Researchers are challenging guidelines that urge diabetes patients to cut back on salt in their diet....
In a study that seems to turn conventional wisdom on its head, they found patients with the highest levels of sodium in their urine had the smallest risk of dying over a 10-year period.
Dr. Elif I. Ekinci of the University of Melbourne in Victoria and colleagues write, "Such data call into question universal recommendations that all adults should endeavor to reduce their salt intake."
Although it isn't the first time findings like these have surfaced, the Australian researchers, like others before them, relied on observations only and didn't actually run an experiment to test the direct impact of eating more or less salt.
Instead, they followed 638 people with longstanding Type 2 diabetes, often accompanied by heart disease and high blood pressure. At the outset of the study, all the patients were in their 60s on average and nearly half of them were obese. "These are precisely the patients in whom more aggressive lifestyle interventions are often applied," the researchers note.
All the patients were treated at a single diabetes clinic, and doctors determined the daily amount of sodium in their urine when the study began. The average amount of sodium in their urine, 4.2 grams per day, was in line with earlier global surveys, the researchers say.
Over the decade the study spanned, 175 patients died, mostly due to heart disease.
For every extra 2.3 grams of sodium in their urine, their risk of dying during the study dropped by 28 percent -- even after accounting for kidney disease, age and other factors likely to be important.
"This is unexpected," Dr. Ekinci, who also worked on the study. "It raises the possibility that in people with Type 2 diabetes, low salt intake is not always beneficial."
According to the 2010 Dietary Guidelines for Americans, they should eat no more than 1.5 grams of sodium -- about two-thirds of a teaspoon of salt -- per day.
Most Americans consume more than twice that amount, U.S. government researchers said last year in a study that pointed to foods like pizza, cookies and meats as the main culprits.
At this point, nobody is recommending any change to the current dietary advice, because the new study doesn't prove that extra salt helps diabetics live longer.
The main problem is that the patients who had lower sodium levels in their urine were sicker and older, said Dr. Paul Elliott, who studies the link between diet and high blood pressure at Imperial College London. "Although the authors used statistical models to try to 'correct' for these imbalances, it remains likely that the results are still confounded by them," he said.
That reasoning seems to be bolstered by the finding that higher blood pressure was tied to longer survival in the study, "which just isn't plausible," added Elliott.
"The reality is that reducing sodium has many effects, some good like reducing average blood pressure, and others bad." For instance, reducing sodium increases insulin resistance, which is the main problem in diabetes. It also ups the production of certain other hormones that have been linked to heart disease.
Diabetes Care, online February 2, 2011
Showing posts with label blood sugars. Show all posts
Showing posts with label blood sugars. Show all posts
Thursday, May 12, 2011
Thursday, February 10, 2011
Is There a 'Safe' Blood Sugar Level?
Q: What is the "safe" blood sugar level? I have heard several opinions from other diabetics, and I am very confused. I was told that it was 154 about a year ago, and my doctor didn't recommend daily monitoring. At one time on a morning fasting, my level was 74.
— Theresa,
A: Yes, there is a safe blood sugar level. It is the optimum range that safely provides the body with adequate amounts of energy. For the average person, it is 70 to 105 mg/dl in a fasting state. (Diabetes is diagnosed when the fasting blood glucose level is at or above 126 mg/dl.)
Glucose values vary depending on the time of day, your activity level, and your diet. Your sugar level of 154 mg/dl, which is high, may not have been determined while you were fasting. If it had been, a physician would have repeated the test. Your doctor did, and your level was determined to be normal at 74 mg/dl.
In this case, daily monitoring is probably not necessary. If your levels are elevated in the future, you will be diagnosed with diabetes. Treatment can include lifestyle modification, diet, and exercise. If these strategies are not adequate to control your blood glucose level, your physician may prescribe oral medicines or insulin. Having a laboratory examination during your yearly physical and maintaining a healthy lifestyle are adequate for now.
Why is it important to keep your glucose level within a normal range? An excess of glucose in the bloodstream causes various chemical changes that lead to damage to our blood vessels, nerves, and cells. Each cell in the body has a function that requires energy, and this energy comes primarily from glucose. The energy allows you to perform various tasks, including talking and walking. It allows your heart to beat and your brain to produce chemicals and signals that help you think, breathe, regulate your internal temperature, and digest and absorb food. The body is a veritable industrial complex! But this complex is also quite delicately balanced. The very cells that process glucose and convert it to energy can be damaged by excess glucose. Imagine a car engine being damaged when it is flooded with gasoline.
A lack of glucose is also extremely detrimental to the body and can have serious consequences — including death. Without a source of energy to fuel the vital functions of the body, these functions cease.
Good luck with your blood glucose management, and don't hesitate to ask your doctor about ways to maintain and improve your health.
— Theresa,
A: Yes, there is a safe blood sugar level. It is the optimum range that safely provides the body with adequate amounts of energy. For the average person, it is 70 to 105 mg/dl in a fasting state. (Diabetes is diagnosed when the fasting blood glucose level is at or above 126 mg/dl.)
Glucose values vary depending on the time of day, your activity level, and your diet. Your sugar level of 154 mg/dl, which is high, may not have been determined while you were fasting. If it had been, a physician would have repeated the test. Your doctor did, and your level was determined to be normal at 74 mg/dl.
In this case, daily monitoring is probably not necessary. If your levels are elevated in the future, you will be diagnosed with diabetes. Treatment can include lifestyle modification, diet, and exercise. If these strategies are not adequate to control your blood glucose level, your physician may prescribe oral medicines or insulin. Having a laboratory examination during your yearly physical and maintaining a healthy lifestyle are adequate for now.
Why is it important to keep your glucose level within a normal range? An excess of glucose in the bloodstream causes various chemical changes that lead to damage to our blood vessels, nerves, and cells. Each cell in the body has a function that requires energy, and this energy comes primarily from glucose. The energy allows you to perform various tasks, including talking and walking. It allows your heart to beat and your brain to produce chemicals and signals that help you think, breathe, regulate your internal temperature, and digest and absorb food. The body is a veritable industrial complex! But this complex is also quite delicately balanced. The very cells that process glucose and convert it to energy can be damaged by excess glucose. Imagine a car engine being damaged when it is flooded with gasoline.
A lack of glucose is also extremely detrimental to the body and can have serious consequences — including death. Without a source of energy to fuel the vital functions of the body, these functions cease.
Good luck with your blood glucose management, and don't hesitate to ask your doctor about ways to maintain and improve your health.
Monday, January 31, 2011
Causes of Type 2 Diabetes
Causes of Type 2 Diabetes
Eating too much and exercising too little are two of the main reasons why people develop type 2 diabetes.
By Madeline Vann, MPH
Medically reviewed by Christine Wilmsen Craig, MD Print Email Insulin is a hormone made in the pancreas that allows glucose (sugar) to leave the bloodstream and enter the cells to be used as fuel. Type 2 diabetes occurs when the pancreas doesn't make enough insulin or the cells of the body become resistant to insulin. It is not known for certain why some people develop type 2 diabetes and some do not; however, there are several factors, such as genetics, obesity, and physical inactivity, that can increase a person's risk of developing type 2 diabetes.
Type 2 Diabetes: Primary Causes
Being obese or overweight puts you at significant risk for developing type 2 diabetes. Four out of five people with type 2 diabetes are overweight or obese.
“One of the links with obesity is that fat induces a mild, low-grade inflammation throughout the body that contributes to heart disease and diabetes,” says Vivian Fonseca, MD, professor of medicine and pharmacology and chief of endocrinology at Tulane University Health Sciences Center in New Orleans.
Excess fat, especially abdominal fat, also changes the way that your body responds to insulin, leading to a condition called insulin resistance. With this condition, your cells cannot use insulin to process blood sugar out of the blood, resulting in high blood sugar levels. While not everyone with insulin resistance develops diabetes, people with insulin resistance are at increased risk of type 2 diabetes.
Type 2 Diabetes: Poor Eating Habits
Eating too much of the wrong kinds of foods can increase your risk of type 2 diabetes. Studies have shown that eating a diet of calorie-dense, refined foods and beverages, such as sodas or fruit juices, and too little raw fruits, vegetables, and whole grains can significantly increase your risk of type 2 diabetes.
Type 2 Diabetes: Too Much TV Time
An analysis of health and nutrition data from a nationally representative sample of adults between the ages of 20 and 54 years of age showed that people who watched television more than two hours a day were more likely than their peers to be obese and to have diabetes. This is probably due to snacking while watching TV. The study found that the frequent TV watchers consumed, on average, 137 more calories a day than their peers. Conversely, the data indicated that cutting TV time back to less than 10 hours a week and adding a daily 30-minute walk led to 43 percent fewer cases of diabetes in the study group.
