Study links body clock to obesity and diabetes

From medicalxpress.com/news

                                                      Credit: CC0 Public Domain

Does skipping a meal at particular times of day reduce your chances of developing obesity or diabetes?

Are the street lights outside making you fat?

Research out of the University of Otago has found connections linking diabetes and obesity to circadian rhythm, often referred to as the body clock.
During the study the researchers examined the effects of disruption to the circadian rhythm of mice in a controlled laboratory setting. They found that repeated jetlag led to weight gain and severe diabetes symptoms.

We need to think about what disrupts our body clock. Anything that interferes with it, such as travel jetlag, social jetlag, shift work, bright-light exposure at the wrong time of day, can be detrimental for human health," says Associate Professor Alexander Tups of the University of Otago's Neuroendocrinology and Brain Health Research Centre.

"Very bright street lights disrupt melatonin, which is the hormone that regulates the circadian rhythm. This disruption can lead to obesity and diabetes if our studies can be translated to humans, but there is also accumulating evidence that disrupted melatonin secretion leads to cancer," Associate Professor Tups adds.

He hopes these findings will prompt experiments with humans to investigate which intensity of artificial light suppresses melatonin, and thereby would be detrimental for human health. This would lead to more informed decisions in choosing artificial light sources for their particular purpose.

A separate study also examined how the body clock influences the ability to process fatty food, and found supportive evidence for the popular diet technique of skipping a meal.
"Essentially, it matters what time you eat. Our bodies produce hormones which appear to work better at fighting off fatty foods consumed at particular times of day. If we avoid eating at times when these hormones are not working, we can reduce the detrimental effects of a fatty diet," Dr. Tups says.

The crucial hormone in regard to eating time is leptin; a body-weight regulatory hormone. Detrimental effects of high-fat feeding are exacerbated during leptin resistant times of the day.
The researchers discovered that contrary to current thinking, resistance against leptin is not universal throughout the day in obese mice.

"There are times when the mice were still sensitive to the hormone—so if the eating pattern is restricted to this time period the beneficial effects can be maximized," Dr. Tups says.
In mice it was particularly detrimental for metabolic health when access to fatty food was restricted to the late night and early morning, times when the animal was resistant to leptin. For mice, this would be dinner time, as they are active during the night and sleep during the day.

Because of this difference the Associate Professor Tups cannot yet give a clear recommendation which meal to skip to lose body weight.
"However, if the results were directly translatable to humans it would be most likely dinner. It needs to be in alignment with our body clock and would also depend on our individual chronotype, that means whether a person is a lark or an owl may make a difference about choosing which meal to skip," he adds.

Both studies are published in Endocrinology and the FASEB Journal.

https://medicalxpress.com/news/2019-08-links-body-clock-obesity-diabetes.html

Diabetes: Reasons Why Your Blood Sugar Levels Are High In The Morning; Tips To Control

From ndtv.com/health

Do you know your blood sugar levels are generally high in the morning? This condition may not affect you much but this can be a difficult situation for a diabetic to handle. Here are the reasons behind this condition and ways to control diabetes.

Blood sugar levels are generally high in the morning. But if you are a diabetic your blood sugar levels can go significantly high. This condition usually happens before breakfast. Diabetes patients of both Type 2 and Type 1 Diabetes have to constantly monitor blood sugar levels to avoid major fluctuations. High blood sugar levels can make the condition worse for a diabetic. People who are not suffering from diabetes may experience high blood sugar levels in the morning due to hormonal changes. But in diabetics, the body does not respond to insulin properly which results in fasting blood sugar levels. This condition is called the dawn phenomenon. The effect of this phenomenon can vary from person to person.

High blood sugar levels in the morning

The natural rise in blood sugar levels early morning is defined as the dawn phenomenon. Diabetics are more likely to experience this phenomenon. This usually happens from 4 a.m. to 8 a.m. This rise in blood sugar levels happens to ensure enough energy to kick start the next day but diabetics do not have enough insulin to react properly to this condition. This results in too high blood sugar levels. You may experience some symptoms like nausea, vomiting, faintness, blurry vision, extreme thirst, fatigue and tiredness.

