Diabetes & Stress: How Stress Affects Your Blood Sugar

From diabetesstrong.com

Everyone experiences stress at some point in their lives. And stress can have a drastic effect on your blood sugar — both immediately and in the long run.
Even the fun stress of a roller coaster ride triggers an increased production of hormones like cortisol, adrenaline, and glucagon. Without these hormones, your body couldn’t complete the task of grocery shopping, let alone endure a heated argument with your mother. 

In this article, we’ll look at the role of cortisol, adrenaline, and glucagon, and how each of these stress-related hormones can affect your blood sugar.
At the end of the post, we will summarize how all of this comes together to impact the day-to-day lives of people living with diabetes, and what you can do to reduce stress in your daily life.

What is stress?

Quite simply, stress is your body’s response to any situation, event, or change in your life that requires a reaction or adjustment. Stress can develop physically, mentally, and emotionally.
And it’s an unavoidable part of life. Both positive and negative experiences can create a stress reaction in your body and mind.
In some cases, you might experience an event that causes stress with no end in sight. An abusive relationship or an unbearable environment at your work are examples of an ongoing source of stress that a person may struggle to break free from. These types of stress can lead to a state of “distress,” which is putting it lightly if you’ve ever experienced it.
Let’s take a closer look at what stress looks like before we add diabetes to the mix.

The symptoms of stress

Stress can manifest differently in one person from the next. For some, positive or negative stress may produce immediate tears, for example. In others, it may cause them to be silent and speechless. And others may become easily angry and irritable.
Depending on the severity of the stress level, your symptoms can vary. Here are some examples of stress symptoms:

Mild to moderate stress

• crying
• anger
• irritability
• excitement
• high blood pressure
• headache
• lack of appetite
• binge-eating
• acid reflux
• difficulty sleeping
• loose bowels
• muscle tension in your neck
• sweaty palms
• tiredness
• shaking
• trembling
• changes in weight
• lack of sex drive

Severe stress

• chronic headaches
• nausea
• diarrhoea
• severe high blood pressure
• chest pain
• sexual dysfunction
• insomnia
• depression
• panic attacks
• anxiety

Research suggests that stress also can bring on or worsen certain symptoms or diseases. Stress is linked to 6 of the leading causes of death: heart disease, cancer, lung ailments, accidents, cirrhosis of the liver, and suicide.
Before we move on to how stress can affect your blood sugar and what you can do to reduce stress, let’s take a closer look at the hormones involved in a stress reaction.

What is cortisol?

This hormone is often discussed in a negative light because too much of it can be a sign that your body is under severe mental or physical stress, and is associated with inflammation and weight gain. 
While its primary role is to help your body manage stress, it also affects nearly every organ in your body and is something your body needs 24 hours a day to stay alive, just like insulin.
Without cortisol, you wouldn’t be able to climb a flight of stairs let alone endure the intense stress from losing a loved one, going through a divorce, or having surgery. 
Cortisol also helps your body:

• Manage your blood pressure 
• Manage the function of your heart 
• Reduce your immune system’s inflammatory
• Reduce overall inflammation
• Breakdown sugar (with the help of insulin) to be used for energy
• Manage how your body metabolizes protein, carbohydrates, and fat

Just like your insulin needs change based on what you’re doing and eating, your body’s cortisol production must precisely match your needs during any given moment, too.

How does cortisol affect your blood sugar?

Not only can cortisol contribute to unwanted high blood sugars, but it’s also essential for treating low blood sugars, too. Let’s take a look.

When cortisol levels are high

When cortisol production increases beyond a healthy baseline, it blunts your body’s sensitivity to insulin. This means you need more insulin during those hours in order to keep your blood sugar in your goal range.
While your body does produce cortisol 24 hours a day, there are certain times of day anyone can expect to be producing more, like first the thing in the morning. And that explains why many of us notice we need more insulin in the earliest hours of the day, and with breakfast.
As soon as you wake up in the morning, your body produces a surge of cortisol, explains the Society for Endocrinology. This surge is critical for simply starting your day and functioning fully now that you are awake!
And if your overall baseline cortisol needs increase due to constant, ongoing stress, you’ll notice that your baseline insulin needs increase, too.

