Can diabetes alert dogs help sniff out low blood sugar?

By Miriam E Tucker

For people with diabetes who take insulin, the risk of losing consciousness from low blood sugar is a constant fear. Devices called continuous glucose monitors (CGMs) can alert wearers to dropping levels, but not everyone has access to them. And even among those who do, some prefer a furrier and friendlier alert option: a service dog with special training to alert owners when their blood sugar reaches dangerously low levels.

These dogs are trained in a variety of ways, and although they receive certification, there is no universally accepted test to ensure their competence. Fully trained dogs can cost in the $20,000 range and typically aren't covered by insurance, although some nonprofit organizations can help offset the cost.
But as the popularity of diabetes alert dogs to detect hypoglycemia has increased dramatically, their effectiveness is largely unknown, according to Evan Los, a pediatric endocrinologist at Oregon Health & Science University who has studied their use. "Though dog trainers and dog users are generally enthusiastic," he notes.
Moreover, it's not clear exactly what the dogs may be detecting. Are they actually "smelling" low blood sugar, or are they reacting to typical hypoglycemia symptoms in their owner, such as sweating or shaking?
Two new studies add scent to the trail. One, published in the journal Diabetes Care, suggests that the dogs may be smelling a particular substance in the person's breath that rises as blood sugar falls.
But a second study, presented by Los at the recent meeting of the American Diabetes Association in New Orleans, found that although the dogs do appear to detect low blood sugar, they also often alerted owners when they didn't have low blood sugar, and were usually slower than a CGM to alert to actual low blood sugar.

In the "Diabetes Care" study, Sankalpa Neupane and colleagues at the University of Cambridge measured the amounts of volatile organic compounds in exhaled breath in eight adult women with Type 1 diabetes. When the patients were given insulin infusions to induce hypoglycemia, levels of one of the most common VOCs in human breath, called isoprene, rose "strikingly," the researchers said.
No relationship was seen between hypoglycemia and any other VOC, including acetone, ethanol or propane.
It's not clear exactly why this happens, but one theory is that isoprene may be a byproduct of cholesterol production, which may be influenced by blood sugar levels. Or the fast heart rate and blood flow that accompany hypoglycemia may simply result in the delivery of more isoprene to the lungs.
While diabetes alert dogs were the impetus for this study, the researchers didn't test dogs to see if they react to the chemical. It's certainly possible that isoprene isn't the whole story, says Dr. Mark Evans, the study's lead investigator and a University of Cambridge lecturer. "All we have done is find one signal," he told NPR. "I suspect that dogs respond to a combination of cues including [VOCs], but also subtle behavioural cues."
Asked to comment, Los said, "Their study didn't test whether dogs have any ability to detect or alert to different concentrations of isoprene, so ... whether this is a compound used by the dogs is unknown."

Doggie over-do?

Los became interested in diabetes alert dogs when some of his patients asked his advice about getting them. "I didn't know anything about them. It turns out almost no one did, but patients were using them anyway."
He and his colleagues studied eight patients with Type 1 diabetes ages 4 to 48 years along with their own trained dogs for one week each, comparing the dogs' accuracy with those of both fingerstick and CGM blood sugar monitoring.
The dogs did alert the owners over three times more often during low blood-sugar episodes than when blood sugar was normal. But just 12 percent of the 16 to 20 average weekly alerts occurred when the patient actually had hypoglycemia.
And when both the dog and the CGM alerted, the CGM alerted first in 73 percent of low blood sugar events, an average of 22 minutes sooner than did the dog.
Los speculates that the dogs might also be reacting to high blood sugars or rapid changes in blood sugar, situations that CGMs also detect and provide feedback for. "Given that a CGM differentiates its alerts clearly, the dog is operating at a disadvantage."