Tips for diabetics to control the effect of dawn phenomenon

Some simple precautions can help in controlling the rise in blood sugar levels in the morning. These methods can help in reducing the negative effects of dawn phenomenon. Some of the steps which you can follow may include:

• You can ask your doctor for a change in medications there can be an increase in dosage in the morning
• Eat a light and healthy breakfast with diabetes-friendly foods
• You can also try exercising in the evening
• Eat dinner a few hours before going to bed
• Go for a walk after eating dinner
• Eat the right dinner with fewer carbs for dinner
• Never skip breakfast

Other ways to control blood sugar levels

• Restricted carbs intake can help in managing blood sugar levels
• Regular exercise is the best way to keep blood sugar levels under control as well as to promote overall health
• Eat a proper diet with fibre rich foods
• Always keep a track of your blood sugar levels
• Sleep properly every night for 6-8 hours
• If you are overweight lose those extra kilos

To fight the symptoms of diabetes effectively you need to follow all the precautions suggested by your doctor. Also, take the advised medicine along with a healthy diet.

Disclaimer: This content including advice provides generic information only. It is in no way a substitute for qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.

https://www.ndtv.com/health/diabetes-reasons-why-your-blood-sugar-levels-are-high-in-the-morning-tips-to-control-diabetes-2090465

Type 2 diabetes: These three foods could help to lower blood sugar - what are they?

From express.co.uk

TYPE 2 diabetes is a chronic condition that affects the way the body metabolises sugar. Left untreated it could lead to serious health complications. These three foods however could help lower a person’s blood sugar levels.

Type 2 diabetes is a condition that causes a person to lose control of their blood glucose levels. The risk for diabetes increases with age, making diabetes common in older adults. Medical experts estimate that approximately 25 per cent of adults over the age of 60 years have diabetes. Type 2 diabetes is a progressive condition which means the longer someone has it, the more help they will need to manage blood glucose levels. This may require medications and eventually, injected insulin could be needed. Fortunately with the right adjustments to lifestyle and diet, the condition can be better managed and potentially even reversed. These three foods could help lower blood sugar levels.

          Type 2 diabetes: Three foods proven to lower blood sugar levels (Image: Getty Images)

Strawberries
Studies show that eating strawberries, which have a low glycaemic index, can lower blood sugar.
Strawberries provide significant amounts of essential nutrients, such as fibre, manganese, folate, and vitamin C.
The low glycaemic index in strawberries and the beneficial plant chemicals help minimise any increase in blood sugar.

Pumpkin seeds
Pumpkin seeds are high in magnesium, fibre, and healthy fatty acids.
Studies have suggested that some of the macromolecules in pumpkin seeds may help manage blood sugar levels for type 2 diabetics.
In animal studies, pumpkin seeds have shown to reduce blood sugar.
Pumpkin seeds have been associated with several health benefits including improving heart health, prostate health and protection against certain cancers.

Walnuts
Walnuts are a great choice for type 2 diabetics when it comes to snacking.
Walnuts are known to help build resistance for insulin, control blood glucose levels and lower the risk of developing type 2 diabetes.
Walnuts are rich in dietary fibres which take longer to breakdown and digest which ensures the slow release of sugar into the bloodstream.
Walnuts also have a low glycaemic index which makes them ideal for type 2 diabetics.

https://www.express.co.uk/life-style/health/1169637/type-2-diabetes-diet-food-strawberries-walnuts-pumpkin-seeds-lower-blood-sugar

Life Well Lived: Defining, avoiding and treating diabetes

By Dr. Vivek Sinha
From alextimes.com

Diabetes. You know that it has to do with sugar. You know that being overweight can be bad for you and may lead to it. But what exactly is diabetes? How can you get it? If your parents have it, can you also have it? And most importantly, how can you decrease your chances of getting it?

As a primary care physician, discussion about diabetes and its treatment with patients, takes up a large portion of my day. According to the 2017 National Diabetes Statistics Report put out by the Centres for Disease Control and Prevention, 12 percent of all US adults – more than 30 million people – had diabetes. Of this number, more than 7 million people were unaware or did not report that they had diabetes.