When cortisol levels are low

On the flip side, without enough or any cortisol you would struggle with constant hypoglycaemia (low blood sugar). 
When a person with diabetes experiences a low blood sugar, cortisol is actually critical to enabling your body to make use of the glucose you consume to bring your blood sugar back up to a safe level.
A severe low blood sugar can nearly deplete your body’s cortisol reserves, which contributes to symptoms of exhaustion even after your blood sugar has returned to a safe level.
If you think cortisol is wreaking havoc on your blood sugar levels, talk to your healthcare team about adjusting your insulin doses to help compensate. And of course, take a look at what areas of your life you could adjust to reduce your emotional and physical stress.

What is adrenaline?

Adrenaline — also known as “epinephrine” — is commonly associated with athletic events, but your body produces adrenaline in response to other events, too. 
An intense argument, a near-miss car accident or a roller coaster ride can all lead to increased adrenaline production.
Adrenaline is your body’s hormonal “flight or fight” response to intense good or bad stress.
This hormone essentially signals to your liver to release glycogen — the stored glucose in your liver. When your body suddenly encounters intense stress, you need extra glucose for energy to endure that stressful event. Without that extra glucose, your blood sugar would drop and you’d simply be lacking the energy necessary to perform during that stressful event.

How does adrenaline affect your blood sugar?

In a non-diabetic body, that surge of adrenaline triggering a surge of glycogen would be accompanied by a surge of insulin, too.
As people with diabetes, we’re missing the “surge of insulin” part, which can easily spike your blood sugar from 120 mg/dL to 300 mg/dL in less than an hour.
Adjusting your insulin for this can be tricky. A quick bolus of insulin using your normal “correction factor ratio” could easily produce little or no effect on the high blood sugar while adrenaline is present.  
Personally, I’ve found that I needed a significant increase in my background insulin doses on the day of a powerlifting competition in order to keep my blood sugar from spiking due to adrenaline. A quick bolus would have no impact and the only thing that would otherwise bring my blood sugar down was when the competition ended and my body relaxed. 
If you’re dealing with predictable adrenaline around a sporting event, for example, talk to your healthcare team about making an adjustment in your background insulin.
If you’re dealing with sudden, unexpected surges of adrenaline because you just got into a car accident, for example, you’ll likely have to try lowering it with a bolus of insulin but may not see it come down for a few hours.

When it’s actually not adrenaline…

One thing adrenaline is often incorrectly associated with is during your workout at the gym. There are other reasons your blood sugar can spike during a typical workout — but unless you’re truly in a competitive environment (rather than just an intense solo workout), it’s unlikely to be adrenaline. 
More likely, you’re breaking down muscle which involves breaking down stored glycogen. Your body then breaks that glycogen down into glucose and cycles it back to your muscles for energy. Without extra insulin on-board, this can easily lead to high blood sugars.

What is glucagon?

Glucagon is another hormone that helps your body endure certain types of stress — including skipping breakfast! 
Glucagon’s role is simple: it tells your liver to release glycogen (mentioned above) which is then converted into glucose and can be used for energy or to purposefully raise your blood sugar.

How does glucagon affect your blood sugar?

Glucagon is actually less associated with emotional stress but does play a role during physical stress when you’ve gone too long without a meal or when you experience a severe low blood sugar.
“The release of glucagon is stimulated by low blood glucose, protein-rich meals, and adrenaline (another important hormone for combating low glucose). The release of glucagon is prevented by raised blood glucose and carbohydrate in meals, detected by cells in the pancreas,” explains Your Hormones.

During a severe low blood sugar…

When you experience a severe low blood sugar, likely below 40 mg/dL, you may seem your blood sugar skyrocket within the hours after, even if you only treated that low with a careful amount of carbohydrates. 
This is your body’s way of saving your life! That surge of glucagon triggers a surge of glycogen which is broken down into glucose and raises your blood sugar. In those of us with diabetes, it simply raises it too high!

When you eat a strict low-carb diet…

During a ketogenic diet, your body is actually going to produce more glucagon throughout the day in order to get more glucose because your body cannot function on ketones alone. 
Your brain requires a second-by-second delivery of glucose in order to function! 
Does this mean you can’t follow a ketogenic diet? No. But it does mean you may notice your background insulin needs actually increase when you cut your carbs that low. This doesn’t happen to everybody but it’s important to keep in mind if you try a ketogenic diet just to see your insulin need skyrocket. 

