Suddenly All the Kids Have Diabetes

From the way diabetes gets talked about in the news, you'd think that everyone and their brother had it. Well, now it's looking more like everyone and their daughter has it. A new study has just been released which shows a pretty terrifying increase in the rate of diabetes and pre-diabetes among young people. In 2000, only 9 percent of teens were diabetic or pre-diabetic. By 2008, a whopping 23 percent of adolescents are. Jesus H. Christ on a cracker. That is a huge increase in just eight years. One small ray of hope is that the test they used, a fasting blood glucose test, doesn't give as accurate a picture of a person's health because it's a single snapshot of blood sugar rather than an average over time. So that number could be somewhat artificially high. Still, even considering that, this news is not good. The author of the study, Ashleigh May, who is an epidemiologist for the CDC, calls the findings "very concerning." Pediatric endocrinologist Larry Deeb, who is also a former president of medicine and science for the American Diabetes Association, says other research shows there could be "a 64% increase in diabetes in the next decade. [...] We are truly in deep trouble. Diabetes threatens to destroy the health care system." As if that wasn't bad enough, this study also found something else that's equally scary: [H]alf of overweight teens and almost two-thirds of obese adolescents have one or more risk factors for heart disease, such as diabetes, high blood pressure or high levels of bad cholesterol. By comparison, about one-third of normal-weight adolescents have at least one risk factor. While it was already clear that we needed to do something to protect the health of our kids, this data suggests we'd better do something quickly. Not that there's any easy way to fix this problem, especially among modern teens who already have so many other things to worry about, like being bullied and not getting caught in a sexting scandal. Perhaps it's time to call upon some kind of health superhero. Will Mr. Metabolic Syndrome save the day and defeat evil Dr. Diabetes? Blood Sugar Man to the rescue? Can we even just get Jack Black in a spandex suit doing PSAs? Someone? Anyone? Help. By Cassie Murdoch

7 Steps to Treating Low Blood Sugar / Hypoglycemia

Low blood sugar symptoms need immediate attention. Here's what you should do to handle this potential emergency.

Hypoglycemia requires fast treatment. When someone with diabetes begins experiencing low blood sugar symptoms, any delay increases the chance that the hypoglycemia could escalate into a life-threatening illness. Left untreated or not treated promptly, hypoglycemia can result in seizures, coma, permanent damage to the nervous system, and death.

Here are the steps you need to take if your diabetes management plan has failed and you begin to have the low blood sugar symptoms that indicate an episode of hypoglycemia:

1. Recognize the symptoms. The symptoms of hypoglycemia vary from person to person, but anyone taking insulin or diabetes medication should know what they are. Low blood sugar symptoms include:

Weakness or fatigue
Cold sweats or clammy skin
Confusion or fuzzy and unclear thinking
Dizziness or light-headedness
Blurred vision
Hunger Nervousness, anger, or irritability
Headache
Rapid heartbeat
Numb or tingling skin
Difficulty speaking
Shakiness

2. Make yourself safe. If you or a family member with diabetes begins to have any of these symptoms, take immediate safety precautions. Pull over if you are driving a car. Sit down right away if you are walking down steps. Hypoglycemia could cause you to lose consciousness and cause harm to yourself or others. You want to make sure that doesn't happen.

3. Test your blood glucose levels. In most cases, providing that symptoms are still mild, test to make sure you actually are having a hypoglycemic episode rather than another malady. Use your blood glucose meter to check. A reading of 70 mg/dl or lower means you need to take quick action. If symptoms are too severe to manage the testing or you can’t get to your glucose meter quickly, move on to step 4.

4. Get some carbs into your body. A diabetic undergoing an episode of hypoglycemia needs to bring blood glucose levels up quickly. Fast-acting carbohydrates, especially simple sugars, can accomplish this. If you are taking insulin or diabetes medication as part of a diabetes management plan, you should always have on hand a bit of quick-fix food equal to 15 to 20 grams of sugar or carbohydrates. Some foods that can provide this amount and quickly raise your blood sugar level include:

4 or 5 saltine crackers
5 or 6 pieces of hard candy
2 tablespoons of raisins
4 teaspoons of sugar
3 or 4 glucose tablets
1 serving of glucose gel
1/2 cup of fruit juice or regular soda
1 cup of milk
1 tablespoon of honey or corn syrup

5. Wait, then verify treatment is working. Don't keep eating, as you might over-treat and cause your blood sugar level to go too high. Instead, wait about 15 minutes and then test your blood sugar level again with a meter. If it's still too low, then eat another 15 to 20 grams of sugar or carbohydrate. Repeat until your blood sugar level is at 70 mg/dl or higher. Once you've reached that level, eat a more nutritious, carbohydrate-containing snack unless a meal is less than one hour away.

6. If your body doesn't respond, seek medical help. If you haven't responded to the carbs or if you've passed out or had seizures, you probably have a case of severe hypoglycemia and need medical attention. If someone in your family or at your workplace is aware of your condition and has been trained to give emergency glucagon injections (a substance that quickly raises blood sugar levels), they should do so immediately, even before calling 911 to get help. A diabetic treated with glucagon should respond quickly and be able to eat some food within 15 minutes.

7. Take long-term steps. If you have recurring hypoglycemic episodes or even one severe case, talk with your doctor about adjusting your diabetes management plan to better fit your lifestyle. You also should ask to have a glucagon injection prescribed to you, so that a family member or friend can administer it if you pass out or experience a seizure from another severe case of hypoglycemia.

Being prepared and knowing what to do about hypoglycemia is an important part of a good diabetes management plan.

Avoid These Diabetes Traps

If you've been diagnosed with type 2 diabetes, watch out for these lifestyle pitfalls that can make controlling your blood sugar more difficult.

You may be scared or stunned by a type 2 diabetes diagnosis, but it’s critical that you start making the changes suggested by your doctor. That's often easier said than done, since for most of us, what we eat, how much we exercise, and other everyday habits are as cozy — and as hard to get rid of — as well-worn slippers or a soft old sweatshirt.

But although you might have a few false starts and even a misstep or two along the way, a diabetes diagnosis must be taken seriously, beginning with abandoning old habits and committing to new ones to reverse or stabilize the condition.

Steps Toward Positive Change
Here’s a great place to begin: Losing just 10 percent of your body weight will improve your blood sugar control, says Margaret Shields, MEd, RD, a diabetes educator with the Washington University Diabetes Center at Barnes-Jewish Hospital in St. Louis. That, in turn, will decrease your heart disease risk and keep you healthy and living longer.

Some more bad habits you should be sure to avoid:

Not testing blood sugar. Yes, you have to draw blood, but no, it doesn’t have to hurt. Your doctor or diabetes educator will show you how to get started with a blood glucose monitor and lancets. Keep your diabetic supplies within reach at home, at work, and even in your car. And with time, Shields says, testing will get easier.

