Type 2 Diabetes Damages Teens' Brains
August 6, 2010
If you ever wondered if it was really important to protect your children from developing type 2 diabetes, you can stop. The definitive answer is in. Scientists in the department of psychiatry at New York University School of Medicine in New York City have found that obese adolescents with type 2 diabetes suffer from measurable and serious cognitive and brain impairments. They are less capable of reading, spelling, reasoning, controlling their impulses and organizing their environments than obese, non-diabetic peers.
"The findings are significant because they indicate that insulin resistance from obesity is lowering children's cognitive performance, which may be affecting their ability to perform well in school," says one of the study authors, Antonio Convit, M.D., professor of psychiatry and medicine at NYU Langone Medical Center and the Nathan S. Kline Institute for Psychiatric Research. And, the scientists report in the journal Diabetologia, this all happens rather quickly.
For the study, published in Diabetologia, the researchers studied 18 obese adolescents with diabetes type 2 and compared their brain and cognitive functioning to obese peers who did not have diabetes. Using MRI scans and other techniques the researchers found that the obese kids with type 2 diabetes had measurably lower volume of brain tissue in certain regions and that they had lowered ability in general intellectual thinking, verbal memory, executive functioning (the ability to organize their environment, problem solve and control their impulses) as well as reading and spelling.
Worse for Teens?
Interestingly, among middle-age adults with type 2 diabetes, researchers identified a reduction in verbal memory and intellectual capacity. But among the kids the deficits were more diverse and far-reaching.
"We have previously found brain abnormalities in adults with type 2 diabetes, but believed those changes might have been a result of vascular disease," says Dr. Convit,. "Now we see that subtle changes in white matter of the brain in adolescents may be a result of the abnormal physiology that accompanies type 2 diabetes. If we can improve insulin sensitivity and help children through exercise and weight loss, perhaps we can reverse these deficits."
How Teens Can Reduce Their Diabetes Risk
The National Diabetes Education Program offers the following tips to help teens get active and eat more healthily to reduce their diabetes risk:
Step Up Your Workout
- Set small goals at first. Don't get upset if you can't do a lot or if you get out of breath at first. Keep moving! Any amount of activity will help. Add more activity each week until you reach your goal.
- Aim for at least 60 minutes everyday. You don't have to do it all at once—20 minutes at a time, three times a day is okay, too. There are lots of ways to be active. Go for a walk, ride a bike, dance, play ball, or shoot hoops. Choose what you like best, then do it! If you are overweight, check with your doctor before you start a physical activity program.
- Be active every day. Physical activity should be part of your daily life. Play sports, take P.E. or dance, or other exercise classes—check out your local Y for some ideas. Get from place to place by walking or biking. Take the stairs whenever you can.
Eat Better
- Take your time when you eat. It takes about 15 minutes for your stomach to tell your brain that you are full. So, wait 15 minutes before eating second helpings.
- Do not skip meals. Eat breakfast, lunch, and dinner, plus a snack. You will have a ready supply of energy and not get too hungry.
- Have a good breakfast: try one or two slices of whole grain toast with a tablespoon of peanut butter, a hard-boiled egg, or a piece of low-fat cheese, along with a glass of low-fat or nonfat milk.
- Make lunch leaner: Have a sandwich with turkey or lean beef. Use mustard or a little low-fat mayonnaise.
- Snack wise: Try a small bowl of whole-grain cereal with low-fat or nonfat milk and a piece of fruit.
- Control your portions: Fill up half of your plate with salad or vegetables. Use small amounts of low-fat salad dressing, mayonnaise, or margarine.
Consider Medication
And talk to your doctor about the possibility that there are medical steps that may help with weight loss. One recent study in the Archives of Pediatrics and Adolescent Medicine found that obese teens without type 2 who took the diabetes drug metformin for a year lost weight (around 6 pounds) and reduced their body mass index, and once they stopped the medicine, kept it off for 3 to 6 months. The researchers said that, "metformin, in combination with lifestyle modification, had a small but statistically significant effect to reduce BMI in obese adolescents. These results indicate that metformin may have an important role in the treatment of adolescent obesity."
Sources: Diabetologia;
National Diabetes Education Program; and
Archives of Pediatrics and Adolescent Medicine
Diabetes Boosts Risk for Liver Disease
August 6, 2010
When it comes to diabetes-related health complications, liver disease was never on the list of things to worry about. But now researchers from St. Michael's Hospital in Toronto have conducted a ground-breaking study, published in the Canadian Medical Association journal, CMJA, that clearly demonstrates that people newly diagnosed with diabetes have a 77% increased risk of liver disease. And for all people with diabetes the rate of cirrhosis and liver failure is double that of people without the disease.
"Diabetes-related liver complications are about a third to a fifth as common as end-stage kidney disease or sight-threatening retinopathy, says study co-author, Gillian L. Booth, M.D., MSc, FRCP, associate professor, department of medicine, University of Toronto. There are important reasons why you shouldn't ignore it.
The liver has many vital functions—it acts as a filter of toxins and bacteria, as the producer of important chemicals that help blood clot and of bile that helps digest food. The liver also stores sugar and vitamins for later use by the body.
It appears that insulin resistance promotes so called fatty liver disease, in which fat deposits accumulate in the liver itself, eventually inhibiting it from doing its work. "When the liver fails there is no form of management that's equivalent to hemodialysis for kidney disease or retinal photocoagulation for retinopathy," says Dr. Booth.
Preventing Liver Disease
Some experts now think that people with diabetes, including the newly diagnosed, should have their liver enzymes tested annually to see if one in particular (alanine aminotransferase) is elevated. That can alert both patient and doctor to a potential problem.
But blood tests alone are not enough to protect the liver, cautions Booth and her colleagues: Weight loss and control of glucose levels and cholesterol (and other blood lipids, such as triglycerides) may prove to be the most important first steps in prevention and treatment. More study is needed, but at least now this most vital of organs will not be damaged by ignorance as much as by diabetes itself.
Depression, Emotions & Type 2 Diabetes—What Is the Connection?
July 7, 2010
Do emotions trigger type 2 diabetes? And does diabetes type 2 cause emotional problems? If the connections seem a bit unlikely, consider this: According to scientists from the Center of Research on Psychology in Somatic Diseases at Tilburg University in the Netherlands, "results of longitudinal studies suggest that not only depression but also general emotional stress and anxiety, sleeping problems, anger, and hostility are associated with an increased risk for the development of type 2 diabetes." Some but not all studies also indicate that childhood neglect, life events, and work stress may also contribute to the development of type 2.
As if that weren't enough, not only do you run the risk of getting type 2 if you are depressed or chronically stressed, you also have a greater chance of developing life-threatening diabetes-related health problems. In a second study, scientists from the Group Health Research Institute and the University of Washington in Seattle tracked rates of microvascular complications (blindness, end-stage kidney disease, amputations and kidney failure deaths) and macrovascular complications (heart attack, stroke, cardiovascular procedures and deaths) in participants with diabetes. They found that those with major depression had a 36 percent higher rate of diabetes-related microvascular complications and a 25 percent higher risk of macrovascular problems.
The diabetes-depression connection may work the other way as well: Diabetes may trigger depression and stress—and then depression and stress may worsen the effects of diabetes. This is a viscous cycle that you want to protect yourself from, according to William Polonsky, Ph.D., founder and director of the Diabetes Behavioral Institute in San Diego. He knows that managing diabetes can be demanding and overwhelming. For many people, it may become just too much. They get what he calls "diabetes burnout." This is characterized by uncontrolled blood sugar levels, the blues, anger and frustration. Polonsky advises that you seek prompt medical attention if you suspect you are depressed. For diabetes burnout and depression, build a support team to help you with diabetes management.
- Talk to your doctor about joining a diabetes support group.
- Ask those closest to you for support. But don’t let them become what Polonsky calls "the diabetes police." That may backfire and make you less willing to act positively.
- Use tools such as a food diary, an online medicine tracker or a pedometer, in addition to regular testing with a glucose monitor, to make management easier.
Sources: U.S. National Library of Medicine, National Institutes of Health; Discov Med. 2010 Feb;9(45):112-8. Does emotional stress cause type 2 diabetes mellitus? A review from the European Depression in Diabetes (EDID) Research Consortium.; Pouwer F, Kupper N, Adriaanse MC.; Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, Tilburg, Netherlands. F.Pouwer@uvt.nl; U.S. National Library of Medicine, National Institutes of Health; Diabetes Care. 2010 Feb;33(2):264-9. Epub 2009 Nov 23. Depression and advanced complications of diabetes: a prospective cohort study.; Lin EH, Rutter CM, Katon W, Heckbert SR, Ciechanowski P, Oliver MM, Ludman EJ, Young BA, Williams LH, McCulloch DK, Von Korff M.; and Group Health Research Institute, Group Health, Seattle, Washington, USA. lin.e@ghc.org
New Hope for Patients with Diabetic Macular Edema
July 7, 2010
Around 45% of Americans diagnosed with diabetes have some degree of diabetic retinopathy, a leading cause of blindness in adults in the United States. Diabetic retinopathy is a condition in which there is damage to the blood vessels in the retina. According to the National Eye Institute, "In some people with diabetic retinopathy, blood vessels may swell and leak fluid. In other people, abnormal new blood vessels grow on the surface of the retina. The retina is the light-sensitive tissue at the back of the eye. Over time, diabetic retinopathy can get worse and cause vision loss. Diabetic retinopathy usually affects both eyes."
Among those who develop retinopathy, 45% also develop diabetic macular edema (DME). In DME, fluid leaks into the center of the macula, the part of the eye where sharp, straight-ahead sight occurs, blurring vision. Now, the first new treatment for DME in 25 years has been identified. A monoclonal antibody called ranibizumab, originally developed to treat wet macular degeneration, appears to have great benefit. Fifty percent of those who received the medication, plus laser treatment if necessary, had substantial improvement in vision, compared with 28% of patients who received only laser treatment—the standard therapy.