When you skip breakfast…

Intermittent fasting is all the rage right now, but there are a few things you need to know if you’re experimenting with this trendy nutrition approach as a person with diabetes.
When you skip breakfast, your body is going to produce more glucagon during those fasting hours because — again — your brain needs glucose in order to function! 
This doesn’t mean you can’t practice intermittent fasting, but it does mean you’ll need to take extra boluses of insulin during those fasting hours to compensate for that additional glucose.

Summary: How stress affects your blood sugar

In short, stress will generally cause your blood sugar to rise. It will also be difficult to bring it down because of the insulin resistance created by stress hormones and the production of glucose from your liver’s response to adrenaline.
The larger majority of stressful situations aren’t something we can easily predict, but once you’re experiencing stress, you can predict that your blood sugar might spike.
Remembering to check your blood sugar during and after stressful situations is an important part of diabetes management, but don’t add to your stress by expecting to be able to easily correct any high blood sugars during a stressful state.

How to deal with stress as a person with diabetes

In general, there’s only so much you can do to prevent the blood sugar spikes from different types of stress hormones because we can’t always predict stress. 
However, if you’re dealing with predictable stress or ongoing stress, definitely talk to your healthcare team about an adjustment in your insulin doses that can help tamper those stubborn high blood sugars.

For those unexpected bursts of stress and rapid spikes in your blood sugar:
You should use your established “correction factor” to determine an appropriate dose of insulin to bring the blood sugar down.
But keep in mind: it’s very likely your blood sugar will sit at that higher level (especially in those with type 1 diabetes) until your body has recovered from the stressful state. When those stress hormones are pumping and adrenaline is causing your liver to produce more glucose, it can be very difficult to “get ahead of it.”

For ongoing stress during a period of your life: 
If you know the next few months are going to be stressful because of a promotion at work, a divorce, the death of a loved one — for example — then a simple increase by a few units in your background insulin dose can have a big impact on staying in your goal blood sugar range.
Don’t underestimate how much ongoing stress can affect your daily insulin needs. Even on the “normal” days during a stressful period of your life, your body is still coping with that ongoing stressor.

How to reduce your stress levels

Learning what helps you manage, reduce, and relieve your overall stress level is a vital lesson. Sometimes the simplest thing can help you take a deep breath, lower your blood pressure, lower stress hormones, and release the physical and mental grip of stress.
Here are a few ideas for reducing your stress levels:

Reducing stress in the moment

• Close your eyes and take deep inhales and exhales for 30 seconds
• Go for a walk
• Exercise to get your heart rate UP which causes your central nervous system to relax
• Go for a drive
• Watch your favourite stand-up comedy
• Make a to-do list to get everything off your mind
• Clean your house
• Call a friend
• Create a “voice memo” like your own private therapy session
• Dance to your favourite music

Everything that makes you calm down, makes you smile, or helps your body relax will have a positive effect on your stress level.

Reducing ongoing stress

Reducing ongoing stress usually requires a significant change in your situation or lifestyle. The causes of ongoing stress are different from person to person, but here are a few ideas for how you can help reduce ongoing stress:

• Identify your biggest stressor and ask yourself: what can I change about this?
• Make time to see a therapist weekly/biweekly
• Make time for regular exercise — a daily walk can do wonders!
• Use a meditation app to at least stop and breathe deeply for 2 minutes every day
• Get your house/office clean-up and organized (with help) so your “space” is clear
• Create weekly to-do lists to manage responsibilities and acknowledge productivity
• Look for a new job, sending out two applications per week
• Leave an unhealthy relationship (get help from friends if needed!)

Managing ongoing stress is difficult because in many cases you cannot just walk away from it. Take a deep breath and step back to see the bigger picture around this stressor. There are always going to be things we can control and change, and things we cannot.

https://diabetesstrong.com/diabetes-stress/

7 Easy Ways To Prevent Diabetes

From ibtimes.com

Diabetes is the leading cause of various health conditions like kidney failure, blindness, lower-limb amputations, and even death in about 1 in 11 adults and more than 400 million individuals who are affected globally. It is, therefore, very important to prevent getting diabetes.

