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
Thursday, May 12, 2011
Friday, April 29, 2011
Diabetes numbers rise, CDC says
The number of Americans who have type 2 diabetes has risen to nearly 26 million, federal officials announced today.
In addition, about 79 million U.S. adults have "prediabetes," a condition in which blood sugar levels are higher than normal but not high enough to be diagnosed as diabetes, according to the federal Centers for Disease Control and Prevention. Prediabetes raises a person's risk of type 2
diabetes, heart disease and stroke.
In 2008, CDC estimated that 23.6 million Americans had diabetes and an additional 57 million adults had prediabetes.
"These distressing numbers show how important it is to prevent type 2 diabetes and to help those who have diabetes manage the disease to prevent serious complications such as kidney failure and blindness," said the CDC's Ann Albright in a statement. "We know that a structured lifestyle program that includes losing weight and increasing physical activity can prevent or delay type 2 diabetes."
About 7 million Americans do not know they have the disease.
The increase was caused by a number of factors, including:
-- More people are developing diabetes. Obesity, which has been increasing, is a leading cause of diabetes.
-- Medical advances are enabling many people to live longer with diabetes.
-- A test known as hemoglobin A1c is now being used to diagnose diabetes.
Type 2 diabetes, which is most common form of the disease, occurs when the body gradually loses the ability to control blood sugar levels. Risk factors include older age, obesity, family history and being sedentary. African Americans, Hispanics and American Indians are among those at increased risk.
Diabetes is the seventh leading cause of death in the United States. People with diabetes are more likely to have heart attacks, strokes, high blood pressure, kidney failure, blindness and require amputations. Diabetes costs $174 billion annually, according to the CDC.
By Rob Stein
In addition, about 79 million U.S. adults have "prediabetes," a condition in which blood sugar levels are higher than normal but not high enough to be diagnosed as diabetes, according to the federal Centers for Disease Control and Prevention. Prediabetes raises a person's risk of type 2
diabetes, heart disease and stroke.
In 2008, CDC estimated that 23.6 million Americans had diabetes and an additional 57 million adults had prediabetes.
"These distressing numbers show how important it is to prevent type 2 diabetes and to help those who have diabetes manage the disease to prevent serious complications such as kidney failure and blindness," said the CDC's Ann Albright in a statement. "We know that a structured lifestyle program that includes losing weight and increasing physical activity can prevent or delay type 2 diabetes."
About 7 million Americans do not know they have the disease.
The increase was caused by a number of factors, including:
-- More people are developing diabetes. Obesity, which has been increasing, is a leading cause of diabetes.
-- Medical advances are enabling many people to live longer with diabetes.
-- A test known as hemoglobin A1c is now being used to diagnose diabetes.
Type 2 diabetes, which is most common form of the disease, occurs when the body gradually loses the ability to control blood sugar levels. Risk factors include older age, obesity, family history and being sedentary. African Americans, Hispanics and American Indians are among those at increased risk.
Diabetes is the seventh leading cause of death in the United States. People with diabetes are more likely to have heart attacks, strokes, high blood pressure, kidney failure, blindness and require amputations. Diabetes costs $174 billion annually, according to the CDC.
By Rob Stein
Wednesday, April 27, 2011
Cause of Blood Vessel Damage in People with Diabetes Discovered
Researchers have identified a key mechanism that appears to contribute to blood vessel damage in people with diabetes....
The researchers said studies in mice show that the damage appears to involve two enzymes, fatty acid synthase (FAS) and nitric oxide synthase (NOS) that interact in the cells that line blood vessel walls. First author Xiaochao Wei said, "We already knew that in diabetes there's a defect in the endothelial cells that line the blood vessels."
"People with diabetes also have depressed levels of fatty acid synthase. But this is the first time we've been able to link those observations together."
Wei studied mice that had been genetically engineered to make FAS in all of their tissues except the endothelial cells that line blood vessels. These so-called FASTie mice experienced problems in the vessels that were similar to those seen in animals with diabetes. "It turns out that there are strong parallels between the complete absence of FAS and the deficiencies in FAS induced by lack of insulin and by insulin resistance," said Clay F. Semenkovich, the Herbert S. Gasser Professor of Medicine, professor of cell biology and physiology and chief of the Division of Endocrinology, Metabolism and Lipid Research, Washington University in St. Louis, Missouri.