The Diabetic Retinopathy Clinical Research Network, which published the research that identified the new treatment option, has also investigated other ways to improve vision when DME occurs. In the June issue of the journal Ophthalmology, they published the results of using a surgical procedure called vitrectomy to treat diabetic macular edema (DME). A vitrectomy removes the clear gel that fills the eye in front of the retina—called the vitreous—and replaces it with saline. They found that for a particular subset of patients (those with at least moderate vision loss and vitreomacular traction—a condition in which the vitreous gel has an abnormally strong adhesion to the retina, leading to retinal swelling and decreased vision), "retinal thickening was reduced in most eyes. Between 28 and 49 percent of eyes with characteristics similar to those included in this study are likely to have improvement of visual acuity, whereas between 13 and 31 percent are likely to have worsening." The operative complication rate is low and researchers recommend further study to see if this too is a good treatment option for DME.
Sources: U.S. National Library of Medicine, National Institutes of Health; U.S. National Library of Medicine, National Institutes of Health; and U.S. National Library of Medicine, National Institutes of Health
For Weight Loss, Portion Control Works
June 3, 2010
Will you give it a try?
The facts are shocking and the repercussion dreadful: 67% of Americans are obese or overweight, according to the Centers for Disease Control and Prevention. That's around 130 million people who face increased risks of heart disease, diabetes, cancer and dementia—to name just a few of the health problems linked to excess fat on the body.
This is a result of simple math—we take in more calories than we burn off. But how that happens turns out to not be all that simple. It is a matter of subtle and not so subtle changes in how we eat, where we eat, when we eat, what we eat, and how our brain perceives the food that is presented to us.
Looking for some relatively easy-to-apply ways to help folks lose weight, researchers have finally come up with a solution that works: Get control of portion-sizes! Weight-loss research published in the journal Obesity Research found that "although [there were] similar patterns of weight loss related to reduced dietary fat consumption, increased fruit and vegetable consumption, increased physical activity and increased planned exercise, the target behavior that induced the greatest weight loss was portion control."
Portion awareness, agrees Cornell University food psychologist and author of Mindless Eating, Brian Wansink, Ph.D., is what's needed to help us make healthier choices each and every time we put food into our mouths—something like 200 times a day he figures.
When our food comes supersized, we eat more than we would if it came in a smaller package—even if it's old and stale. In Wansink's often cited popcorn study, he gave one group of study participants fresh popcorn in oversize buckets and they ate 46% more than when it came in smaller containers. But taste didn't make much of a difference. Folks given 14-day-old stale popcorn ate 37% more of the bad tasting stuff when it was served in a larger bucket!
Fortunately, you can adjust the portion sizes you eat rather simply—without weighing and measuring food—if you adopt one of the "plate" methods.
The New American Plate is based on a method that's used in Europe. It involves simply dividing an 8- or 9-inch plate into thirds. Fill two-thirds of it with plant foods—vegetables, fruits, whole grains and beans. Then fill the remaining third with protein—seafood, red meat, or poultry.
With the Idaho Plate Method, you divide your plate into quarters, filling one half with non-starchy vegetables. Fill a quarter with grains or starchy vegetables and the remaining quarter with protein. A serving each of fruit and dairy go outside the plate.
Which is best? That depends. The Idaho Method is a little more defined, says Miriam Pappo, MS, RD, director of clinical nutrition at Montefiore Medical Center in New York City. And it may be easier to divide a plate into quarters, rather than thirds. But the New American Plate offers people a little more protein, which may boost satiety. Bottom line: "Either method is excellent for eating well," Pappos says.
Hot Dog Bites Back
June 3, 2010
Processed meats can raise your risk of heart disease and type 2 diabetes dramatically.
Deli sandwiches, piled with processed lunchmeats (excluding poultry), bacon and or sausage, are as bad for you as they are good tasting. And it turns out it is probably the preservatives, smoking and salt used in their production that are the culprits.
A new study from the Harvard School of Public Health (HSPH) shows that eating a daily serving of 1–2 slices of lunch meat or other processed foods (that is a really, really small portion of around 1.8 ounces!) is associated with a 42% higher risk of heart disease and a 19% higher risk of type 2 diabetes. Surprisingly, unprocessed meats (beef, pork, lamb) were not associated with any increased risk.
Researchers concluded: "This suggests that differences in salt and preservatives, rather than fats, might explain the higher risk of heart disease and diabetes seen with processed meats, but not with unprocessed red meats."
Doctors know that salt can increase blood pressure and laboratory studies have shown that nitrates (preservatives in processed meats) can increase circulatory disease and reduce glucose tolerance. But more research needs to be done to tease out the role that processed meats play in disease. For example, studies have found that eating more meat (both processed and unprocessed) is associated with higher risk of colorectal cancer, but unprocessed red meat has not been studied separately, so it could simply be the processed meats in those studies that were the culprits.
The conclusion? "To lower risk of heart attacks and diabetes, people should consider which types of meats they are eating. Processed meats such as bacon, salami, sausages, hot dogs and processed deli meats may be the most important to avoid," says Renata Micha, a research fellow in the department of epidemiology at HSPH and lead author of the study. "Based on our findings, eating one serving per week or less would be associated with relatively small risk."
New Treatment for Diabetic Eye Disease: Medication Doubles Chance of Improvement
May 5, 2010
Between 40–45% of Americans diagnosed with diabetes have some stage of diabetic retinopathy—the most common form of diabetic eye disease and a leading cause of blindness in American adults. Retinopathy is caused by the swelling and leaking of tiny blood vessels in the retina of the eye.
According to the National Eye Institute, there are four stages of diabetic retinopathy:
- Mild nonproliferative retinopathy. This is the earliest stage of retinopathy and it is characterized by small areas of balloon-like swelling in the retina's tiny blood vessels.
- Moderate nonproliferative retinopathy. In this advancing stage, the blood vessels that feed the retina become blocked.
- Severe nonproliferative retinopathy. This is characterized by the increase in blocked retinal blood vessels.
- Proliferative retinopathy is the most advanced stage of the disease, in which the blocked vessels cause the retina to grow new vessels to compensate. These new vessels are not hearty and they break, causing bleeds. When they leak blood, severe vision loss and even blindness can result.
Treatment Breakthrough
A second eye problem often accompanies retinopathy: diabetic macular edema (DME)—and it affects about 45% of those with retinopathy. In diabetic macular edema, fluid leaks into the center of the macula, the part of the eye where sharp, straight-ahead vision occurs. The macula then swells and vision becomes blurry. This can happen at any stage of diabetic retinopathy, but is most common as the disease worsens.
Now, the first new treatment for diabetic macular edema in 25 years has been identified. A monoclonal antibody called ranibizumad, originally developed to treat age-related wet macular degeneration, appears to have great benefit, according to a new study conducted by the Diabetic Retinopathy Clinical Research (DRCR) Network and published in the journal Ophthalmology.
Researchers studied 691 patients with DME and found that 50% of those who received ranibizumad eye injections (brand name Lucentis), plus laser treatment if necessary, had substantial improvement in their vision a year after they were treated, compared with 28% of patients who received only laser treatment. And the results held up after two years, as well.
This is a "seminal" study," says George A. Williams, M.D., chair of the ophthalmology department at Oakland University William Beaumont School of Medicine. "First and most importantly, it provides patients an improved therapy for diabetic macular edema. Second, the DRCR Network study is the first multi-center, randomized clinical trial to show how ranibizumab and the laser work together to improve treatment."
Stay tuned: The American Academy of Ophthalmology will review the study findings and make recommendations on whether Lucentis plus laser treatment should be the preferred treatment for a large number of patients with DME.
Searching for Diabetes in Youth—And Not Liking What They Find!
May 5, 2010
Researchers have uncovered a whole roster of risks to young people with type 2 diabetes. If you are in your 20s and have type 2 diabetes, you hold your future in your hands, suggest the experts from The Methodist Hospital in Houston.
Chances are you suffer from high blood pressure and have what is called "central obesity" (in men, a waist that is 40 inches around or greater and in women, a waist size of 35 inches or greater) and either high triglycerides (150+), insulin resistance or low HDL ("good") cholesterol levels. If that is you, by the time you are 40 you may well have a heart attack or stroke.
The profound risks of having early type 2 diabetes are being revealed by The SEARCH for Diabetes in Youth study. For example, one study found more than 10% of kids with type 2 diabetes are overweight and almost 80% are obese—which leads to a whole roster of health problems, not all related to diabetes.
Another part of the SEARCH initiative found that more than 27% of kids who are under the age of 20 and have type 2 diabetes have very poor glucose control. The many complications of diabetes—from nerve and kidney disease to vision problems and cardiovascular disease—are related to the effects of chronically high blood sugar levels.
But poor glucose control and obesity are not the only ways to damage your health. A third SEARCH research effort uncovered that fact that many kids with type 2 diabetes and poor control of their blood sugar levels also have dangerously high levels of total cholesterol (65%), LDL ("bad”" cholesterol (43%) and triglycerides (40%).
Outlining the risks, Dale J. Hamilton, diabetes clinical services chief at The Methodist Hospital explains: If you have high blood pressure, "central obesity," and either high triglycerides (150+), insulin resistance, or low HDL ("good") cholesterol levels—watch out! You need to take steps to reduce those risks and improve your quality of life today and in the future.
The good news is that you can do a lot to reverse these risks if you act now, and stay the course over the rest of your life. "Small changes every day can help curb big problems later on," Dale J. Hamilton, diabetes clinical services chief at The Methodist Hospital. "Losing five to 10 pounds will help lower blood pressure. Reducing saturated fats, carbohydrates, and eating about two-thirds the amount you eat now will help you lose weight around the middle. Walk 45 minutes a day instead of 30."
Protecting Your Heart
April 20, 2010
According to the American Heart Association, heart disease and stroke are the number one causes of death and disability among people with type 2 diabetes. At least 65% of people with diabetes die of some form of heart disease or stroke.
The Association is optimistic however, that you can reduce your risks dramatically. "You can," says the AHA, "avoid or delay heart and blood vessel disease by controlling your other risk factors."
Taking Control
Lifestyle measures can have a greater impact on preventing coronary heart disease and heart attacks than on practically any other disorder. More specifically, lifestyle changes can reduce elevated cholesterol levels—and the simplest change to make is to limit your intake of saturated fat.