Type 2 Diabetes: Physical Inactivity
Just as body fat interacts with insulin and other hormones to affect diabetes development, so does muscle. Lean muscle mass, which can be increased through exercise and strength training, plays a role in protecting the body against insulin resistance and type 2 diabetes. A six-month study of 117 older men and women with abdominal obesity recently demonstrated that a mix of aerobic and resistance training exercises helped to reduce insulin resistance.
Type 2 Diabetes: Sleep Habits
Sleep disturbances have been shown to affect the body’s balance of insulin and blood sugar by increasing the demand on the pancreas. Over time, this can lead to type 2 diabetes. An analysis of data from 8,992 adults who participated in the First National Health and Nutrition Examination Survey showed that over the course of a decade, those who slept fewer than five hours a night or more than nine were at increased risk of type 2 diabetes.
Type 2 Diabetes: Genetics
Genes play an important role in determining a person's risk of type 2 diabetes. Researchers have identified at least 10 genetic variations linked to increased risk for this disease. However, your genes are not your fate; diet and exercise can prevent type 2 diabetes even if you have family members with the condition.
Eating too much and exercising too little are two of the main reasons why people develop type 2 diabetes.
By Madeline Vann, MPH
Medically reviewed by Christine Wilmsen Craig, MD Print Email Insulin is a hormone made in the pancreas that allows glucose (sugar) to leave the bloodstream and enter the cells to be used as fuel. Type 2 diabetes occurs when the pancreas doesn't make enough insulin or the cells of the body become resistant to insulin. It is not known for certain why some people develop type 2 diabetes and some do not; however, there are several factors, such as genetics, obesity, and physical inactivity, that can increase a person's risk of developing type 2 diabetes.
Type 2 Diabetes: Primary Causes
Being obese or overweight puts you at significant risk for developing type 2 diabetes. Four out of five people with type 2 diabetes are overweight or obese.
“One of the links with obesity is that fat induces a mild, low-grade inflammation throughout the body that contributes to heart disease and diabetes,” says Vivian Fonseca, MD, professor of medicine and pharmacology and chief of endocrinology at Tulane University Health Sciences Center in New Orleans.
Excess fat, especially abdominal fat, also changes the way that your body responds to insulin, leading to a condition called insulin resistance. With this condition, your cells cannot use insulin to process blood sugar out of the blood, resulting in high blood sugar levels. While not everyone with insulin resistance develops diabetes, people with insulin resistance are at increased risk of type 2 diabetes.
Type 2 Diabetes: Poor Eating Habits
Eating too much of the wrong kinds of foods can increase your risk of type 2 diabetes. Studies have shown that eating a diet of calorie-dense, refined foods and beverages, such as sodas or fruit juices, and too little raw fruits, vegetables, and whole grains can significantly increase your risk of type 2 diabetes.
Type 2 Diabetes: Too Much TV Time
An analysis of health and nutrition data from a nationally representative sample of adults between the ages of 20 and 54 years of age showed that people who watched television more than two hours a day were more likely than their peers to be obese and to have diabetes. This is probably due to snacking while watching TV. The study found that the frequent TV watchers consumed, on average, 137 more calories a day than their peers. Conversely, the data indicated that cutting TV time back to less than 10 hours a week and adding a daily 30-minute walk led to 43 percent fewer cases of diabetes in the study group.
Type 2 Diabetes: Physical Inactivity
Just as body fat interacts with insulin and other hormones to affect diabetes development, so does muscle. Lean muscle mass, which can be increased through exercise and strength training, plays a role in protecting the body against insulin resistance and type 2 diabetes. A six-month study of 117 older men and women with abdominal obesity recently demonstrated that a mix of aerobic and resistance training exercises helped to reduce insulin resistance.
Type 2 Diabetes: Sleep Habits
Sleep disturbances have been shown to affect the body’s balance of insulin and blood sugar by increasing the demand on the pancreas. Over time, this can lead to type 2 diabetes. An analysis of data from 8,992 adults who participated in the First National Health and Nutrition Examination Survey showed that over the course of a decade, those who slept fewer than five hours a night or more than nine were at increased risk of type 2 diabetes.
Type 2 Diabetes: Genetics
Genes play an important role in determining a person's risk of type 2 diabetes. Researchers have identified at least 10 genetic variations linked to increased risk for this disease. However, your genes are not your fate; diet and exercise can prevent type 2 diabetes even if you have family members with the condition.
Thursday, January 27, 2011
Foot Care Is Essential With Diabetes
From inspecting your feet for sores to keeping your skin dry, proper foot care is essential when you have diabetes. Practice these tips to reduce the risk of infection and protect your feet.
You may think of diabetes as a blood sugar problem, and it is. But the nerve and blood vessel damage caused by diabetes can also become a problem for your feet if you develop neuropathy and lose feeling in your feet or hands or get an infection. To ensure the best possible foot health, follow these 11 easy tips to avoid injury, and your feet will be healthy longer.
Nerve damage is a complication of diabetes that makes it hard to feel when you have sores or cracks in your feet. “Patients with diabetes are looking for any changes in color, sores, or dry, cracked skin,” says podiatrist Steven Tiller, MD, of Portland, Ore. Place a mirror on the floor to see under your feet or ask a friend or relative for help if you can’t see all parts of your feet clearly.
When people with diabetes develop nerve damage or neuropathy, it’s hard to tell if the bath water is too hot. “They won’t realize they are actually scalding their skin,” explains Dr. Tillet. Stepping into a bath before checking the temperature can cause serious damage to your feet, and burns and blisters are open doors to infection. Use your elbow to check the water temperature before getting into the tub or shower.
Shoe shopping for people with diabetes requires a little more attention to detail than you may be used to. Tillet advises looking for shoes with more depth in the toe box, good coverage of both top and bottom, and without seams inside the shoe that can rub on your foot. Likewise, seek socks without seams, preferably socks that are padded and made from cotton or another material that controls moisture.
Wearing shoes with good coverage outside to protect your feet makes sense to most people, but even inside your house, puttering around without shoes puts your feet at risk for small cuts, scrapes, and penetration by splinters, glass shards, and the misplaced sewing needle or thumbtack. If you have neuropathy, you might not notice these dangerous damages until they become infected. It’s best to wear shoes at all times, even in the house.
Make sure that drying your feet is part of your hygiene routine. “The space between the toes is very airtight,” says Tillet. “Skin gets moist and breaks down, leading to infection.” Prevent this by toweling off thoroughly after washing your feet and by removing wet or sweaty socks or shoes immediately. You can still use moisturizer to prevent dry, cracked skin — just avoid putting it between your toes.
Attend to bunions, calluses, corns, hammertoes, and other aggravations promptly, so they don’t lead to infection due to pressure sores and uneven rubbing. Even seemingly harmless calluses may become problems if you ignore them, notes Tillet. See a podiatrist, a doctor who specializes in foot care, instead of heading to the pharmacy for an over-the-counter product for feet — some products are irritating to your skin and can actually increase the risk of infection even while they treat the bunion, callus, or corn on your foot.
Because wearing the correct shoes is so important, orthotic footwear is a great investment in protection and comfort. Shoes made especially for people with diabetes are available at specialty stores and through catalogs, or you can visit your podiatrist for advice. Medicare will cover one pair of diabetic shoes a year, with the addition of three inserts to reduce pressure on your feet. Your doctor may recommend this type of diabetic shoe if you have an ulcer or sore that is not healing.
People with diabetes benefit from exercise, but you still must go easy on your feet. Many fitness classes and aerobics programs include bouncing, jumping, and leaping, which may not be the best activities for your feet, especially if you have neuropathy. Instead, look into programs, such as walking, that don’t put too much pressure on your feet. Just make sure you have the right shoe for whatever activity you choose.
The dangers of smoking run from your head to your feet. “The nicotine in a cigarette can decrease the circulation in the skin by 70 percent,” says Tillet. So if you smoke, you are depriving your feet of the nutrient- and oxygen-rich blood that helps keep them healthy and fights infection. “Diabetic patients already have risk factors that compromise their blood vessels. It’s never too late to stop smoking,” says Tillet.
“There’s a direct relationship between blood sugar level and damage to the nerve cells,” says Tillet. Out-of-control blood sugar leads to neuropathy, which will make it hard to know when your feet are at risk or being damaged. The better you are at controlling your blood sugar, the healthier your feet will be over the long term. Finally, if you already have an infection, high blood sugar levels can make it hard for your body to fight it.