Not taking diabetic medications at the right time. To keep blood sugar balanced, you have to “feed” your body at specific times — whether it’s with meds or food. Otherwise you’re wasting time and money and damaging your body.

Skipping meals. If you want to lose weight, skipping meals to hurry the process isn’t the answer. Skip breakfast or lunch, and the drop in blood sugar will set off a chain reaction that disrupts insulin levels and blood sugar — and you’ll likely eat more later. Take time to eat simple, balanced meals. You may also benefit from a mind-set boost: “Try not to think of it as a ‘diabetes diet’ because it’s basically heart-healthy eating, the way we all should eat,” says Ellen Calogeras, RD, LD, a diabetes educator with the Cleveland Clinic Diabetes Center.

Emotional eating. If you feel depressed, anxious, or stressed, it will affect your blood sugar, so it’s important to get your emotions under control. Medication, meditation, psychotherapy, exercise, and deep breathing can help, alone or in combination.

Binge eating. Stock up on healthy foods — avoid temptation every time you open your kitchen cabinets by not buying chips, doughnuts, and other “trigger” foods.

Drinking too much sugar. Go for milk or water as beverages of choice. When you want to enjoy fresh juice, put the brakes on at a half-cup.

Skipping veggies. Vegetables supply nutrients that support all your body functions, including helping to regulate both blood pressure and blood sugar. Get a wide variety in deep hues — red, yellow, orange, and green.

Avoiding fish in favor of red meat. Fish like salmon and tuna are rich in heart-healthy omega-3 fatty acids. Don't care for seafood? Other good sources of lean protein include chicken and beans.

Skipping exercise. Getting your weight and blood sugar under control means getting enough regular exercise. Though the goal is 150 minutes of aerobic exercise each week, if exercise doesn’t get you excited, make it easy on yourself and break down that total into manageable amounts — short but frequent bouts. “Just 10 minutes of walking several times a day is good,” says Shields.

Getting too little sleep. With less than five hours of sleep, you disrupt hormones that control hunger and blood glucose, so give yourself an earlier bedtime if you’ve been shortchanging yourself on the shut-eye. If snoring is a problem, talk with your doctor. You may have sleep apnea, which disrupts hormone levels and drives up blood sugar.

Diabetes Educators: A Helping Hand
If you need a bigger push to get moving, working with a certified diabetes educator can help. These health-care professionals have the important job of helping people learn how to manage diabetes successfully. The American Association of Diabetes Educators is a great resource for more information.

“Take all this very seriously,” says Shields. “The ability to follow diet and exercise guidelines is what separates the winners from the losers. And with diabetes, the stakes are very high.”

Stem Cell Therapy May Reverse Diabetes

An immune regulator from healthy cord blood stem cells (CB-SCs) can "educate" the T cells of a person with type 1 diabetes (T1D), enabling the pancreas to produce insulin....

Yong Zhao, MD, PhD, from the University of Illinois at Chicago, and colleagues base their "stem cell educator therapy" on observations that multipotent stem cells from human cord blood can alter regulatory T cells (Tregs) and islet B cell–specific T-cell clones. The new approach alters autoimmunity both in non-obese diabetic mice and in islet B cells from patients with diabetes.

In a small, open-label trial, a single treatment reduced the median daily dose of required insulin by 38% at 12 weeks for patients with moderate T1D and some B-cell function (36 ± 13.2 U/day at baseline vs 22 ± 1.8 U/day 12 weeks post-treatment), and by 25% in patients with severe T1D and no residual function (48 ± 7.4 U/day at baseline vs 36 ± 4.4 U/day 12 weeks post-treatment). The investigators saw no change in insulin requirements among the control group.

The researchers circulated lymphocytes from patients' blood in a closed-loop "stem cell educator," co-culturing the cells for 2 to 3 hours with adherent CB-SCs from healthy donors. The device sandwiches CB-SCs between 9 discs of a hydrophobic material, with a top cover plate and a lower collecting plate through which the lymphocytes exit. The investigators infused the "educated" lymphocytes into the patients and measured both levels of C-peptide and glycated hemoglobin and indicators of immune function at 4, 12, 24, and 40 weeks.

Investigators conducted this open-label, phase 1/2 clinical trial at the General Hospital of Jinan Military Command in China from October 2010 until January 2011, 15 patients (median age, 29 years [range, 15 - 41 years]; median diabetic history, 8 years [range, 1 - 21 years]) received a single treatment. Three control patients received a sham treatment lacking cells.

Primary endpoints were feasibility (change in C-peptide secretion), safety by 12 weeks, and preliminary evidence of improved B cell function by 24 weeks. Immune modulation was a secondary end point.

Overall, the treated individuals displayed better C-peptide and glycated hemoglobin A1c values, lower daily requirement for insulin, and decreased autoimmunity.

Patients with moderate T1D had improved fasting C-peptide levels at 12 and 24 weeks. Those with severe T1D showed successive improvement in fasting C-peptide levels.

A1c levels for patients with moderate T1D fell from 8.73% ± 2.49% at baseline to 7.67% ± 1.03% at 4 weeks (P = .036), and to 6.82% ± 0.49% at 12 weeks post-treatment. For those with severe T1D, A1c levels fell 1.68% ± 0.42% at 12 weeks post-treatment, with no change seen in the control group.

Stem cell education significantly increased the percentage of Tregs in peripheral blood, as well as levels of CD28 and inducible co-stimulator. Cytokine balance improved. The CB-SCs produce an autoimmune regulator which may eliminate autoreactive T cells.

"This innovative approach may provide CB-SC-mediated immune modulation therapy for multiple autoimmune diseases while mitigating the safety and ethical concerns associated with other approaches," conclude the researchers.

BMC Med. Published online January 10, 2012.

Paula Deen Announces She Has Diabetes

TV chef Paula Deen—the queen of deep-fried Southern cooking—joins Halle Berry, Randy Jackson, Dick Clark and 28.5 million other Americans in battling diabetes.

The Daily reported last week that the Food Network star--famed for artery-clogging fare as deep-fried macaroni and cheese—wrapped in bacon—would soon come clean about a “big fat secret," her type 2 diabetes diagnosis. Deen just announced the diabetes news with Today’s Al Roker.

Rumors about Deen’s diabetes first surfaced in April when both the National Enquirer and The Daily Mail reported that the bestselling cookbook author was keeping her disorder hidden due to concerns that it would harm her career. However, learning that she has a disease strongly linked to obesity and unhealthy eating would hardly shock fans who have watched her prepare such belly-busters as egg-and-bacon-topped burgers served between two glazed donuts.

Deen, who has described butter as “a little stick of smiles and happiness,” has already come under fire for the lavish amounts of fat and sugar in her cooking. Now that the diva of the deep fryer has confirmed a diabetes diagnosis, what might be ahead for her? Here’s a look at a disease that’s predicted to affect in one in three Americans in coming years if current trends continue.

Use these 7 diabetes tips to manage your condition

What triggers type 2 diabetes?