So how can we treat, or, better yet, prevent diabetes from occurring? In order to understand this, we must first understand exactly what diabetes is and how it is caused.
Simply said, diabetes is a condition where our bodies cannot properly use the food we eat, leading to an abnormal amount of sugar or glucose in our blood. This high amount of glucose can then lead to significant medical problems like heart disease, kidney disease, blindness and many more conditions.

When we eat food, it is broken down into glucose. Glucose is what our body uses as energy. However, once this glucose is produced, it cannot be used by the body unless it is sent into the cells that need it for energy. For the glucose to be transported into the cells it uses a transport device called insulin. Insulin is a hormone that is made by the pancreas, a small organ located near the stomach. When the body senses that glucose is high, it sends a signal to the pancreas to make more insulin. The insulin then “takes” the glucose and transports it into the proper cells where we use it up as energy. This is how it normally works.

Diabetes occurs when our body either does not make insulin, or the insulin it does make does not work. Without properly functioning insulin, the glucose builds up in our blood. This is why we test people’s blood for the level of sugar in their body. While it is very important to determine which predominant type of diabetes one has, because treatments may differ, it is also important to know that the lines between both types may be blurred, especially if someone has had uncontrolled diabetes for some time.

                            Diet and exercise can help prevent and treat diabetes. (File Photo)

If sugar remains high in a person’s blood for too long, very serious problems can occur, including blindness, limb amputation, kidney failure, a weakened immune system and increased risk of heart attack and stroke.

Symptoms of high blood sugar are often subtle at first. They can include fatigue, frequent urination, excessive thirst, extreme hunger, unexplained weight loss or numbness and tingling in the hands or feet. These symptoms often can develop so slowly and gradually that the person may not notice that he or she is having new symptoms. Often, patients may not have any symptoms at all. Many patients find out they have diabetes from their primary care physicians on routine screening physicals or labwork.

So how do we detect diabetes if symptoms are not always present? Assuming we are talking about people who do not have symptoms, we must look at various risk factors. Risk factors for diabetes are vast. They include different categories:
A.) Things we can change, such as being overweight or having a sedentary lifestyle;
B.) Things we cannot change, such as age greater than 45, diabetes in a first-degree relative, history of diabetes during pregnancy, history of vascular disease or being in a high risk ethnic or racial group, including African American, Hispanic, Native American, Asian American and Pacific Islanders; and
C.) Things we may be able to change, such as high blood pressure and high cholesterol.

The U.S. Preventative Task Force and the American Diabetes Association both give recommendations to physicians about who should get tested for diabetes. Generally speaking, the ADA advises all adults who have a body mass index greater than 25 and an additional risk factor for diabetes should get tested at least once every three years. In adults without any risk factors, the ADA advises to start checking at age 45. The USPSTF advises that testing for diabetes as part of a cardiovascular risk profile assessment should begin on all adults with an elevated BMI starting at the age of 40 and should be repeated every three years, at a minimum.

There are different guidelines that apply to children and people with certain higher risk conditions, such as pregnancy. If someone is having the subtle signs and symptoms of diabetes, they should have a thorough medical history, physical exam and appropriate blood work drawn, regardless of their age.

The most common tests used to screen for diabetes are several types of blood and urine tests. One type looks at the actual blood glucose at the specific time of testing and the other type looks at the average blood glucose over a period of three to four months. The urine test looks for the presence of glucose and a specific type of protein. There is also a test called the oral glucose tolerance test — a short version of this is often used to test pregnant women during a specific time in their pregnancy.

Once a person has tested positive for diabetes, it is extremely important to start treatment right away. There are multiple types of pill and injection medications available. Some of these medications help the body produce more insulin, some help the body recognize the insulin that it already produces, and, of course, actual insulin can be given as well.

The type, dosage and number of medications that a person with diabetes needs is a very personal decision that should be discussed with the patient’s physician. Various factors should be considered.