Modify your fat intake
The National Cholesterol Education Program (NCEP) guidelines recommend reducing total fat to between 25 and 35% of total calories (most Americans take in 35 to 40% of calories from fat), with the majority of fat calories coming from mono- or polyunsaturated fat. Also advised is limiting the intake of saturated fat in order to reduce blood cholesterol levels—specifically LDL ("bad") cholesterol.
However, don't get too carried away: very-low-fat diets decrease heart-protective HDL cholesterol and increase triglyceride levels, whereas the moderate-fat diet recommended by the NCEP guidelines can help reduce triglycerides and raise HDL cholesterol, particularly in people with metabolic syndrome, a condition that markedly increases the risk of coronary heart disease and diabetes. (Metabolic syndrome is characterized by abnormally high blood sugar levels due to insulin resistance, accompanied by other factors that include abdominal obesity, high blood pressure, low levels of HDL cholesterol, and high levels of triglycerides.)
- Keep saturated fat intake to less than 7% of calories. Meats, poultry skin, and whole-milk dairy products contain the most saturated fat and thus should be limited in the diet.
- Get half your total fat intake from monounsaturated fats. These fats are particularly plentiful in olive oil, canola oil, almonds, walnuts, and avocados.
- Get less than 300 mg of dietary cholesterol per day, and less than 200 mg if you have elevated levels of LDL cholesterol.
- Eat fatty fish at least twice a week. Salmon, sardines, and albacore tuna are all good choices.
- Limit trans fats to less than 1% of total calories. Check food labels.
Remember that these recommendations need not be followed at each meal. It is more important to even out fat intake over the course of a week. If you eat a high-fat lunch, for example, you can compensate by eating a low-fat dinner or a little less fat than usual over the next several meals.
Recipe Bonus! Heart Healthy, Tasty and Fun to Prepare
April 20, 2010
If you are like most Americans, you eat out or use prepared food for the vast majority of your meals. Now, it may be convenient, but it's certainly expensive—and more importantly, generally unhealthy. And it is cutting down on your enjoyment of food, while expanding your waistline. According to a Pew Research Center survey, about six-in-ten Americans say they eat more than they should, either often (17%) or sometimes (42%). And a majority of us report that we eat more junk food than we should, either often (19%) or sometimes (36%). But we are having a good time eating. Ironically the heavier we are, the less we say we enjoy food or eating. The Pew survey found that among overweight adults, only 42% say they enjoy eating a great deal.
So how can you take charge of your diet, increase your enjoyment of food and shed extra pounds? By doing a little home cooking. Fortunately some of us are still pretty good cooks—and many of the rest of us have some interest in learning. About a third of the public (34%) say they enjoy cooking "a great deal" and another quarter (26%) say they enjoy cooking "a fair amount." So to help you return the joy of eating to your daily routine and improve your heart health, here are some recipes that your whole family will enjoy.
Herbed Cream of Tomato Soup
Makes 4 servings
To help give the soup a creamy texture, the recipe starts out with a roux, which is a combination of fat and flour. (Traditionally it would be butter, but we use olive oil instead.) When the roux is heated, the starch granules in the flour swell to thicken the soup.
1 teaspoon olive oil
2 tablespoons flour
1 1/2 cups tomato-vegetable juice
1 cup evaporated low-fat (2%) milk
1/2 cup chopped fresh basil
3/4 teaspoon tarragon
1/2 teaspoon salt
1/4 teaspoon pepper
1 can (15 ounces) crushed tomatoes
1/4 cup tomato paste
2 teaspoons light brown sugar
4 teaspoons reduced-fat sour cream
- In a large nonstick saucepan, heat the oil over medium heat. Add the flour and stir well to coat. Gradually stir in the tomato-vegetable juice and evaporated milk and cook, stirring constantly, until the mixture is smooth and slightly thickened, about 5 minutes.
- Stir in the basil, tarragon, salt, and pepper. Reduce the heat to low and stir in the crushed tomatoes, tomato paste, and brown sugar. Cover and simmer for 10 minutes, stirring occasionally, to develop the flavors and thicken the soup.
- Serve the soup topped with a dollop of the sour cream.
per serving: 167 calories, 3.4g total fat (1.4g saturated), 8mg cholesterol, 3g dietary fiber, 28g carbohydrate, 8g protein, 869mg sodium. good source of: calcium, lycopene, potassium, riboflavin, vitamin B6, vitamin C.
Green Beans with Fresh Tomatoes & Basil
Makes 4 servings
While these beans are delicious hot, they are equally good at room temperature or chilled. The vibrant green color of the beans may become somewhat duller, but the flavor will not suffer.
1 1/2 pounds green beans, halved crosswise on the diagonal
2 teaspoons olive oil
1 small red onion, halved and thinly sliced
3 cloves garlic, slivered
3/4 pound plum tomatoes, coarsely chopped
1/4 cup chopped fresh basil
1/2 teaspoon salt
1 tablespoon red wine vinegar
- In a vegetable steamer, steam the green beans until crisp-tender, 3 to 5 minutes.
- Meanwhile, in a large nonstick skillet, heat the oil over medium heat. Add the onion and garlic, and cook until the onion is soft, about 5 minutes.
- Add the tomatoes, basil, and salt, and bring to a boil. Add the beans and cook, stirring frequently, until the sauce is slightly reduced and the beans are tender, about 3 minutes. Stir in the vinegar.
per serving: 108 calories, 3.1g total fat (0.5g saturated), 0mg cholesterol, 7g dietary fiber, 20g carbohydrate, 4g protein, 305mg sodium. good source of: fiber, folate, magnesium, niacin, potassium, riboflavin, thiamin, vitamin B6, vitamin C.
Broiled Tuna with Mango Vinaigrette
Makes 4 servings
A nectar is a fruit juice that includes the fruit pulp and is invariably sweetened. It makes a nice basis for a quick, low-fat salad dressing. The yellow bell pepper is here because it has a mild, sweet flavor and contributes nice color to this dish, but you could just as easily use a red pepper.
3/4 pound tuna steak
3/4 teaspoon salt
2 cloves garlic
1/2 cup mango nectar
2 tablespoons red wine vinegar
1 tablespoon olive oil
3 tablespoons chopped fresh mint
1 1/2 cups canned pinto beans (rinsed and drained)
1 yellow bell pepper, diced
1 cup halved cherry tomatoes
3 scallions, thinly sliced
- Preheat the broiler. Sprinkle the tuna with 1/4 teaspoon of the salt. Broil the tuna 4 inches from the heat, turning once, for 7 minutes, or until the fish just flakes when tested with a fork. Set aside to cool, then cut into bite-size pieces.
- In a small pot of boiling water, cook the garlic for 2 minutes to blanch. Drain and finely chop.
- In a large bowl, combine the remaining 1/2 teaspoon salt, the garlic, mango nectar, vinegar, oil, and mint. Stir in the beans, bell pepper, tomatoes, and scallions, tossing to combine.
- Gently fold in the tuna and serve warm, at room temperature, or chilled.
per serving: 261 calories, 4.9g total fat (0.8g saturated), 41mg cholesterol, 7g dietary fiber, 27g carbohydrate, 28g protein, 479mg sodium. good source of: fiber, folate, niacin, omega-3 fatty acids, potassium, selenium, thiamin, vitamin B6, vitamin C.
Make Sure You Take Your Diabetes Medications
April 8, 2010
It can be overwhelming to manage a daily or weekly roster of medications: You may take oral drugs or insulin to control your diabetes, statins for high cholesterol, beta blockers for high blood pressure, a baby aspirin for your heart, and a smattering of vitamins, allergy pills, and who knows what else! According to a new report from the Center for Technology and Aging, 12% of older adults use 10 or more meds a week.
It's little wonder that people forget, skip, or mix up their medications with alarming frequency. And many studies have found that people make themselves sicker when they fail to follow their prescribed medication routines.
What can you do to help protect yourself from serious medication-related complications?
- Get organized. Set up pillboxes organized by day of the week or time of day.
- Ask the doctor if there is any way to reduce the number of doses you take or consolidate medications into one pill.
- Ask the doctor if it is possible to prescribe multiple medicines with matching time schedules. One study from the University of Missouri found this can make a significant difference in compliance.
- Ask your doctor for an annual medication review. Be sure you need to continue taking all your meds; discuss the difficulties you have with scheduling or remembering.
"If people are taking multiple medications on a regular basis, they need to have an annual check-up," says Rebecca Snead, executive vice president of the National Alliance of State Pharmacy Associations. In fact, she says, for patients on Medicare, "Those who are eligible will get a comprehensive medication review on an annual basis, starting [this year]. But even if it's not a covered benefit, you need to sit down and have a comprehensive medication review every year."
The Power of Orange Juice
April 8, 2010
How to Reduce Cardiovascular Inflammation
Ever wonder why it is so important to eat a low-fat and smart carb diet? Turns out that when you load your plate with fatty foods and processed carbohydrates, you are triggering chemical responses in the body that cause inflammation, damage the linings of your blood vessels, promote insulin resistance, and lead to heart disease—to name a few of the unhealthy results.
However, if you fall off your healthy-diet plan, you can ease the damage done by drinking orange juice! That's what researchers at the University of Buffalo discovered. Their study involved three groups of 10 normal-weight healthy men and women between the ages of 20 and 40. All the folks were given a hearty 900-calorie breakfast that consisted of an egg "muffin" sandwich, a sausage "muffin" sandwich, and a serving of hash browns. The meal contained 81 grams of carbohydrates, 51 grams of fat, and 32 grams protein. Then one group drank 300 calories of a not-from-concentrate orange juice while another had an equivalent amount of water and a third had a 300-calorie glucose drink. All participants were given 15 minutes to finish their food and drink. Blood samples were collected before the meal and at 1, 3 and 5 hours afterwards. There was no significant difference in inflammatory mediators among the groups before the meal.
The results were surprising. The people who had the OJ were tested and found to have an increase in inflammation (free radicals) of 42%, but the others saw a jump of 62 and 63%. The OJ also prevented a spike in a substance that interferes with insulin sensitivity—a key trigger of type 2 diabetes.