While the cause isn’t fully understood, type 2 diabetes starts when the body becomes insensitive to insulin, a hormone that acts like a key to let sugar—the body’s main source of fuel—into cells. This forces the pancreas to pump out higher and higher amounts of insulin, to try to keep up with demand. Ultimately, the pancreas becomes exhausted and blood sugar rises, leading to diabetes. A diet that’s high in saturated fats—such as the deep-fried dishes that figure prominently in Deen’s cooking—also increase insulin resistance.

Who’s at risk?

Like Paula Deen, about 90 percent of people who develop type 2 diabetes are overweight. And the more belly fat you have, the more likely you are to develop insulin resistance. A particular danger zone is a waist circumference of more than 35 inches for a woman and 40 inches for a man.

Other risk factors include family history, a couch potato lifestyle, age (risk rises significantly after age 45), and ethnicity, with African-Americans and Hispanics, Native Americans and Asian Americans facing a greater threat of the disease. Women who have had gestational diabetes during pregnancy or who have given birth to babies weighing over 9 pounds are also at higher risk.

Learn which foods can help diabetes patients manage their blood sugar

What are the symptoms?

One-third of the 28.5 million Americans with diabetes and the 87 million with pre-diabetes (an earlier stage) don’t know it because the disease may not cause symptoms until serious complications set in.

Warning signs include increased thirst, frequent urination, extreme hunger, blurred vision, slow-healing wounds, and frequent infections, such as gum infections, bladder infections, or yeast infections.

How dangerous is diabetes?

The disease triples the danger of heart attacks and strokes. Other complications, particularly if diabetes goes undiagnosed and untreated, include kidney damage, nerve damage, blindness, foot infections and lower leg amputation.

Recent research suggests that high blood sugar may also boost for Alzheimer’s disease in diabetes with a certain gene. A 2011 study linked high blood sugar to increased risk for colon cancer.

Read about how diet affects your children's risk of diabetes

What’s the best test to check for diabetes?

The American Diabetes Association (ADA) considers the oral glucose tolerance test the “gold standard” for diabetes detection. After an overnight fast, you’ll drink a sugary liquid, with blood samples taken at timed intervals to measure sugar levels. The ADA also recommends the A1C blood test, which measures your average blood sugar level for the past two to three months. Have your blood sugar checked every three years, starting at age 45, or at a younger age if you are overweight with at least one other risk factor.

Is there a diabetes diet?

There’s no specific diet advised for everyone with the disease. However, large studies show that focusing on low-fat, high-fiber foods—such as fruits, vegetables and whole grains—is the healthiest plan for diabetes.

Figuring out the what to eat can be complex for people who are newly diagnosed, so doctors advise working with a registered dietician to develop a meal plan that takes health goals, food preferences and lifestyle into account.

Find out about the top 5 diabetes-healing supplements

What’s the treatment?

Along with a healthy diet, therapies for type 2 typically include medication—which can include both diabetes drugs and statins to reduce heart disease risk--exercising at least 150 minutes per week, and weight loss. Deen may want to take cooking lessons from such chefs as Art Smith, who shed a whopping 85 pounds after getting a diabetes diagnosis.

And if you have pre-diabetes, a review of 28 previous studies, published in Health Affairs this month, finds losing 5 to 7 percent of your body weight (10 to 12 pounds if you weight 200), coupled with stepping up exercise and improving your eating habits, cuts the risk of progressing to full-blown diabetes by 50 percent.

Will Deen now revamp her famously fatty recipes to trim down calories? And if so, will her fans be willing to give up deep-fried Twinkies and eat more veggies? Stay tuned to see what the TV chef dishes up next.

6 Emergency Complications of Type 2 Diabetes

Uncontrolled diabetes can control your health. Help prevent these serious diabetes complications by learning the warning signs.

People with type 2 diabetes are at increased risk of many serious health problems, including heart attack, stroke, vision loss, and amputation. But by keeping your diabetes in check — that means maintaining good blood sugar control — and knowing how to recognize a problem and what to do about it should one occur, you can prevent many of these serious complications of diabetes.

Heart Attack
Heart disease and stroke are the top causes of death and disability in people with diabetes. If you experience any of the following heart attack warning signs, call 911 immediately:
-Chest discomfort that feels like pressure, squeezing, fullness, or pain in the center of your chest, lasting for a short time or going away and returning
-Pain elsewhere, including the back, jaw, stomach, or neck; or pain in one or both arms
•Shortness of breath
•Nausea or lightheadedness
Heart attack symptoms may appear suddenly or be subtle, with only mild pain and discomfort.

Stroke
Stroke warning signs may include:
Sudden numbness or weakness in the face, arm, or leg, especially if it occurs on one side of the body
-Feeling confused
-Difficulty walking and talking and lacking coordination
-Developing a severe headache for no apparent reason
If you suddenly experience any of these stroke symptoms, call 911 immediately. As with a heart attack, immediate treatment can be the difference between life and death.

Nerve Damage
People with diabetes are at increased risk of nerve damage, or diabetic neuropathy, due to uncontrolled high blood sugar. As a result, various foot and skin problems can occur, including:
•Foot problems. Nerve damage associated with type 2 diabetes can cause a loss of feeling in your feet, which makes you more vulnerable to injury and infection. You may get a blister or cut on your foot that you don't feel and, unless you check your feet regularly, an infection can develop. Untreated infections can result in gangrene (death of tissue) and ultimately amputation of the affected limb.
•Skin problems. Diabetes can make it more difficult for your body to fight infections, causing skin problems. Various skin conditions are linked to diabetes, and even the most minor cuts or sores can turn serious fast. Any bumps, cuts, or scrapes should be cleaned and treated with an antibiotic cream and monitored carefully.
If you notice any of the following symptoms, see your doctor:
•Inflammation and tenderness anywhere on your body
•Red, itchy rash surrounded by small blisters or scales
•Cuts, sores, or blisters on your feet that are slow to heal and are not as painful as you would expect
•Numbness, tingling, or burning sensations in your hands or feet, including your fingers and toes
•Sharp pain that gets worse at night
•Muscle weakness that makes walking difficult
•Bladder infections and problems with bladder control
•Bloating, stomach pain, constipation, nausea, vomiting, or diarrhea
•Erectile dysfunction in men and vaginal dryness in women

Kidney Disease
Type 2 diabetes increases your risk of kidney disease, or diabetic nephropathy, a condition in which the blood vessels in your kidneys are damaged to the point that they cannot filter out waste properly. If left untreated, dialysis (a treatment to filter out waste products from the blood) and ultimately a kidney transplant may be needed.
Typically, you won’t notice symptoms of kidney disease until it has advanced. However, if you experience any of the following symptoms, tell your doctor:
•Swelling in your ankles and legs
•Leg cramps
•A need to go to the bathroom more often at night
•A reduction in your need for insulin
•Nausea and vomiting
•Weakness and paleness
•Itching
The best way to prevent type 2 diabetes-related kidney problems is to have your urine, blood, and blood pressure monitored regularly and to keep your blood sugar and blood pressure under control.