A dog's world

Despite the many false alerts, surveyed dog users were very satisfied (8.9 on a 10-point scale) and fairly confident (7.9/10) in their dog's ability to detect hypoglycaemia.
Evans told NPR those results don't surprise him. "I suspect that dog owners are more tolerant of false negatives [from their dog] than a device falsely alarming, which really irritates."
For patients without CGMs who have a trained dog and find it helpful, Los says that "I would never tell them to get rid of it, because it's alerting them to more hypoglycemia symptoms than they would otherwise know about."
More research is needed, he said, to determine whether particular training approaches, breeds or other factors might make dogs better hypoglycemia-detecting best friends.
"Although it appears CGM outperformed trained dogs in this study, it is intriguing that dogs were able to detect some hypoglycemia," Los said. "Perhaps understanding what factors impact dog reliability could help optimize dog performance."
Then there's the warm fuzzy effect. Other possible benefits not measured in the study could include having a positive partner in the daily management of a chronic disease, Los added, especially one "in which the daily tasks are not very rewarding."

http://www.scpr.org/news/2016/07/29/63088/can-diabetes-alert-dogs-help-sniff-out-low-blood-s/

This is what diabetes really looks like: Teen reveals truth about condition - without a cake in sight

By Nicola Oakley

A young woman with Type 1 Diabetes has shared a powerful post warning people not to make light of the condition on social media.
Referring to the common practice of people tagging their photos of sugary food #Diabetes, 18-year-old Madeline Milzark decided to set the record straight on what Diabetes really looks like.
Sharing a photo to her Facebook page while she sits on the floor holding a cup of tea with a blood sugar level monitor nearby, she wrote:
"Diabetes isn't your piece of cake or that super sized McDonald's meal with extra fries - or anything you see coated with sugar.
"Diabetes is an 18-year-old girl sitting on her bathroom floor shaking and not able to breathe because her blood sugar dropped and praying her Grandma's phone is near her and she got the text message to bring some sugar since she's too weak to yell and the whole room is spinning.

"It's a nine-year-old boy...

...who is trying to play outside with his friends and ends up being carted away in an ambulance because he went unconscious when he didn't feel his sugar slipping.

"It's a 32-year-old girl

...who FINALLY got the news that she's pregnant and going to have the family she's always wanted, but instead of celebrating like she should be she's worried to death that her blood sugars won't stay in range with all of the hormones and that it's going to kill her baby before she gets to meet it... and maybe even her.

"It's a three-year-old...

...who doesn't understand why her mommy has to stab her with a syringe every single time she eats, but not her brother.

"It's a four-year-old girl...

...that I read about recently who lost her life because a doctor misdiagnosed her diabetes as the flu and she ended up a victim of diabetic ketoacidoses, where your blood literally turns acidic from the lack of insulin in your body and attacks your organs.

"Diabetes is your mother, your neighbor, your cousin.

"Diabetes isn't the morbidly obese man you see on TV. It isn't something people ask for or give themselves.
"It's a disease that isn't picky when it chooses who to attack, it doesn't care if you're two months old or if you're 73.
"It doesn't care if you eat Big Macs and McChickens every day of your life or if you're a strict vegan who goes to the gym daily.
"Diabetes is me. Diabetes is a whole ton of people who fight for their life every single day and go to bed not sure if they're going to wake up the next morning.
"So before you tag your huge dessert #Diabetes , think about what #Diabetes really looks like."
Madeline has now launched a Facebook page, Type One Madeline , to spread awareness of the condition.

http://www.mirror.co.uk/news/real-life-stories/what-diabetes-really-looks-like-8514243

10 Tips for College-Bound Students with Diabetes

By Jose Quintos, MD

Going off to college is an exciting time. It’s a rite of passage that tests a young adult’s ability to adapt academically and socially. Of course, this new-found independence comes with its share of anxiety and stress. That is especially true for students who have type 1 diabetes.

Changes to surroundings, routine and support systems can be daunting. However, with some careful coordination, the transition from your home to dorm life can be smooth.
Here are tips I often provide to my patients and their parents as they prepare for college.
1. Tell your new roommate, resident advisor (RA), friends, coaches and professors that you have diabetes. It’s important for those around you to know so they can help you in the event of an emergency. Professors should know that you may need diabetes equipment or snacks while you are in class.
2. Teach your roommate or close friends about diabetes and how they can help you. Educate them about signs of hypoglycemia and how to administer glucagon.
3. Develop an eating routine. College schedules can greatly impact your routine. If your meal times vary too much, you may have difficulty recording and comparing your blood sugar readings. Plan to eat meals at the same times each day. This is easier to do if you maintain a regular sleep schedule. 