Comparing FASTie mice to normal animals, as well as to mice with diabetes, Wei and Semenkovich determined that mice without FAS, and with low levels of FAS, could not make the substance that anchors nitric oxide synthase to the endothelial cells in blood vessels. "We've known for many years that to have an effect, NOS has to be anchored to the wall of the vessel," Semenkovich said.
"Xiaochao discovered that fatty acid synthase preferentially makes a lipid that attaches to NOS, allowing it to hook to the cell membrane and to produce normal, healthy blood vessels." In the FASTie mice, blood vessels were leaky, and in cases when the vessel was injured, the mice were unable to generate new blood vessel growth.
The actual mechanism involved in binding NOS to the endothelial cells is called palmitoylation. Without FAS, the genetically engineered mice lose NOS palmitoylation and are unable to modify NOS so that it will interact with the endothelial cell membrane. That results in blood vessel problems.
It's a long way, however, from a mouse to a person, so the researchers next looked at human endothelial cells, and they found that a similar mechanism was at work.
"Our findings strongly suggest that if we can use a drug or another enzyme to promote fatty acid synthase activity, specifically in blood vessels, it might be helpful to patients with diabetes," Wei said.
Journal of Biological Chemistry. Jan. 2011
The researchers said studies in mice show that the damage appears to involve two enzymes, fatty acid synthase (FAS) and nitric oxide synthase (NOS) that interact in the cells that line blood vessel walls. First author Xiaochao Wei said, "We already knew that in diabetes there's a defect in the endothelial cells that line the blood vessels."
"People with diabetes also have depressed levels of fatty acid synthase. But this is the first time we've been able to link those observations together."
Wei studied mice that had been genetically engineered to make FAS in all of their tissues except the endothelial cells that line blood vessels. These so-called FASTie mice experienced problems in the vessels that were similar to those seen in animals with diabetes. "It turns out that there are strong parallels between the complete absence of FAS and the deficiencies in FAS induced by lack of insulin and by insulin resistance," said Clay F. Semenkovich, the Herbert S. Gasser Professor of Medicine, professor of cell biology and physiology and chief of the Division of Endocrinology, Metabolism and Lipid Research, Washington University in St. Louis, Missouri.
Comparing FASTie mice to normal animals, as well as to mice with diabetes, Wei and Semenkovich determined that mice without FAS, and with low levels of FAS, could not make the substance that anchors nitric oxide synthase to the endothelial cells in blood vessels. "We've known for many years that to have an effect, NOS has to be anchored to the wall of the vessel," Semenkovich said.
"Xiaochao discovered that fatty acid synthase preferentially makes a lipid that attaches to NOS, allowing it to hook to the cell membrane and to produce normal, healthy blood vessels." In the FASTie mice, blood vessels were leaky, and in cases when the vessel was injured, the mice were unable to generate new blood vessel growth.
The actual mechanism involved in binding NOS to the endothelial cells is called palmitoylation. Without FAS, the genetically engineered mice lose NOS palmitoylation and are unable to modify NOS so that it will interact with the endothelial cell membrane. That results in blood vessel problems.
It's a long way, however, from a mouse to a person, so the researchers next looked at human endothelial cells, and they found that a similar mechanism was at work.
"Our findings strongly suggest that if we can use a drug or another enzyme to promote fatty acid synthase activity, specifically in blood vessels, it might be helpful to patients with diabetes," Wei said.
Journal of Biological Chemistry. Jan. 2011
Tuesday, April 26, 2011
Understanding the 2010 Consensus Recommendations for Diabetic Foot Ulcer Care
Note to the Reader: These articles summarize the "Consensus Recommendations on Advancing the Standard of Care for Treating Neuropathic Foot Ulcers in Patients with Diabetes," authored by Robert J. Snyder et al., published as a supplement to Ostomy Wound Management in April 2010.
Published as a supplement to the April 2010 issue of Ostomy Wound Management was a pivotal reference paper titled, "Consensus Recommendations on Advancing the Standard of Care for Treating Neuropathic Foot Ulcers in Patients with Diabetes."1 The authors are a recognized group of leading experts in the field who convened the consensus panel.