Eye Problems
People with type 2 diabetes are at risk of several eye conditions, including diabetic retinopathy (which affects the blood vessels in the eye), glaucoma, and cataracts. If left untreated, these conditions can cause vision loss.
Call your doctor if you notice any of these warning signs:
•Blurry vision that lasts for more than two days
•Sudden loss of vision in one or both eyes
•Floaters, black or gray spots, cobwebs, or strings that move when you move your eyes
•A sensation of seeing "flashing lights"
•Pain or pressure in one or both eyes

Hyperglycemia
Hyperglycemia means you have too much sugar in your blood. High blood sugar doesn't always produce symptoms; therefore, it is important to check your blood sugar regularly, as indicated by your doctor. When symptoms of hyperglycemia occur, they may include:
•Frequent urination
•Extreme thirst
•Feeling tired and weak
•Blurry vision Feeling hungry even after eating
If you frequently have high blood sugar, tell your doctor. He or she may need to make changes to your medication and suggest diet and lifestyle modifications to help you gain and maintain better blood sugar control.
The key to preventing many of the complications of diabetes is to keep your blood sugar at a healthy level. To do this, eat right, exercise, monitor your blood sugar as recommended by your doctor, and don't smoke.
Report any unusual signs or symptoms to your doctor. Together you can work to prevent these diabetes-related health complications.

By Hedy Marks, MPH
Medically reviewed by Pat F. Bass III, MD, MPH

Almonds Can Improve Diabetes Control

Two new studies into the potential health benefits of eating almonds have supported evidence that they can help people with type 2 diabetes to maintain their blood glucose and cholesterol levels....

One of the studies, published in the journal, Metabolism, showed that consuming an ounce of almonds straight before eating a high-starch meal brought a 30 per cent reduction in post-meal glucose levels for patients with type 2 diabetes, compared with a 7 per cent reduction for non-diabetics. In addition, after overnight fasting, patients with type 2 diabetes whose meal contained almonds had a lowering of blood sugar levels after their meal.

The effect of regular almond consumption on blood glucose levels for people with type 2 diabetes was also investigated, with the daily consumption of one ounce of almonds over a 12-week period being associated with a 4 per cent reduction in hemoglobin A1c (HbA1c) and the same reduction in body mass index (BMI).

The second study, which was published in Diabetes Care, revealed that nuts such as almonds could help to maintain healthy levels of blood glucose and cholesterol for both men and post-menopausal women who suffer from type 2 diabetes.

Karen Lapsley, chief science officer for the Almond Board of California, commented "Those with diabetes are faced with many challenges with their disease management, which is why we are always energized when new research is published that supports our understanding of almonds' role in helping alleviate some of the difficulties."

Diabetes UK, Diabetes Care, Oct. 2011

Study Cites Eleven Risk Factors That Could Predict Amputation

Given that lower extremity amputation is a devastating consequence of diabetic foot infection, physicians must be vigilant for the signs that could presage amputation. In a new study in Diabetes Care, authors have developed a risk score of 11 factors that could predict amputation.

Researchers identified 3,018 patients who were hospitalized for culture-documented diabetic foot infection at 97 hospitals in the U.S. between 2003 and 2007. Among those patients, 21.4 percent underwent a lower extremity amputation.

The 11 risk factors for amputation, in ascending order of point value, are: chronic renal disease or creatinine >3 mg/dL; male sex; temperature <96°F or >100.5°F; age 50 or older; ulcer with cellulitis; history of amputation; albumin <2.8 g/dL; history of peripheral vascular disease; white blood cell count >11,000 per mm3); surgical site infection; and transfer from another acute care facility.

Authors note that treatment of a patient with a low score may require fewer medical resources than a patient with a high risk score. The study also says in an attempt to avoid amputation, healthcare providers should concentrate efforts on a patient with a risk score of more than 21 as they have a 50 percent chance of amputation.

Lead study author Benjamin A. Lipsky, MD, notes researchers developed the risk score specifically to use information that is present at (or soon after) the time of hospitalization. As he notes, this info includes findings from the history, physical examination or simple laboratory tests. He foresees “relatively minimal” organizational challenges for healthcare facilities implementing this scoring system. Dr. Lipsky says facilities would just need to educate providers about the score and perhaps provide a score sheet with explanations on how to use it.

Although the study used a database of patients who were hospitalized for their diabetic foot infection, this risk score would likely apply to the majority of patients who do not require hospitalization, according to Dr. Lipsky, a Professor of Medicine at the University of Washington and the Director of the Primary Care Clinic at the VA Puget Sound Health Care System. He and his co-authors would like to see the score validated in such a population.

David G. Armstrong, DPM, MD, PhD, cites the importance of the risk score system, saying it will be helpful to have a predictable system as another tool to predict outcomes. He compares this to a wound classification system, which is “highly predictive of good and bad outcomes” when a patient presents with a wound.

Dr. Armstrong has found the most critical predictors of amputation to be infection, ischemia and renal disease. He expresses surprise that renal disease was not more of a factor in the study.

“We believe that people on dialysis, people with end-stage renal disease and people with kidney disease are going to become increasingly important targets for aggressive intervention or hospice,” says Dr. Armstrong, the Director of the Southern Arizona Limb Salvage Alliance (SALSA).

Dr. Lipsky would like to see if the score can be further simplified and refined so clinicians can remember it more easily. He would also like to see the risk score applied to patients in other countries and healthcare systems.

By Brian McCurdy, Senior Editor

Fat Disrupts Sugar Sensors Causing Type 2 Diabetes

US researchers say they have identified how a high-fat diet interferes with the body's sugar sensors and triggers type 2 diabetes....

The authors argue that a deeper understanding of the processes involved could help them develop a cure. One of the main risk factors for type 2 diabetes is being overweight -- rising obesity levels have contributed to a doubling of diabetes cases in the last 30 years.

Sugar in the blood is monitored by pancreatic beta cells. If sugar levels are too high then the cells release the hormone insulin, which tells the body to bring the levels back down. Key to this is the enzyme GnT-4a. It allows the cells to absorb glucose and therefore know how much is in the blood.

Researchers at the University of California and the Sanford-Burnham Medical Research Institute say they have shown how fat disrupts the enzyme's production. Experiments on mice showed that those on a high-fat diet had elevated levels of free fatty acids in the blood. These fatty acids interfered with two proteins - FOXA2 and HNF1A - involved in the production of GnT-4a. The result: fat effectively blinded cells to sugar levels in the blood and the mice showed several symptoms of type 2 diabetes. The same process also took place in samples of human pancreatic cells.

Lead researcher Dr. Jamey Marth said, "The observation that beta cell malfunction significantly contributes to multiple disease signs, including insulin resistance, was unexpected."