If the likely reason that a person has diabetes is due to factors that they cannot change then the medications may be permanent, however if a person likely has diabetes due to reasons that they can change, such as sedentary lifestyle and obesity, then the medications may be temporary until they can control their risk factors.

I advise my patients that regardless of what type of diabetes they have or for whatever reason, they should always participate in an active lifestyle which includes 30 to 60 minutes of moderately-intensive aerobic activity three to five days a week. Prior to starting an exercise regimen, a clearance examination by their physician should be performed so other risk factors, such as heart disease, can be identified. In my opinion, exercise and dietary changes should be “prescribed” to every single person with diabetes.

Diabetes is an extremely serious condition, but there is hope. We know how to test for it, we know who to test for it and we know how to treat it. Most importantly, in certain patients, it is possible to manage diabetes with proper diet and exercise, under a physician’s guidance. So, talk to your doctor. Get tested if appropriate and know your numbers. As the saying goes, knowledge is power.

https://alextimes.com/2019/08/life-well-lived-defining-avoiding-and-treating-diabetes/

Type 1 diabetes technology: advances and challenges

From thelancet.com

Technologies to support the management of type 1 diabetes have seen tremendous advances over the past few decades. Starting with the development of early insulin pumps and blood glucose meters, progress has accelerated in recent years with the development of new devices and integration with consumer electronics and cloud-based data systems. The past few weeks alone have seen news reports that Apple stores are to start selling Bluetooth-enabled glucose metres that link to the iPhone and Apple Watch, while Dexcom's G6 continuous glucose monitoring (CGM) system's software is being upgraded to work directly with Apple's smartwatch. Meanwhile, Abbott has announced a substantial ramping up of production of its flash glucose monitoring system—a variety of CGM in which glucose data are accessed retrospectively when the user flashes or scans the sensor with a receiver or smartphone—to meet increasing demand.

Other major recent developments include the approval of insulin smart pens (injector pens that record amount and timing of insulin doses, with data shared with mobile apps to track trends and make dosing recommendations), advances in CGM and insulin pump technologies, and the integration of CGM and insulin pumps into hybrid closed-loop systems that can adjust insulin delivery on the basis of live glucose measurements.

These developments make this a time of unique promise for people with type 1 diabetes, as well as parents of paediatric patients, with novel technologies offering the potential opportunity to ease the burden of self-management and to improve glycaemic control, reduce hypoglycaemia, and improve quality of life. However, important challenges remain.

On June 27, the US Food and Drug Administration (FDA) issued a warning that some Medtronic MiniMed insulin pumps were being recalled because of cybersecurity vulnerabilities, which could allow someone other than the user to connect wirelessly to a nearby pump and change the settings, with potentially dangerous consequences. Although such risks are largely theoretical (the FDA notes that it is “not aware of any reports of patient harm” related to these vulnerabilities), cybersecurity concerns are being taken seriously by the diabetes technology community. In 2016, the Diabetes Technology Society produced a voluntary Standard for Wireless Diabetes Device Security (known DTSec, updated in 2017), and in October, 2018, the Insulet Omnipod DASH insulin pump system became the first device to be certified under DTSec. Last year also saw the FDA and Health Canada release draft premarket guidance for the management of cybersecurity in medical devices generally, which should lead to improved standards for future device approvals.

Beyond technical and regulatory questions around cybersecurity, another major issue is cost and accessibility of novel diabetes technologies, with expensive devices and supplies limiting accessibility, whether based on private health insurance coverage or provision in publicly funded health systems. Even within the UK National Health Service (NHS), there is substantial geographical variation in access to diabetes technologies. In response, earlier this year the charity Diabetes UK, working with NHS England, produced a consensus guideline intended to rationalise and improve access to available technologies. The guideline—endorsed by several diabetes organisations—provides a unified pathway based on incremental use of technology monotherapies (insulin pumps, CGM, or flash glucose monitoring) or dual therapies, similar to pathways used for drug combinations during treatment intensification in patients with type 2 diabetes. The inclusion of flash glucose monitoring—which is generally cheaper and simpler to use than real-time CGM—in the guideline follows a campaign by Diabetes UK and others to end the so-called postcode lottery in availability of these devices, which led to a new NHS policy to harmonise access that came into effect in April this year.