Your doctor and your diabetes team are great sources of information if you need ideas and inspiration for taking care of your feet, quitting smoking, or staying on top of your “numbers” — your weight, blood sugar, and other measures of health, such as blood pressure. Of course, if you notice any changes in your feet that concern you, it’s a good idea to see your doctor before your next regularly scheduled check-up.
You may think of diabetes as a blood sugar problem, and it is. But the nerve and blood vessel damage caused by diabetes can also become a problem for your feet if you develop neuropathy and lose feeling in your feet or hands or get an infection. To ensure the best possible foot health, follow these 11 easy tips to avoid injury, and your feet will be healthy longer.
Nerve damage is a complication of diabetes that makes it hard to feel when you have sores or cracks in your feet. “Patients with diabetes are looking for any changes in color, sores, or dry, cracked skin,” says podiatrist Steven Tiller, MD, of Portland, Ore. Place a mirror on the floor to see under your feet or ask a friend or relative for help if you can’t see all parts of your feet clearly.
When people with diabetes develop nerve damage or neuropathy, it’s hard to tell if the bath water is too hot. “They won’t realize they are actually scalding their skin,” explains Dr. Tillet. Stepping into a bath before checking the temperature can cause serious damage to your feet, and burns and blisters are open doors to infection. Use your elbow to check the water temperature before getting into the tub or shower.
Shoe shopping for people with diabetes requires a little more attention to detail than you may be used to. Tillet advises looking for shoes with more depth in the toe box, good coverage of both top and bottom, and without seams inside the shoe that can rub on your foot. Likewise, seek socks without seams, preferably socks that are padded and made from cotton or another material that controls moisture.
Wearing shoes with good coverage outside to protect your feet makes sense to most people, but even inside your house, puttering around without shoes puts your feet at risk for small cuts, scrapes, and penetration by splinters, glass shards, and the misplaced sewing needle or thumbtack. If you have neuropathy, you might not notice these dangerous damages until they become infected. It’s best to wear shoes at all times, even in the house.
Make sure that drying your feet is part of your hygiene routine. “The space between the toes is very airtight,” says Tillet. “Skin gets moist and breaks down, leading to infection.” Prevent this by toweling off thoroughly after washing your feet and by removing wet or sweaty socks or shoes immediately. You can still use moisturizer to prevent dry, cracked skin — just avoid putting it between your toes.
Attend to bunions, calluses, corns, hammertoes, and other aggravations promptly, so they don’t lead to infection due to pressure sores and uneven rubbing. Even seemingly harmless calluses may become problems if you ignore them, notes Tillet. See a podiatrist, a doctor who specializes in foot care, instead of heading to the pharmacy for an over-the-counter product for feet — some products are irritating to your skin and can actually increase the risk of infection even while they treat the bunion, callus, or corn on your foot.
Because wearing the correct shoes is so important, orthotic footwear is a great investment in protection and comfort. Shoes made especially for people with diabetes are available at specialty stores and through catalogs, or you can visit your podiatrist for advice. Medicare will cover one pair of diabetic shoes a year, with the addition of three inserts to reduce pressure on your feet. Your doctor may recommend this type of diabetic shoe if you have an ulcer or sore that is not healing.
People with diabetes benefit from exercise, but you still must go easy on your feet. Many fitness classes and aerobics programs include bouncing, jumping, and leaping, which may not be the best activities for your feet, especially if you have neuropathy. Instead, look into programs, such as walking, that don’t put too much pressure on your feet. Just make sure you have the right shoe for whatever activity you choose.
The dangers of smoking run from your head to your feet. “The nicotine in a cigarette can decrease the circulation in the skin by 70 percent,” says Tillet. So if you smoke, you are depriving your feet of the nutrient- and oxygen-rich blood that helps keep them healthy and fights infection. “Diabetic patients already have risk factors that compromise their blood vessels. It’s never too late to stop smoking,” says Tillet.
“There’s a direct relationship between blood sugar level and damage to the nerve cells,” says Tillet. Out-of-control blood sugar leads to neuropathy, which will make it hard to know when your feet are at risk or being damaged. The better you are at controlling your blood sugar, the healthier your feet will be over the long term. Finally, if you already have an infection, high blood sugar levels can make it hard for your body to fight it.
Your doctor and your diabetes team are great sources of information if you need ideas and inspiration for taking care of your feet, quitting smoking, or staying on top of your “numbers” — your weight, blood sugar, and other measures of health, such as blood pressure. Of course, if you notice any changes in your feet that concern you, it’s a good idea to see your doctor before your next regularly scheduled check-up.
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
Monday, January 17, 2011
Out-of-Control Sugar Cravings
Q: I am a type 2 diabetic. I do well with meals, but I crave something sweet (like cookies, cake, candy) constantly, and most times I lose the battle to resist. How can I get rid of this craving once and for all?
— Jacqueline, Kansas
A: Despite popular beliefs about how blood sugar levels relate to craving, there is very little if any evidence indicating this to be true. Food cravings are largely a psychological phenomenon that relates to old habits and learning. The most likely reason that we see cravings in folks like you who have developed type 2 diabetes may simply be that the history of eating patterns that contributed to the development of the diabetes is persisting. Here's the good news: As is the case with all learned behavior, cravings can be "unlearned."
Cravings can arise in several ways. If you have used food to reward yourself, make yourself feel better when stressed or upset, or celebrate certain special events, depending on how frequently you do this, those foods can become associated with any of the above examples. When you feel these emotions, or are in the situations associated with that food, that association triggers thoughts about the food — in other words, a craving. The problem is that over a lifetime, the number of subtle triggers that become solidly paired with these foods grows. So it’s sometimes impossible to put your finger on the cause of the craving, which leads people to assume it’s being triggered by some internal physiological need (which is probably not the case).
The good news is that there is a simple answer: Stop pairing consumption of the craved food with the craving. Of course, even simple answers are not always easy. Fighting cravings can be tough. They are powerful and very real. So here are a few tips to get you started:
Delay. Wait 10 to 20 minutes (or as long as you can) before giving into the craving. In the best-case scenario, often the craving will subside in that time period, and you will not eat the food at all. However, even at those times when you aren’t able to fully fight off the craving, the time delay helps reduce its power.
Distract. Just thinking about the craved food during the delay can maintain the power of the craving. By distracting yourself and trying not to think about the craved food, you will ensure that the craving weakens.
Avoid. Finding alternatives to your most difficult-to-control foods that are equally satisfying and consuming these in moderation in a planned way (not in response to a craving) allows you to not feel deprived while controlling consumption of the food. Alternatively, some people seem to do well consuming a small amount of the actual craved food at planned times, but recent evidence suggests that this may in fact prolong the removal of the cravings.
Remember, you can take control of cravings.
— Jacqueline, Kansas
A: Despite popular beliefs about how blood sugar levels relate to craving, there is very little if any evidence indicating this to be true. Food cravings are largely a psychological phenomenon that relates to old habits and learning. The most likely reason that we see cravings in folks like you who have developed type 2 diabetes may simply be that the history of eating patterns that contributed to the development of the diabetes is persisting. Here's the good news: As is the case with all learned behavior, cravings can be "unlearned."
Cravings can arise in several ways. If you have used food to reward yourself, make yourself feel better when stressed or upset, or celebrate certain special events, depending on how frequently you do this, those foods can become associated with any of the above examples. When you feel these emotions, or are in the situations associated with that food, that association triggers thoughts about the food — in other words, a craving. The problem is that over a lifetime, the number of subtle triggers that become solidly paired with these foods grows. So it’s sometimes impossible to put your finger on the cause of the craving, which leads people to assume it’s being triggered by some internal physiological need (which is probably not the case).
The good news is that there is a simple answer: Stop pairing consumption of the craved food with the craving. Of course, even simple answers are not always easy. Fighting cravings can be tough. They are powerful and very real. So here are a few tips to get you started:
Delay. Wait 10 to 20 minutes (or as long as you can) before giving into the craving. In the best-case scenario, often the craving will subside in that time period, and you will not eat the food at all. However, even at those times when you aren’t able to fully fight off the craving, the time delay helps reduce its power.
Distract. Just thinking about the craved food during the delay can maintain the power of the craving. By distracting yourself and trying not to think about the craved food, you will ensure that the craving weakens.