He suggested that boosting GnT-4a levels could prevent the onset of type 2 diabetes: "The identification of the molecular players in this pathway to diabetes suggests new therapeutic targets and approaches towards developing an effective preventative or perhaps curative treatment." "This may be accomplished by beta cell gene therapy or by drugs that interfere with this pathway in order to maintain normal beta cell function."

Dr. Iain Frame, Director of Research at Diabetes UK, said, "The researchers have linked their results in mice to the same pathways in humans and although they did not show they could prevent or cure type 2 diabetes, they have shown it is a theory worth investigating further."

"We will watch this with great interest and hope this early work will eventually lead to some benefit to people with type 2 diabetes."

Stress Predicts Development of Impaired Glucose Metabolism

Perceived stress and stressful life events predict the development of impaired glucose metabolism (IGM) over 5 years in previously normoglycemic individuals, according to results from the Australian Diabetes, Obesity, and Lifestyle study AusDiab)....

The study by Emily Williams, PhD, Monash University, Melbourne, Australia, showed that perceived stress increased the risk for incident IGM over 5 years by between 1.04 and 1.06, depending on the model used. Using the same models, high levels of stressful life events also increased the risk for incident IGM by between 1.24 and 1.35 in the same longitudinal cohort.

Dr. Williams reported that, "The effect size sounds quite small but for every point increase [in these models], there is a 4% increased risk of developing IGM, so stress is quite a strong risk factor for IGM." "And we think stress management should be incorporated into multiple health behavioral interventions for the most effective prevention and management of diabetes."

AusDiab included 11,247 adults older than 25 years who were randomly selected from 42 areas of Australia. At baseline, a 2-hour, 75-g oral glucose tolerance test was given along with the Perceived Stress Questionnaire and a life events score to measure psychosocial adversity.

At 5 years, more than 6,500 of the original participants returned for follow-up during which another 2-hour oral glucose test was taken and the questionnaires re-administered.

"We used the outcome of a polled analysis of fasting glucose, impaired glucose tolerance, and diabetes to have a larger category of impaired glucose metabolism to try and tap into a wider range of abnormal glucose metabolism, and by measuring perceived stress as well as the experience of stress, we tried to measure both objective and subjective markers of stress. Only subjects who were normoglycemic at baseline were included in the analyses," said Dr. Williams.

At 5-year follow-up, 474 subjects had progressed to IGM. Adjusting for age, sex, and education, logistic regression analyses showed that perceived stress increased the odds of IGM by 1.06. Controlling for the same variables, those reporting high levels of stressful life events were 34% more likely to have developed IGM at 5 years compared with those reporting low levels of stressful life events.

When health behaviors were added to the model, results showed that perceived stress increased the odds of IGM by 1.05. The same model also showed that those reporting high levels of stressful life events had a 35% higher risk of developing IGM compared with those reporting low levels of stressful life events. Adding obesity to the mix attenuated the effect of perceived stress as a risk factor for IGM but not by much, at an odds ratio of 1.04.

Similarly, obesity slightly attenuated the risk for stressful life events contributing to IGM at an odds ratio of 1.26. Lastly, when all variables plus traditional cardiovascular disease (CVD) risk factors were added to the analysis, perceived stress still had the same effect on IGM risk at an odds ratio of 1.04. Again, compared with those who reported low levels of stressful life events, those reporting high levels of stressful life events had a 24% greater chance of developing IGM at 5 years when analyzed in the final model.

Table 1. Perceived Stress as a Risk Factor for Impaired Glucose Metabolism

Controlling for
Odds Ratio

Model 1: Age, sex, education
1.06

Model 1 plus health behaviors (model 2)
1.05

Model 2 plus obesity (model 3)
1.04

Model 3 plus cardiovascular disease risk factors (model 4)
1.04



Table 2. Stressful Life Events as a Risk Factor for Impaired Glucose Metabolism

Controlling for
Odds Ratio

Model 1 low life stress vs high life stress
1.34

Model 2 low life stress vs high life stress
1.35

Model 3 low life stress vs high life stress
1.26

Model 4 low life stress vs high life stress
1.24

Investigators also evaluated how stress affected glycemic control over time among subjects who already had diabetes at baseline. Interestingly, said Dr. Williams, there no relationships between stress and glycemic control was observed in men, but among women with diabetes at baseline, both perceived stress and stressful life events were shown to predict elevated glycosylated hemoglobin at follow-up, after adjustment for other risk factors (P = .024).

Dr. Williams stated that, "All of the evidence in CVD suggests that stress is a key independent risk factor for the development of heart disease, but it hasn't been done in diabetes, and yet they are on the same chronic disease trajectory. "So there is no reason to think stress isn't involved in the development of diabetes too and even more so because diabetes requires so much daily management it's bound to affect a person's experience."

Diet Soft Drinks Not Linked to Type 2 Diabetes

New research demonstrates that the consumption of diet soft drinks is not associated with an increased risk of type 2 diabetes....

The study adds weight to the significant research using low-calorie sweeteners that has shown intake of these ingredients does not affect the development of type 2 diabetes. The authors concluded, "This supports our hypothesis that participants use artificially sweetened beverages as dieting aids or because of poor health. A lack of adjustment for these [health and lifestyle] factors may therefore have contributed to illusory associations [between diet soda consumption and type 2 diabetes] in other studies." They further noted, "The association between artificially sweetened beverages and type 2 diabetes was largely explained by health status, pre-enrollment weight change, dieting, and body mass index."

The researchers followed 40,389 adult men enrolled in the Health Professionals Follow-Up study from 1986 until 2006, to examine the associations between the normal consumption of sugar-sweetened beverages and diet soft drinks and the development of type 2 diabetes.

The data from 2,680 reported cases of type 2 diabetes developed over the 20-year study seemed to indicate that both types of beverages were associated with an increased incidence of type 2 diabetes. However, after adjusting for the health and lifestyle factors, including family history of type 2 diabetes, smoking, physical activity, high triglycerides, high blood pressure, diuretic use, body mass index (BMI), and total calorie intake, the Harvard University researchers found no significant association between diet soft drinks and incidence of type 2 diabetes.

Major health organizations including the American Diabetes Association and the American Dietetic Association support the use of low-calorie sweeteners for people with diabetes to control calorie intake. The American Dietetic Association states in its position paper on the use of nutritive and nonnutritive sweeteners, "Nonnutritive sweeteners are appropriate in medical nutrition therapy for people with diabetes and may help control energy intake." The statement further notes, "Nonnutritive sweeteners do not affect glycemic response and can be safely used by those with diabetes." "When used as part of an overall healthy diet, low-calorie sweeteners, diet soft drinks and other light products can be beneficial tools in helping people control caloric intake and weight," adds Beth Hubrich, a registered dietitian with the Calorie Control Council, an international trade association.

American Journal of Clinical Nutrition, May 2011

Broccoli Sprouts Have Benefits for Diabetes Patients

Broccoli sprouts may boost antioxidant defenses in people with diabetes....