The world's population with diabetes will increase from 171 million to 366 million by 2025.2 In the U.S., there are an estimated 24 million people with diabetes. Up to 25% of those with diabetes will develop a foot ulcer in their lifetimes.3 That translates roughly to 1-2% of the diabetic patients per year.
Diabetic foot ulcers (DFU) and lower extremity amputations (LEA) are a costly problem. In 2007, it was estimated that $30 billion was spent for the care of those two conditions.4
The recommendations from the consensus panel are important because they help to update the standard of care based on a review of 111 studies. The recommendations are divided into three categories: Assessment, Treatment, Advanced Therapies.
In this issue we will look at recommendations on assessment of the diabetic foot ulcer.
Recommendations on Assessment of the Diabetic Foot Ulcer
The team approach to assessment and management of the DFU is recognized as the standard of care. No physician "is an island", and the co-morbidities within the diabetic foot cross multiple physician disciplines. A thorough history should be performed. Since wound healing delays can occur with anemia, renal insufficiency, and uncontrolled blood sugar, a CBC and HbA1c should be performed at baseline. If osteomyelitis is suspected, erythrocyte sedimentation rate (ESR) and (CRP) should be ordered.
The patient's nutritional status should be assessed by history and serum pre-albumin. Historical concerns are unintentional weight loss, chronic alcohol use, and problems chewing or swallowing. Smoking is a risk factor for peripheral arterial disease (PAD) and delays wound healing. One should remember the four A's of smoking cessation: Ask about smoking, Advise to quit, offer Assistance, Arrange follow-up.
Neurologic screening should consist of 10 gram monofilament and 128-Hz tuning fork tests. Vascular evaluation is more complicated. There is no single test that can completely evaluate vascular health. Palpation of pulses or ante brachial index (ABI) cannot be relied upon in this population. The absence of pulses is a good indicator of poor flow, but the presence of pulses cannot rule out arterial insufficiency. The toe brachial index (TBI) is less susceptible to false readings due to diabetic arterial calcification. Skin perfusion pressure (SPP) measures capillary pressure in the skin and is very sensitive at uncovering vascular disease in diabetics as well as predicting wound healing. Transcutaneous oximetry (TCPO2) can validate referral for hyperbaric oxygen. Vascular imaging tests should be performed by an appropriate specialist if there is reasonable suspicion of underlying vascular disease.
The foot examination should include assessment of dermatologic changes, musculoskeletal deformities, and ulcer evaluation. Dermatologic changes can show inflammation by thermometry or thermography. Also, it can reveal ischemia by the presence of purpura, fat atrophy, loss of hair growth, or taut skin. The podiatrist is a key member of the team for understanding the biomechanical abnormalities that lead to ulceration. Range of motion of the ankle and first metatarsophalangeal joints should be assessed for restriction in dorsi-flexion. Inspect for deformities associated with Charcot joint disease.
Radiography is useful to help uncover osteomyelitis or deformities. The foot should be x-rayed at baseline and it is appropriate to perform bilateral x-rays for comparison.
The wound assessment and documentation includes size, depth, shape, probing, undermining, condition of the wound bed, and condition of the periwound area. One should use a standard wound classification scheme. The consensus panel recommends use of the University of Texas Classification.5
Infection is devastating to the diabetic foot and its evaluation is primarily clinical. Heat, redness, pain, and swelling are the classic symptoms. The diabetic neuropathic patient does not always exhibit all those signs, so one should be aware of secondary signs like exudate, delayed healing, discolored granulation tissue, and malodor. Culture should only be taken if the clinician suspects infection.
Published as a supplement to the April 2010 issue of Ostomy Wound Management was a pivotal reference paper titled, "Consensus Recommendations on Advancing the Standard of Care for Treating Neuropathic Foot Ulcers in Patients with Diabetes."1 The authors are a recognized group of leading experts in the field who convened the consensus panel.
The world's population with diabetes will increase from 171 million to 366 million by 2025.2 In the U.S., there are an estimated 24 million people with diabetes. Up to 25% of those with diabetes will develop a foot ulcer in their lifetimes.3 That translates roughly to 1-2% of the diabetic patients per year.