"These data emphasize that a high-fat, high-carbohydrate meal is profoundly and rapidly proinflammatory, and that this process occurs at the cellular and molecular level," says Paresh Dandona, M.D., distinguished professor of medicine, director of the Diabetes-Endocrinology Center of Western New York at Kaleida Health and senior author on the study. The doctor adds that such inflammation of the blood vessels is a basic trigger of atherosclerosis, and that inflammation may become permanent if a person eats such unhealthy meals frequently.
Discord or ACCORD? New Findings about Optimal Treatment for Type 2 Diabetes
March 18, 2010
Right after daylight savings time returned, new light was shed on the best ways to treat type 2 diabetes and its complications. The ACCORD (Action to Control Cardiovascular Risk in Diabetes) study and its various findings have shaken up the diabetes treatment world—at least a bit. The three papers relating to ACCORD that were published March 14, 2010 in the New England Journal of Medicine online at www.nejm.com are:
Here's a rundown of the content of each journal article from the ACCORD study, and what it means to you and your doctor as you work to establish your most effective and beneficial treatment regimen.
Combination Lipid Therapy: The goal was to determine the effectiveness of a combination therapy using a statin (in this case, simvastatin) and a fibrate (in this case fenofibrate, which is the generic name for medications designed to lower triglycerides) to reduce cardiovascular events such as stroke and heart attack, as compared to taking a statin alone.
More than 5,500 people participated and after almost 5 years, the researchers found that while there is a possible benefit for people who have a high triglyceride level and a low level of "good" HDL cholesterol, overall, "the combination of fenofibrate and simvastatin did not reduce the rate of fatal cardiovascular events, nonfatal myocardial infarction, or nonfatal stroke, as compared with simvastatin alone. These results do not support the routine use of combination therapy with fenofibrate and simvastatin to reduce cardiovascular risk in the majority of high-risk patients with type 2 diabetes."
If you are on a combination therapy, do not stop taking your medications until you discuss the potential benefits and the added risks of the treatment with your doctor.
Intensive Blood-Pressure Control: The goal of this part of the ACCORD study was to determine if people with high blood pressure who lowered it to a systolic pressure of 120 mm Hg had fewer nonfatal heart attacks, nonfatal strokes or fatal cardiovascular events than people who lowered their systolic blood pressure to 140 mm Hg. (Systolic blood pressure is the pressure exerted on the vascular system when the heart contracts; it is the top number in a blood pressure reading such as 120 over 90).
A total of 4,733 participants were followed for a little less than 5 years. Researchers found that lowering blood pressure to normal levels (that is 120)—below currently recommended level of less than 130 for people with diabetes—"did not significantly reduce the combined risk of fatal or nonfatal cardiovascular disease events in adults with type 2 diabetes who were at especially high risk for cardiovascular disease events." And as significant, the scientists found that among the group using intensive therapy to lower their blood pressure to 120, "serious adverse events that were attributed to blood-pressure medication were more frequent."
Risk-Factor Control: The ACCORD study is now over, and while its initial findings are significant, over time researchers will tease out more and more information from the data. Combined with the knowledge from two other large scale studies it can reshape our knowledge of how to best treat type 2 diabetes.
The bottom line, researchers propose, is the ACCORD shows that doctor and patients should establish flexible goals for controlling diabetes that take into account each person's individual health issues and strengths. They also addressed the confusion around the earlier-released ACCORD findings that indicated that aggressive treatment to lower A1Cs to 6% might increase fatal events. "A previous study by the ACCORD investigators," they wrote, "concluded that a strategy of intensified glycemic control was associated with an increased risk of death. However, a recent meta-analysis did not confirm such an increase in risk, and the role of intensified glycemic control has been a subject of debate. In this issue of the Journal, the joint publication of the ACCORD blood pressure trial (and the ACCORD lipid trial although not resolving this issue, makes the picture of diabetes management more complete."
That means it has never been more important to talk with your doctor about your treatment plan and to take the time to fully understand the medications you take and how they work.
Coffee and Diabetes: What Is the Connection?
March 9, 2010
To unravel the sometimes-confusing information that researchers have found on drinking coffee, tea and decaf, here's a look at some recent studies and what they may mean for your health.
Coffee: The Pros
Sharper Focus and Heart Health: You may think that coffee's benefits are limited to waking you up and sharpening your focus—at least that's what several studies have shown. But new research out of Germany, published in the American Journal of Clinical Nutrition, has found that caffeine intake can significantly improve your levels of HDL "good" cholesterol and improve the ratio of HDL to LDL "bad" cholesterol, both significant ways to improve cardiovascular health and reduce the possibility of heart disease or heart attacks—the number one killers of people with diabetes. (What they looked for and did not find was any indication that drinking coffee is helpful for controlling blood glucose levels.) The study, incidentally, was paid for by a consortium of European coffee companies.
Another study of more than 130,000 men and women conducted by Kaiser Permanente and presented at the American Heart Association's Conference on Cardiovascular Disease Epidemiology and Prevention, March 2, 2010, found that people who drank four or more cups of coffee a day had an 18% lower risk of being hospitalized for heart rhythm problems (arrhythmia) and those drinking one to three cups a day cut their risk by 7%. Lead author, Arthur Klatsky, M.D., senior consultant in cardiology at the Kaiser Permanente Medical Care Program said, "These data should be reassuring to people who drink moderate amounts of coffee that their habit is not likely to cause a rhythm disturbance." And, he pointed out, while the study does not mean that people should drink coffee to prevent rhythm problems, "it does support the idea that people who are at risk for rhythm problems or who have rhythm problems do not need to abstain from coffee."
Preventing Diabetes: Other research shows that coffee can significantly reduce the chance that you will develop diabetes, if you do not yet have prediabetes. The European Prospective Investigation into Cancer and Nutrition, which looked at more than 60,000 French women for more than a decade and was also published in the American Journal of Clinical Nutrition, found that drinking coffee with lunch correlated strongly with reducing the incidence of type 2 diabetes in study participants. This is on the heels of a University of Sydney report published in the Archives of Internal Medicine in December 2009 that found tea, coffee, and decaf coffee all reduced the risk of diabetes. In that study, each additional cup of coffee that a person drank reduced the risk of developing diabetes by 7%; and if you take in three to four cups a day, then the risk is slashed by an astounding 25%. Decaf coffee also proved even more beneficial: Three to four cups a day reduce the risk by 33%. For tea, drinking three to four cups a day reduced risk of type 2 diabetes by 20%.
Coffee: The Cons
Spiking Blood Sugar Levels: Among those with type 2 diabetes, a small study from Duke University from 2008, indicated that caffeine may cause blood sugar to spike a couple of hours after it is consumed. On days the study participants were given caffeine pills (250 mg, or the equivalent of about 2½ cups of regular coffee; decaf has less than 6 mg of caffeine per cup) their blood glucose levels went up 8% higher than on days when they had no caffeine. And after every meal their blood sugar spiked higher than it did on the days they had no caffeine. The lead researcher James D. Lane, Ph.D., described the results as clinically significant, and said caffeine seemed to raise glucose levels by as much as oral medications lowered it.
So what to do? It is confusing: For those without diabetes, coffee may prevent the development of the disease, and for those with diabetes, coffee may make it harder to control. But various researchers have speculated that it is not the caffeine that makes coffee protective for diabetes, but it is the substance that promotes insulin resistance. That's why decaf is more protective against diabetes than regular coffee and why researchers feel pretty sure that other substances in the coffee, yet to be identified, are what are healthful in various ways.
Are My Oral Type 2 Diabetes Medications Heart-Safe?
March 9, 2010
After a two year inquiry into the safety of the type 2 diabetes drug rosiglitazone to determine if it increased the risk of heart problems, the U.S. Senate Finance Committee issued their findings highlighting potential health risks. The report was developed over the last two years by committee investigators who reviewed more than 250,000 pages of documents provided by the drug's manufacturer, the FDA, and several research institutes. The report can be found at www.finance.senate.gov.
But what does that mean for you, the person dutifully taking what your doctor prescribes, and facing potential risks?
The American Heart Association issued the following guidelines after the Senate Committee's report.
- Consult with your physicians on any matters concerning risk factors you may have for heart disease and stroke, such as diabetes.
- In managing your diabetes, "focus on glycemic (blood sugar) control keeping your HbA1c levels below 7.0 to reduce the risk of the 'microvascular' complications of diabetes, such as kidney failure, painful nerve problems, and decreased vision or even blindness."
- The AHA states that any diabetes management program should be founded on a healthy diet and physical activity as well as healthful control of blood pressure and cholesterol and triglycerides. The AHA also adds: "An aspirin regimen should be used under the advice of a physician in patients who have known cardiovascular disease due to atherosclerosis."
- They then recommend that the type 2 oral medication metformin should "generally be the first choice, particularly in obese patients." Other medications should be used if a person cannot get their A1Cs down to satisfactory levels.
- They go on to add that, "if a thiazolidinediones (TZD), such as pioglitazone or rosiglitazone, is prescribed, it should not be used with an expectation of benefit in reducing the occurrence of heart attack or stroke, and the rationale for the choice of a TZD should be discussed with your physician. However, patients who have successfully achieved recommended HbA1c control on a TZD might consider remaining on their medication. If the treating physician and/or the patient are uncomfortable with using a TZD, another medication could be substituted. There is currently not enough data to support the choice of a specific TZD."
Type 2 Diabetes Drug Alert
February 24, 2010
A safety review notice was issued by the Food and Drug Administration (FDA) on February 23 about rosiglitazone, a drug used in several popular oral diabetes medications—Avandia®, Avandamet®, and Avandaryl®—to increase the body's sensitivity to insulin. But it has been suspected of triggering potentially fatal cardiovascular problems for several years. In 2007, Steve E. Nissen, M.D., chairman of the department of cardiovascular medicine at the Cleveland Clinic published a New England Journal of Medicine study that concluded "rosiglitazone was associated with a significant increase in the risk of myocardial infarction [heart attack]… patients and providers should consider the potential for serious adverse cardiovascular effects of treatment with rosiglitazone for type 2 diabetes." And the same year, the Food in Drug Administration issued a safety alert about a possible association between rosiglitazone and increased heart-related risk.