According to findings, a daily dose of five or 10 grams of the broccoli sprout powder was associated with an increase in the total antioxidant capacity of the blood, and reductions in malondialdehyde (MDA), a reactive carbonyl compound and a well-established marker of oxidative stress. The study adds to the growing body of science supporting the potential health benefits of broccoli and broccoli sprouts, most often touted for their potential anti-cancer activity.

The tissue of cruciferous vegetables, like broccoli, cauliflower, cabbage and Brussels sprouts, contain high levels of the active plant chemicals glucosinolates. These are metabolized by the body into isothiocyanates, which are known to be antioxidants and powerful anti-carcinogens. The main isothiocyanate from broccoli is sulphoraphane.

The new study employed a broccoli sprout powder that provided a dose of sulphoraphane isothiocyanates of 22.5 micromoles per gram, and looked at the potential antioxidant activity of broccoli sprout powder to counter oxidative stress in diabetics.

Oxygen-breathing organisms naturally produce reactive oxygen species (ROS), which play an important role in a range of functions, including cell signaling. However, over production of these ROS from smoking, pollution, sunlight, high intensity exercise, or simply ageing, may overwhelm the body's antioxidant defenses and lead to oxidative stress.

Oxidative stress has been linked to an increased risk of various diseases including cancer, Alzheimer's, and cardiovascular disease.

Researchers also note that oxidative stress is a key driver in the onset of insulin resistance, which ultimately leads to diabetes. Diabetes itself is associated with increased levels of oxidative stress, and this can promote the development of diabetes-related complications

Researchers from the National Nutrition and Food Technology Research Institute at the Shahid Beheshti University of Medical Sciences in Tehran, Iran, recruited 81 diabetics to participate in their double-blind, placebo-controlled, randomized clinical trial.

Participants were randomly assigned to receive either five or 10 grams per day of the broccoli sprout powder, or placebo, for four weeks.

Results showed that both broccoli groups experienced significant decreases in MDA, a well-established marker of oxidative stress, as well as reductions in levels of oxidized LDL cholesterol, another oxidative stress marker.

The doses used in this study provided 225 micromoles and 112 micromoles sulforaphane isothiocyanates daily per 10 g and 5 g broccoli sprout doses, respectively.

European Journal of Clinical Nutrition; "Broccoli sprouts reduce oxidative stress in type 2 diabetes: a randomized double-blind clinical trial" Z Bahadoran, P Mirmira, et al

Patients with Type 2 Diabetes Lack Knowledge about Hypoglycemia

A national online survey of more than 2,530 adults living with Type 2 diabetes in the US reveals that many patients remain uneducated about the risks for hypoglycemia....


The survey also highlighted why hypoglycemia may be more of a health hazard than previously reported, as patients said they often experience low blood sugar during daily activities such as working and driving.

In the survey, 55% of respondents said they had experienced at least one episode of hypoglycemia. Of 702 patients with diabetes who reported hypoglycemia, 42% had experienced low blood sugar symptoms while working, 26% while exercising, and 19% while driving.

The fact that patients with diabetes experience hypoglycemia while working and driving is especially problematic, as these activities require focus and concentration, and experiencing hypoglycemia during driving can be life-threatening.

Many patients were unable to name the leading causes of hypoglycemia, which is a great cause for concern. Twenty-seven percent of those surveyed did not know that the leading causes of hypoglycemia included skipping meals, and 35% did not know that some diabetic medications may enhance the risk for hypoglycemia. Forty-six percent of patients with Type 2 diabetes also remained unaware that excessive exercise may bring on hypoglycemia, particularly when combined with certain medications for Type 2 diabetes.

Although the study clearly showed that at least half (52%) of the patients surveyed were concerned about experiencing a future episode of hypoglycemia, some did not know that the most common symptoms are dizziness (22%) and shakiness (17%), and 39% incorrectly thought that thirst was the primary symptom of hypoglycemia.

Although hypoglycemia has long been known to be a risk associated with diabetes and its treatment, it often falls under the radar of busy physicians, particularly those in primary care, who may be treating patients for other conditions stated, stated Etie Moghissi, MD, vice president and president-elect of AACE, and an associate clinical professor of medicine at the University of California–Los Angeles. Yet hypoglycemia has clear risks, as well as being an expensive burden for the healthcare system. Indeed, the survey showed that 6% of patients who responded to the online survey had to be treated for hypoglycemia in the emergency room.

Dr. Moghissi noted that, "The survey shows that it's important to inform patients about the causes, symptoms, and how to address hypoglycemia." To achieve that goal, the American College of Endocrinology recently launched a program called Blood Sugar Basics, an educational program with an interactive website that includes fact pages on how patients with diabetes can best manage their blood sugar levels.

The results of the survey were announced at the American Association of Clinical Endocrinologists (AACE) 20th Annual Meeting and Clinical Congress. April 15, 2011.

Preventing Type 2 Diabetes with Early Pharmacological Intervention

According to Ralph DeFronzo, it is never too early to prevent diabetes....

In the U.S., 26 million individuals have type 2 diabetes, and twice as many have impaired glucose tolerance (IGT). Approximately 40-50% of individuals with IGT will progress to type 2 diabetes over their lifetime. Therefore, treatment of high-risk individuals with IGT to prevent type 2 diabetes has important medical, economic, social, and human implications.

Weight loss, although effective in reducing the conversion of IGT to type 2 diabetes, is difficult to achieve and maintain. Moreover, 40-50% of IGT subjects progress to type 2 diabetes despite successful weight reduction. In contrast, pharmacological treatment of IGT with oral antidiabetic agents that improve insulin sensitivity and preserve β-cell function -- the characteristic pathophysiological abnormalities present in IGT and type 2 diabetes -- uniformly have been shown to prevent progression of IGT to type 2 diabetes.

The most consistent results have been observed with the thiazolidinediones (Troglitazone in the Prevention of Diabetes [TRIPOD], Pioglitazone in the Prevention of Diabetes [PIPOD], Diabetes Reduction Assessment with Ramipril and Rosiglitazone Medication [DREAM], and Actos Now for the Prevention of Diabetes [ACT NOW]), with a 50-70% reduction in IGT conversion to diabetes. Metformin in the U.S. Diabetes Prevention Program (DPP) reduced the development of type 2 diabetes by 31% and has been recommended by the American Diabetes Association (ADA) for treating high-risk individuals with IGT. The glucagon-like peptide-1 analogs, which augment insulin secretion, preserve β-cell function, and promote weight loss, also would be expected to be efficacious in preventing the progression of IGT to type 2 diabetes. Because individuals in the upper tertile of IGT are maximally/near-maximally insulin resistant, have lost 70-80% of their β-cell function, and have an ∼ 10% incidence of diabetic retinopathy, pharmacological intervention, in combination with diet plus exercise, should be instituted.