Diabetic foot ulcers (DFU) and lower extremity amputations (LEA) are a costly problem. In 2007, it was estimated that $30 billion was spent for the care of those two conditions.4
The recommendations from the consensus panel are important because they help to update the standard of care based on a review of 111 studies. The recommendations are divided into three categories: Assessment, Treatment, Advanced Therapies.
In this issue we will look at recommendations on assessment of the diabetic foot ulcer.
Recommendations on Assessment of the Diabetic Foot Ulcer
The team approach to assessment and management of the DFU is recognized as the standard of care. No physician "is an island", and the co-morbidities within the diabetic foot cross multiple physician disciplines. A thorough history should be performed. Since wound healing delays can occur with anemia, renal insufficiency, and uncontrolled blood sugar, a CBC and HbA1c should be performed at baseline. If osteomyelitis is suspected, erythrocyte sedimentation rate (ESR) and (CRP) should be ordered.
The patient's nutritional status should be assessed by history and serum pre-albumin. Historical concerns are unintentional weight loss, chronic alcohol use, and problems chewing or swallowing. Smoking is a risk factor for peripheral arterial disease (PAD) and delays wound healing. One should remember the four A's of smoking cessation: Ask about smoking, Advise to quit, offer Assistance, Arrange follow-up.
Neurologic screening should consist of 10 gram monofilament and 128-Hz tuning fork tests. Vascular evaluation is more complicated. There is no single test that can completely evaluate vascular health. Palpation of pulses or ante brachial index (ABI) cannot be relied upon in this population. The absence of pulses is a good indicator of poor flow, but the presence of pulses cannot rule out arterial insufficiency. The toe brachial index (TBI) is less susceptible to false readings due to diabetic arterial calcification. Skin perfusion pressure (SPP) measures capillary pressure in the skin and is very sensitive at uncovering vascular disease in diabetics as well as predicting wound healing. Transcutaneous oximetry (TCPO2) can validate referral for hyperbaric oxygen. Vascular imaging tests should be performed by an appropriate specialist if there is reasonable suspicion of underlying vascular disease.
The foot examination should include assessment of dermatologic changes, musculoskeletal deformities, and ulcer evaluation. Dermatologic changes can show inflammation by thermometry or thermography. Also, it can reveal ischemia by the presence of purpura, fat atrophy, loss of hair growth, or taut skin. The podiatrist is a key member of the team for understanding the biomechanical abnormalities that lead to ulceration. Range of motion of the ankle and first metatarsophalangeal joints should be assessed for restriction in dorsi-flexion. Inspect for deformities associated with Charcot joint disease.
Radiography is useful to help uncover osteomyelitis or deformities. The foot should be x-rayed at baseline and it is appropriate to perform bilateral x-rays for comparison.
The wound assessment and documentation includes size, depth, shape, probing, undermining, condition of the wound bed, and condition of the periwound area. One should use a standard wound classification scheme. The consensus panel recommends use of the University of Texas Classification.5
Infection is devastating to the diabetic foot and its evaluation is primarily clinical. Heat, redness, pain, and swelling are the classic symptoms. The diabetic neuropathic patient does not always exhibit all those signs, so one should be aware of secondary signs like exudate, delayed healing, discolored granulation tissue, and malodor. Culture should only be taken if the clinician suspects infection.
Saturday, April 23, 2011
Should I Be Concerned About Varicose Veins?
Q: I am 64 years old and have only recently started developing varicose veins in my legs. I'm using compression stockings, but they're uncomfortable during the warm months. What other options do I have to deal with them? Aside from the increased risk of a blood clot, do they pose any serious health risks? Will the varicose veins start to look worse as I get older?
A: Varicose veins can be very unpleasant, particularly from a cosmetic point of view. These enlarged and tortuous veins usually show up in the legs; they are subject to high pressure when you’re upright and therefore likely to be uncomfortable and perhaps even painful while you're standing or walking. Varicose veins can also sometimes itch, and scratching them can cause ulcers. Ulcers that infect your veins can lead to blood clots — this is a condition known as superficial thrombophlebitis and is usually isolated to superficial veins. In rare cases, these blood clots can extend into deep veins, becoming a more serious problem. Still, varicose veins very rarely bring on serious complications. More than anything else, they are considered to be a cosmetic problem, which, unfortunately, can worsen as you grow older.
