Athlete with Type 1 diabetes tells of marathon motivation

From bbc.co.uk

A former Commonwealth Games cyclist has told of what motivated him to complete a 350-mile ultra marathon held inside the Arctic Circle.

Roddy Riddle, who is from Inverness and has Type 1 diabetes, completed the 6633 Ultra in Canada in just under seven days earlier this month.
He entered the race previously but was unable to finish it.
Mr Riddle said he let people down that time and "wasn't coming home" until he completed his second attempt.
To finish the race, competitors must reach the end in eight days or less.

Mr Riddle not only completed it within that time but was the first Scot to do so and finished the event in second place.
He told BBC Radio Scotland's Personal Best programme that he did the marathon to show that having Type 1 diabetes did not mean giving up on goals.

Mr Riddle said: "Last year, as I did this time, people could follow my progress."Families with children or other family members with Type 1 diabetes were following my progress and it was them I felt I let down.
"I wanted to prove that having Type 1 diabetes shouldn't stop you achieving your goals or achievements in life.
"By not finishing, I had let myself down, I had let my family down, my friends down and most importantly the whole diabetes community down."

'Wacky hallucinations'

Mr Riddle said he arrived at the start line for his second attempt much wiser and with more respect for the race.
He pulled a four-wheel pulk, a type of sledge carrying his supplies, instead of the two-wheel version that gave him back pain on the first attempt.
Mr Riddle said: "I had also learned that I should sleep when I needed to sleep and eat when I needed to eat. It meant I didn't have the wacky hallucinations I had last year."
He added: "I wasn't going back a third time. I was not coming home until I finished. Not finishing wasn't an option.
"But I was better prepared. Mentally I knew what I needed to do."

http://www.bbc.co.uk/news/uk-scotland-highlands-islands-39404805

Just 10 Minutes of High-Intesity Exercise May Cut Diabetes Risk in Kids

From ndtv.com

The role of regular exercising has long been deemed important to prevent a host of lifestyle diseases including cancer, diabetes among others. The World Health Organisation recommends at least 150 minutes of moderate-intensity exercise or 70 minutes of vigorous exercising for adults in a week to maintain a healthy lifestyle. Kids between 5-17 years should undertake at least 60 minutes of moderate to vigorous physical activity daily to maintain good health and optimum physical development. A recent report published in the journal Medicine and Science in Sports and Exercise, suggests just 10 minutes of high-intensity physical activity every day for kids to keep heart problems and metabolic diseases at bay.

Researchers from Wake Forest Baptist Medical Centre in the US found that replacing light-intensity physical activity with brief periods of vigorous exercise may provide significant cardio-metabolic benefits in young people with relatively large waist measurements and elevated levels of insulin in their blood.

For the study, the team analysed 11,588 young people aged between 4 and 18 from countries like the US, Brazil and other European countries. Participants' age, gender, level of physical activity and at least one biomarker of a cardio-metabolic risk were studied. Their weight, blood pressure, HDL, LDL, triglycerides, glucose and insulin levels were monitored.

As a result only 32 significant associations out of a possible 360 were found while evaluating the relationships between the biomarkers and vigorous physical activity. All 32 associations were related to reduced waist circumference and insulin levels. The relationships between high-intensity exercise and the other biomarkers were inconsistent.

"The results suggest that substituting modest amounts of vigorous physical activity for longer-duration light exercise may have cardio-metabolic benefits above and beyond those conveyed by moderate activity and the avoidance of sedentary behaviour," said Justin B Moore, Associate Professor at Wake Forest Baptist.

"But as vigorous activity was independently associated with only two of the markers examined, it may be that its truly meaningful benefits may be limited, relative to less-intense exercise," Moore added.

http://food.ndtv.com/health/just-10-minutes-of-high-intesity-exercise-may-cut-diabetes-risk-in-kids-1673431