What was known then, according to the National Library of Medicine, was that the drug "may cause fluid retention that may lead to or worsen congestive heart failure (condition in which the heart is unable to pump enough blood to the other parts of the body)." They advise, in their Medline Plus online article, that "before you start to take rosiglitazone, tell your doctor if you have or have ever had congestive heart failure, especially if your heart failure is so severe that you must limit your activity and are only comfortable when you are at rest or you must remain in a chair or bed. Also tell your doctor if you were born with a heart defect, and if you have or have ever had swelling of the arms, hands, feet, ankles, or lower legs; heart disease, high blood pressure; coronary artery disease (narrowing of the blood vessels that lead to the heart); a heart attack; an irregular heartbeat; or high cholesterol or fats in the blood. Your doctor may tell you not to take rosiglitazone or may monitor you carefully during your treatment."
"If you develop congestive heart failure or other heart problems, you may experience certain symptoms. Tell your doctor immediately if you have any of the following symptoms, especially when you first start taking rosiglitazone or after your dose is increased: large weight gain in a short period of time; shortness of breath; swelling of the arms, hands, feet, ankles, or lower legs; swelling or pain in the stomach; waking up short of breath during the night; the need to sleep with extra pillows in order to breathe while lying down; frequent dry cough; or increased tiredness."
Now that the FDA has issued another notice of a safety review, people are feeling increased concern about taking rosiglitazone. This is what is current as of the last week of February 2010: The drug has not been pulled off the shelves. The FDA is currently reviewing scientific information that they received in August of 2009 from RECORD, a large, long-term study on the possible heart-attack related risks of rosiglitazone. The review will be completed in July of this year.
The FDA's current advice for anyone taking the drug is:
- Don't stop taking your medication without talking with your health care professional.
- Discuss any questions or concerns you have about rosiglitazone with your health care professional.
- Read the Medication Guide that comes with each rosiglitazone prescription to better understand the risks and benefits of your medication.
- Report any side effects with rosiglitazone to FDA's MedWatch program either online, by regular mail, by fax, or by phone.
- fda.gov/Safety/MedWatch/
- Regular Mail: Use postage-paid, pre-addressed FDA form 3500
- Fax: 1.800.FDA.0178
- Phone: 1.800.332.1088
Against the Grain
February 24, 2010
We have all been told that whole wheat is good for us—in fact, it is touted as the best choice when it comes to bread. Its high fiber content helps control blood sugar levels and is good for the digestive system, not to mention that it contains minerals and vitamins lost when grains are refined. But new research indicates that white rye flour, made from the inner, white part of the rye kernel, leads to better insulin and blood sugar levels compared to regular wheat flour and rye bran.
According to says Liza Rosén, a doctoral candidate in Applied Nutrition and Food Chemistry at Sweden's Lund University Faculty of Engineering who led the study, people who ate a breakfast of boiled rye kernels ate 16% fewer calories for lunch than those who ate breakfast bread made from white flour. "Since rye has been shown to yield low insulin responses, I started [my research] with that," says Rosén. "A high insulin response can lead to insulin resistance so that the body has a hard time responding to insulin. Insulin resistance can result in high blood sugar, high blood pressure, and bad blood fats, which in turn increase the risk of age-related diabetes and cardiovascular diseases."
Wheat prompts a higher insulin response than rye, Rosén says, because "rye contains more soluble fibers than wheat [and] they probably prevent the uptake of fat and other nutritional substances in the intestine."
Depression and Diabetes
February 12, 2010
If you suffer from type 2 diabetes and major depression, you are at seriously increased risk for life-threatening health problems. That's the conclusions of Washington state researchers in this month's issue of the journal Diabetes Care. Looking at more than 4,600 people, they found that those who had diabetes but were not depressed fared far better than those who suffered from both diabetes and depression. For that group, the danger of kidney failure and retinopathy leading to blindness increased 36% and the risk of a heart attack climbed 25%.
Why is diabetes and depression such a dangerous combination? It is true that diabetes patients with major depression tend to:
- be slightly younger and heavier,
- have more co-existing medical conditions,
- be more likely to be treated with insulin, and
- are more often women and more often smokers.
Even more significantly, people who have type 2 diabetes and are depressed also tend to have higher levels of a certain substance in the blood that is formed when blood sugar molecules attach to hemoglobin, an oxygen-carrying protein the red blood cells.
However, after taking these differences between depressed and non-depressed people with type 2 diabetes into account, the folks who suffer from depression are still at increased risk of kidney failure and heart attacks.
These findings come on the heels of a 2008 University of Washington study that found that among older people with diabetes who were on Medicare, depression was associated with a higher death rate from all causes during a two-year study period. Writing in the Journal of General Internal Medicine, lead author Wayne Katon, M.D., professor of psychiatry and behavioral sciences, noted that previous research indicates that depression and diabetes is a potentially lethal mix among young to middle-aged patients. Depression also puts patients at greater risk of complications from their diabetes.
The researchers found that people with both diabetes and depression had an increased risk of about 36% to 38% of dying from any cause during their two-year follow-up of all participants. A total of 12.1% of study participants who had both diabetes and depression died during that period. Among those without depression, 10.4% died.
One interesting change between this study group and those in the more recent survey: There was no difference in the rate of cardiovascular or cerebrovascular events (such as heart attack or stroke) between those people treated with antidepressants and those who had no indication of depression.
"Rates of mortality from vascular disease may be decreasing in recent years among patients with diabetes due to more aggressive treatment of high blood pressure, cholesterol, and glucose levels," the researchers surmised, "as well as widespread use of preventative medications such as aspirin and beta blockers."
Osteoporosis and Diabetes: Another One-Two Punch
February 12, 2010
Women with type 2 diabetes should talk to their doctor about their increased risk for bone fractures and osteoporosis—if they also take the much-prescribed oral diabetes medications known as TZDs (thiazolidinediones). TZDs include:
These drugs decrease insulin resistance and increase cells' insulin sensitivity. TZDs also cut down on the amount of glucose made by the liver in patients with type 2 diabetes.
A recent study published in The Journal of Clinical Endocrinology & Metabolism revealed the association between TZDs and bone loss: Women older than 65 were shown to have a 70% increased risk for developing fractures and younger women had a 50% increase in the risk.
The researchers from Detroit's Center for Health Services Research and Department of Internal Medicine at Henry Ford Hospital did not observe this association for men, "despite having nearly equal numbers of men and women in our study," says study co-author Zeina A. Habib, M.D.
To determine the relationship between TZD use and fracture risk in people with type 2 diabetes, the researchers followed 9,620 women and 9,450 men for seven years.
During the study period, 4,511 patients had at least one prescription fill for a TZD. The increased risk of bone fracture in women appeared after approximately one year of TZD use.
The bone breaks appeared in unusual locations: Typically, osteoporosis-related fractures involve the vertebra and hip. This study, however, found TZD use in women to be associated with fractures of the neck, thigh, leg and foot.
"Fractures are just one of a growing number of problems associated with these medications. Henry Ford and other researchers have previously found that this class of medications also can increase risk of congestive heart failure hospitalization," says study senior author L. Keoki Williams, M.D., MPH, who is affiliated with the Center for Health Services Research and Department of Internal Medicine at Henry Ford Hospital.
Dr. Williams notes that there are other medication options available to treat insulin resistance in patients with type 2 diabetes. "TZDs may put some patients at increased risk for other health issues, and I encourage patients to talk with their physician about other suitable options," says Dr. Williams. "If the physician feels the patient should be placed on a TZD, routine screening for bone loss and prophylactic therapy to prevent bone loss and fractures may also be needed."
On the Road—with Diabetes
January 27, 2010
Traveling with diabetes requires preplanning and careful management of medications and supplies—plus extra attention to your blood sugar levels, which can be affected by stress, changing sleep patterns, and erratic eating schedules. But there is no reason why an adult or child with type 1 or type 2 diabetes cannot enjoy a trip to grandma's, or around the world.
To help you get through the airport, adjust medication schedules, and feel your best, here are some tips.
Airport Security: Running the Gauntlet
- If you are going to be passing through airport security, obtain a signed letter from your doctor indicating that you have diabetes and that you need to carry insulin, syringes, pumps and/or lancets.
- All medication must have the original labels with the name on it that matches the passenger's ticket.
- You need a written prescription from your doctor for each item that you are transporting. You will have to obtain extra ones from your physician, since you will have surrendered the original to the pharmacist to have the prescription filled. You will also need prescriptions for continuous glucose monitors, standard glucose monitors, insulin pumps, glucagons shots, syringes, etc.
- Have syringes and vials of insulin in their original packaging and with a prescription. Even if you use an insulin pump, be sure to bring back-up insulin and syringes. Advise screeners that pumps cannot be removed because they are attached to a catheter under your skin. Manufacturers say that screening technologies do not harm the pump; but many people prefer visual inspections—be aware that it will increase your time in screening.
- Know what is and isn't allowed by TSA (Transportation Safety Administration) guidelines: Prescription medicine with a name that matches the passenger's ticket, up to 8 oz. of liquid (insulin) or low blood sugar treatment gel, and up to 4 oz. of non-prescription liquid medications are permitted. If you need to bring more than the allowed amount for carry-on, pack them in your checked luggage. Checked baggage may be subjected to cold temperatures, so be sure to carefully insulate any insulin bottles. Inspect the insulin after you arrive for crystallization or cloudiness. If you suspect that the insulin may be spoiled, discard the bottle and do not use it.
Adjusting Your Medication Schedule
- Before you head out for a car trip or an excursion by air, talk with your doctor about how travel may affect your diabetes management. Traveling can change your eating routine, your medication schedule, and your sleep patterns—all of which can raise or lower your blood sugar levels to an unhealthy point.
- Zoning out: Ask your doctor how changes in time zones may affect your medication schedule. On oral medications: With most pills, you gradually can change the time you take them. But if medications must be taken at a specific time—say, before meals—you have to adjust your schedule to the new clocks. On insulin: If you are on long-acting and short-acting insulin, test frequently and take short-acting insulin before every meal, whatever the time. Test and adjust insulin doses if your blood sugar is fluctuating.