One of the options you might wish to consider to reduce the appearance of your varicose veins is surgical intervention. Vein stripping is one particular surgical treatment that can help. There are also newer, less-invasive treatments such as ultrasound-guided foam sclerotherapy, radiofrequency ablation, and endovenous laser treatment, each of which has its own pros and cons. Nonsurgical treatment options include elastic stockings, elevating the legs, and exercise.
A: Varicose veins can be very unpleasant, particularly from a cosmetic point of view. These enlarged and tortuous veins usually show up in the legs; they are subject to high pressure when you’re upright and therefore likely to be uncomfortable and perhaps even painful while you're standing or walking. Varicose veins can also sometimes itch, and scratching them can cause ulcers. Ulcers that infect your veins can lead to blood clots — this is a condition known as superficial thrombophlebitis and is usually isolated to superficial veins. In rare cases, these blood clots can extend into deep veins, becoming a more serious problem. Still, varicose veins very rarely bring on serious complications. More than anything else, they are considered to be a cosmetic problem, which, unfortunately, can worsen as you grow older.
One of the options you might wish to consider to reduce the appearance of your varicose veins is surgical intervention. Vein stripping is one particular surgical treatment that can help. There are also newer, less-invasive treatments such as ultrasound-guided foam sclerotherapy, radiofrequency ablation, and endovenous laser treatment, each of which has its own pros and cons. Nonsurgical treatment options include elastic stockings, elevating the legs, and exercise.
Friday, April 22, 2011
Controlling Diabetes With Exercise
Exercise can be an effective way to get your blood sugar under control. Get motivated to start — and stick to — an exercise plan.
By Krisha McCoy, MS
Medically reviewed by Pat F. Bass III, MD, MPH Print Email Exercise is important for everyone, but it can be especially important for your health if you have diabetes. People who exercise regularly are better able to control their diabetes, thereby reducing their risk of diabetes complications.
Diabetes and Exercise: Why It’s Important to Stay Fit
If you have diabetes, you have an increased risk of developing certain health conditions, including heart attack, stroke, kidney disease, and nerve problems. By following your doctor's recommendations for keeping your blood glucose levels under control, you can reduce your risk of developing these complications.
Researchers have found that people who exercise regularly have:
Lower blood glucose levels
Lower blood pressure
Better cholesterol levels
Improved ability to use insulin
Decreased risk of stroke
Decreased risk of heart diseaseStronger bones
Less chance of falling
Easier weight loss
Less body fat
More energy
Reduced stress levels
In addition, if you use insulin to treat your diabetes, exercise can be part of the daily schedule that you and your diabetes health care team develop to control your blood glucose levels.
Diabetes and Exercise: Getting Started
Talk with your diabetes health care team before you begin an exercise program. They can help you design an exercise program that is safe and effective for you. Make sure to ask about any limitations. If you have heart disease, kidney disease, eye problems, or foot problems, there may be some physical activities that you should not do.
To get started with an exercise program:
Find physical activities you like. Choose activities that you enjoy doing and that are convenient. Try new activities, such as walking, dancing, swimming, or bicycling, until you find one you like.Schedule your workouts. Make exercise part of your schedule, just like work and doctor appointments. Aim to work out for at least half an hour on most or all days of the week.Slowly increase your time and intensity. Don't start out doing too much, or you may get burned out. Begin with just a few minutes, and add a little time, distance, or intensity to your workouts each week.Find an exercise partner. Ask a friend or neighbor to join you in your exercise plan. For many people, having a person who is counting on you will make you less likely to skip a workout. Keep a workout journal. Each time you exercise, write down what you did and what your blood glucose levels were. That way you can keep track of your progress and see how activity affects your diabetes control. Diabetes and Exercise: A Note about Hypoglycemia
Although exercise is an excellent way to help control your blood glucose levels, it is not without its risks. One of the most serious risks of exercising when you have diabetes is a condition called hypoglycemia.
With hypoglycemia, increased activity causes your blood glucose to fall to dangerously low levels. This can happen while you are exercising or even many hours later. Hypoglycemia can make you feel shaky, weak, and confused. If your blood glucose levels drop low enough, hypoglycemia could cause you to faint or have a seizure.
Talk with your doctor about strategies for preventing hypoglycemia. You may need to have a snack before you exercise or closely monitor your blood glucose levels before, during, and after exercising.