The UK has generally lagged behind other high-income countries such as Germany and the USA in terms of patients accessing diabetes technologies. Hopefully the recommendations in the new consensus guidelines will help to ensure that more people who stand to benefit will have access to these devices. The guideline is intended both for local policy makers to ensure an integrated approach to availability and for clinicians to use as a guide for joint decision making with patients. Both functions will be important, in view of the crucial role that clinician attitudes to technology can have both in terms of access to and successful use of diabetes technologies.

https://www.thelancet.com/journals/landia/article/PIIS2213-8587(19)30269-4/fulltext

Type 2 diabetes warning: Doing this activity could increase risk of developing condition

From express.co.uk

TYPE 2 diabetes is a largely preventable condition if people lead a healthy lifestyle. This also means that poor decisions can hike the risk. It may come as a surprise that a certain everyday activity can increase the risk.

Type 2 diabetes means a person’s pancreas doesn’t produce enough insulin to control their blood sugar levels.
Over time, rising blood sugar levels can pose life-threatening risks such as heart disease or strokes.
As the condition is strongly linked to lifestyle factors, certain actions can mitigate the risks, but this also means poor choices can increase a person’s likelihood of developing the condition.

According to research presented at the joint International Congress of Endocrinology and European Congress of Endocrinology, people who wolf down their food are two and a half times more likely to suffer from type 2 diabetes than those who take their time.
While numerous studies have linked eating quickly to overeating and obesity, this is the first time eating speed has been identified as an independent risk factor for type 2 diabetes.

A Lithuanian research team led by Dr Lina Radzeviciene compared 234 newly diagnosed type 2 diabetes patients to 468 people who were free from the disease. Cases and controls were matched by gender and age.
The participants filled out an in-depth questionnaire designed to collect information on possible diabetes risk factors in which they rated their eating speed compared to others (slower, the same, faster).
Body measurements (height, weight, waist and hip circumference) were also taken according to World Health Organisation recommendations.

After adjusting for other risk factors (a family history of diabetes, education, morning exercise, body mass index, waist circumference, cigarette smoking and plasma triglyceride levels) the researchers found a more than two-fold increase in the risk of type 2 diabetes associated with faster eating habits.
Additional findings showed the cases had a higher body mass index and significantly lower education level compared to the controls.

Researcher Dr Lina Radzeviciene from Lithuanian University of Health Sciences said: "The prevalence of type 2 diabetes is increasing globally and becoming a world pandemic. It appears to involve interaction between susceptible genetic backgrounds and environmental factors. It's important to identify modifiable risk factors that may help people reduce their chances of developing the disease."

Dr Radzeviciene's team previously found that coffee consumption (four or more cups a day) significantly decreased risk of type 2 diabetes.
They also found that smoking and egg consumption (more than five eggs a week) increased the risk.
Interestingly, to counter the risk of developing type 2 diabetes, another study published in the journal Mayo Clinic proceedings found that building moderate muscle strength may help.

https://www.express.co.uk/life-style/health/1167795/diabetes-type-2-diet-food-eating-quickly-blood-sugar

T1International’s Report on Insulin Prices Around the World

From asweetlife.org

In a time when the insulin price crisis in America has become a such prominent news story, it’s easy to lose sight of the global scope of the issue. The same three big pharmaceutical companies that dominate the American market control the world market as well. Wildly varying national health, drug and insurance policies make for wildly varying insulin prices. Add entirely different economic climates, and it becomes clear that the affordability of diabetes supplies differs extraordinarily from one country to another.

Enter the 2018 T1International Patient Survey (PDF). An attempt to gauge global insulin affordability and the extent of rationing, the report shows that “a worryingly high number of people with Type 1 diabetes are subject to life-threatening rationing due to financial costs.” T1International is a non-profit that advocates for worldwide access to insulin and diabetes supplies, and the organization hopes that these new statistics will help elucidate the challenges it and its allies face.