- Pump it up: If you are on an insulin pump, you must work with the doctor to adjust the dosing schedule to suit your glucose control needs and the time zone. For short trips you may be able to stay with your routine, but much depends on your eating and sleeping patterns and how dramatically they change.
- Meal time: As you pass through time zones, or are shuttled around in airports without time to eat, you need to keep careful tables on your blood sugar levels and have plenty of emergency snacks and glucagon available. You also have to schedule time to get food in airports between flights: if that means you need to take longer to get to your destination, so be it.
A 2007 study in the journal Paediatric Child Health found that "insulin dosing may need to be adjusted if time zones are crossed during flight. When traveling east, the day is shortened and, if it is shortened by more than 2 hours, it may be necessary to decrease the amount of intermediate- or long-acting insulin [you take]. Conversely, if [traveling west and] the day is lengthened by more than 2 hours, more units of insulin may be needed." Once the flight is over, you then have to calculate a new pattern of medicating yourself so you don't overdose or underdose. Check blood sugar levels frequently.
High Blood Pressure & Diabetes: A Dangerous Duo
January 27, 2010
High blood pressure is a problem affecting up to 66% of adults with diabetes. But, unfortunately, hypertension rarely has symptoms. That's why the American Diabetes Association recommends that you have your blood pressure checked at the doctor's office two to four times a year. If your blood pressure is even slightly elevated, you increase your risk of eye, kidney and heart problems.
People with diabetes should aim for blood pressure readings of 130/80 or less. The first number is called systolic pressure and signifies the pressure as your heart pushes blood through the blood vessels. The second number, diastolic pressure, signifies the pressure when the vessels relax between heartbeats.
How Can You Control your Blood Pressure?
Medications and lifestyle changes can have a powerful effect on elevated blood pressure and reduce your risk of serious complications such as heart attack and stroke. Lifestyle remedies include modifying your diet, exercising more, quitting smoking, losing weight, reducing stress, and drinking alcohol moderately.
The wise food choices you can make are:
- Eat one or two servings of vegetables at lunch and at dinner. Eat fruit (take into account how it affects your glucose levels and pick the higher fiber, lower sugar fruits, such as blackberries, when possible).
- Switch to low-fat or fat-free dairy products (such as low-fat cheese and skim milk).
- Eat whole-grain breads (such as whole-wheat bread) and cereals.
- Choose lean meats and meat substitutes in place of red meat and prepared or sandwich meats.
- Bake, broil, roast or grill meats; steam vegetables. Avoid all fried foods.
- Add little or no salt to your food. Use spices and herbs for flavoring in place of fat. Avoid packaged foods with a high sodium content.
Exercise alternatives:
- Talk with your doctor about the kinds of physical activity that will be safe and good for you. Then aim for at least 30 minutes a day most days of the week. Walking is a great healthy routine as are cycling, yoga, and swimming.
Reduce your alcohol intake:
- Your blood pressure doesn’t appreciate your drinking! But if you do drink alcohol, limit yourself to one drink a day for women and two a day for men.
Quit smoking:
- Think heart. Elevated blood pressure puts a strain on it; smoking clogs up the blood vessels. The combination is lethal. Do we need to say more? Talk with your health care team about methods that can help.
Several types of blood pressure medications are available. Below the main ones recommended for people with diabetes. Other medications, such as thiazide diuretics, which may elevate blood sugar levels, and beta blockers, which can mask the symptoms of hypoglycemia, are not recommended for people with diabetes.
- ACE (angiotensin-converting enzyme) inhibitors are recommended for people with diabetes and high blood pressure because they seem to lower the pressure and protect against kidney disease and other diabetes-blood vessel-associated complications.
- ARBs (angiotensin II receptor blockers) also keep the blood vessels open and relaxed to help lower blood pressure. Like ACE inhibitors, ARBs protect your kidneys.
- Diuretics: so called "water pills," help rid your body of extra water and sodium through urine, which decreases blood volume and lowers pressure in the blood vessels.
Type 2 Diabetes Control Tricks and Tips
January 13, 2010
After 18 weeks of sticking with a low-glycemic diet—that is, substituting carbohydrates that digest slowly and have less of an effect on blood sugar for those that spike blood sugar—people with type 2 diabetes can see a significant improvement in their health and diabetes control.
That is what Ohio State researchers reported in the journal Public Health Nutrition. After 9 weeks of intervention, people with diabetes type 2 who were taught about the advantages of low-glycemic foods lost an average of about 5.1 pounds, decreased their waist circumference by 1.1 inches, reduced their body mass index (BMI; a ratio of weight to height) by almost a point, and lowered their after-meal blood glucose levels by 18 points.
What are the low-glycemic foods? Foods that slow the speed of digestion and prevent rapid increases in blood sugar, such as many vegetables, whole grains, dairy foods, nuts and seeds, beans and fruits, are called low-glycemic foods. On the glycemic-index, which ranks the relative impact of various carbohydrates on blood sugar, low-glycemic foods have a rating of 55 or less. Foods with a point value of 100 are the equivalent of pure glucose (sugar).
According to the American Diabetes Association, the following foods are "superfoods" that have a low-glycemic index and provide key nutrients that many of us do not get enough of through our food.
- Beans—They're very high in fiber and are good sources of magnesium and potassium. Although they are starchy, a 1⁄2 cup provides as much protein as an ounce of meat without the saturated fat.
- Dark green leafy vegetables—These greens, such as spinach, collards, and kale, are so low in calories and carbohydrates, you can't eat too much.
- Citrus fruits—Think of grapefruit, oranges, lemons and limes for soluble fiber and vitamin C.
- Sweet potatoes—These are a lower GI alternative to white potatoes and are packed with vitamin A and fiber.
- Pearled barley and oatmeal—They offer a high fiber breakfast with a low GI index and contain potassium.
- Nuts—An ounce of nuts can go a long way to supplying you with healthy fats. Other benefits are a dose of magnesium and fiber. Some nuts and seeds, such as walnuts and flax seeds, also contain omega-3 fatty acids.
Here's look at the glycemic index of some common foods:
Breads
- White bread 70
- Wholemeal bread 69
- Pumpernickel 41
- Dark rye 76
- Sourdough 57
- Heavy mixed grain 30–45
Legumes
- Lentils 28
- Soybeans 18
- Baked beans (canned) 48
Breakfast cereals
- Cornflakes 84
- Cheerios 83
- Puffed Wheat 80
- All Bran 42
- Porridge 46
Adding Insulin to the Mix
January 13, 2010
People with type 2 diabetes have traditionally taken oral medications such as metformin and sulfonylureas when lifestyle adjustments are not sufficient to control elevated glucose levels. Insulin has been considered the therapy of last resort; in fact, research shows that, on average, insulin isn't prescribed until 10 or 15 years after a person is initially diagnosed with type 2 diabetes. Sadly, that is often after complications, such as kidney or nerve damage, have developed and it is too late to institute strict glucose control that can reduce the risk of such health problems.
But now there is research to show that adding insulin to the oral medication regimen can improve glucose control and help reduce weight gain. And doing it sooner rather than later may be the best therapy. (A third of those with diabetes type 2 will eventually end up on insulin anyway as their body's cells become less and less responsive to insulin and the pancreas loses its ability to pump out sufficient supplies of the blood-sugar controlling hormone.)
A study in the New England Journal of Medicine examined 708 people with elevated glucose levels while taking while taking metformin and sulfonylurea therapy. Over the course of 3 years the participants were divided into three groups and given biphasic insulin aspart [a mixture of intermediate- and fast-acting insulin] twice daily, prandial insulin aspart [short acting insulin at meal times] three times daily, or basal insulin detemir [long acting] once daily (twice if required).
Basal insulin, which gives a well-controlled base line over a length of time, provided the best results. Participants on that type of insulin gained less weight and experienced fewer low blood sugar alarms than the others. The best blood sugar control, as measured by A1Cs, was achieved by those on the basal insulin and the prandial, mealtime, dosing.
Other studies have shown the same positive results from adding insulin to the type 2 diabetes management program. The United Kingdom Prospective Diabetes Study produced data that showed that 50% of those who took insulin plus a sulfonylurea had a desirable median HbA1c level of 6.7% after 6 years.
Nonetheless, many people are reluctant to begin taking insulin. They may feel the change represents failure or that it will make their diabetes worsen. These and other obstacles—such as the fear of hypoglycemia, weight gain, or pain caused by the needles—are surmountable.
According to Joseph Tibaldi, M.D., author of a 2008 study in the Americal Journal of Medicine that looks at initiating and intensifying insulin therapy in type 2 diabetes, "with modern treatment options, insulin therapy need no longer be feared by patients with type 2 diabetes or their carers. Many common concerns in this respect are unfounded, and today's insulin regimens are generally simple, effective, and well tolerated."The Coffee Cure?
December 15, 2009
Researchers at The George Institute for International Health in Sydney, Australia, may have found a way to stop or at least slow down the diabetes epidemic: Take a coffee or tea break, and do it often.
They looked at the findings from 18 studies, including 457,922 people, on the relationship between coffee and tea drinking and the diagnosis of type 2 diabetes. According to study author and public health expert Rachel Huxley, "In those individuals drinking more three to four cups a day, there was a 25% reduction in the risk of diabetes. And in those drinking six cups a day, there was a 40% reduction in risk day—compared to non-coffee drinkers."
Similar reductions in risk were observed for tea and decaffeinated beverages. "This," says Huxley, "suggests that any diabetes-sparing effect is not driven primarily through caffeine, as was previously thought."
For decaf, the same amount of brew slashed the risk by 33%; and tea drinkers saw a 20% reduction. Huxley and her colleagues think that compounds in coffee and tea—including magnesium and antioxidants known as lignans or chlorogenic acids—may be what may be at work to prevent type 2 diabetes.
In the study, the scientist explained that "the implications for the millions of individuals who have diabetes, or who are at future risk of developing it, [c]ould be substantial." They imagine a time when people who have the greatest risk for diabetes may be advised to "increase their consumption of tea and coffee in addition to increasing their levels of physical activity and weight loss."