In addition to eating healthfully and taking insulin or other diabetes medications, exercise is a valuable tool for keeping you healthy. Commit to a regular exercise program, and you will not only have better control over your diabetes, but you will also gain more self-confidence and a better sense of well-being.
By Krisha McCoy, MS
Medically reviewed by Pat F. Bass III, MD, MPH Print Email Exercise is important for everyone, but it can be especially important for your health if you have diabetes. People who exercise regularly are better able to control their diabetes, thereby reducing their risk of diabetes complications.
Diabetes and Exercise: Why It’s Important to Stay Fit
If you have diabetes, you have an increased risk of developing certain health conditions, including heart attack, stroke, kidney disease, and nerve problems. By following your doctor's recommendations for keeping your blood glucose levels under control, you can reduce your risk of developing these complications.
Researchers have found that people who exercise regularly have:
Lower blood glucose levels
Lower blood pressure
Better cholesterol levels
Improved ability to use insulin
Decreased risk of stroke
Decreased risk of heart diseaseStronger bones
Less chance of falling
Easier weight loss
Less body fat
More energy
Reduced stress levels
In addition, if you use insulin to treat your diabetes, exercise can be part of the daily schedule that you and your diabetes health care team develop to control your blood glucose levels.
Diabetes and Exercise: Getting Started
Talk with your diabetes health care team before you begin an exercise program. They can help you design an exercise program that is safe and effective for you. Make sure to ask about any limitations. If you have heart disease, kidney disease, eye problems, or foot problems, there may be some physical activities that you should not do.
To get started with an exercise program:
Find physical activities you like. Choose activities that you enjoy doing and that are convenient. Try new activities, such as walking, dancing, swimming, or bicycling, until you find one you like.Schedule your workouts. Make exercise part of your schedule, just like work and doctor appointments. Aim to work out for at least half an hour on most or all days of the week.Slowly increase your time and intensity. Don't start out doing too much, or you may get burned out. Begin with just a few minutes, and add a little time, distance, or intensity to your workouts each week.Find an exercise partner. Ask a friend or neighbor to join you in your exercise plan. For many people, having a person who is counting on you will make you less likely to skip a workout. Keep a workout journal. Each time you exercise, write down what you did and what your blood glucose levels were. That way you can keep track of your progress and see how activity affects your diabetes control. Diabetes and Exercise: A Note about Hypoglycemia
Although exercise is an excellent way to help control your blood glucose levels, it is not without its risks. One of the most serious risks of exercising when you have diabetes is a condition called hypoglycemia.
With hypoglycemia, increased activity causes your blood glucose to fall to dangerously low levels. This can happen while you are exercising or even many hours later. Hypoglycemia can make you feel shaky, weak, and confused. If your blood glucose levels drop low enough, hypoglycemia could cause you to faint or have a seizure.
Talk with your doctor about strategies for preventing hypoglycemia. You may need to have a snack before you exercise or closely monitor your blood glucose levels before, during, and after exercising.
In addition to eating healthfully and taking insulin or other diabetes medications, exercise is a valuable tool for keeping you healthy. Commit to a regular exercise program, and you will not only have better control over your diabetes, but you will also gain more self-confidence and a better sense of well-being.
Tuesday, April 19, 2011
How to Reduce After Breakfast Blood Sugars 40%
A high-protein, low-carbohydrate snack before breakfast attenuates post-breakfast hyperglycemia....
Previous studies have shown a considerable reduction in hyperglycemia after the second meal of the day, provided that breakfast had been taken. The preservation of this effect in Type 2 diabetes was not confirmed until recently. Postprandial hyperglycemia acts as an independent risk factor for cardiovascular disease, a major cause of death in subjects with Type 2 diabetes. It was hypothesized that post-breakfast hyperglycemia in subjects with Type 2 diabetes could be improved non-pharmacologically by using a high-protein, low-carbohydrate prebreakfast snack.
Researchers studied 10 men and women with diet- and/or metformin-controlled Type 2 diabetes. Metabolic changes after breakfast were compared between 2 days: breakfast taken only and soya-yogurt snack taken prior to breakfast.