NINJABETIC – The language of diabetes

From diabetestimes.co.uk

At this year’s Diabetes UK Professional Conference I had the pleasure of presenting with a fellow patient advocate, and amazing leader in diabetes youth work, Dani Cochrane. Dani and I were honoured to be delivering the first ever patient-led workshop in the history of the conference (so we were told by the lovely Simon O’Neil), but that also bought a lot of pressure!
Would people turn up? We were in competition against Partha Kar after all. Would people listen? Would we be able to answer their questions? Would the workshop be a complete disaster ending with us drowning our sorrows later in the pub and sobbing uncontrollably into our insulin pumps?
It seemed these worries were unnecessary as the workshop, ‘The Language of Diabetes’, was a great success and positive feedback came flooding in from healthcare professionals across the UK and as far as Australia! It would appear that mine and Dani’s combined 28 years’ experience of living with type 1 diabetes paid off and we were able to provide a valuable insight that is difficult to teach from a book or a lecture.
Our workshop was important to us not only as patients, but also as healthcare professionals ourselves. Dani and I are fortunate enough to be able to see the world of diabetes from both sides of the table and we wanted to get that across in the hour we had. We were not there to judge the audience, just as we would not expect any healthcare professional to judge a patient. This was a key message that we wanted to deliver, mutual respect between patients and professionals is so very important.
Kicking off the workshop we were joined by a clinical psychologist and a dietician who, through the use of role play, showed the audience just how confusing conversations around HbA1c can be. Although I laughed along at the utterly confusing, jargon-laced conversation between the two, my personal experience of having this conversation bought home how difficult it can be.
It reminded me of how often I would go away from an appointment with a result and really not understand the meaning of it or the implications that it would have for me. It reminded me of how I felt like an underachiever, along with the feeling of incompetence for not quite being up to the level of knowledge around these conversations that seemed to be expected of me. Writing this, the very words that I have used to explain how I felt back then are the very words that I want to remove myself from. These are negative words associated with negative feelings and no patient, parent or carer should come away with an HbA1c result, or from the conversation about it, feeling negative.
Next up I spoke about my first ever ‘make or break’ experience in secondary care when a discussion around diabetes-related complications arose. I say make or break because that conversation was a big factor in causing me to rebel against my diabetes for a long time, sadly the consequence of which was that complications did catch up with me. However, being older and slightly wiser, I am now able to reflect back on that important day which I remember so well, and pass on my thoughts and ideas about how things could have been for me had the conversation gone differently.
I knew that I did not want to hear the words “amputations”, “blindness”, “kidney failure” etc, but what would have gotten me off to the start in my diabetes life that I needed were “you can do this”, “you are stronger than you know”, “diabetes will not stop you” and “we are here to support you”. Those words and that encouragement could have been the deal breaker in capturing my attention from day one and would have shown me just what is possible when it comes to living with diabetes.
Last, but by certainly no means least, was the star of the show, Dani, who facilitated a fantastic interactive group workshop in which she demonstrated that what people may see when they look at a patient, isn’t always what it seems. Dani and the audience talked about the importance of not making assumptions about a person, or how they are feeling, without getting to know and understand that person first.
Building a relationship between patients and healthcare professionals is incredibly important when it comes to long-term conditions and both sides in the room demonstrated that taking a non-judgemental approach to a conversation is what matters most to them. By both sides basing a conversation on fact, rather than assumption, it gives the opportunity for an honest and open conversation to develop and to take them forward, rather than causing a barrier to form.
It was a fantastic discussion to have and I was incredibly pleased with the way the audience opened up to us and to each other about the barriers that they come across, as well as sharing their experiences and tips in improving communication and language used in consultations.
A great positive that myself and Dani took away is the opportunity to now take this workshop further and to develop a national mission statement about how language can be used positively to improve consultations between healthcare professionals and people with diabetes! I would like to thank Diabetes UK for giving us the opportunity to deliver this workshop and a huge thanks goes to my partner in crime, Dani, who I had the pleasure of being joined at the pancreas with throughout the conference!

http://diabetestimes.co.uk/ninjabetic-language-diabetes/

There’s Now More Evidence That Type 2 Diabetes Can Actually Be Reversed

From rd.com

A new study published in the Journal of Clinical Endocrinology & Metabolism is sweetening the pot when it comes to the potential of reversing type 2 diabetes and adds to the growing body of evidence that intensive lifestyle changes can go a long way in managing the disease.
Researchers found that when diabetes patients received a combination of oral medication, insulin, and a personalized exercise and diet plan for two to four months (and then stopped all diabetes medication), up to 40 percent were able to keep their blood glucose numbers at remission levels for three months without meds.

“The idea of reversing the disease is very appealing to individuals with diabetes. It motivates them to make significant lifestyle changes and to achieve normal glucose levels,” said study author Natalia McInnes, MD, MSc, FRCPC, of McMaster University in Canada in a news release. (Typical treatment for the roughly 29 million Americans with type 2 diabetes is regular blood glucose testing, insulin, and medication.)
For the study, 83 individuals with type 2 diabetes were split into three groups. Two received oral medication, insulin, and a personalized exercise and diet plan that cut their daily caloric intake by 500 to 750 a day (one group followed the intervention for eight weeks, the other was treated for 16 weeks); both groups stopped taking diabetes medications at the end of the intervention and were encouraged to continue the lifestyle changes on their own. A control group received standard blood sugar management advice.
Three months after the intervention was completed, 11 out of the 27 “intervention-ers” in the 16-week program met the criteria for complete or partial remission, compared just four out of the 28 control group participants. “The research might shift the paradigm of treating diabetes from simply controlling glucose to an approach where we induce remission and then monitor patients for signs of relapse,” said McInnes.

http://www.rd.com/health/conditions/reversing-type-2-diabetes/

Is there a link between climate change and diabetes?

From cnn.com

Scientists have long warned that rising global temperatures may impact public health in a devastating way because climate change is associated with deadly weather events, the spread of infectious diseases and even food shortages.

Now, researchers are looking at whether climate change might be linked to another public health concern: Type 2 diabetes.

Between 1996 and 2009, as outdoor temperatures rose across the United States, so did the prevalence of diabetes, according to a study published in the journal BMJ Open Diabetes Research & Care on Monday.

"We were surprised though by the magnitude of the effect size," said Lisanne Blauw, a researcher at Leiden University Medical Centre in The Netherlands and lead author of the study.

"We calculated that a 1-degree Celsius rise in environmental temperature could account for more than 100,000 new diabetes cases per year in the USA alone," she said. "Future research into the effects of global warming on our health status is therefore of great importance."

However, this observational study simply reveals an association between climate and diabetes, not a causation. Among the factors known to cause Type 2 diabetes are being overweight or obese and having a family history of the disease.

"I think calorie consumption and weight are probably the biggest by a country mile," said Dr. Adrian Vella, an endocrinologist who has researched Type 2 diabetes at the Mayo Clinic. He was not involved in the new study.

"I think the general message always should be that association studies do not actually imply causation," he said of linking climate change and diabetes.

Currently, about one out of every three Americans will develop Type 2 diabetes, according to the Centres for Disease Control and Prevention.

For the new study, researchers analysed data on the incidence of Type 2 diabetes in the United States, including the territories of Guam, Puerto Rico and the Virgin Islands, between 1996 and 2009. The data came from the CDC's Behavioural Risk Factor Surveillance System.

The researchers also analysed data on the mean annual temperature per state using data from the National Centres for Environmental Information.

Global data were analysed, too. Information on fasting blood glucose levels and obesity was gathered through the World Health Organization's Global Health Observatory online database.