Avoid. Finding alternatives to your most difficult-to-control foods that are equally satisfying and consuming these in moderation in a planned way (not in response to a craving) allows you to not feel deprived while controlling consumption of the food. Alternatively, some people seem to do well consuming a small amount of the actual craved food at planned times, but recent evidence suggests that this may in fact prolong the removal of the cravings.
Remember, you can take control of cravings.
Tuesday, January 4, 2011
Diabetes And Feet: Why A Podiatrist Is A Vital Part Of A Diabetic’s Care
Diabetes is a serious disease that affects millions of Americans, and that number is going to astronomically grow as the baby boomer generation ages further. Complications associated with diabetes can be devastating, and can lead to organ failure and even death. Foot-related complications in particular are very common in diabetes, and unfortunately cause the majority of leg amputations performed by surgeons. Comprehensive care by a podiatrist can identify foot problems early before they lead to leg loss, and in many cases can prevent those problems in the first place. This article will discuss the ways a podiatrist can protect diabetic feet, and ultimately save a diabetic’s limb and life.
Diabetes is a disease in which glucose, the body’s main source of ‘fuel’, is not properly absorbed into the body’s tissues and remains stuck in the bloodstream. Glucose is a type of ’sugar’ derived from the body’s digestion of carbohydrates (grains, breads, pastas, sugary food, fruits, starches, and dairy) The body needs a hormone called insulin, which is produced in the pancreas, to coax the glucose into body tissue to fuel it. Some diabetics are born with or develop at a young age an inability to produce insulin, resulting in type 1 diabetes. The majority of diabetics develop their disease as they become much older, and the ability of insulin to coax glucose into tissue wanes due to a sort of resistance to or an ineffectiveness of the action of insulin. This is called type 2 diabetes. Diabetes can also develop from high dose steroid use, during pregnancy (where it is temporary), or after pancreas disease or certain infections. The high concentration of glucose in the blood that remains out of the body tissue in diabetes can cause damage to parts all over the body. Organs and tissue that slowly are damaged by high concentrations of glucose stuck in the blood include the heart, the kidneys, blood vessels, the brain, the nerve tissue, skin, and the immune and injury repair cells. The higher the concentration of glucose in the blood, and the longer this glucose is present in the blood in an elevated state, the more damage will occur. Death can occur with severe levels of glucose in the blood stream, although this is not the case in most diabetics. Most diabetics who do not control their blood glucose well develop tissue damage over a long period of time, and serious disease, organ failure, and the potential for leg loss does eventually arrive, although not right away.
Foot disease in diabetes is common, and one of the more devastating and taxing complications associated directly and indirectly with high blood sugar. Foot disease takes the form of decreased sensation, poor circulation, a higher likelihood of developing skin wounds and infections, and a decreased ability to heal those skin wounds and infections. Key to this entire spectrum of foot complications is the presence of poor sensation. Most diabetics have less feeling in their feet than non-diabetics, due to the indirect action increased glucose has on nerve tissue. This decreased sensation can be a significant numbness, or it can be a mere subtle numbness that makes sharp objects seem smooth, or erases the irritation of a tight shoe. Advanced cases can actually have phantom pains of burning or tingling in addition to the numbness. With decreased sensation comes a much greater risk for skin wounds, mostly due to the inability to feel pain from thick calluses, sharp objects on the ground, and poorly fitting shoes. When a wound has formed as a result of skin dying under the strain of a thick corn or callus, from a needle or splinter driven into the foot, or from a tight shoe rubbing a friction burn on the skin, the diabetic foot has great difficulty starting and completing the healing process. Untreated skin wounds will break down further, and the wound can extend to deeper tissue, including muscle and bone. Bacteria will enter the body through these wounds, and can potentially cause an infection that can spread beyond the foot itself. A diabetic’s body has a particularly difficult time defending itself from bacteria due to the way high glucose affects the very cells that eat bacteria, and diabetics tend to get infected by multiple species of bacteria as well. Combine all this with decreased circulation (and therefore decreased distribution of nutrients and chemicals to preserve foot tissue and help it thrive), and one has all the components in place for a potential amputation. Amputations are performed when bacteria spreads along the body and threatens death, when wounds and foot tissue will not heal as a result of gangrene from advancing tissue death and infection, and when poor circulation will not allow the tissue to thrive ever again. The statistics following a leg amputation are grim: about half of diabetics who undergo one amputation will require an amputation of the other foot or leg, and about that same number in five years will be dead from the heart strain endured when one’s body has to expend energy to use a prosthetic limb.
A podiatrist can ensure that all the above complications are significantly limited, and in some cases prevented all together. Podiatrists are physicians who specialize solely in the care of foot and ankle disease, through medicine and surgery. The attend a four year podiatric medical school following college, and enter into a two or three year of hospital-based residency program after that to hone their advanced reconstructive surgical skills, and to study advanced medical. Podiatrists are generally considered the experts on all things involving the foot and ankle, and their unique understanding amongst other medical specialties of how the foot functions in relationship to the leg and ground (biomechanics) allows them to target therapy towards controlling or changing that function in addition to treating tissue disease. A great majority of the problems that lead to diabetic amputations start off as problems related to the structure of the foot and how it relates to the ground and to the shoe worn above. Controlling or repairing these structural problems will often result in prevention of wounds, which in turn will prevent infection, gangrene, and amputation.
To start with, a podiatrist will provide a diabetic patient with a complete foot exam that takes into account circulation, sensation, bone deformities, and skin issues, and pressures generated by walking and standing. From this initial assessment, a protection and treatment course can be created specific to the individual needs of the diabetic for maintenance, protection, and active treatment of problems that do develop. Commonly performed maintenance services include regular examinations several times a year to identify developing problems, care of toe nails to prevent a diabetic with poor sensation from accidentally cutting themselves when attempting to trim their nails, regular thinning of calluses to prevent wounds from developing, and repetitive education on diabetic foot problems to ensure proper habits are followed. Preventative services include using special deep shoes with protective inserts in diabetics at-risk for developing wounds from regular shoes, assessment of potential circulation problems with prompt referral to vascular specialists if needed, and possible surgery to reduce the potential of wounds to develop over areas of bony prominences. Active treatment of foot problems performed by a podiatrist involves the care and healing of wounds, the treatment of diabetic infections, and surgery to address serious foot injury, deep infections, gangrene, and other urgent problems. Because of a podiatrist’s unique understanding of the way the foot structure affects disease and injury, all treatment will be centered around the principles of how the foot realistically functions in conjunction with the leg and the ground. This becomes invaluable in the struggle to prevent diabetic wounds and infections, while allowing one to remain mobile and active at the same time.
The essential goal of a podiatrist in caring for a diabetic patient is to prevent wounds, infections, and the amputations that result. This philosophy is called limb salvage, and it is accomplished through the above listed methods. Because of the severity of foot disease as a complication of diabetes, a podiatrist is an integral part of a diabetic’s care, and sometimes can even be the physician that diagnoses diabetes in the first place if foot disease appears as an early symptom of undiagnosed diabetes. For these reasons, all diabetics should be assessed by a podiatrist for potential problems, and those at-risk for foot wounds and infections should have regular foot examinations and preventative treatment. As a final note, online resources by podiatrists discussing diabetic foot issues abound, including a regular blog by this author (thediabeticfoot.blogspot.com). While these resources do not replace a diabetic foot exam, they do help educate diabetics on how best to care for their feet, and what to do if problems develop. This can lead to better knowledge and understanding of foot issues when diabetics begin to see a podiatrist regularly, and can help prevent early foot complications from developing.
Diabetes is a disease in which glucose, the body’s main source of ‘fuel’, is not properly absorbed into the body’s tissues and remains stuck in the bloodstream. Glucose is a type of ’sugar’ derived from the body’s digestion of carbohydrates (grains, breads, pastas, sugary food, fruits, starches, and dairy) The body needs a hormone called insulin, which is produced in the pancreas, to coax the glucose into body tissue to fuel it. Some diabetics are born with or develop at a young age an inability to produce insulin, resulting in type 1 diabetes. The majority of diabetics develop their disease as they become much older, and the ability of insulin to coax glucose into tissue wanes due to a sort of resistance to or an ineffectiveness of the action of insulin. This is called type 2 diabetes. Diabetes can also develop from high dose steroid use, during pregnancy (where it is temporary), or after pancreas disease or certain infections. The high concentration of glucose in the blood that remains out of the body tissue in diabetes can cause damage to parts all over the body. Organs and tissue that slowly are damaged by high concentrations of glucose stuck in the blood include the heart, the kidneys, blood vessels, the brain, the nerve tissue, skin, and the immune and injury repair cells. The higher the concentration of glucose in the blood, and the longer this glucose is present in the blood in an elevated state, the more damage will occur. Death can occur with severe levels of glucose in the blood stream, although this is not the case in most diabetics. Most diabetics who do not control their blood glucose well develop tissue damage over a long period of time, and serious disease, organ failure, and the potential for leg loss does eventually arrive, although not right away.