Arthritis Drug May Slow Onset of Type 1 Diabetes
December 15, 2009
A monoclonal antibody called rituximab that is used to treat both rheumatoid arthritis and non-Hodgkin's lymphoma, may help people newly diagnosed with type 1 diabetes preserve their body's ability to produce insulin.
How does this biologic drug work? Well, when the body starts killing off healthy insulin-producing beta cells in the pancreas, it is immune system cells that wage the war. So-called T cells do the dirty work, but B cells are thought to urge them on. Rituximab directly attacks and destroys B cells. When there are fewer B cells, there are fewer triggers of the marauding T cells and more insulin-producing beta cells stay alive.
Philip Raskin, M.D., an author of the study published in the New England Journal of Medicine, explains, "Our findings in no way suggest that rituximab should be used as a treatment or that it will eliminate the need for daily insulin injections. [But] the results provide evidence that B cells play a significant role in type 1 diabetes and that selective suppression of these B cells may deter the destruction of the body's beta cells."
The study followed 81 people, ages eight to forty, who had been diagnosed with type 1 diabetes within the previous 100 days. In a randomized double-blind environment, they were given either infusions of rituximab or a placebo once a week for 4 weeks. The participants were then tracked for 2 years. After the first year, the people who had received the biologic drug needed to inject less insulin and had better blood sugar control than those who had been on the placebo. The next step, Dr. Raskin says, is to evaluate the potential effects of rituximab in diabetes.
Taking Control of Risk Factors for Diabetes and Heart Disease
December 2, 2009
You can control your risk for developing full-blown diabetes and improve your heart health without drugs, but it takes discipline.
The Diabetes Prevention Program (DPP) followed more than 3,200 people who were all overweight and had blood sugar levels higher than normal, but not high enough for a diagnosis of diabetes—a condition called prediabetes. The DPP revealed that participants who lost a modest amount of weight by eating a low-fat diet and increasing physical activity to at least 150 minutes of moderate exercise a week reduced their chances of developing diabetes by 58%. Taking metformin was less effective; it reduced the risk by 31%.
Lifestyle changes worked particularly well for participants aged 60 and older, reducing their risk by 71%. About 5% of the lifestyle intervention group developed diabetes each year during the study period, compared with 11% of those in the placebo group. About 7.8% of the metformin group developed diabetes each year.
Further analysis of the data generated by the study revealed that the intensive lifestyle regimen can also sharply reduce the systemic inflammation associated with diabetes and obesity and may reduce the risk of heart disease.
According to Steve Haffner, M.D., M. PH., the chair of the DPP, and colleagues, the DPP was able to evaluate the effect of lifestyle changes and the oral diabetes drug metformin on moderate inflammation (as indicated by blood levels of a substance called C-reactive protein [CRP]) and on blood coagulation (as indicated by fibrogen levels). CRP and fibrogen levels are known indicators of cardiovascular disease.
Writing in the journal Diabetes, the DPP researchers stated that in men, metformin reduced CRP by 7% and lifestyle intervention reduced it by 33%. The placebo group saw in increase in CRP levels of 5%. Women taking metformin saw CRP levels fall 14%, while the lifestyle group cut them by 29%. There was no change in the placebo group.
"In conclusion," the study authors said, "intensive lifestyle intervention reduced levels of nontraditional cardiovascular risk factors [CRP and fibrogen] both relative to placebo and to a lesser degree relative to metformin. These significant reductions were achieved despite a relatively modest weight loss of around 6 to 7% over the first year with most participants still being obese at the end of the first year."
"The DPP study suggests that not only does intensive lifestyle intervention reduce the risk of developing type 2 diabetes, but it also has effects on markers that may eventually reduce the risk of cardiovascular disease."
Risks of Pre-Gestational Diabetes
December 2, 2009
Just as there is prediabetes, a condition in which blood sugar levels are elevated, but not enough to be diagnosed as diabetes, there is gestational glucose intolerance, a kind of pre-gestational diabetes. This is a condition in which blood sugar levels rise during pregnancy, but are not (yet) high enough to be diagnosed as gestational diabetes.
Researchers have found that pre-gestational diabetes poses serious health risks to the mother. According to a new study in The Endocrine Society’s Journal of Clinical Endocrinology & Metabolism, many women with the condition develop metabolic syndrome as soon as three months after giving birth.
Metabolic syndrome often leads to type 2 diabetes and heart disease. It is characterized a specific group of risk factors, such as having excess fat deposited around the waist, high triglyceride levels, high blood pressure, and high fasting blood glucose levels.
To control pre-gestational diabetes, work closely with your physician to determine the best nutritional and exercise plan for you and your baby.
Help your baby dodge the health issues your higher glucose levels create for a newborn such as problems breathing, excess body fat, low glucose levels right after birth, and an increased risk of developing type 2 diabetes later in life. (Your child's risk for type 2 diabetes may be lower if you breastfeed your baby and if your child maintains a healthy weight.)
Step to take include:
- Losing 5 to 7% of your body weight to sharply reduce the risk of developing type 2. Then reach and maintain your ideal weight.
- Becoming physically active for 30 minutes most days. Walk, swim, exercise, or go dancing.
- Following a healthy eating plan. Eat more grains, fruits, and vegetables. Cut down on fat and calories.
New Monotherapy Approved for Type 2 Diabetes
November 18, 2009
A study, published in Clinical Therapeutics, has demonstrated that a non-insulin, injectable drug therapy for type 2 diabetes, exenatide (Byetta), is an effective way for some patients to control their glucose levels and their weight. That's what led the Food and Drug Administration (FDA) to approve its use as a monotherapy, when lifestyle adjustments alone are not enough to avoid the ups and downs of type 2 diabetes.
Study participants treated with 5 mcg or 10 mcg of exenatide reduced their A1C by 0.7 percentage points and 0.9 percentage points, respectively. For every 1% reduction in A1C levels, there is a 10% reduction in risk of diabetic complications.
There are some potential negative side effects from the drug, however. Most common is nausea, affecting 3% of those taking a dose of 5mcg and 13% of those taking 10 mcg. More serious, but rarer side effects are kidney-related problems and acute pancreatitis. Talk to your doctor about these potential risks and the benefits.
Smile: Diabetes and Dental Health
November 18, 2009
Because gum disease, also called periodontal disease, can make it more difficult to control blood glucose levels and may raise the overall levels of inflammation in the body—already inflamed by high glucose levels and perhaps excess body fat—it is essential that everyone with diabetes take extra care of their teeth and gums. Inflammation is implicated in heart disease (the number one killer of folks with diabetes) and a whole roster of diabetes-related complications.
To help people with diabetes and their healthcare providers, the new International Diabetes Federation (IDF) guidelines encourage doctors, dentists and diabetes-care professionals to regularly ask their patients if they have symptoms of periodontal disease, such as swollen or red gums or bleeding during tooth brushing. The IDF also wants to encourage people with diabetes to learn about the risks of poor dental health and take steps to improve their dental hygiene—by scheduling regular cleanings, practicing twice daily brushing and flossing and establishing good control of blood glucose levels.
When It's Time to Add Insulin
November 7, 2009
If you have type 2 diabetes and find that oral medications and lifestyle adjustments are not doing enough to keep your blood sugar levels in line, you are a candidate for insulin injections. But how should you use insulin to obtain optimal blood sugar levels?
A three-year, randomized, controlled study (the highest quality type) of 708 people with type 2 diabetes compared the results of adding a once-a-day, basal insulin injection, three-a-day insulin injections—one at each mealtime, or insulin injections twice a day. The people who added insulin through once-a-day (basal) insulin injections and those who then added injections at mealtimes showed better control of their blood sugar levels than people who took insulin injections twice a day. Those who took basal insulin injections once a day also had fewer low blood sugar (hypoglycemic) episodes and gained less weight.
Jonathan Levy, lead clinician at the Oxford (UK) Centre for Diabetes, Endocrinology and Metabolism and co-principal investigator for the study explains: "Starting with a basal insulin and adding a mealtime insulin if required provided the best combination of effectiveness, safety and treatment satisfaction."
Does Your House Make You Fat?
November 7, 2009
A new study published in the Annals of Behavioral Medicine found that the number of TVs in a household, the presence or absence of exercise equipment in the home, and the amount of food that's left out on the kitchen counter have a huge influence on a person's weight management.
Researchers from California Polytechnic State University examined the health records of more than 167 people across the country who had managed to lose 10%—or more—of their body weight and keep it off for five years. They also looked at two groups who were overweight or obese but dieted frequently. The results surprised the researchers: "The home environment really came out as a stronger factor than we would have anticipated," said lead study author, professor Suzanne Phelan. "You have to pay attention to your home environment if you want to succeed. Do you have TVs in every room? When you walk into your kitchen, do you see high-fat food or healthy food?"
So what's the take-away for those looking to stick with more exercise, better food choices and a less sedentary lifestyle? The researchers concluded: Keep healthy things right at hand. If you want to choose better foods, keep better foods within reach. If you want to be more active, create opportunities for exercise in various rooms in the house. Lasting weight control, they advise, is about skill power, not just willpower.
Antioxidant Supplements: More Harm Than Good?
October 30, 2009
We've been told over and over again that we don't get enough antioxidants in our diet to fight the good fight against aging and cancer. That's why many of us take antioxidant supplements, such as beta carotene and vitamins E, A, and C. But we may be upsetting an important balance in the body that allows naturally occurring free radical (oxidized) molecules to do good as well as harm. That's the conclusion of a recent study published in the October issue of Cell Metabolism. The scientists found that antioxidants, commonly promoted as health-enhancing, may in fact speed up the early onset of type 2 diabetes by blocking free radical molecules' ability to enhance insulin action.
The problem is that while there is evidence that antioxidants in fruits and vegetables can protect us from cancer, cardiovascular disease, and type 2 diabetes, there is also scientific evidence that the targets of the antioxidants—oxidized free radical molecules or reactive oxygen species (ROS)—provide essential health benefits. In biology, it turns out, it is all about balance. And when we dose ourselves with antioxidant pills we upset the balance in ways we don't even know.