Here is a list of the easiest ways to prevent diabetes:

1. Reduce Sugar Intake- Consuming sugary foods can increase your risks of developing diabetes and thereby, it is important that you cut down sugars and refined carbs. Also, the increase in blood sugar levels can induce insulin production. When this phenomenon occurs rapidly, it can lead to progressively high blood sugar levels and insulin levels and eventually turn into type 2 diabetes. Simply cutting down sugars can help prevent diabetes.

2. Exercise Regularly- Regular physical activity can aid the insulin sensitivity of your cells. Studies have found that moderate-intensity exercise increased insulin sensitivity and higher-intensity workouts produced even better insulin sensitivity.

3. Shed Those ‘Few Extra Pounds’- You might be at risk of being prediabetic if you are overweight or obese. Excess visceral fat can lead to inflammation and insulin resistance, which might increase your risk of diabetes. Losing even a very small amount of weight can help reduce diabetes risk and the more you lose, the better will be its benefits.

4. Consume A Very-Low-Carb Diet- When you follow a diet which is extremely low in carbohydrates, such as the keto diet, it can help prevent diabetes. Such a diet can not only help lower your blood sugar and insulin levels but also reduce your risk for diabetes.

Diabetics patients with NAFLD or NASH are at higher risk of developing liver cancer or cirrhosis. Photo: Pixabay

5. Stop Being A Couch Potato- Sedentary behaviours should be avoided if you’re trying to prevent diabetes. Studies have consistently proved a positive link between a sedentary lifestyle and diabetes risk. Follow simple ways such as standing up from your workspace and walking around for some time every hour, or climbing the stairs instead of using the elevator.

6. Limit Your Alcohol Intake And Quit Smoking- Cutting down alcohol and cigarettes can help reduce your risk of diabetes. Excess alcohol intake can cause weight gain and raise your blood pressure and cholesterol levels. Studies show that smokers are at a higher risk of acquiring diabetes when compared to non-smokers.

7. Go For Regular Check-Ups- As you get older, it is recommended that you see your doctor regularly and get your blood sugar levels tested regularly. Keeping track of your blood sugar levels can encourage you to make lifestyle modifications and thereby prevent diabetes effectively.

https://www.ibtimes.com/7-easy-ways-prevent-diabetes-2836440

Type 2 Diabetes Remission Possible With ‘Achievable’ Weight Loss

From scitechdaily.com
By University of Cambridge

People who achieve weight loss of 10% or more in the first five years following diagnosis with type 2 diabetes have the greatest chance of seeing their disease go into remission, according to a study led by the University of Cambridge.
The findings suggest that it is possible to recover from the disease without intensive lifestyle interventions or extreme calorie restrictions.

Type 2 diabetes affects 400 million people worldwide and increases the risk of heart disease, stroke, blindness, and amputations. While the disease can be managed through a combination of positive lifestyle changes and medication, it is also possible for the high blood glucose levels that define diabetes to return to normal – through significant calorie restriction and weight loss. An intensive low-calorie diet involving a total daily intake of 700 calories (less than one cheeseburger) for 8 weeks has been associated with remission in almost nine out of ten people with recently diagnosed diabetes and in half of people with longstanding disease.

However, there is little evidence to show whether the same effect can be achieved by people undergoing less intensive interventions, which are more feasible and potentially scalable to the wider population. To answer this question, a team led by researchers at the University of Cambridge studied data from the ADDITION-Cambridge trial, a prospective cohort study of 867 people with newly diagnosed diabetes aged 40 and 69 years recruited from general practices in the eastern region.

The research was funded by Wellcome, the Medical Research Council and the National Institute for Health Research.
The researchers found that 257 participants (30%) participants were in remission at five-year follow-up. People who achieved weight loss of 10% or more within the first five years after diagnosis were more than twice as likely to go into remission compared to people who maintained the same weight.
“We’ve known for some time now that it’s possible to send diabetes into remission using fairly drastic measures such as intensive weight loss programs and extreme calorie restriction,” says Dr Hajira Dambha-Miller from the Department of Public Health and Primary Care.