Foot disease in diabetes is common, and one of the more devastating and taxing complications associated directly and indirectly with high blood sugar. Foot disease takes the form of decreased sensation, poor circulation, a higher likelihood of developing skin wounds and infections, and a decreased ability to heal those skin wounds and infections. Key to this entire spectrum of foot complications is the presence of poor sensation. Most diabetics have less feeling in their feet than non-diabetics, due to the indirect action increased glucose has on nerve tissue. This decreased sensation can be a significant numbness, or it can be a mere subtle numbness that makes sharp objects seem smooth, or erases the irritation of a tight shoe. Advanced cases can actually have phantom pains of burning or tingling in addition to the numbness. With decreased sensation comes a much greater risk for skin wounds, mostly due to the inability to feel pain from thick calluses, sharp objects on the ground, and poorly fitting shoes. When a wound has formed as a result of skin dying under the strain of a thick corn or callus, from a needle or splinter driven into the foot, or from a tight shoe rubbing a friction burn on the skin, the diabetic foot has great difficulty starting and completing the healing process. Untreated skin wounds will break down further, and the wound can extend to deeper tissue, including muscle and bone. Bacteria will enter the body through these wounds, and can potentially cause an infection that can spread beyond the foot itself. A diabetic’s body has a particularly difficult time defending itself from bacteria due to the way high glucose affects the very cells that eat bacteria, and diabetics tend to get infected by multiple species of bacteria as well. Combine all this with decreased circulation (and therefore decreased distribution of nutrients and chemicals to preserve foot tissue and help it thrive), and one has all the components in place for a potential amputation. Amputations are performed when bacteria spreads along the body and threatens death, when wounds and foot tissue will not heal as a result of gangrene from advancing tissue death and infection, and when poor circulation will not allow the tissue to thrive ever again. The statistics following a leg amputation are grim: about half of diabetics who undergo one amputation will require an amputation of the other foot or leg, and about that same number in five years will be dead from the heart strain endured when one’s body has to expend energy to use a prosthetic limb.
A podiatrist can ensure that all the above complications are significantly limited, and in some cases prevented all together. Podiatrists are physicians who specialize solely in the care of foot and ankle disease, through medicine and surgery. The attend a four year podiatric medical school following college, and enter into a two or three year of hospital-based residency program after that to hone their advanced reconstructive surgical skills, and to study advanced medical. Podiatrists are generally considered the experts on all things involving the foot and ankle, and their unique understanding amongst other medical specialties of how the foot functions in relationship to the leg and ground (biomechanics) allows them to target therapy towards controlling or changing that function in addition to treating tissue disease. A great majority of the problems that lead to diabetic amputations start off as problems related to the structure of the foot and how it relates to the ground and to the shoe worn above. Controlling or repairing these structural problems will often result in prevention of wounds, which in turn will prevent infection, gangrene, and amputation.
To start with, a podiatrist will provide a diabetic patient with a complete foot exam that takes into account circulation, sensation, bone deformities, and skin issues, and pressures generated by walking and standing. From this initial assessment, a protection and treatment course can be created specific to the individual needs of the diabetic for maintenance, protection, and active treatment of problems that do develop. Commonly performed maintenance services include regular examinations several times a year to identify developing problems, care of toe nails to prevent a diabetic with poor sensation from accidentally cutting themselves when attempting to trim their nails, regular thinning of calluses to prevent wounds from developing, and repetitive education on diabetic foot problems to ensure proper habits are followed. Preventative services include using special deep shoes with protective inserts in diabetics at-risk for developing wounds from regular shoes, assessment of potential circulation problems with prompt referral to vascular specialists if needed, and possible surgery to reduce the potential of wounds to develop over areas of bony prominences. Active treatment of foot problems performed by a podiatrist involves the care and healing of wounds, the treatment of diabetic infections, and surgery to address serious foot injury, deep infections, gangrene, and other urgent problems. Because of a podiatrist’s unique understanding of the way the foot structure affects disease and injury, all treatment will be centered around the principles of how the foot realistically functions in conjunction with the leg and the ground. This becomes invaluable in the struggle to prevent diabetic wounds and infections, while allowing one to remain mobile and active at the same time.
The essential goal of a podiatrist in caring for a diabetic patient is to prevent wounds, infections, and the amputations that result. This philosophy is called limb salvage, and it is accomplished through the above listed methods. Because of the severity of foot disease as a complication of diabetes, a podiatrist is an integral part of a diabetic’s care, and sometimes can even be the physician that diagnoses diabetes in the first place if foot disease appears as an early symptom of undiagnosed diabetes. For these reasons, all diabetics should be assessed by a podiatrist for potential problems, and those at-risk for foot wounds and infections should have regular foot examinations and preventative treatment. As a final note, online resources by podiatrists discussing diabetic foot issues abound, including a regular blog by this author (thediabeticfoot.blogspot.com). While these resources do not replace a diabetic foot exam, they do help educate diabetics on how best to care for their feet, and what to do if problems develop. This can lead to better knowledge and understanding of foot issues when diabetics begin to see a podiatrist regularly, and can help prevent early foot complications from developing.
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
Saturday, December 25, 2010
7 Easy Lunches for Type 2 Diabetes
Sticking to your diabetes diet at lunchtime is easier than you think. Here's a week's worth of ideas to keep your midday meal interesting and healthy.
If breakfast is the most neglected meal of the day, lunch can often be the most hurried. Fast-food restaurants and food courts often prevail over more healthy options because we lead such hectic lives. But they don't have to be your only option — and, in fact, they shouldn't be your first choice if you have type 2 diabetes.
In general, try to pack your own lunch whenever possible — the health benefits can be enormous. Short on prep time? Put these quick and nutritious lunch ideas on your diabetes menu to fill you up and keep your blood sugar in check.
1. Salads
Salad should be a part of your lunch menu if you have diabetes. You can create a different salad every day of the week by varying your toppings. Try grilled chicken, shrimp, or fish, but avoid heaping on a lot of fattening ingredients, such as bacon bits and heavy cheeses.
Salads with lots of raw vegetables are best, including carrots, cucumbers, radishes, celery, and spinach. Sprinkle nuts or seeds on top, add a few dried cranberries, and garnish with some avocado chunks to give it zip. Always choose low-fat or fat-free salad dressings or, for a change, flavored vinegars.
2. Sandwiches
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As with salads, there are many ways to spice up a sandwich. Start with whole-grain bread or a whole-wheat tortilla. Add lean meat, such as turkey, ham, or grilled chicken; layer on your choice of veggies; add mustard, low-fat mayo, or hummus to the mix — and you have a filling and tasty lunch. Stay away from greasy chips, French fries, and other fattening sides. Instead choose fruit, a few pretzels, or carrot and celery sticks to complement your meal.
3. Hearty Soups
Soup can be a good option for lunch, with many healthy choices to consider. Chicken noodle, chicken and rice, and tomato (made without cream) are all good soup choices. Others include butternut squash, gazpacho and other chunky vegetable varieties, miso, and pasta and bean soups. Avoid cream-based soups and chowders. Remember, soup freezes well. You can make a large batch and freeze it in individual containers; with a microwave you have a nearly instant lunch.
4. Pasta
As long as you choose whole-grain pasta, you can eat all types of noodles, such as penne, angel hair, or spaghetti. Top it with a healthy tomato sauce, then add chicken, shrimp, or turkey meatballs and a variety of vegetables. Add a crisp salad and you have a healthy and filling lunch.
5. Pizza
Pizza can be a good choice &mash; in moderation. Choose a thin-crust variety, ask for light cheese, and include vegetables as the topping instead of fatty meats like pepperoni.
6. Tuna, Chicken, and Shrimp Salads
When you make these protein-based mixes, you can control the mayonnaise and the good-health factor. Choose low-fat mayonnaise, and not too much of it. Add fiber and bulk with chopped celery, diced bell pepper, and chopped onions to taste. Serve on whole-grain bread or scoop onto a bed of lettuce.
7. Veggie Stir-Fry
For a more exotic lunch, go for a bowl of vegetable stir-fry and brown rice. Avoid the fast-food version, which can be high in fat and sodium, and make it yourself by sautéing the vegetables with a healthy cooking spray and soy sauce. Prepare it the night before for dinner, making enough to bring leftovers for lunch.