The United States in Context

The organization’s analysis sheds light on America’s performance in comparison to two other broad groups: high income (e.g. Germany, Japan, Australia) and low/middle income (e.g. India, Ecuador, Peru). The U.S. is, of course, comfortably categorized as a high income nation, but generally speaking, it performs more like a low/middle income nation.

Of the more than 600 American survey respondents, 25.9% reported rationing or foregoing insulin sometime in the last year. This rate was even higher than that of the low/middle income countries (22.3%), and was nowhere close to the far lower rate of the other high income countries (a mere 6.5%). The U.S. has “by far the highest insulin rationing of any high income country.”
In addition, 32.4% of those from high-income countries reported that they had full health coverage and paid nothing out of pocket. Again, the U.S. (6.5%) and in the low/middle income countries (6.2%) performed similarly.

Global Challenges

It is difficult to generalize about the low/middle income category, which takes in an extremely large and diverse group of countries, many of which had as few as just one respondent in the survey – these included nations such as Yemen and Rwanda. As poorly as the United States performed, among people with diabetes in some of the world’s less prosperous countries face, an astonishing 45.6% of those reported that they had absolutely no coverage for their costs – a claim that only 4.3% of Americans made.

An effort was made to make the survey available to those without ready internet access; some respondents filled out their answers with pen and paper, facilitated by T1International’s partner organizations. But the survey would invariably have been most visible to motivated participants of the diabetes online community, and responses were clustered mostly in high income nations, which suggests that the numbers dramatically understate the extent of global insulin rationing. An executive summary notes that “it has been reported that one out of every two people globally in need of insulin cannot access or afford it.”

A webpage accompanying the report offers maps and sortable data. Users can also read the comments of respondents, some of which provide harrowing anecdotal evidence of the dire straits that some people with T1D face.

https://asweetlife.org/t1internationals-report-on-insulin-prices-around-the-world/?utm_source=ASweetLife.org+List&utm_campaign=1b8130f2a6-ASweetLife+Weekly+Update++-+Nov.+14%2C+2017_COPY_01&utm_medium=email&utm_term=0_5125b14cf8-1b8130f2a6-413392997

How to Know if You're Over-Managing Your Diabetes

From healthline.com

Experts say there is a balancing act of medication, insulin, and lifestyle changes that must be considered when drawing up a treatment plan.

Treating type 1 and type 2 diabetes with medication is more complicated than you might think.
And finding the right balance may be more difficult than anticipated.
A recent study concluded that some people with diabetes are being overmedicated, and their treatment plan is actually too intense.
Some past research has indicated that the majority of people with type 2 diabetes aren’t being treated aggressively enough and aren’t seeing improvements in their blood sugar levels.
However, the more recent study reports that a number of people taking insulin or other diabetes medications are experiencing hypoglycaemia (low blood sugar levels) severe enough to send them to the emergency room.
The research discovered that when patients in the United States received more medication than required in order to achieve their HbA1c goals, it directly contributed to 4,774 hospitalizations and 4,804 emergency room visits over the course of two years.

The research estimates that about 20 percent of adults with diabetes in the United States are being over-treated — especially those with type 2 diabetes. This translates to approximately 2.3 million people being over-treated between 2011 and 2014, explained the study.
“This isn’t break-through science,” Dr. Rozalina McCoy, anendocrinologist and primary care physician at the Mayo Clinic in Minnesota and a lead researcher on the study, told Healthline.
“But it demonstrates the real human impact of overly intensive treatment in a patient with diabetes,” she explained.
“We know as clinicians that we shouldn’t be over-treating older patients or those with multiple health conditions, but other patients can be over-treated, too. The toll it takes on a patient’s life is real, especially if they are winding up in the emergency room.”

The challenges to treatment

While a person could take an oral or an injectable diabetes medication or have insulin injections to treat diabetes, the way those medications work are vastly different.
In addition, the amount of insulin a person needs for different times of day or different aspects of blood sugar management varies.
The amount of medication or insulin a person needs is based on a number of variables, including body weight, age, activity level, diet, stress, and overall beta-cell function.