The results showed that there was a significant lower rise in plasma glucose on the snack day. The incremental area under the glucose curve was 450 ± 55 mmol · min/l on the snack day compared with 699 ± 99 mmol · min/l on the control day (P = 0.013). The concentration of plasma free fatty acids immediately before breakfast correlated with the increment in plasma glucose (r = 0.50, P = 0.013).
This study demonstrated for the first time that the provision of a practical, high-protein, low-carbohydrate snack prior to breakfast reduced by 40% the postprandial plasma glucose increment in people with Type 2 diabetes. These findings confirm a potent expression of the second-meal effect in people with Type 2 diabetes. The importance of the present observation is that a more practical means of improving glucose tolerance could potentially be of therapeutic benefit in people with Type 2 diabetes.
Researchers observed no effect of the prior snack on insulin secretion after breakfast. The mechanism underlying the second-meal effect has been shown to be due to suppression of plasma FFA, allowing greater storage of glucose as muscle glycogen. They had previously demonstrated a strong negative correlation between the decrease of preprandial plasma FFA levels and the postmeal glucose increment. In the present study, a significant positive correlation was found between prebreakfast plasma FFA and the rise in postprandial plasma glucose concentration.
The snack used in the present study was empirically designed. It will be important to optimize both the composition of the snack and the interval before breakfast to maximize the benefit of this approach. In everyday life, the gap between snack and breakfast would have to be accommodated, for instance, by delaying breakfast until mid-morning. Although the snack induced a small increase in plasma glucose, it was minimal and unlikely to contribute to the hyperglycemic burden. The sample size was dictated by prior power calculation (80% power with 10 subjects).
The study demonstrated that a high-protein, low-carbohydrate snack before breakfast attenuates postbreakfast hyperglycemia and further studies must determine whether long-term use is associated with improvement in A1c.
Previous studies have shown a considerable reduction in hyperglycemia after the second meal of the day, provided that breakfast had been taken. The preservation of this effect in Type 2 diabetes was not confirmed until recently. Postprandial hyperglycemia acts as an independent risk factor for cardiovascular disease, a major cause of death in subjects with Type 2 diabetes. It was hypothesized that post-breakfast hyperglycemia in subjects with Type 2 diabetes could be improved non-pharmacologically by using a high-protein, low-carbohydrate prebreakfast snack.
Researchers studied 10 men and women with diet- and/or metformin-controlled Type 2 diabetes. Metabolic changes after breakfast were compared between 2 days: breakfast taken only and soya-yogurt snack taken prior to breakfast.
The results showed that there was a significant lower rise in plasma glucose on the snack day. The incremental area under the glucose curve was 450 ± 55 mmol · min/l on the snack day compared with 699 ± 99 mmol · min/l on the control day (P = 0.013). The concentration of plasma free fatty acids immediately before breakfast correlated with the increment in plasma glucose (r = 0.50, P = 0.013).
This study demonstrated for the first time that the provision of a practical, high-protein, low-carbohydrate snack prior to breakfast reduced by 40% the postprandial plasma glucose increment in people with Type 2 diabetes. These findings confirm a potent expression of the second-meal effect in people with Type 2 diabetes. The importance of the present observation is that a more practical means of improving glucose tolerance could potentially be of therapeutic benefit in people with Type 2 diabetes.
Researchers observed no effect of the prior snack on insulin secretion after breakfast. The mechanism underlying the second-meal effect has been shown to be due to suppression of plasma FFA, allowing greater storage of glucose as muscle glycogen. They had previously demonstrated a strong negative correlation between the decrease of preprandial plasma FFA levels and the postmeal glucose increment. In the present study, a significant positive correlation was found between prebreakfast plasma FFA and the rise in postprandial plasma glucose concentration.
The snack used in the present study was empirically designed. It will be important to optimize both the composition of the snack and the interval before breakfast to maximize the benefit of this approach. In everyday life, the gap between snack and breakfast would have to be accommodated, for instance, by delaying breakfast until mid-morning. Although the snack induced a small increase in plasma glucose, it was minimal and unlikely to contribute to the hyperglycemic burden. The sample size was dictated by prior power calculation (80% power with 10 subjects).
The study demonstrated that a high-protein, low-carbohydrate snack before breakfast attenuates postbreakfast hyperglycemia and further studies must determine whether long-term use is associated with improvement in A1c.
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