4. Keep your dorm room stocked. Keep pre-packaged foods in your dorm and replenish regularly. Don’t let your reserves get too low. Also, prepare a sick-day kit with things like fast-acting insulin, saltines, Gatorade and glucagon. Make sure you can easily access the kit.
5. Create a contacts list of important people you may need to reach. This list may include your doctors, college health services, insulin pump vendors, insurance company, pharmacy and a certified diabetes educator.
6. Understand alcohol’s impact. Drinking is more dangerous for people with diabetes and can cause hypoglycemia even after you’ve gone to sleep. Also, symptoms of hypoglycemia and overindulgence of alcohol can be easily confused. For more information, visit the College Diabetes Network web site collegediabetesnetwork.org.
7. Register with the disability service and/or campus health office on campus. These resources can advocate for you and help make sure your needs are met. That can include helping reschedule an exam if your blood sugar is low.
8. Find out if your college has a College Diabetes Network (CDN) chapter. These campus clubs are a tremendous resource for students with type 1 diabetes to support each other. If your college lacks a chapter, think about starting your own. Learn more at collegediabetesnetwork.org.
9. Review the American Diabetes Association’s publication Going to College with Diabetes: A Self Advocacy Guide for Students. The guide contains useful information like how to communicate with your college’s disability service office and what your legal rights are as a student with diabetes.
10. Have fun! Enjoy the opportunity ahead of you and make the most of your time in college. Remember that with the right planning and support, having diabetes won’t get in the way of achieving your goals.  

http://www.lifespan.org/Newsroom/News.aspx?NewsId=75925/10-Tips-for-College-Bound-Students-with-Diabetes/

Wise food choices make managing diabetes better

By Rita Hodges

Why is it so important that people with diabetes pay careful attention to what they eat and when? It’s because it helps to control their blood sugar (glucose) levels and prevents complications from developing.

We can change many aspects of our lives to become more healthful. Eating the same amount of food at certain times during the day helps with the carbohydrate metabolism problem that is caused by diabetes.

Another way to be more healthful is to pay attention to what you eat and to make wise food choices.

Foods and nutrition play an important part in managing diabetes, but for people to use these key tools, they must know the right kinds and amounts of food to eat each day.

Foods are classified according to the major nutrients they provide: carbohydrates, proteins, and fats. Dietary intake of these nutrients can affect the body’s ability to function.

Too often, life is spent in a rush.

Because of this, food is often eaten quickly, without any consideration of the nutrition it provides. But eating properly and healthfully takes planning and advance decisions to ensure the right choices in foods are made.

People with diabetes can eat the same foods as the rest of their families, but they need to make sure their eating habits are healthy to better control their diabetes.

Healthy, nutritious foods enable the body to grow, maintain, and repair tissues and to balance its chemistry.

The body needs proteins, carbohydrates, fats, vitamins, minerals, and water in the right amounts and at the right times to function well.

No one food supplies all the nutrients the body needs. The food we eat can really make a difference in the amount of glucose in our blood. Choosing healthful foods is a lifestyle choice that we must make if we are to control our diabetes.

Let your meal plan guide your daily food choices. Everyone with diabetes should follow these simple guidelines, which are the keys to controlling diabetes:

• Eat a variety of grains daily, especially whole grain choices of bread, cereals, rice, and pasta.

• Eat a variety of fruits and vegetables daily.

• Eat less total fat, saturated fat, trans fatty acids and cholesterol.

• Eat fewer foods that are high in salt or sugar.

• Make wise meal choices, and eat at the same times throughout the day.

To build a healthy meal plan, begin with the grains: breads, cereals, rice, and pasta. Eat at least six servings from this group this day. Include at least three to five vegetables and two to four fruits in your meals every day. Choose two 3-ounce servings from the protein group and two or three servings from the dairy group.