The researchers found that for every 1-degree Celsius increase in outdoor temperature, there was about a 4% increase of the total diabetes incidence in the United States per year between 1996 and 2009, Blauw said. An increase of 1 degree Celsius is equivalent to an increase of 1.8 degrees Fahrenheit on the Fahrenheit temperature scale.

The worldwide prevalence of glucose intolerance rose by 0.17% per 1-degree Celsius increase in temperature, the researchers found.

"To the best of our knowledge, this study is the first to assess the association of outdoor temperature with diabetes incidence and the prevalence of raised fasting blood glucose on a national and global level," the researchers wrote.

Although more research is needed to determine why -- and how -- this correlation even exists, the study posed one hypothesis that involves the way cooler temperatures can activate a type of body fat called brown fat, or brown adipose tissue.

"The function of brown fat tissue is to burn fat to generate heat, which is important to prevent a decline in body temperature during cold exposure. Therefore, we hypothesize that brown fat plays a role in the mechanism underlying the association between outdoor temperature and diabetes," Blauw said. "In warmer climates, brown fat may be less activated, which may causally lead to insulin resistance and diabetes."

On the other hand, Vella said that brown fat doesn't have that much of an impact on metabolism in humans.

"In humans, brown adipose tissue likely explains about 1% or 2% of energy expenditure in cold situations, and shivering explains far more, so it's an exaggeration," he said.

"Between 1996 and 2009, I believe the environment has changed," he added. "Lots of things changed that might change diabetes incidence, right? The actual population composition changed a little bit. The caloric consumption of that population likely changed. We don't know about physical activity."

In 2012, an International Diabetes Federation report indicated that Type 2 diabetes and climate change may be interconnected public health concerns.

Climate change threatens the fresh food supply, which may negatively impact the diets of those with diabetes, according to the report. Also, deadly heat waves may weaken overall health due to dehydration.

"In hotter temperatures, dehydration and heatstroke increases morbidity and mortality in people with diabetes. People with diabetes are predisposed to cardiovascular events during heat waves and higher mortality from heart attack on days of high air pollution," according to the report.

Meanwhile, an increased prevalence of diabetes may lead to more carbon emissions being generated by the health care systems treating those patients.

"Diabetes-related complications -- such as (cardiovascular disease), stroke and renal failure -- cost lives and money. Hospitalizations from such complications are also energy-intensive and increase (greenhouse gas) emissions," according to the report.

Last week, the Medical Society Consortium on Climate & Health released a "medical alert" report titled "Climate Change Is Harming Our Health".

The report outlined how, across the country, climate change may lead to deadly heat waves; worsened outdoor air quality; hazardous extreme weather events; food-related infections; water-related infections; mosquito- and tick-borne infections; wildfires; and higher levels of depression, anxiety and PTSD among flood victims and farmers.

In the executive summary, the authors wrote, "We -- physicians in medical societies representing over half of the nation's doctors -- see a need to share our growing understanding and concern about the health consequences of climate change with all Americans."

http://edition.cnn.com/2017/03/20/health/climate-change-type-2-diabetes-study/

Open your bedroom window at night to prevent obesity and type 2 diabetes, says Oxford prof

From telegraph.co.uk

Opening your bedroom window at night to allow in a cool breeze could be simple, if chilly, way of preventing obesity and Type 2 diabetes, an Oxford University academic has suggested.
Professor of Endocrinology Ashley Grossman said there was mounting evidence that cooling the body even by just a couple of degrees was beneficial for health.
His comments were made after a new study by Dutch scientists appeared to find a link between global warming and diabetes.
The researchers suggested that a one degree centigrade rise in environmental temperature could lead to 100,000 new cases of diabetes in the US each year because the body needed to burn less brown fat to keep warm, leading to insulin sensitivity and weight gain.
Prof Grossman said the research supported the ‘keep cool’ theory of decreasing diabetes and obesity.
“There is some rather encouraging evidence that cooling the body, even by a few degrees, may improve or reduce diabetes,” he said.
“Living in a cool environment may be useful to increase insulin sensitivity and ward off diabetes.
“Together with work indicating that adequate sleep can also help avoid obesity and diabetes, maybe we should all aim have a good night’s sleep in a cool bedroom with the windows open to the night breeze.”
A recent study by Maastricht University Medical Centre in the Netherlands advised turning the thermostat down to between 15 C and 17 C for a few hours a day to keep weight down.
The experts claimed that because we spend so much time indoors, often in overheated homes and offices, our bodies do not naturally burn calories to keep warm. Temperatures closer to what it is like outside might be more beneficial to health.
Simply being colder raises the metabolic rate - the speed at which calories are burnt - by 30 per cent, and shivering can burn around 400 calories an hour as it increases the metabolic rate fivefold.
The new research Leiden University Medical Centre, which was published in BMJ Open Diabetes Research & Care,  set out to investigate if global increases in temperature were contributing to the type 2 diabetes epidemic.
Nearly two thirds of Britons are overweight or obese and some 3.6 million people have diabetes, most of which is Type 2.
They looked at temperature data and diabetes incidence in 50 US states as well as the territories of Guam, Puerto Rico and the Virgin Islands.  They found that on average, per one degree centigrade increase in temperature, type 2 diabetes incidence increased by 0.314 per 1,000.
The human body stores two types of fat, white and brown. While white fat stores calories, brown fat is converted into energy and heat so keeping cool is thought to stimulate brown fat, and bring weight loss.
However although the link between a cold body and diabetes is fairly well established, researchers said the idea that it might be linked to climate change was unlikely.
Dr Louise Brown, Senior Statistician at the Medical Research Council Clinical Trials Unit at University College London, said: “Overall, the uncovering of this association is interesting but I do not feel that is of great help in our fight against the increasing global incidence of diabetes, unless they are suggesting that we all move to colder climates.
“If they have stumbled across a useful pointer that leads to appropriate metabolic research on the role of brown fat in the development of diabetes then great, but their claims are too strong at this stage.”
Prof Sir David Spiegelhalter, Winton Professor for the Public Understanding of Risk at the University of Cambridge, added: “Even if these estimates were true, it would mean a 2 degrees rise in average temperature was associated with an increased incidence of diabetes of 0.7 per cent.
“In those circumstances I don't think this would be the biggest concern."

