling in his hands and feet. "I thought that was odd. So the next day, I checked my blood glucose and my jaw dropped because it was so high. I checked the next day in disbelief, and it was still elevated."
"Right then and there, I thought 'My toes at 60. There is NO WAY I was going to lose my toes at 60.'"
Once PJ was diagnosed with type 2 diabetes, the tight belt became the focus of his attention. "I sucked it up, started to exercise and eat right and lost 30 pounds over 4 months. My glucose dropped and has remained low for 5 years. I even had to put a new hole in my belt!"
"Now I watch my diet and exercise 4 days a week. Keeping my 30 pounds off is challenging. I hate it, but it works! I do it for my toes. I do it for my brain, heart, kidneys, eyes and ultimately, my family. I thank God for the kick in the butt to check my blood glucose that day."
Developing and maintaining a healthy lifestyle can be a challenge any time of the year, but especially during the holidays. During American Diabetes Month® this November, join the movement to Stop Diabetes® and download your very own Celebrations Survival Guide. Get tips to handle the holidays and avoid tight belts this Thanksgiving season.
Comprehensive Care for Diabetic Neuropathy
Diabetic neuropathy is a common complication of diabetes that can be difficult to treat using oral medications alone. By addressing both the neuropathy and the underlying diabetes, patients experience better overall outcomes.
“The standard treatment for diabetic neuropathy involves medication management using either Neurontin [gabapentin], Lyrica [pregabalin] or Cymbalta [duloxetine],” says Kelly Miller, D.C., FASA, N.M.D., Clinical Director of Waldo Rehabilitation, Health and Wellness in Kansas City, MO. “However, statistically, those medications are only helpful for about 30% of patients suffering from diabetic neuropathy — and they are expensive drugs with many side effects.”
At Waldo Rehabilitation, Health and Wellness, treatment for diabetic neuropathy in patients with type 2 diabetes involves management of the patient’s disease through specialized nutritional services meant to help patients lose weight. This diet helps correct the metabolic syndrome.
“If patients’ blood sugar levels are unstable, their risk for developing other complications, such as retinopathy, kidney failure and nerve damage, is much higher,” says Dr. Miller. “We provide patients with type 2 diabetes education about their diabetes and the options available to help better manage their insulin resistance through lifestyle modifications. We have medical doctors, podiatrists, chiropractors and physical therapists on staff — all under one roof. This cooperative integration of the different disciplines allows us to treat chronic conditions, such as diabetes, in a comprehensive manner that can be challenging for a single provider.”
Diabetic Neuropathy Management
When patients present at Waldo Rehabilitation, Health and Wellness with diabetic neuropathy, a specific regimen of injections is utilized. Immediately following these injections, which are administered by a podiatrist, patients receive electrotherapy and infrared light therapy surrounding the injection site, which helps to not only anesthetize the fibers causing pain, but also increases circulation in the patient’s foot by 3,000%, according to Dr. Miller.
“By administering electrotherapy immediately after the injections have been completed, the medication is able to provide pain relief while also alleviating the numbness patients experience,” says Dr. Miller. “Improved sensory perception of the feet puts patients at decreased risk for wounds, infections and falls, which not only improves their overall well-being, but also reduces the amount of health care dollars spent on wound care. By taking a proactive approach to diabetes and diabetic neuropathy, we are able to reduce the number of patients who suffer from diabetic foot wounds, falls and other related health problems.”
For diabetic patients experiencing other health concerns, such as pain in their hips, knees and shoulders, physical therapy and chiropractic services are provided. Transdermal nutritional formulas are also used for diabetic neuropathy patients to help reverse any nerve damage that has been sustained and help them sleep.
“By utilizing a comprehensive approach that entails stabilizing blood sugar levels, correcting type 2 diabetes and applying specific nutrients — including B vitamins, melatonin, vitamin D and magnesium — patients have better outcomes for diabetic neuropathy,” says Dr. Miller. “In many cases, we can reverse nerve damage that has been sustained, which provides a much higher quality of life for patients.”
“The standard treatment for diabetic neuropathy involves medication management using either Neurontin [gabapentin], Lyrica [pregabalin] or Cymbalta [duloxetine],” says Kelly Miller, D.C., FASA, N.M.D., Clinical Director of Waldo Rehabilitation, Health and Wellness in Kansas City, MO. “However, statistically, those medications are only helpful for about 30% of patients suffering from diabetic neuropathy — and they are expensive drugs with many side effects.”
At Waldo Rehabilitation, Health and Wellness, treatment for diabetic neuropathy in patients with type 2 diabetes involves management of the patient’s disease through specialized nutritional services meant to help patients lose weight. This diet helps correct the metabolic syndrome.
“If patients’ blood sugar levels are unstable, their risk for developing other complications, such as retinopathy, kidney failure and nerve damage, is much higher,” says Dr. Miller. “We provide patients with type 2 diabetes education about their diabetes and the options available to help better manage their insulin resistance through lifestyle modifications. We have medical doctors, podiatrists, chiropractors and physical therapists on staff — all under one roof. This cooperative integration of the different disciplines allows us to treat chronic conditions, such as diabetes, in a comprehensive manner that can be challenging for a single provider.”
Diabetic Neuropathy Management
When patients present at Waldo Rehabilitation, Health and Wellness with diabetic neuropathy, a specific regimen of injections is utilized. Immediately following these injections, which are administered by a podiatrist, patients receive electrotherapy and infrared light therapy surrounding the injection site, which helps to not only anesthetize the fibers causing pain, but also increases circulation in the patient’s foot by 3,000%, according to Dr. Miller.
“By administering electrotherapy immediately after the injections have been completed, the medication is able to provide pain relief while also alleviating the numbness patients experience,” says Dr. Miller. “Improved sensory perception of the feet puts patients at decreased risk for wounds, infections and falls, which not only improves their overall well-being, but also reduces the amount of health care dollars spent on wound care. By taking a proactive approach to diabetes and diabetic neuropathy, we are able to reduce the number of patients who suffer from diabetic foot wounds, falls and other related health problems.”
For diabetic patients experiencing other health concerns, such as pain in their hips, knees and shoulders, physical therapy and chiropractic services are provided. Transdermal nutritional formulas are also used for diabetic neuropathy patients to help reverse any nerve damage that has been sustained and help them sleep.
“By utilizing a comprehensive approach that entails stabilizing blood sugar levels, correcting type 2 diabetes and applying specific nutrients — including B vitamins, melatonin, vitamin D and magnesium — patients have better outcomes for diabetic neuropathy,” says Dr. Miller. “In many cases, we can reverse nerve damage that has been sustained, which provides a much higher quality of life for patients.”
Subscribe to:
Posts (Atom)