If you can afford the extra calories, add a small amount of fat, oil, and sweets. Cut back on salt.

People with diabetes are especially concerned with carbohydrates, since their bodies don’t metabolize starches well.

Carbohydrates that have a higher fiber content-breads, cereals, vegetables, and fruits-are better tolerated than simple carbohydrates with less fiber and higher sugar contents, such as milk, fruit juices, and concentrated sweets such as sugar, syrup, and honey.

Fiber is also an important part of the meal plan, especially for those that have diabetes. Whole grain pastas, dried peas and beans, whole-grain flour, cereals, fruits and vegetables all have fiber, which is better for those with diabetes.

While raising the amount of fiber in their meal plans, people with diabetes need to be aware of the amount of fats they consume. Because people with diabetes have higher amounts of lipids (fats) and extra sugar in

their blood, they face a greater risk of heart disease and stroke than do people who don’t have diabetes. Reduce the amount of fat consumed by following these guidelines:

• Eat more fruits, vegetables, cereals, grains and starches that have no saturated fatty acids, no trans fats, and no cholesterol.

• Choose vegetable oils with higher levels of unsaturated fatty acids and lower levels of saturated fatty acids. Some of the healthier oils are safflower, sunflower, corn, soybean, canola, olive, and peanut.

• Eat lean meat from the leg or loin cuts of beef, pork or lamb, poultry and fish. Trim all visible fat.

• Buy lower-fat milk and milk products.

• Read labels to look for hidden sources of fats in foods.

http://www.waxahachietx.com/article/20160723/NEWS/160729800/?Start=1

 

 

 

Healthy fats and brisk walking can slash diabetes risk, researchers say

By Sarah D Young

Insulin resistance and Type 2 diabetes are on the rise in the U.S., but researchers may have uncovered a new way to keep the disease at bay.
According to the results of a large study, published recently in PLOS Medicine, healthy fats may be the key to lowered blood sugar levels and increased insulin resistance.

Substituting as few as 100 calories worth of carbohydrates for 100 calories worth of healthy fats, such as nuts, seeds, and vegetable oil, can help cut the risk of type 2 diabetes by an estimated 20 percent, the researchers claim.

The study’s co-leader, Dr. Dariush Mozaffarian, Dean of the Friedman School of Nutrition Science and Policy at Tufts University in Boston, says the message is simple: “Don’t fear the healthy fats.”

“Our findings support preventing and treating these diseases by eating more fat-rich foods like walnuts, sunflower seeds, soybeans, flaxseed, fish and other vegetable oils and spreads, in place of refined grains, starches, sugars and animal fats,” Mozaffarian said in a release.

But diet changes aren't the only way to combat type 2 diabetes. When it comes to keeping glucose levels under control, a little moderate exercise may have a big impact. 

Brisk walking

New research from Duke Health has revealed that it’s moderate, not high intensity, exercise that is most effective at controlling metabolism in people at risk for diabetes.

In the study, individuals with pre-diabetes were randomly placed into groups and tracked over six months. Some participants adopted diet and exercise changes while others made changes only to their exercise regime.

In the exercise-only group, it was discovered that moderate-intensity exercise (where participants walked briskly 11.5 miles each week) produced a 7 percent improvement in glucose tolerance on average.

In contrast, participants who walked vigorously for the same amount each week had only a 2 percent average improvement.

One lifestyle change

While high intensity exercise may burn more glucose, moderate-intensity exercise helps burn fat in the muscles (where glucose is stored after a meal). The researchers explain that this can help block glucose uptake by the muscles.

Lead author, Dr. William Kraus -- professor of medicine in the Division of Cardiology at Duke University School of Medicine, says this new finding could benefit pre-diabetic patients who may have a hard time committing to more than one lifestyle change.