http://www.telegraph.co.uk/science/2017/03/20/open-bedroom-window-night-prevent-obesity-type-2-diabetes-says/

Exercise, diet better than medicine for treating Type 2 diabetes, says UBC group

From vancouversun.com

Taking medication to tightly control and lower blood glucose levels is the advice frequently given by doctors to the 400,000 B.C. residents with Type 2 diabetes — but it’s a “misguided” approach, according to the University of B.C. Therapeutics Initiative.
More than $1 billion is spent annually on diabetes drugs in this province, but in its latest bulletin to doctors, the TI says a growing body of research casts doubt on the effectiveness of Type 2 diabetes treatment. Doctors should focus instead on prescribing lifestyle modifications such as weight loss, exercise and healthier diets instead of medications to many patients, it says.
Type 2 diabetes, characterized by resistance to insulin, is largely caused by obesity, lack of exercise, high-carbohydrate diets and aging.
With the exception of a drug called metformin, many glucose-lowering medications like insulin can lead to weight gain or potentially cause low blood sugar (hypoglycemia), which can lead to falls, driving accidents or even loss of consciousness, the TI says. More than half of Type 2 diabetes patients take such medications. (Insulin is an essential medication for those with Type 1 diabetes, which accounts for less than 10 per cent of all diabetes cases in B.C.).
The TI, an independent body that provides advice to doctors, said the optimal blood glucose level target is actually unknown in Type 2 diabetics, and there’s still no conclusive evidence that taking medications to lower blood glucose levels will decrease complications of the condition. Such complications include kidney disease, blindness, cardiovascular disease, strokes and amputations.
Dr. Tom Perry, a Vancouver internist and clinical pharmacologist with the TI, said doctors tend to minimize harms when prescribing drugs to patients.
At the same time, he says that he’s had few “star” diabetic patients willing to put in the hard work to shrink waistlines, exercise and change diet patterns.
“It’s kind of frightening because we don’t really have the right evidence for treating the Type 2 epidemic. What we’ve been doing is not very scientific,” he said, adding that publicly funded (as opposed to pharmaceutical industry-sponsored) research trials are needed to study the best treatment approaches.
Vancouver endocrinologist Dr. Tom Elliott said he’s in general agreement with the TI that some doctors may be over-treating Type 2 diabetics.
“But there are lots of patients we may be under-treating too. The problem is we don’t know how low the glucose levels should go in order to reduce the risk of bad things happening to patients.”
In an article he wrote last fall, Elliott discussed the growing controversy, saying it is true that in borderline patients, there is little high quality evidence regarding glucose lowering drugs for preventing long-term complications.
“What’s clear is that a concerted effort needs to be made to help high-risk groups to achieve better blood sugar control,” Elliott wrote.
Lawrence Leiter, a professor of medicine and nutritional sciences at the University of Toronto and a specialist in the division of endocrinology at the city’s St. Michael’s Hospital, was critical of the TI bulletin. He said the TI group has been overly selective in choosing which studies to base its recommendations upon.

“In the past two years, we have evidence from large, well-conducted, randomized controlled trials that three different medications for the management of diabetes — empagliflozin (Jardiance), liraglutide (Victoza) and semaglutide (not yet approved) — significantly reduced the risk of cardiovascular events in patients with a history of diabetes and cardiovascular disease, and that empagliflozin also reduced the risk of kidney problems.

“Canadian Diabetes Association clinical practice guidelines have for many years emphasized that we must not just lower blood glucose levels but also improve all risk factors, including blood pressure and cholesterol (and) the most recent update to our guidelines, published in November 2016, now recommend the use of empagliflozin and liraglutide to reduce the risk of complications in appropriate patients.”

http://vancouversun.com/news/local-news/exercise-diet-better-than-medicine-for-treating-type-2-diabetes-says-ubc-group

Can whole-body vibration stave off obesity and diabetes?

From medicalnewstoday.com

An intriguing study, published this week in the journal Endocrinology, compares the benefits of whole-body vibration with regular exercise. Could this innovative intervention help to stave off obesity and diabetes? Preliminary findings suggest that it could.
It is difficult to ignore the obesity crisis currently sweeping across the United States and the rest of the West. As the Centres for Disease Control and Prevention (CDC) write: "Obesity is common, serious, and costly."
More than a third of U.S. adults are obese and, in some states, over 35 percent of adults fall into the obese category.
It is now well documented that obesity brings with it a range of negative health consequences, not least of which is diabetes.
One of the best ways to combat obesity is physical activity, but many people struggle to exercise regularly for a number of reasons. Anything that can either replace or add to the benefits of exercise could be hugely beneficial for a large proportion of the population.

Investigating WBV

WBV involves standing, sitting, or lying on a machine with a vibrating platform. As the machine vibrates, it transmits energy through the body, resulting in muscles contracting and relaxing many times per second.
First tested for its therapeutic benefits in the late 19th century, WBV has been studied for use in a range of situations. For instance, the European Space Agency is investigating it as a potential way to maintain muscle mass on long space flights.
Over recent years, WBV has also been assessed for use in a number of medical conditions. For example, a study in 2009 concluded that WBV might be beneficial for increasing muscle strength in the knees of females with osteoarthritis. Another study from the same year showed that WBV improved cardiorespiratory fitness and muscle strength in older adults. Similarly, an investigation in older adults found that WBV could help to improve balance.
The current project set out to understand whether WBV could mimic the benefits of regular exercise on muscle and bone. McGee-Lawrence and her team studied the effect in a mouse model.