“These interventions can be very challenging to individuals and difficult to achieve. But, our results suggest that it may be possible to get rid of diabetes, for at least five years, with a more modest weight loss of 10%. This will be more motivating and hence more achievable for many people.”
Senior author Professor Simon Griffin of the MRC Epidemiology Unit added: “This reinforces the importance of managing one’s weight, which can be achieved through changes in diet and increasing physical activity. Type 2 diabetes, while a chronic disease, can lead to significant complications, but as our study shows, can be controlled and even reversed.”

In order to clarify the best way to help patients with type 2 diabetes achieve sustained weight loss, the team is currently undertaking a study called GLoW (Glucose Lowering through Weight management). The study compares the current education program offered by the NHS to people after they have been diagnosed, with a program delivered by WW (formerly Weight Watchers®). The team is looking to recruit individuals who have been diagnosed with type 2 diabetes within the last three years, have not attended a structured education program and are able to visit one of our testing centers in Wisbech, Ely or Addenbrooke’s Hospital. Further details can be found at the GLOW Study website.

https://scitechdaily.com/type-2-diabetes-remission-possible-with-achievable-weight-loss/

Type 2 diabetes: Drinking this before bed may help lower blood sugar

From express.co.uk

TYPE 2 diabetes is a serious condition in which the body loses control of the amount of glucose (sugar) in the blood, and left untreated, serious complications can occur. Drinking a certain drink before bed may help keep blood glucose levels in check.

Type 2 diabetes causes the body not to respond to insulin properly - a hormone that helps the body uses glucose for energy - and the body may not produce enough. This causes blood glucose levels to become too high, triggering symptoms such as needing to go to the toilet more often, feeling constantly thirsty, and blurred vision. If type 2 diabetes is left untreated, serious health complications can occur, including kidney failure, nerve damage, heart disease and stroke. So what can be done to keep blood glucose levels in check?

Experts say a healthy diet can help manage blood glucose levels.

There’s nothing you cannot eat, but certain foods should be limited.
The NHS recommends you eat a wide range of foods, including fruit, vegetables and some starchy foods like pasta, and keeping sugar fat and salt to a minimum.
Eating breakfast, lunch and dinner every day is also important, and meals shouldn’t be skipped.
In addition to three meals a day, a recent trend has seen people drink apple cider vinegar before bed - and it’s been shown to help control blood glucose levels.

                                                                     (Image: GETTY)

It’s made my combining apples with yeast to create alcohol, which is then fermented into acetic acid by added bacteria.
Research has suggested consuming apple cider vinegar can slow the emptying of your stomach, preventing large spikes in blood glucose.
It’s also been shown to increase insulin sensitivity which can lower blood sugar.

Drinking apple cider vinegar before meals or before bed may benefit blood glucose levels the most.
One study in people with type 2 diabetes found taking two tablespoons of apple cider vinegar at bedtime for two days reduced fasting blood sugar levels by up to 6 per cent.

Losing weight if you’re overweight can make it easier for the body to lower blood sugar levels, and apple cider vinegar has also been shown to help with this.
In one study, obese adults drank a 500ml beverage with one tablespoon, two tablespoons or no vinegar daily.
After 12 weeks, the vinegar groups weighed significantly less and had less abdominal fat than the control group.
Its weight loss benefits are believed to be related to its acetic acid content, which reduces fat storage, suppresses appetite, slows digestion, increases fat burning and delays the release of hunger hormones.

https://www.express.co.uk/life-style/health/1183804/type-2-diabetes-diet-drink-apple-cider-vinegar-lower-blood-sugar

Why those with diabetes should add nuts to their diets

From wtop.com

A tasty treat in your pantry or on grocery store shelves could be key to lowering your risk for heart disease — especially for people with diabetes, according to a 2019 study.
The study in Circulation Research, an American Heart Association journal, found that people with diabetes who ate at least five small servings of tree nuts a week were 17 percent less likely to develop heart disease. Researchers followed patients from a younger age in their life and followed up with them over time to determine whether they developed heart disease.

The results are very interesting and play into doctors’ understanding of how diet plays a key role in a patient’s risk or avoidance of cardiovascular disease, said Dr. Patrick Bering, a cardiologist at the MedStar Heart & Vascular Institute at MedStar Washington Hospital Centre.