More Healthy Lunch Tips for Type 2 Diabetes
To better control type 2 diabetes, keep these tips in mind:
Choose low-fat or fat-free salad dressings and watch how much you use.
Pick whole-grain bread over white bread.
Practice portion control.Follow the diabetes food pyramid: Eat more grains, beans, and starchy vegetables and less fats, sweets, and alcohol. In between and equally divided are protein choices, non-starchy vegetables, fruit, and milk and dairy products.
Choose lean protein sources, such as turkey, ham, chicken, lean roast beef, and fish.
Avoid fried foods.
Stay away from fatty chips and mayonnaise-based salads, like potato salad. Complement your meal with sliced carrots and celery or fruit salad.
If you are craving a sweet after lunch and fresh fruit just won't do, reach for sugar-free, fat-free frozen yogurt. Be careful of sorbets and sherbets that are loaded with sugar.
Avoid sugary beverages; drink water and tea instead.
Consult with a certified diabetes educator or registered dietitian to get more lunch ideas. How much and what types of food you should eat varies, depending on your specific needs — a dietitian can help create a meal plan that is right for you.
If breakfast is the most neglected meal of the day, lunch can often be the most hurried. Fast-food restaurants and food courts often prevail over more healthy options because we lead such hectic lives. But they don't have to be your only option — and, in fact, they shouldn't be your first choice if you have type 2 diabetes.
In general, try to pack your own lunch whenever possible — the health benefits can be enormous. Short on prep time? Put these quick and nutritious lunch ideas on your diabetes menu to fill you up and keep your blood sugar in check.
1. Salads
Salad should be a part of your lunch menu if you have diabetes. You can create a different salad every day of the week by varying your toppings. Try grilled chicken, shrimp, or fish, but avoid heaping on a lot of fattening ingredients, such as bacon bits and heavy cheeses.
Salads with lots of raw vegetables are best, including carrots, cucumbers, radishes, celery, and spinach. Sprinkle nuts or seeds on top, add a few dried cranberries, and garnish with some avocado chunks to give it zip. Always choose low-fat or fat-free salad dressings or, for a change, flavored vinegars.
2. Sandwiches
There's more content below this advertisement. Jump to the content.
As with salads, there are many ways to spice up a sandwich. Start with whole-grain bread or a whole-wheat tortilla. Add lean meat, such as turkey, ham, or grilled chicken; layer on your choice of veggies; add mustard, low-fat mayo, or hummus to the mix — and you have a filling and tasty lunch. Stay away from greasy chips, French fries, and other fattening sides. Instead choose fruit, a few pretzels, or carrot and celery sticks to complement your meal.
3. Hearty Soups
Soup can be a good option for lunch, with many healthy choices to consider. Chicken noodle, chicken and rice, and tomato (made without cream) are all good soup choices. Others include butternut squash, gazpacho and other chunky vegetable varieties, miso, and pasta and bean soups. Avoid cream-based soups and chowders. Remember, soup freezes well. You can make a large batch and freeze it in individual containers; with a microwave you have a nearly instant lunch.
4. Pasta
As long as you choose whole-grain pasta, you can eat all types of noodles, such as penne, angel hair, or spaghetti. Top it with a healthy tomato sauce, then add chicken, shrimp, or turkey meatballs and a variety of vegetables. Add a crisp salad and you have a healthy and filling lunch.
5. Pizza
Pizza can be a good choice &mash; in moderation. Choose a thin-crust variety, ask for light cheese, and include vegetables as the topping instead of fatty meats like pepperoni.
6. Tuna, Chicken, and Shrimp Salads
When you make these protein-based mixes, you can control the mayonnaise and the good-health factor. Choose low-fat mayonnaise, and not too much of it. Add fiber and bulk with chopped celery, diced bell pepper, and chopped onions to taste. Serve on whole-grain bread or scoop onto a bed of lettuce.
7. Veggie Stir-Fry
For a more exotic lunch, go for a bowl of vegetable stir-fry and brown rice. Avoid the fast-food version, which can be high in fat and sodium, and make it yourself by sautéing the vegetables with a healthy cooking spray and soy sauce. Prepare it the night before for dinner, making enough to bring leftovers for lunch.
More Healthy Lunch Tips for Type 2 Diabetes
To better control type 2 diabetes, keep these tips in mind:
Choose low-fat or fat-free salad dressings and watch how much you use.
Pick whole-grain bread over white bread.
Practice portion control.Follow the diabetes food pyramid: Eat more grains, beans, and starchy vegetables and less fats, sweets, and alcohol. In between and equally divided are protein choices, non-starchy vegetables, fruit, and milk and dairy products.
Choose lean protein sources, such as turkey, ham, chicken, lean roast beef, and fish.
Avoid fried foods.
Stay away from fatty chips and mayonnaise-based salads, like potato salad. Complement your meal with sliced carrots and celery or fruit salad.
If you are craving a sweet after lunch and fresh fruit just won't do, reach for sugar-free, fat-free frozen yogurt. Be careful of sorbets and sherbets that are loaded with sugar.
Avoid sugary beverages; drink water and tea instead.
Consult with a certified diabetes educator or registered dietitian to get more lunch ideas. How much and what types of food you should eat varies, depending on your specific needs — a dietitian can help create a meal plan that is right for you.
Wednesday, December 15, 2010
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
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.
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.
Saturday, September 25, 2010
Using Insulin with Type II Diabetes
Although most people with Type II diabetes are on oral medications, some may need insulin to control their blood sugar levels.
By Marijke Vroomen-Durning, RN
Medically reviewed by Pat F. Bass III, MD, MPH
Type II diabetes, previously known as adult-onset or non-insulin-dependent diabetes, is becoming more common in North America. As more people are diagnosed with type 2 diabetes, more research is being done into better ways to manage the disease.
Type II Diabetes: Medications
Type II diabetes is usually treated with oral medications that stimulate insulin production in the pancreas. Insulin, used in type 1 diabetes, was generally only given in Type II diabetes as a last resort if the oral medications weren’t working.
Gerald Bernstein, MD, associate professor of medicine at Albert Einstein College of Medicine in Bronx, N.Y., and a past president of the American Diabetes Association, says that the idea of going on to insulin is often seen as a threat: “If you don’t lose weight, you’ll wind up on insulin.” But, over time, researchers and doctors are learning that it may be in a patient’s best interest to begin insulin treatment earlier for type 2 diabetes, rather than later.
It’s important to understand the goal of treating diabetes. The treatment of diabetes is, of course, meant to lower blood sugar levels, but this is the short-term goal. The long-term goal of diabetes treatment is to slow the progression of the disease and, therefore, delay or prevent complications.
Vincent Woo, MD, chair of the clinical and scientific section of the Canadian Diabetes Association, says “this is a big topic,” and refers to the association’s guidelines, which say:
• If after two to three months of lifestyle changes, blood sugar control hasn't improved, it’s time to start medications. This could include insulin in combination with oral medications.
• If blood sugar levels aren’t under control after a trial period of oral medications alone, insulin may be added if appropriate. Insulin is normally administered under the skin several times per day, either by injection or via an insulin pump. Several years ago an inhaled insulin was marketed in the United States, but it was discontinued due to poor sales.
Dr. Bernstein agrees: “The reality is that all of the new data and the goals of glucose control suggest that insulin would actually be better used if it were started very early in type 2 diabetes.” New guidelines “suggest that insulin should be the earliest medication intervention after the patient is taught lifestyle changes and is placed on metformin,” he says.
Type 2 Diabetes: Using Insulin for a Short Period
Many people with type II diabetes do quite well with oral medications and just need to be vigilant. Unfortunately, diabetes is a complicated illness that gets worse when your body is stressed. The stresses aren’t necessarily things like a serious illness or surgery — they could include stress over an infection or a good stress, like pregnancy. Regardless of the cause, in these situations you may need insulin to get you over the hump.
The idea here is you’re given insulin while your body heals itself from the stress and, if all goes well; the insulin may be reduced or eliminated once the stressor is gone and your body returns to its pre-stress self.
These insulin’s will be either short-acting or longer-acting insulins, or both, depending on what your body needs at that point. But, you should remember that this is most likely a temporary measure and that the hope — and aim — of the treatment is to get you back onto your usual diabetes management plan.