Obesity, diabetes, and WBV

Five-week-old male mice were used in the study: half were normal mice, and the rest were genetically unresponsive to leptin. Leptin is a hormone that helps to generate a sense of fullness; animals without a leptin response are predisposed to overeating and are therefore more likely to develop obesity and diabetes.
Both types of mice were split into three experimental groups:

• WBV group - 20 minutes per day
• treadmill exercise group - 45 minutes of walking daily
• sedentary - no exercise

For the first week, the mice were allowed to get used to their equipment. Then, a 12-week exercise regimen began. They were weighed each week.
At the end of the trial, the genetically obese, diabetic mice showed similar benefits from both treadmill exercise and WBV. The obese mice gained less weight following WBV and exercise than the obese mice in the sedentary group, although they were still heavier than the normal mice.
Both exercise and WBV increased muscle mass and improved insulin sensitivity in the obese mice.

Although WBV is not intended to entirely replace exercise, it could play an important role for individuals who either cannot exercise or cannot exercise enough. However, although the results are encouraging, they should be reinterpreted with caution; as McGee-Lawrence says, "because our study was conducted in mice, this idea needs to be rigorously tested in humans to see if the results would be applicable to people."

http://www.medicalnewstoday.com/articles/316383.php

How Managing Diabetes Can Protect Your Kidneys

From futureofpersonalhealth.com

Do you have diabetes or high blood pressure? Are you African-American, Hispanic, Native American or Asian? Do you have a family member with kidney disease? If you said yes to any of these questions, it is especially important to learn about your kidneys and how to maintain good kidney health.
In talking to people who have had kidney failure and also have diabetes, I have heard it said, “I had never even heard of kidney disease and had no idea how important my kidneys were.”

The blood link

The kidneys filter the blood and rid the body of waste products. They reabsorb needed fluid, electrolytes and minerals, and regulate hormones responsible for red blood cell production and bone health. Some ways to prevent kidney disease include controlling blood pressure and cholesterol, maintaining a healthy weight and quitting smoking.
One of the major ways to prevent kidney disease is by managing diabetes. Goals for management of diagnosed kidney disease include all of the above as well as adjusting medications if your blood sugar is not at goal, avoiding low blood sugar levels, and making needed dietary adjustments.
It is important to become educated in diabetes self-management to decrease your risk of developing kidney disease, blindness, foot or limb amputations, and other complications. People often say that they cannot tolerate blood sugar levels below 200 mg/dL, or that an elevated level is “normal for me.” Intolerance of acceptable blood sugar levels occurs when the levels have been running too high for too long. Avoid symptoms and further complications by slowly lowering your blood sugar to the appropriate level.

Taking control

Diabetes is a self-managed disease. That means that choices you make or do not make affect how well you can manage your diabetes. However, less than seven percent of people with diabetes receive proper education. The best way to learn about diabetes is to find a diabetes educator. Diabetes educators can be nurses, dietitians, pharmacists and other healthcare professionals who are experts in the art of diabetes education and management. They assist you in setting and achieving goals, problem solving, and establishing healthy behaviours that work for you; ultimately leading to improved health.
Organizations like the American Association of Diabetes Educators (AADE) and the American Diabetes Association (ADA) offer resources on diabetes education and self-management. You can find a diabetes educator near you at diabeteseducator.org. By taking a few steps to manage your diabetes, you can prevent and preserve kidney function for a healthier and happier life.

http://www.futureofpersonalhealth.com/prevention-and-treatment/how-managing-diabetes-can-protect-your-kidneys?utm_source=propeller

Types of diabetes

From telegraph.co.uk

Type 1 diabetes

Occurs when the pancreas (a small gland behind the stomach) doesn’t produce insulin – the hormone that regulates blood glucose levels. If the amount of glucose in the blood is too high, it can, over time, damage the body’s organs.
Just 10 per cent of all diabetes is type 1 but it’s the most common type of childhood diabetes.

Type 2 diabetes

The body doesn’t produce enough insulin to function properly, or the body’s cells don’t react to insulin. This means that glucose remains in the bloodstream and isn’t used as fuel for energy.
90 per cent of adults with diabetes have type 2, and it tends to develop later in life

Gestational diabetes

Around one in 20 pregnant women experience such high blood sugar that their bodies are unable to produce enough insulin to metabolise it. This needs to be managed during pregnancy but almost always clears up after giving birth.

Source: NHS Choices

Type 2 diabetes can be reversed in just four months, trial shows

From telegraph.co.uk

Type 2 diabetes can be reversed in just four months by cutting calories, exercising and keeping glucose under control, a trial has shown.
Although the condition is considered to be chronic, requiring a lifetime of medication, Canadian researchers proved it was possible to restore insulin production for 40 per cent of patients.
The treatment plan involved creating a personalised exercise regime for each trial participant and reducing their calories by between 500 and 750 a day. The participants also met regularly with a nurse and dietician to track progress and continued to take medication and insulin to manage their blood sugar levels.
After just four months, 40 per cent of patients were able to stop taking their medication because their bodies had begun to produce adequate amounts of insulin again.
The researchers at McMaster University in Ontario, Canada, said the programme worked because it gave the insulin-producing pancreas ‘a rest.’
"The research might shift the paradigm of treating diabetes from simply controlling glucose to an approach where we induce remission and then monitor patients for any signs of relapse," said the study's first author, Dr Natalia McInnes, of McMaster.
"The idea of reversing the disease is very appealing to individuals with diabetes. It motivates them to make significant lifestyle changes.
“This likely gives the pancreas a rest and decreases fat stores in the body, which in turn improves insulin production and effectiveness."
"The idea of reversing the disease is very appealing to individuals with diabetes. It motivates them to make significant lifestyle changes.
The number of people in the UK with type 2 diabetes has trebled over the last two decades, rising from 700,000 in the 1990s to 2.8 million today, according to new figures from Cardiff University. The condition costs the NHS around £14 billion a year, but if the intervention worked at the same level for Britons, then more than one million people could benefit.