Type 2 diabetes can be prevented with early pharmacological intervention; DeFronzo RA, Abdul-Ghani M; Diabetes Care 34 Suppl 2 S202-9 (May 2011)

Diabetes numbers rise, CDC says

The number of Americans who have type 2 diabetes has risen to nearly 26 million, federal officials announced today.

In addition, about 79 million U.S. adults have "prediabetes," a condition in which blood sugar levels are higher than normal but not high enough to be diagnosed as diabetes, according to the federal Centers for Disease Control and Prevention. Prediabetes raises a person's risk of type 2
diabetes, heart disease and stroke.

In 2008, CDC estimated that 23.6 million Americans had diabetes and an additional 57 million adults had prediabetes.

"These distressing numbers show how important it is to prevent type 2 diabetes and to help those who have diabetes manage the disease to prevent serious complications such as kidney failure and blindness," said the CDC's Ann Albright in a statement. "We know that a structured lifestyle program that includes losing weight and increasing physical activity can prevent or delay type 2 diabetes."

About 7 million Americans do not know they have the disease.

The increase was caused by a number of factors, including:

-- More people are developing diabetes. Obesity, which has been increasing, is a leading cause of diabetes.

-- Medical advances are enabling many people to live longer with diabetes.

-- A test known as hemoglobin A1c is now being used to diagnose diabetes.

Type 2 diabetes, which is most common form of the disease, occurs when the body gradually loses the ability to control blood sugar levels. Risk factors include older age, obesity, family history and being sedentary. African Americans, Hispanics and American Indians are among those at increased risk.

Diabetes is the seventh leading cause of death in the United States. People with diabetes are more likely to have heart attacks, strokes, high blood pressure, kidney failure, blindness and require amputations. Diabetes costs $174 billion annually, according to the CDC.

By Rob Stein

How Body Shape Affects Diabetes Risk

Where do you carry your excess fat? The answer may have implications for your type 2 diabetes risk.

Apple or pear? The question may imply a healthy snack — or an important distinction between body shapes that affects type 2 diabetes risk.

In general, people whose fat collects on their abdomen — making them resemble apples over time — are at greater risk for type 2 diabetes. But the good news is, you can escape your shape.

Being overweight is a significant risk factor for diabetes, no matter your shape. “Patients who have a higher body mass index have a higher risk [of diabetes],” says Danny Sam, MD, an internal medicine physician with Kaiser Permanente in Santa Clara, Calif., who specializes in the treatment of adult diabetes. Body mass index (BMI) is calculated by comparing weight and height.

But while any overweight person is at increased risk for diabetes, those who carry a lot of that extra weight over the belly are at particular risk. The apple shape not only predisposes you to diabetes but to poor heart health as well.

Identifying Your Type 2 Diabetes Body Type

Body shapes determined by fat deposits seem to predict your type 2 diabetes risk. It may be helpful to know the terms for the body shape categories:

Apple. People whose fat collects around their waistline may end up looking more like apples than any other fruit. This body type is also called “android” and the fat collection is sometimes referred to as “central adiposity.”Pear. In women especially, fat can be drawn to the buttocks and thighs. The good news is that this type of fat distribution is less likely than abdominal fat to lead to insulin resistance or type 2 diabetes. This is also called the “gynecoid” body shape or “gluteo-femoral” fat.Overall. Some people collect fat everywhere at a fairly even rate. But because being overweight or obese, regardless of your body shape, increases type 2 diabetes risk over being normal weight, the fact that you don’t fall into either apple or pear shape doesn’t completely let you off the hook when it comes to preventing type 2 diabetes and other chronic health conditions.

Measure Your Waist

Some people can tell by sight if they are apple- or pear-shaped. But if your risk of diabetes isn’t clear from a glance in the mirror, there is one important measurement that can help you determine your risk of diabetes and heart disease: your waist. If you are a woman and your waistline is greater than 35 inches, you are at increased risk for type 2 diabetes. For a man, the magic number is 40 inches. If your tape measure reveals you are at or above these numbers, it’s time for a little waist whittling.

Escape Your Shape

The good news is that your body shape is not your disease destiny. There is one way to reduce your type 2 diabetes risk: weight loss to maintain a healthy body weight.

Here are the steps you can take:

Be physically active. Sam emphasizes that physical activity has been shown to help prevent diabetes and will help you control your weight. Mix up your activities to include both aerobic activities, such as walking or swimming, and some weight training or core-strengthening so you get overall slimming benefits.Watch your weight. If you already know you are an apple or a pear, chances are you are also overweight. Getting back to a normal weight and staying there is your best bet for staving off diabetes. If you are having a hard time figuring out what your goal weight should be, talk to your doctor.Eat a healthy diet. A nutritious, varied diet full of lean protein, whole grain, fruits, and veggies is your best bet for long-term health. If you are pre-diabetic or have diabetes already, you must also control your blood sugar. Aim for low-fat menu planning as well, if you want to whittle down your waist. If the body shape you see in the mirror seems riskier than you want it to be, don’t despair. With some work you can beat your diabetes risk — while feeling and looking healthier.

Easy Steps to Reduce Diabetes Risk

From walking more to getting your blood sugar checked, you can reduce your chances of getting diabetes by following just a few easy steps.

Being overweight, not getting enough physical activity, and constantly being stressed out are all strong risk factors for type 2 diabetes. These are problems that many people face, but the good news is that you can make a few simple changes to your life to create a diabetes prevention program and reduce your diabetes risk.
Think diabetes prevention at the start of every day. “Eat a breakfast of protein and complex carbohydrates,” says Suzanne Steinbaum, DO, a cardiologist and director of Women and Heart Disease at Lenox Hill Hospital in New York City. “Eating a meal like this prevents the sugar highs and lows that often come with a breakfast of simple carbohydrates and sugars, like a bagel or a donut, which can cause those feelings of fatigue and lethargy that make you crave sugar again to increase your energy.”

Fred Pescatore, MD, an author and physician who practices nutritional medicine in New York City, says one of your best overall strategies for diabetes prevention is to steer clear of most foods that are white — white bread, white rice, and white pasta top the list. “These simple carbohydrates can cause blood sugar to spike even more than regular sugar,” he says. “This may lead to a blood sugar dip, resulting in additional sugar cravings. Avoiding white foods will help to stop this vicious cycle.”

One of the biggest causes of diabetes in this country is overeating that leads to obesity. A basic strategy for avoiding overeating is to reduce your portions by using smaller dishes than you usually would for all your meals, according to Dr. Steinbaum. “Rather than worrying about servings, pay attention to cups and tablespoons,” she says. “To help with this, instead of using a large dinner plate, use a salad plate for dinner.”

Most people think it’s okay to drink soda as long as they stick to diet soda instead of the regular sugary kind. But Steinbaum cautions that water might be the better choice for diabetes prevention. “Studies have shown that even diet soda can increase the incidence of metabolic syndrome, a pre-diabetic condition associated with insulin resistance,” she says.