Living with diabetes can be frustrating, especially if you are trying your best to keep your blood sugar levels under control. While using insulin may not have been in your plan or vision of diabetes management, you should keep in mind your long-term goal of slowing down the disease process. And, if insulin is part of that plan, learning how to manage and use the insulin may be exactly what you need.
By Marijke Vroomen-Durning, RN
Medically reviewed by Pat F. Bass III, MD, MPH
Type II diabetes, previously known as adult-onset or non-insulin-dependent diabetes, is becoming more common in North America. As more people are diagnosed with type 2 diabetes, more research is being done into better ways to manage the disease.
Type II Diabetes: Medications
Type II diabetes is usually treated with oral medications that stimulate insulin production in the pancreas. Insulin, used in type 1 diabetes, was generally only given in Type II diabetes as a last resort if the oral medications weren’t working.
Gerald Bernstein, MD, associate professor of medicine at Albert Einstein College of Medicine in Bronx, N.Y., and a past president of the American Diabetes Association, says that the idea of going on to insulin is often seen as a threat: “If you don’t lose weight, you’ll wind up on insulin.” But, over time, researchers and doctors are learning that it may be in a patient’s best interest to begin insulin treatment earlier for type 2 diabetes, rather than later.
It’s important to understand the goal of treating diabetes. The treatment of diabetes is, of course, meant to lower blood sugar levels, but this is the short-term goal. The long-term goal of diabetes treatment is to slow the progression of the disease and, therefore, delay or prevent complications.
Vincent Woo, MD, chair of the clinical and scientific section of the Canadian Diabetes Association, says “this is a big topic,” and refers to the association’s guidelines, which say:
• If after two to three months of lifestyle changes, blood sugar control hasn't improved, it’s time to start medications. This could include insulin in combination with oral medications.
• If blood sugar levels aren’t under control after a trial period of oral medications alone, insulin may be added if appropriate. Insulin is normally administered under the skin several times per day, either by injection or via an insulin pump. Several years ago an inhaled insulin was marketed in the United States, but it was discontinued due to poor sales.
Dr. Bernstein agrees: “The reality is that all of the new data and the goals of glucose control suggest that insulin would actually be better used if it were started very early in type 2 diabetes.” New guidelines “suggest that insulin should be the earliest medication intervention after the patient is taught lifestyle changes and is placed on metformin,” he says.
Type 2 Diabetes: Using Insulin for a Short Period
Many people with type II diabetes do quite well with oral medications and just need to be vigilant. Unfortunately, diabetes is a complicated illness that gets worse when your body is stressed. The stresses aren’t necessarily things like a serious illness or surgery — they could include stress over an infection or a good stress, like pregnancy. Regardless of the cause, in these situations you may need insulin to get you over the hump.
The idea here is you’re given insulin while your body heals itself from the stress and, if all goes well; the insulin may be reduced or eliminated once the stressor is gone and your body returns to its pre-stress self.
These insulin’s will be either short-acting or longer-acting insulins, or both, depending on what your body needs at that point. But, you should remember that this is most likely a temporary measure and that the hope — and aim — of the treatment is to get you back onto your usual diabetes management plan.
Living with diabetes can be frustrating, especially if you are trying your best to keep your blood sugar levels under control. While using insulin may not have been in your plan or vision of diabetes management, you should keep in mind your long-term goal of slowing down the disease process. And, if insulin is part of that plan, learning how to manage and use the insulin may be exactly what you need.
Sunday, September 19, 2010
Flaxseed and Diabetes
Q: Is flaxseed beneficial for people with type 2 diabetes? Does it help my prostate gland as well?
– Frank, Florida
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, Florida
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, September 1, 2010
Simple Blood Test Predicts Who Might Develop Type 2 Diabetes Among Healthy Women
Doctors may have identified a new and simple way to predict risk for developing Type 2 diabetes. The result of a simple blood test may be the earliest alert to doctors and patients to implement lifestyle changes that may delay or prevent the onset of the disease….
Samia Mora, M.D., and colleagues at Harvard Medical School and the Brigham and Women's Hospital used Nuclear Magnetic Resonance (NMR) to investigate the relationship of NMR-measured lipoproteins and the development of future Type 2 diabetes. The outcome of Dr. Mora's work showed that NMR-measured lipoprotein particles were associated with development of Type 2 diabetes, independent of other risk factors, particularly HDL-cholesterol and triglycerides measured by standard laboratory methods.
According to Dr. Mora, "Our findings indicate for the first time that even before the onset of clinical Type 2 diabetes, the size and number of the lipoprotein particles may indicate which women go on to develop future disease. This could provide an important opportunity for a woman with a normal blood glucose, but an abnormal NMR lipoprotein test result, to intervene early by following a healthy diet, losing weight, and increasing her physical activity level, all known ways to reduce her chance of developing diabetes even years before she gets a high glucose reading."
Doctors typically look for increases in glucose and triglycerides, and decreases in HDL cholesterol, to determine if a patient is becoming pre-diabetic. Even before changes in glucose levels are detectable, there are significant changes in the metabolism of cholesterol and triglycerides.
LDL "bad" cholesterol, HDL "good" cholesterol and triglycerides, are carried throughout the body inside molecules called lipoprotein particles. The particles travel into artery walls where they deposit the cholesterol, which forms artery-clogging plaque. Researchers wanted to know the significance of the particle size and number in apparently healthy individuals: could these readings predict future disease? Could they, in fact, predict who might develop Type 2 diabetes in time for early intervention?
The researchers conducted a study of 26,836 initially healthy women who were then followed for 13 years, during which 1,687 developed Type 2 diabetes. Dr. Mora noted, "Our study, which was conducted in a large population of healthy women, found that larger LDL and HDL particles were associated with lower risk and smaller LDL and HDL particles were associated with higher risk of diabetes. Even in women with normal triglyceride and HDL cholesterol measured by standard tests, having smaller LDL particles imparted higher risk of diabetes."
The team concluded that NMR-measured lipoprotein particle size and number provide an opportunity to better predict a healthy woman's chance of developing future diabetes, a type of early warning system. "Our finding suggests that these lipoprotein alterations may occur years before onset of overt hyperglycemia and clinical diagnosis of diabetes, providing a potential opportunity for the early detection and prevention of Type 2 diabetes and its complications."
Although standard laboratory tests can be used to measure the cholesterol and triglycerides carried by the particles, these tests do not provide a reliable indication of the number or size of the particles in the bloodstream. Particle number and size can be measured from a small blood specimen using another test (NMR), technology that has been used in research settings for over 40 years. More recently, NMR has been used in the clinical laboratory to determine particle number and size in the blood.
Samia Mora, M.D., and colleagues at Harvard Medical School and the Brigham and Women's Hospital used Nuclear Magnetic Resonance (NMR) to investigate the relationship of NMR-measured lipoproteins and the development of future Type 2 diabetes. The outcome of Dr. Mora's work showed that NMR-measured lipoprotein particles were associated with development of Type 2 diabetes, independent of other risk factors, particularly HDL-cholesterol and triglycerides measured by standard laboratory methods.
According to Dr. Mora, "Our findings indicate for the first time that even before the onset of clinical Type 2 diabetes, the size and number of the lipoprotein particles may indicate which women go on to develop future disease. This could provide an important opportunity for a woman with a normal blood glucose, but an abnormal NMR lipoprotein test result, to intervene early by following a healthy diet, losing weight, and increasing her physical activity level, all known ways to reduce her chance of developing diabetes even years before she gets a high glucose reading."
Doctors typically look for increases in glucose and triglycerides, and decreases in HDL cholesterol, to determine if a patient is becoming pre-diabetic. Even before changes in glucose levels are detectable, there are significant changes in the metabolism of cholesterol and triglycerides.
LDL "bad" cholesterol, HDL "good" cholesterol and triglycerides, are carried throughout the body inside molecules called lipoprotein particles. The particles travel into artery walls where they deposit the cholesterol, which forms artery-clogging plaque. Researchers wanted to know the significance of the particle size and number in apparently healthy individuals: could these readings predict future disease? Could they, in fact, predict who might develop Type 2 diabetes in time for early intervention?
The researchers conducted a study of 26,836 initially healthy women who were then followed for 13 years, during which 1,687 developed Type 2 diabetes. Dr. Mora noted, "Our study, which was conducted in a large population of healthy women, found that larger LDL and HDL particles were associated with lower risk and smaller LDL and HDL particles were associated with higher risk of diabetes. Even in women with normal triglyceride and HDL cholesterol measured by standard tests, having smaller LDL particles imparted higher risk of diabetes."