The condition occurs when an individual does not produce enough insulin, the hormone that allows cells to absorb glucose into the blood, or when the insulin that is produced does not work properly.
As a result, blood sugars build up in the body and the cells do not receive the energy they need. Over time type 2 diabetes can lead to damage to the blood vessels, nerves and organs and trigger kidney disease and blindness. It also increases the risk of a heart attack and stroke.
The increased number of people with the disease has been linked to rising levels of obesity.  Between 1993 and 2010 the proportion of obese people in the UK went from 13 per cent to 26 per cent for men and from 16 per cent to 26 per cent for women.
The charity Diabetes UK is currently funding a large trial to find out if a low-calorie diet can put type 2 diabetes into remission in the long term.
Emily Burns, the research communications manager of Diabetes UK said: “We’re looking forward to seeing the results in 2018. In the meantime, we encourage people with Type 2 diabetes to follow a healthy diet that is low in sugar, saturated fats and salt.
“We know that diet, exercise and medications can help people with Type 2 diabetes to manage their condition. We’re starting to see mounting evidence that putting Type 2 diabetes into remission is feasible as well.”
Naveed Sattar, a professor of metabolic medicine at the University of Glasgow, said: "We know now that intensive diet changes – with calorie restriction over period of few weeks to few months can reverse diabetes in many patients but what we need to determine are ways to keep the weight off and keep people in diabetes 'remission'.

"What happens with weight loss per se is that fat is sucked out of key organs relevant to the efficient metabolism of sugar so this means liver, muscles and pancreas lose fat and start to restore their normal functions leading to lower sugar levels. 
"The present trial is unusual in that it also uses drugs to help get to low glucose levels in the short term with the hypothesis that getting sugars to normal may also help reduce toxic effects on pancreas and kick starts its function.
"However, this is a very controversial hypothesis.  Most researchers think that in order to have diabetes undergo proper 'remission' it’s about more substantial weight loss, without use of drugs and to sustain benefits required keeping most of the weight lost off.   I tend to agree with latter notion." 
The research was published in the Journal of Clinical Endocrinology & Metabolism.
Elsewhere researchers from Copenhagen University Hospital in Denmark warned that ibuprofen should not be sold over the counter after finding that it raised the risk of a heart attack by 31 per cent.

http://www.telegraph.co.uk/science/2017/03/15/type-2-diabetes-can-reversed-just-four-months-trial-shows/

Screentime linked to greater diabetes risk among children

From theguardian.com

Children who are allowed more than three hours of screentime a day are at greater risk of developing diabetes, new research suggests.
The study found that children who were glued to their screens for three or more hours a day scored higher on measures of body fat and had higher levels of resistance to the hormone insulin than their peers who spent an hour or less watching TV, videos or playing computer games.
But the authors cautioned that the research does not show that increased screentime itself results in raised levels of risk factors for the disease.
“Screentime could be capturing something about your behaviours – how much sedentary time you have and how much you break that up [or] what your dietary habits [are], potentially,” said Claire Nightingale, a medical statistician at St George’s, University of London and co-author of the research.
Writing in the journal Archives of Disease In Childhood, Nightingale and colleagues described how they sought to probe whether for children, as is known for adults, screentime is linked to an increase in risk factors for type 2 diabetes. To do so, they analysed data from the Child Heart and Health Study in England – a survey carried out between 2004 and 2007 of almost 4,500 children, aged between nine and 10, from primary schools in three UK cities: London, Birmingham and Leicester.
Among the questions asked, data was collected on the length of time the children spent watching TV, video games or playing computer games. A host of physical measurements were also taken including measures of the children’s body fat and resistance to insulin – a hormone that controls blood glucose levels. In addition, levels of physical activity were monitored for 2,031 of the children.
The results revealed that while 37% of children reported that they spent an hour or less watching TV or playing computer games a day, 18% reported spending three or more hours in front of a screen.
Comparing the groups, researchers found the children who reported three or more hours of screentime scored higher on various measures of body fat. What’s more, these children had 10.7% higher levels of insulin after fasting, 10.5% higher levels of estimated insulin resistance and 9.3% higher levels of leptin – a hormone involved in controlling appetite – all of which are risk factors for type 2 diabetes.
The associations held even when factors such as socioeconomic status and levels of physical activity were taken into account.However the study did not follow up on the children to see whether they actually went on to develop diabetes.
While the data was collected a decade ago, before electronic devices such as smartphones became ubiquitous, the team believe the link between screentime and diabetes risk is likely to remain. But Nightingale said it is difficult to offer advice to parents. “Potential decreases in screentime could be beneficial, but we can’t really say a cut-off point,” she said.
Dan Howarth, head of care at Diabetes UK, said that the study highlights a worrying trend.
“The rising number of type 2 diabetes in children is an alarming statistic and addressing the nation’s childhood obesity issues should be the responsibility of us all,” he said.
“Encouraging physical activity over a sedentary lifestyle, such as that relating to screen time, and a healthy balanced diet clearly plays a significant part.”