“I think the findings are very exciting and add to our understanding of what constitutes a healthy diet — especially for those patients who have already developed diabetes,” Dr. Bering said.
Nuts can be a great option for anyone to eat because they are “jam-packed with lots of quality nutrients,” Dr. Bering said.
“They have unsaturated fatty acids, they have plant chemicals that are called phytochemicals, they have fibre, certain vitamins including vitamin E and folic acid; they also have important minerals for our body like calcium, potassium and magnesium.” he said.

However, not all nuts are created equal, Dr. Bering pointed out. Tree nuts, like almonds, cashews, hazelnuts, pine nuts, pistachios and walnuts, grow above ground and have more high-quality nutrients that are beneficial. The Mediterranean Diet is an option that incorporates a lot of tree nuts and, as a result, populations who adhere to that diet often have a lower risk for cardiovascular disease, Dr. Bering said.

Tree nuts may do more than just help reduce the risk for heart disease — they can help those with diabetes in other ways, too.
“The minerals, fibres and chemicals are more likely to provide anti-inflammatory effects, and inflammation in diabetes is one of the key driving forces of a lot of the complications in the eyes, in the kidneys, and the vasculature,” Dr. Bering said.

While nuts have many nutritional benefits, it’s important to be aware of portion size and salt content. One serving of nuts is about a third of a cup; if you eat more than that, you could be overeating, Dr. Bering said.
Also, some pre-salted or pre-flavoured nuts are high in sodium. Dr. Bering recommends those with diabetes or kidney or heart disease problems get nuts without salt and add in some unsalted flavouring on their own.

Those with diabetes can take other precautions to reduce heart disease risk as well, such as avoiding ultra-processed foods. Those are the foods that “often have the worst health effects” and contain artificial sweeteners and can lead to adverse cardiovascular health or obesity-related illnesses, Dr. Bering said.

https://wtop.com/medstar-washington/2019/09/why-those-with-diabetes-should-add-nuts-to-their-diets/

Workplaces could be good setting for diabetes prevention

From reuters.com

People in certain occupations have a three-times-higher risk of type 2 diabetes compared to those in other jobs, probably because of lifestyle factors, a nationwide study in Sweden suggests.
Getting these workers to ramp up physical activity could be the first step to preventing the disease, the researchers say.

“The way to target the workplace is by finding employees at the highest risk,” study leader Dr. Sofia Carlsson from the Institute of Environmental Medicine at the Karolinska Institutet in Stockholm told Reuters Health by phone. “We wanted to go through all occupations in the entire Swedish population and see where the risks and prevalence of type 2 diabetes were highest.”

About 7% of Swedish adults, and 4.2% of the working population, have diabetes.
Carlsson’s team used population registries to identify more than 4.5 million Swedish citizens born between 1937 and 1979 who were gainfully employed between 2001 and 2013.
Rates of diabetes varied by profession, from 2.5% to 8.8% in men and from 1.2% to 6.4% in women, the researchers reported at the annual meeting of the European Association for the Study of Diabetes and in the journal Diabetologia.

Among male professional drivers, for example, 8.8% had diabetes, as did 7.8% of manufacturing labourers but only 2.5% of computer scientists. Among women, prevalence was highest in manufacturing workers, at 6.4%, followed by kitchen assistants (5.5%) and cleaners (5.1%). It was lowest among specialist managers, at 1.2%.

Professional drivers, manufacturing workers and cleaners were at the highest risk, and the irregular hours and shifts, stress and sleeping time associated with these occupations could be the cause, Carlsson said.

“We see risk factors early in the working career, and this could be targeted through workplace intervention,” she added.
While association is not the same as causation, the research provides direction for next steps, said Dr. Ronald Tamler, Professor of Medicine, Endocrinology, Diabetes and Bone Disease at the Icahn School of Medicine at Mount Sinai in New York City, who was not involved in the study. “Is there a causative effect in certain occupations and if so, how can we mitigate that?”

Carlsson pointed to attempts in the U.S. to implement diabetes prevention programs at work.
“A randomized clinical trial in the U.S. in the early 2000s showed lifestyle modification counselling reduced the risk of type 2 diabetes by around half,” she said. And it didn’t ask much from the people with diabetes: “A 5% reduction in weight, more physical activity, and a 70-minute brisk walk every day,” Carlsson said.