The team concluded that NMR-measured lipoprotein particle size and number provide an opportunity to better predict a healthy woman's chance of developing future diabetes, a type of early warning system. "Our finding suggests that these lipoprotein alterations may occur years before onset of overt hyperglycemia and clinical diagnosis of diabetes, providing a potential opportunity for the early detection and prevention of Type 2 diabetes and its complications."
Although standard laboratory tests can be used to measure the cholesterol and triglycerides carried by the particles, these tests do not provide a reliable indication of the number or size of the particles in the bloodstream. Particle number and size can be measured from a small blood specimen using another test (NMR), technology that has been used in research settings for over 40 years. More recently, NMR has been used in the clinical laboratory to determine particle number and size in the blood.
Tuesday, August 10, 2010
Foot Doctors Can Help Diabetics Avoid Amputation
Podiatrists detect conditions that might lead to limb loss, experts say.
FRIDAY, Aug. 6 (HealthDay News) -- Being treated by a podiatrist helps diabetes patients reduce their risk of amputation, research shows.
Podiatrists, also called podiatric physicians, are medical specialists of the foot, ankle and lower leg.
"More than half of all amputations in the U.S. are related to diabetes. Podiatrists are detecting conditions that can lead to amputation. That's just what we do," study co-author Dr. James Wrobel, an associate professor of medicine at Rosalind Franklin University of Medicine and Science in North Chicago, said in a university news release.
The study of nearly 29,000 diabetes patients, aged 18 to 64, found that those who had had at least one visit with a podiatrist prior to receiving a foot ulcer diagnosis had a lower risk of amputation and hospitalization (nearly 15 percent and 17 percent, respectively).
The study findings were presented in July at a meeting of the American Podiatric Medical Association in Seattle.
Complications related to diabetes are the leading cause of non-traumatic lower limb amputation in the United States and cost an estimated $3 billion a year, according to the Amputee Coalition of America. An estimated 24 million Americans have diabetes and 86,000 undergo amputations each year, based on information from the U.S. Centers for Disease Control and Prevention.
FRIDAY, Aug. 6 (HealthDay News) -- Being treated by a podiatrist helps diabetes patients reduce their risk of amputation, research shows.
Podiatrists, also called podiatric physicians, are medical specialists of the foot, ankle and lower leg.
"More than half of all amputations in the U.S. are related to diabetes. Podiatrists are detecting conditions that can lead to amputation. That's just what we do," study co-author Dr. James Wrobel, an associate professor of medicine at Rosalind Franklin University of Medicine and Science in North Chicago, said in a university news release.
The study of nearly 29,000 diabetes patients, aged 18 to 64, found that those who had had at least one visit with a podiatrist prior to receiving a foot ulcer diagnosis had a lower risk of amputation and hospitalization (nearly 15 percent and 17 percent, respectively).
The study findings were presented in July at a meeting of the American Podiatric Medical Association in Seattle.
Complications related to diabetes are the leading cause of non-traumatic lower limb amputation in the United States and cost an estimated $3 billion a year, according to the Amputee Coalition of America. An estimated 24 million Americans have diabetes and 86,000 undergo amputations each year, based on information from the U.S. Centers for Disease Control and Prevention.
Wednesday, June 16, 2010
Mental decline from diabetes can start in middle age
(Reuters Health) - Diabetes can lead to a decline in memory, thinking speed, and mental flexibility in middle age, but controlling the blood sugar disorder might prevent some of these effects, new research from the Netherlands suggests.
Health
While the mental decline may be invisible to the individual, the fact that the drop-off starts accumulating in middle age puts diabetics at greater risk later on because of reduced "brain reserves," Dr. David Knopman, of the Mayo Clinic in Rochester, Minnesota, told Reuters Health.
"Like a bicycle tire that's been partially deflated -- you'll be OK riding around but if you develop another little leak you'll be much closer to a flat tire much faster," said Knopman, who was not involved in the Dutch study.
Astrid Nooyens and colleagues at the National Institute for Public Health and the Environment in the Netherlands examined the health records and mental acuity scores of more than 2,600 men and women between the ages of 45 and 70 who enrolled in a large ongoing study into lifestyle effects on health.
At the five-year mark, of the 139 participants with type 2 diabetes, 61 were diabetics at the beginning of the study and 78 developed the chronic disease within the next five years.
The study confirmed the findings of earlier research, by Knopman and others, of an association between diabetes and declines in such mental functions as the ability to think quickly and recall words, but this is the first project to test memory and demonstrate how quickly the drop-off can occur.
Over a five-year period, decline in overall mental functioning in people with type 2 diabetes, while small, was nearly 3 times more pronounced than in non-diabetics.
But it didn't take many years for the impact to be felt. Even those who developed diabetes after beginning the study saw twice as much of a decline as their non-diabetic counterparts.
Compared to the "healthy" participants, participants who had long-term diabetes registered the largest declines in mental function. Those who developed diabetes during the trial saw less pronounced declines than their long-term counterparts in most areas except information processing, where they appeared to do a little better than the "healthy" people.
Type 2 diabetes is characterized by high blood sugar levels caused by the body's inability to process sugar properly. The illness can usually be controlled through diet and exercise but may also require drugs.
The Nooyens group found that while memory continues to decline for those with diabetes, the drop-off in thinking speed appears to occur in the first five years and then level off. That led the authors to suggest that early treatment and control of blood sugar levels could help thinking speed, but probably not memory, they note in the journal Diabetes Care.
The researchers found that for a small group of people who had lived with diabetes for nearly seven year, blood sugar levels did not explain the entire decline in mental function. In those people, they suspect other conditions related to diabetes such as high blood pressure and obesity.
The study did not look at whether patients with well-controlled diabetes experienced less mental decline compared to their poorly controlled counterparts, although the authors point out that there are other reasons, such as heart disease, to control sugar levels as well.
They also note that the random blood tests of both the long- and short-term diabetics suggested what treatment they were getting was "insufficient."
SOURCE: link.reuters.com/xyd69k Diabetes Care, online June 2, 2010
Health
While the mental decline may be invisible to the individual, the fact that the drop-off starts accumulating in middle age puts diabetics at greater risk later on because of reduced "brain reserves," Dr. David Knopman, of the Mayo Clinic in Rochester, Minnesota, told Reuters Health.
"Like a bicycle tire that's been partially deflated -- you'll be OK riding around but if you develop another little leak you'll be much closer to a flat tire much faster," said Knopman, who was not involved in the Dutch study.
Astrid Nooyens and colleagues at the National Institute for Public Health and the Environment in the Netherlands examined the health records and mental acuity scores of more than 2,600 men and women between the ages of 45 and 70 who enrolled in a large ongoing study into lifestyle effects on health.
At the five-year mark, of the 139 participants with type 2 diabetes, 61 were diabetics at the beginning of the study and 78 developed the chronic disease within the next five years.
The study confirmed the findings of earlier research, by Knopman and others, of an association between diabetes and declines in such mental functions as the ability to think quickly and recall words, but this is the first project to test memory and demonstrate how quickly the drop-off can occur.
Over a five-year period, decline in overall mental functioning in people with type 2 diabetes, while small, was nearly 3 times more pronounced than in non-diabetics.
But it didn't take many years for the impact to be felt. Even those who developed diabetes after beginning the study saw twice as much of a decline as their non-diabetic counterparts.
Compared to the "healthy" participants, participants who had long-term diabetes registered the largest declines in mental function. Those who developed diabetes during the trial saw less pronounced declines than their long-term counterparts in most areas except information processing, where they appeared to do a little better than the "healthy" people.
Type 2 diabetes is characterized by high blood sugar levels caused by the body's inability to process sugar properly. The illness can usually be controlled through diet and exercise but may also require drugs.
The Nooyens group found that while memory continues to decline for those with diabetes, the drop-off in thinking speed appears to occur in the first five years and then level off. That led the authors to suggest that early treatment and control of blood sugar levels could help thinking speed, but probably not memory, they note in the journal Diabetes Care.
The researchers found that for a small group of people who had lived with diabetes for nearly seven year, blood sugar levels did not explain the entire decline in mental function. In those people, they suspect other conditions related to diabetes such as high blood pressure and obesity.
The study did not look at whether patients with well-controlled diabetes experienced less mental decline compared to their poorly controlled counterparts, although the authors point out that there are other reasons, such as heart disease, to control sugar levels as well.
They also note that the random blood tests of both the long- and short-term diabetics suggested what treatment they were getting was "insufficient."
SOURCE: link.reuters.com/xyd69k Diabetes Care, online June 2, 2010
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