https://www.theguardian.com/science/2017/mar/13/screentime-linked-to-greater-diabetes-risk-among-children

Increased PE in schools can prevent diabetes and encourage healthy lifestyle

From scotsman.com

In recent years, public health campaigns have urged Scots to think about “the big three” killers – heart attacks, cancer and strokes. Our appalling health record has made us world leaders when it comes to death from these often preventable illnesses.
But it is another potentially deadly condition that threatens hundreds of thousands of Scots. Rising obesity levels mean that diabetes is becoming more prevalent. Many of those suffering from diabetes and its complications could have been spared from their misery by taking preventative measures in the form of physical exercise. Doctors at the Royal College of Surgeons in Edinburgh say more than 180,000 Scots could avoid diabetes if they began taking part in regular physical activity. The message on the importance of maintaining fitness has been painfully slow to get through to Scots but the Scottish Government must redouble its efforts to ensure that it does. All political parties at Holyrood pronounce their commitment to the provision of adequate physical education in Scotland’s schools, but the truth is that Physical Education (PE) remains an under-resourced part of the curriculum. Scotland’s education system is under considerable pressure right now; literacy and numeracy standards have fallen unacceptably low and there remains disagreement between teachers over the merits of the Curriculum for Excellence.
In the current debate, the importance of PE in schools is being ignored.
It is difficult, in adulthood, to change bad habits. Far better, then, to ensure that young Scots acquire good habits as soon as possible.
PE should not be an afterthought in our schools. An exercise habit developed early can last a lifetime. Education Secretary John Swinney has a considerable task in front of him as he attempts to improve standards in education. We hope he will add to his list of priorities a substantial, meaningful increase in the hours of PE offered throughout a child’s school career.

http://www.scotsman.com/news/opinion/leader-increased-pe-in-schools-can-prevent-diabetes-and-encourage-healthy-lifestyle-1-4389782

Downside to Gluten-Free Diets: Diabetes Risk?

From WebMD.com

"Gluten-free" may be the latest diet fad, but new research casts some doubt on its presumed health benefits.
In a large study of U.S. health professionals, scientists found that those with the least gluten in their diets actually had a slightly higher risk of developing type 2 diabetes over a few decades.
The findings do not prove that a low-gluten diet somehow contributes to diabetes. But the study raises questions about the long-term benefits of avoiding gluten, which many people assume to be a healthy move.
Some people -- namely, those with the digestive disorder celiac disease -- do have to shun gluten, said lead researcher Geng Zong.
But there is little research on whether other people stand to gain from going gluten-free, said Zong. He is a research fellow in nutrition at Harvard T.H. Chan School of Public Health, in Boston.
That's a big evidence gap, according to Zong -- given the popularity and expense of gluten-free foods.
Gluten is a protein found in grains such as wheat, rye and barley. Gluten-free diets are a must for people with celiac disease -- an autoimmune disorder in which gluten-containing foods cause the immune system to attack the small intestine.
But gluten-free, or at least gluten-light, diets have caught on as a way for anyone to lose weight and improve their health.
One recent study found that the number of Americans who say they've gone gluten-free tripled between 2009 and 2014.
The new findings are based on nearly 200,000 U.S. health professionals whose health and lifestyle habits were followed over three decades.
The low-gluten fad did not exist when the study period began, in the 1980s, Zong pointed out. But participants' gluten intake naturally varied, based on how often they ate foods like bread, cereal and pasta.
Over 30 years, just under 16,000 study participants developed type 2 diabetes -- a disease in which blood sugar levels are persistently too high. Obesity is one of the major risk factors.

http://www.webmd.com/diabetes/news/20170309/downside-to-gluten-free-diets-diabetes-risk#1

Recipe: Try Pho, a delicious soup with noodles, vegetables and chicken in a spicy broth.

From diabetes.org.uk

Vietnamese soup with noodles, vegetables and chicken in a spicy broth – a delicious meal in a bowl.

Just click on this link: https://www.diabetes.org.uk/Guide-to-diabetes/Recipes/Pho/?utm_source=bronto&utm_medium=email&utm_term=Image+-+Pho+recipe&utm_content=Image+-+Pho+recipe&utm_campaign=Enewsletter+March+2017

Type 1 Versus Type 2: Complications in Youth with Diabetes

From pharmacytimes.com

Young individuals with type 2 diabetes are more likely to develop condition-related complications than their type 1 counterparts. The results are part of the latest findings of the SEARCH for Diabetes Youth study, which was funded by the National Institutes of Health and the CDC, and conducted research regarding diabetes complications in young patients.

The study’s researchers noted that teens and young adults with type 2 diabetes are at an increased risk of developing kidney, nerve, and eye diseases than their peers with type 1 diabetes. Researchers gathered the results by evaluating youth with type 1 and type 2 diabetes, and examining how quickly and often they developed signs of complications.

Among the participants, those with type 2 diabetes exhibited signs of complications more often in nearly every measure than those with type 1. The findings showed:
 

• Nearly 20% developed a sign of kidney disease versus 6% with type 1
• About 18% developed nerve disease versus about 9% with type 1
• About 9% developed eye disease versus 6% with type 1
• Measures for hypertension and arterial stiffness were greater in those with type 2 diabetes, but close to equal for cardiovascular autonomic neuropathy.

Barbara Linder, MD, study author and senior advisor for childhood diabetes research at the NIH’s Institute of Diabetes and Digestive Kidney Disease, noted that the results challenge assumptions that young people don’t develop complications from diabetes.