A basic lifestyle strategy to assist with diabetes prevention is to keep a detailed food journal. You can use paper or a Web site or mobile phone application like My Calorie Counter, but whatever you choose, don’t spare any details. “If you write down everything you eat, you are less apt to overeat or to unconsciously pick at food or ‘graze,’” says Steinbaum. “It also lets you look back at what you’ve eaten, so you can more easily modify your behavior.”

Some people get frustrated by constantly monitoring a scale while trying to lose weight. Steven Joyal, MD, author of What Your Doctor May Not Tell You About Diabetes, says that measuring your waistline might be a better way to foster diabetes prevention. “Greater than 40 inches for men or greater than 35 inches for women means you’re at an increased risk,” he says.

Remember that inactivity is a diabetes cause and activity is a key to diabetes prevention. When it comes to exercise, some people use time constraints or other commitments as excuses not to work out. If you think that not doing a long workout means you shouldn’t bother at all, Dr. Joyal respectfully begs to differ. “A power-packed, yet short-duration exercise program of 12 minutes every other day can have a tremendous impact on your body,” he says.

Another simple way to fit more diabetes prevention strategies into your everyday, daily routine is to find ways to add more activity to everything you do. For example, when you pull into a parking lot, Dr. Pescatore suggests parking as far away from your destination as possible and walking the rest of the way. “Walking burns calories, builds muscle, and utilizes blood sugar,” he says. Other steps include taking the stairs instead of the elevator and doing sit-ups, push-ups, or even stretches while watching TV.

Stress is a risk factor for type 2 diabetes. So while focusing on eating less and exercising more, it’s important not to overlook stress reduction. “Take a yoga class, try meditation, and set boundaries around family and friends,” says Robyn Webb, MS, food editor of Diabetes Forecast magazine and author of 13 cookbooks published by the American Diabetes Association. “Seek professional therapy for issues in your life that you feel you need help with.”

Finally, if you have a family history of diabetes or are at risk, you should get your blood checked once a year to truly know your status. Pescatore says the two most important tests your doctor should perform are checking your hemoglobin A1C levels and your fasting insulin levels. If you commit to making all the previous suggestions, your efforts should show in your lab results.

Healthy Snacking With Type 2 Diabetes

You might not have to forgo that afternoon snack if you have type 2 diabetes, but you may have to change what you eat.

Having a quick bite to eat in the afternoon or before bed is a habit many people might not think twice about. However, after someone is diagnosed with type 2 diabetes, it seems like every eating habit gets scrutinized, including snacks. Since adjusting lifestyle factors like diet and exercise are among the first steps in managing type 2 diabetes, snacking in a healthy and controlled way can help manage the disease.

Living with Type 2 Diabetes: Should I Snack?

Not everyone with type 2 diabetes should snack regularly. Snacking patterns should be tailored to an individual’s preferences, schedule, and medication. For example, someone taking insulin can use a snack to help prevent a drop in blood sugar between meals. Someone else might have a snack while preparing dinner, to relieve hunger and keep from overeating before dinner is ready. Snacking in general can help spread out food intake over the course of a day, helping to lower blood lipids and glucose for people with type 2 diabetes.

Living with Type 2 Diabetes: Choosing the Right Snack

Choosing the right snack along with the right scheduling is equally important. Here are some tips for selecting that perfect snack:

Choose quality. Lorena Drago, MS, a registered dietitian and diabetes educator with the American Association of Diabetes Educators, has a catchy way to remember the important criteria for a good snack: “I tell my patients to mind their Ps and Qs — P stands for portion and Q for quality.” Keeping snack portion sizes small is important, but so is choosing quality, healthy snacks. For example, three crackers with one slice of cheese is a better-quality snack than a chocolate bar.Get educated. Educate yourself about basic nutrition components like carbohydrates, fat, and protein so that you are comfortable reading nutrition labels. Drago advises choosing snacks with “staying power,” those that will prevent you from eating too much later in the day. Drago recommends snacks with some fat and some protein, to slow food absorption and keep you feeling full longer. Stay away from foods heavy in carbohydrates, like sugary desserts.Plan ahead. Plan snacks in advance to make sure healthy choices are available and to prevent overeating. Living with Type 2 Diabetes: The Dark Side of Snacking

There's more content below this advertisement. Jump to the content.
Snacking can work against you if you take it too far. Thomas Wolever, MD, PhD, professor of nutritional sciences at the University of Toronto, says that research shows that when people with type 2 diabetes eat six meals a day, instead of three, they tend to overeat and, in turn, gain weight, which overcomes any potential benefit of managing blood glucose and lipids.

Since weight control is often a primary concern for people with type 2 diabetes, snacking carefully and strategically is very important. Some diabetics may have a hard time stopping after eating one handful of tasty cashews — a tightly restricted eating schedule might work better for these people.

People with type 2 diabetes should examine their own lifestyle, personality, and medication before deciding whether snacking is a healthy approach for tackling their diabetes. Diabetes educators can help you make these decisions and offer suggestions for how to fit different approaches into your lifestyle. The best snacking pattern for you is a custom plan that will fit comfortably into your lifestyle and help keep your type 2 diabetes under control.

Is 'Borderline' Diabetes Really Diabetes?

Q: I just learned that I'm a "borderline" diabetic, even though my blood glucose reading was very close to normal. Now I'm not sure what to do. Should I be consistently checking my blood sugar level, eating differently, or taking medication as though I actually have diabetes? I don't want to develop diabetes, but I don't want to take unnecessary precautions either.

A: Great question! Now that you've been diagnosed with prediabetes, prevention is key. Prediabetes is characterized by either impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). Both of these terms refer to the level of sugar in the bloodstream, and they're both ways of saying that you have prediabetes.

If your fasting glucose level (a test in which blood is drawn after six hours without food) is between 100 and 125 mg/dl, you have IFG. If your blood sugar level two hours after a glucose challenge test is between 139 and 200 mg/dl, you have IGT.

Okay — now that we have the classification straight, why should you be worried about these numbers if yours are not in the diabetic range? Here's why: As your blood glucose rises above the normal level, your risk of developing damage in the body's small blood vessels, and ultimately your risk of a heart attack or stroke, also rises. In addition, having abnormal glucose levels is a risk factor for developing outright diabetes in the future.

By bringing you blood sugar levels back in the normal range, you can probably prevent the onset of diabetes and other complications, such as coronary artery disease. It is not absolutely essential to frequently check your glucose levels at home as long as you and your doctor monitor them periodically.

The precautions that you can and should take to prevent complications and the onset of diabetes consist of the same habits you'd cultivate to stay healthy in general. These include exercising, eating healthfully and not excessively, and maintaining your ideal body weight. One study showed that among a group of individuals who had prediabetes, those who lost as little as 7 percent of their body weight delayed the onset of diabetes or prevented it. There are also medicines that have been shown to prevent diabetes. While I do not recommend medicines to all people with prediabetes, it might be advisable in some cases. I wish you luck in this journey toward health.

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