The findings are significant for the U.S. population, too, where according to the Centres for Disease Control and Prevention, one out of every 10 people has diabetes.
In earlier U.S. studies, professional drivers and shift workers were more likely to have diabetes.
“In the U.S. too, people with lower socioeconomic status, less physical activity, poor access to healthcare and lower health literacy are at greater risk,” Tamler said.

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“Ultimately, diabetes is a massive cost driver in healthcare and a considerable source of absenteeism at work,” Tamler said, adding the current study offers a chance for employers to start preventive programs.

https://www.reuters.com/article/us-health-diabetes/workplaces-could-be-good-setting-for-diabetes-prevention-idUSKBN1WC240

Scientists Identify Potential Way to Prevent Type 1 Diabetes

From virginia.edu

Researchers believe they have identified a way to prevent type 1 diabetes by restoring the immune system’s natural balance. The approach may also prove effective for battling other autoimmune diseases such as lupus and eczema, they hope.

It could also have benefits for people who have already developed diabetes: The researchers believe it could reduce or eliminate the need to take drugs that suppress the immune system after islet transplantation, a promising potential treatment for diabetes that is now being investigated.

The scientists, at the University of Virginia School of Medicine and Vanderbilt University, are seeking partners in the pharmaceutical industry who can make the product they need, a concentrated form of an antibody called human immunoglobulin, or IgM. That’s their next step before they can begin human testing to determine IgM’s effectiveness at preventing diabetes.

Preeti Chhabra, a research scientist in the Cellular Therapeutics and Transplant Core, and transplant surgeon Dr. Kenneth Brayman. (Photo by Dan Addison, University Communications)

“We’re reaching out to current manufacturers of IgM to see if we can work with them to develop products that are very concentrated in it, because it doesn’t work with regular immunoglobulin,” UVA transplant surgeon Dr. Kenneth Brayman explained. “With many immunosuppressive agents, if you give them at the right time, you can prevent the disease. But when you stop the drug, the disease recurs. But it’s different with IgM. IgM is reprogramming the immune system.”

Understanding Diabetes
Brayman began working several years ago with Vanderbilt’s Dr. Daniel Moore to try to understand the role of IgM in the development of diabetes. Their work spurred them to examine whether patients with diabetes were IgM deficient, and those findings have led them to believe that a concentrated dose of IgM may head off the development of the condition.

“The holy grail would be to identify patients at risk using biomarkers or genomics and then intervene in what is called the pre-hypoglycaemic phase of autoimmunity,” Brayman said. “These patients are clinically silent [exhibit no symptoms], in that their glucose is normal until they reach a threshold below which they don’t have enough beta cells to make enough insulin to prevent them from becoming diabetic.”

To understand that process, and find ways to stop it, the research team includes a wide range of expertise, including UVA’s Stephen Rich, a top expert in the genetics of complex human diseases, and Preeti Chhabra, a research scientist in the Cellular Therapeutics and Transplant Core who focuses on diabetes and transplant immunology. The work, part of the Virginia Precision Individualized Medicine for Diabetes (PrIMeD) Project, was inspired by UVA’s Dr. Peter Lobo, an early promoter of IgM and its anti-inflammatory properties.

Regulating the Immune Response
The researchers believe concentrated IgM could also help improve treatment for people who already have developed diabetes by facilitating the transplantation of clumps of pancreatic cells called islets. The islets include the insulin-making beta cells.

“To successfully transplant cells into humans with type 1 diabetes, you have to prevent rejection, and you have to prevent recurrence of autoimmunity,” Brayman explained. “If the IgM can lower or eliminate the amount of conventional immunosuppression that needs to be used, it would be very helpful, because there are people who would love to have islet transplant, but they don’t want to be on long-term immunosuppression.

“So it would change the risk-benefit paradigm for them,” he said. “And then, for other autoimmune diseases, currently the only way to control many of these is with conventional immunosuppression. So if you can give IgM and then the patient is tolerized to their own antigens that are acting as stimulants for the autoimmune process, then hopefully you can make the disease quiescent and prevent a lot of long-term complications.”

Next Steps
The researchers hope to start testing IgM to determine if can prevent diabetes in people within the next couple of years, but the timing will depend on their ability to find a suitable industry partner and then obtain the necessary federal approvals.

https://news.virginia.edu/content/scientists-identify-potential-way-prevent-type-1-diabetes