“Particularly for youth with type 2, this research demonstrates the clear need to learn how to reduce or delay the debilitating complications of diabetes, itself a huge challenge for young people to manage,” Dr. Linder said in a press release.
The authors concluded that the study demonstrates a greater need for early monitoring for the development of complications among young adults and teens with diabetes so that health care providers can delay the onset of these complications.

http://www.pharmacytimes.com/resource-centers/diabetes/type-1-versus-type-2-complications-in-youth-with-diabetes

Exercise Guide: Workout Tips for People with Type 1 Diabetes

From pastemagazine.com

For those with type 1 diabetes, exercise comes with a different set of challenges. Insulin sensitivity, glucose metabolism and carbohydrate intake all become important factors. In order to help people with type 1 diabetes find a safe and efficient exercise routine, an international team of researchers published exercise and nutrition guidelines that help prevent fluctuations in blood sugar.
This set of guidelines is the first of its kind. For two years, the 21-person research team looked at data from clinical trials and studies in order to come up with a consensus on exercise management for those with type 1 diabetes.
The researchers found that regular exercise is key for individuals with type 1 diabetes. It can help decrease total daily insulin needs and can lead to fewer diabetes-related complications. But in order to exercise safely, patients must monitor their blood glucose levels before, during and after exercise as well as alter their insulin plan to match their increased physical activity. These precautions are taken in order to avoid hypoglycemia, or when sugar levels go too low.
Dr. Rémi Rabasa-Lhoret from the Montreal Clinical Research Institute says that “these guidelines fulfil a major unmet need to help patients with type 1 diabetes, and their healthcare professionals, to overcome the various barriers for exercise and this, in turn, should help them to achieve the multitude of health benefits that exercise affords.”

Here are some of the research team’s healthy exercise tips for those with type 1 diabetes:
• Monitoring glucose throughout exercise is essential.
• A blood glucose level between 7 to 10 mm/L is recommended when beginning exercise.
• Before exercise, ingest carbohydrates if insulin concentrations are high.
• Different types of exercise affect blood glucose levels differently.
• Resistance exercise, such as weight lifting or elastic resistance bands, is best for glucose stability.
• The risk of hypoglycemia is increased 24 hours after exercise.
• Insulin plans should be adjusted with increased exercise.

https://www.pastemagazine.com/articles/2017/02/exercise-guideline-for-people-with-type-1-diabetes.html

Childhood type 1 diabetes control improves again

From diabetestimes.co.uk

Diabetes control for children has improved for the sixth year running, according to the National Paediatric Diabetes Audit (NPDA).
The report, which looked at data from all 28,439 young people with diabetes in England and Wales, also showed the number of children attending essential care checks has also risen.
However, the audit did state there is still considerable variability providing care in terms of diabetes outcomes which require better working relationships, sharing of good practice and instigation of quality improvement strategies to improve care.
Dr Justin Warner, clinical lead for the NPDA and member of the Royal College of Paediatrics and Child Heath, said: “The fact that care for children with diabetes continues to significantly improve is excellent news and is what we aim to demonstrate when delivering this audit year on year.
“We want centres delivering paediatric diabetes care to learn from best practice, share good experience and improve results, so this is heartening to see.”
The data used in the report showed the following:

• The number of children and young people with type 1 diabetes achieving excellent diabetes control has increased from 17 per cent (2013/14) to 27 per cent (2015/16).
• The number of children and young people with type 1 diabetes with poor diabetes control fell from 24 per cent (2013/14) to 18 per cent (2015/16).
• Almost all children and young people with type 1 diabetes had an HbA1c (99 per cent) and a height and weight measured (98 per cent) during the audit year.
• Two thirds of young people underwent essential foot checks (66 per cent) compared with 55 per cent in the previous year.
• Two thirds (66 per cent) were screened for complications relating to their eyes (retinopathy screening), up from 64 per cent in the previous year.
• A total of 66 per cent were screened for kidney complications (urinary albumin), an improvement from 52 per cent in the previous year.

Dr Warner added: “The impact of the improvement in blood glucose levels over the last six years should not be underestimated and will reduce the risk of future complications significantly. The improvements reflect the massive amount of work and quality improvement provided by healthcare teams, parents and patients.
“This has been supported by high level strategies including the formation of the National Regional Networks1, the Best Practice Tariff in England2, Paediatric Diabetes Health Board investment in Wales3, Quality Assurance (peer review) programmes4, national and local Quality Improvement programmes5 and National Institute for Health and Care Excellence (NICE) guidance6.
“Furthermore, the improvements seen in completion of essential health checks – foot, eye and kidney disease screening – is excellent news and means that children and young people with diabetes are receiving improved care, reducing the risk of complications and allowing early recognition and intervention where necessary.”
Despite seeing improvements, the report also recognised there remain some deficiencies in care:
There remains considerable variability between centres across England and Wales providing care in terms of diabetes outcomes which require better working relationships, sharing of good practice and instigation of quality improvement strategies to improve care.

A total of 9.7 per cent of young people with type 1 diabetes are already demonstrating early signs of  kidney disease and 13.8 per cent show early signs of eye disease putting them at increased risk of kidney failure and blindness.

Children with type 1 diabetes were more likely to be overweight or obese compared to the general population.

Children and young people living in the most deprived areas were at increased risk of diabetes complications and poor diabetes control compared to those in the least deprived areas.

Two thirds of young people aged 12  and above with type 1 diabetes are not receiving all seven recommended health checks on an annual basis – HbA1c, height and weight, blood pressure, kidney function, eye screening, foot examination, and thyroid function

Although much less common in childhood, those with type 2 diabetes tend to come primarily from non-white ethnicity, are obese and have higher blood pressure compared to those with type 1 diabetes putting them at a higher risk of long-term complications.

The audit includes specific recommendations to commissioners of health services, diabetes networks, and paediatric diabetes centres, to address the inequalities across England and Wales.

http://diabetestimes.co.uk/childhood-diabetes-control-improves-again/