“When faced with the decision of trying to do weight loss, diet, and exercise versus exercise alone, the study indicates you can achieve nearly 80 percent of the effect of doing all three with just a high amount of moderate-intensity exercise,” Kraus said.
“I was heartened by the fact that I found out that I can give patients one message and they can get nearly the same effect as when required to exercise, diet and lose weight all at the same time.”

https://www.consumeraffairs.com/news/healthy-fats-and-brisk-walking-can-slash-diabetes-risk-researchers-say-072116.html

Breastfeeding May Reduce Mother's Risk of Diabetes: Study

From food.ndtv.com

Breastfeeding has the potential to reduce the long-term risk of developing Type 2 diabetes among women with gestational diabetes, and is a cost-effective intervention, says a study.
The findings revealed that breastfeeding can alter the maternal metabolism to protect against diabetes.

The metabolites in women who breastfed for more than three months differed significantly from those who had shorter lactation periods. "Longer periods of lactation are linked to a change in the production of phospholipids and to lower concentrations of branched-chain amino acids in the mothers' blood plasma," lead-author Daniela Much from Helmholtz Zentrum Munchen -- a German recearch institute. The metabolites involved were linked in earlier studies with insulin resistance and type 2 diabetes, the researchers said. "The findings of our study provide new insights into disease-related metabolic pathways that are influenced by lactation and could thus be the underlying reason for the protective effect," added Sandra Hummel from Helmholtz Zentrum Munchen.
Previous studies have showed that breastfeeding for more than three months postpartum has a protective effect, which lasts for up to 15 years after gestational diabetes.
For their analyses, the scientists examined almost 200 patients who had developed gestational diabetes. The participants in the study received a standardised glucose solution and gave a fasting blood sample beforehand, and during the test. The scientists then compared the samples on the basis of 156 different known metabolites. "On average, women with gestational diabetes breastfeed less often and for shorter duration than non-diabetic mothers," Hummel said adding, "the aim is now to develop strategies that will improve the breastfeeding behaviours of mothers with gestational diabetes."

http://food.ndtv.com/health/breastfeeding-may-reduce-mothers-risk-of-diabetes-study-1434378

Diabetes researchers say 'healthy' fats could hold off the disease

From breakingnews.ie

Eating “healthy” fats found in vegetable oil, nuts, and fish may keep diabetes at bay by improving the body’s regulation of blood sugar, research suggests.
Replacing carbohydrates and “saturated” fat from meat and dairy products with the nutrients reduces risk factors for Type 2 diabetes, say scientists.
The evidence comes from an analysis of pooled data from 102 trials comparing the effects of different diets followed by 4,660 adult participants.

(AP)

Researchers looked at how the foods people ate affected measures of metabolic health, including blood sugar levels, and the ability to produce and respond to the hormone insulin.
Diets rich in monounsaturated or polyunsaturated fats had a beneficial effect on key markers of blood sugar control.

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Every 5% switch away from carbohydrates or saturated fats to “healthy” fats as a source of dietary energy resulted in a 0.1% reduction in levels of a blood molecule used to monitor long-term sugar regulation.
Such a change is estimated to reduce the incidence of Type 2 diabetes by 22% and heart and artery disease by 6.8%, said the researchers writing in the journal Public Library of Science Medicine.
Lead scientist Dr Dariush Mozaffarian, from Tufts University in Massachusetts, US, said: “The world faces an epidemic of insulin resistance and diabetes.
“Our findings support preventing and treating these diseases by eating more fat-rich foods like walnuts, sunflower seeds, soybeans, flaxseed, fish, and other vegetable oils and spreads, in place of refined grains, starches, sugars, and animal fats.
“This is a positive message for the public. Don’t fear healthy fats.”
The most consistent benefits resulted from increasing consumption of polyunsaturated fats in place of either carbohydrates or saturated fat, the study found.
Blood sugar is regulated by the hormone insulin, which controls how much of it is stored or used as “fuel” for cells.
If too little insulin is produced, or the body stops responding to it properly, blood sugar can rise leading to the health problems associated with diabetes.

http://www.breakingnews.ie/world/diabetes-researchers-say-healthy-fats-could-hold-off-the-disease-745623.html