There are studies that suggest taking antioxidants may shorten lifespan. And recent research has found that taking antioxidant supplements while exercising may counteract the longer-term benefits of physical activity. "In a way," says the study's lead researcher Tony Tiganis, "we think there is a delicate balance and that too much of a good thing—surprise, surprise—might be bad."
So stick with the guidelines for 7 servings of fruits and vegetables a day—and you will let the ROS in the body promote insulin action and help protect yourself from premature aging and various diseases.
Diabetes May Affect a Woman's Heartbeat
October 30, 2009
Diabetes affects more than 23 million Americans and, according to a recent seven-year study of more than 17,000 people with the disease, nearly 4%, or 1 million, also have atrial fibrillation (AF)—an irregular heartbeat that can lead to stroke, heart attack, and chronic fatigue.
Women with diabetes are at a particularly increased risk of developing AF—something that was not fully appreciated until the study, published in Diabetes Care, found the connection. Sumeet Chugh, M.D., coauthor of the study and associate director of the Cedars-Sinai Heart Institute in Los Angeles says, "AF is the most common arrhythmia in the world, and diabetes is one of the most common and costly health conditions. Our study points out that there is a connection between these two epidemics—one we should pay closer attention to, especially among women. The gender differences need to be looked at more closely because they could have significant implications for how we treat diabetes in men and women."
At the start of the study, which also included around 17,000 people without diabetes as a control group, 3.6% of the patients with diabetes had AF while 2.5% of the non-diabetic patients had the condition—a difference of 44%. During the study period, people with diabetes were more likely than people without diabetes to develop AF. But the increased risk was only significant among women.
Diabetes and Diet's Secret Vice
October 7, 2009
Eating disorders and what is called disordered eating, which includes overeating and skipping meals, are a huge problem for people with type 1 diabetes and people with type 2 diabetes. Unfortunately, many people don't recognize that they have a distorted relationship to food. That's why it is so important to find out the signs and symptoms of eating disorders, such as anorexia nervosa, bulimia nervosa, and disordered eating and what you can do to adopt a healthy eating style.
Eating disorders are more common among people with type 1 diabetes than among those who have type 2 diabetes. On the other hand, people with diabetes type 2 are more apt to have disordered eating patterns, and may purge, binge, practice food restriction or use other ineffective methods to control or lose weight. These disordered eating habits are less severe than full-blown eating disorders but they still have profound impact on weight and overall health.
Unfortunately it is very difficult to get proper diagnosis and treatment for unhealthy eating habits unless you are frank with your health care providers. Writing in Diabetes Spectrum, researchers, Raquel Franzini Pereira, M.S., R.D., and Marle Alvarenga, M.S., Ph.D., point out that, "when behaviors such as eating in the car, eating with guilt, skipping meals, eating to cope with stress or emotional distress, binge eating, and frequent and strict dieting are not only socially accepted behaviors, but also tend to be considered common and therefore normal among people, including educators, they may not be perceived as deserving proper clinical attention." But they do. As do other behaviors including obsessive weighing, excessive calorie counting and over-exercising.
Type 1 Diabetes: The bottom line, say Franzizzi and Alvarenga, is that 27% of adolescents with type 1 diabetes binge and purge and 24% restrict their diets to try to lose weight. The results are devastating: there is a 15.7-fold increase in mortality of females with diabetes and anorexia when compared with females with diabetes alone. Another tactic: Skipping insulin doses or reducing the amount of insulin taken in order to lose weight may be common among somewhere between 15 and 37% of women and 34% of adolescents with type 1 diabetes. And this leads to lack of blood sugar control and eventually to serious complications—kidney disease, heart disease and nerve disease, eye problems, depression and more.
Type 2 Diabetes: Among people with type 2 diabetes, the study suggests that disordered eating or eating disorders often come before the diabetes diagnosis and may have a part in causing the obesity that usually proceeds diagnosis—some estimates say eating disorders may contribute to as many as 90% of cases of type 2 diabetes.
Treatment and Help
Eating disorders and disordered eating habits can cause serious health problems for people with diabetes and require astute medical intervention (particularly in the case of eating disorders), psychological support, and a health care team who can help reshape the patient's view of him- or herself and his or her relationship to food. (Although eating disorders affect women more often than men, adolescent and adult males also need to be aware of the part that these problems can play in that handling—or mishandling—of their diabetes.) If you think that you have a troubled relationship to food, talk to your diabetes educator, your primary care physician, a trusted teacher or friend…someone who can lend support and help you take steps to start a process of change. Healthy eating will help you will gain better control of your diabetes, and can help you avoid many health complications down the road.
The Hearty Heart
October 7, 2009
A new study has validated a simple and inexpensive way to reduce the risk of heart attack, stroke, and heart disease for people with diabetes. Many lives were saved by a program that bundled two generic, low-cost drugs—a cholesterol-lowering statin (lovastatin) and a blood pressure-lowering drug (lisinopril)—and gave daily doses to 68,560 people with diabetes or heart disease for two years. It is estimated that the protocol prevented 1,271 heart attacks and strokes in the first year following the study period, according to a paper published online in The American Journal of Managed Care.
Although previous research showed that statins and blood pressure medications separately can reduce the incidence of heart attacks and strokes, this study was the first to show that delivering this combination to a large group of people with diabetes and heart disease could save lives and reduce health care costs. The study results? The duo of drugs reduced the number of heart attacks and strokes among the many participants by an astounding 60%.
"Heart disease is the number one killer in the United States, and 23 million Americans have diabetes," says the study's lead author, R. James Dudl, M.D., the diabetes clinical lead at Kaiser Permanente’s Care Management Institute. "This is a proven program that can be applied in many settings to reduce heart attacks and strokes, and at the same time decrease the cost of care for those events."
Designing to Save Lives
January 1, 2010
When the ancient Greek philosopher Plato said, "Necessity is the mother of invention", he didn't single out style as a factor in the problem-solving process. But perhaps he should have. After all, aesthetic principles were a primary consideration for Susan Eisen, an El Paso, Texas, jewelry designer who developed diabetes in 1991. While being treated at an inpatient diabetes center, a nurse asked Eisen if she wore a medical-alert bracelet. Eisen didn't and she soon discovered that many other people with diabetes didn't, either, often because they saw these bands as uncomfortable or unattractive.
Sure, they're a potential lifesaver since they can alert people to the fact that someone has a serious condition if there's a medical emergency. But "many people with diabetes don't like what's out there—medical IDs negatively brand you and no one wants to have their medical condition advertised to the world," notes Eisen, now 57, a mother of two grown children. "The hardest people to satisfy are children because they're very concerned about their image. Unless it's super-cool, they won't wear it—and they're the most vulnerable."
So Eisen started thinking about what sort of medical identification bracelet she would wear. It would have to be something fashionable, sturdy, and comfortable, for starters, she decided. After brainstorming and tinkering with numerous designs she came up with the LIFETAG concept—"jewelry that can save your life!"—which started as a medical ID tag that could be stuck onto an existing bracelet or necklace. Then, she began creating a line of stunning, high-quality pieces, ranging from trendy styles (using black rubber, aluminum, or glass beads) to classic designs (with sterling silver or gold links, even diamonds). "I figured, if I would wear it, other people would, too," she recalls. "It's a way to match art and beauty with the medical needs of a person. There's really no limit to what I can do with these designs."
Birth of A Need
Ironically, when Eisen discovered that she has diabetes, she wasn't shocked by the diagnosis but she was by the type. After all, she had developed classic symptoms such as having to go to the bathroom frequently during the night and blurred vision. "I went to take a jewelry appraisal exam and I felt weird," she recalls. "I was dying of thirst, and I had lost eight pounds in one week after trying to lose weight for months." Three out of four of her grandparents had had diabetes, and "my niece got diabetes when she was 11 months old so when I started having these symptoms, I went to the doctor and got tested right away," recalls Eisen. That's when she learned that her blood sugar was over 400 mg/dL and she was diagnosed with type-1 diabetes.
It took a while to get her diabetes under control but she has done so with an insulin pump that shoots her with insulin every hour and lifestyle changes. Eisen works out twice a week with a trainer, usually riding an exercise bike and doing weight training on machines. She meditates several times per week and makes sure she gets eight hours of sleep per night. And she tries to eat three meals—with lots of lean protein, fruit, vegetables, and nuts—plus two snacks per day. "Snacking keeps my energy levels high and prevents me from getting hungry," she explains. "When your blood sugar goes low and you have diabetes, your brain doesn't work the way it should—and it affects your driving. This really scared me, especially because I travel a lot on my own." To make sure her blood sugar stays in her target zone, she tests her blood sugar four times per day.
Discovering Her Love for Jewelry-Making
A native of El Paso, Eisen had always been interested in art so after getting married at 19, she started taking studio classes in pottery, ceramics, sculpture, and working with metals at the University of Texas at El Paso. "As a teenager, I loved modern art and design but it wasn't until college that I discovered my passion for jewelry," she recalls. "I fell in love with metals—their textures, the shine and polishing of the metals, the way you can form and bend the pieces. After I had a miscarriage, something just snapped in me and I went into designing and making jewelry. It became a very big passion for me." After she'd been designing sculptural pieces of jewelry, using precious metals and gemstones—including contemporary rings and necklaces, and abstract-style necklaces—for several years, two friends who'd been running a jewelry store in El Paso decided to part ways. They asked Eisen if she wanted to take over and she did in 1980.
These days, medical ID bracelets account for about 20% of Eisen's designs, though she plans to expand her LIFETAG line (lifetag.com) even more. "Unfortunately, there's a big market for the medical IDs," says Eisen, a certified gemologist who also wrote Crazy About Jewelry!: The Expert Guide to Buying, Selling and Caring for Your Jewelry. "Everyone has something or someone in their family that requires a medical ID. The biggest criticism I hear is that it's too pretty—people are worried that police and EMS [emergency medical service] responders won't notice it.
"My feeling is that if you've been wearing nothing in the way of a medical ID and you're wearing one of my designs," she adds, "it’s a 100 percent improvement because it could save your life. Once you start wearing it, it becomes a habit. Then, if you don't wear it, you feel very insecure."
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