These factors largely determine whether a person with type 2 diabetes will eventually need insulin or not.
“Even though type 1 diabetes is incredibly challenging to live with and very complicated, we at least understand why low blood sugars are happening,” said McCoy, “and as clinicians, we generally know where to start when making adjustments in their treatment to reduce those severe and recurring hypoglycaemic events.”
She added, “With type 2 diabetes, it’s much harder to pinpoint the exact problem — especially when a patient’s A1c is still high but they’re experiencing frequent hypoglycaemia, and they’re taking multiple medications.”

McCoy said that many clinicians don’t realize how easily a person with type 2 diabetes can experience hypoglycaemia. Overall, the rate of low blood sugars in those with type 2 diabetes is lower compared to those with type 1, but its occurrence in people with type 2 is more than previously thought.
“One issue that contributes to the problem is that the risk of hypoglycaemia for a patient with type 2 diabetes doesn’t come right away when they are first diagnosed,“ explained McCoy.
“First, they try to manage their diabetes through diet, exercise, and metformin — which cannot cause low blood sugars.”
In a person with type 1 diabetes, McCoy said hypoglycaemia is expected and is essentially part of the diagnosis package.

A person with type 1 diabetes immediately receives an education about the signs and symptoms of low blood sugars, what can cause them, how to treat them, and how to prevent them from occurring too often.
A person with type 2 diabetes will only get financial reimbursement from their health insurance plan to see a diabetes educator for a specific number of years after the initial diagnosis.
By the time they are starting more intensive diabetes medications or insulin, the opportunity for a thorough education on blood sugar management may be minimal because of cost.

“Only a small fraction of patients with type 2 are getting proper education because there are not enough diabetes educators, not enough time with practitioners, and not enough financial reimbursement years down the road when they start taking insulin,” said McCoy.
“The risk of low blood sugar in a patient with a low A1c is actually very low because they’re not usually on an intensive treatment plan,” she added.
The higher the person’s A1c is, explained McCoy, the higher their risk of hypoglycaemia is because the person’s doctor may be intensifying their treatment by increasing their dosages or by adding additional medications in an effort to lower their blood sugar levels.

Insulin and type 2 diabetes

People with type 1 diabetes are taught how to count carbohydrates and adjust their insulin dosage to account for the amount of food they want to eat.
One unit too much or too little can easily lead to a high or low blood sugar, but people with type 1 are taught to expect these fluctuations and encouraged to check their blood sugars many times a day to help juggle this type of challenge.

People with type 2 diabetes aren’t encouraged to check their blood sugar routinely. They may be taking their insulin as prescribed, but they may not understand how imperative it is that the amount of food they’re eating matches the insulin dose, or how to adjust it if they don’t want to eat that much food.
Too often, people with type 2 are told to take “X” amount of insulin at every meal, which means they’ll need to eat “X” amount of carbohydrates to meet that insulin dose.
This creates a problem of “feeding your insulin,” which can lead to overeating, weight gain, and dangerous blood sugar fluctuations when you don’t eat enough to meet the insulin dose.

“There’s an assumption that type 2 diabetes is easier to manage than type 1 diabetes, but the moment a patient with type 2 is prescribed insulin, we should start treating them more like a patient with type 1 diabetes,” said McCoy.
“One of the biggest things I do with my type 2 patients taking insulin is to ‘undo’ that prescribed insulin dose and carb quantity at every meal,” explained McCoy.
“Instead, if they aren’t willing to learn how to count carbohydrates and adjust the insulin dose specifically, we talk about dosing for meals in more general terms of a ‘small’ or ‘medium’ or ‘large’ meal, with insulin dose options for each size. Eyeballing the meal is still better than forcing a patient to eat a certain amount of food to cover the insulin dose they’re told to take no matter what,” she explained.

When intensive management is needed

Gary Scheiner, CDE, author, and head of Integrated Diabetes Services in Wynnewood, Pennsylvania, said he agrees with McCoy’s assessments… to a point.
“Glucose targets must be individualized based on a patient’s abilities, risks, and limitations,” Scheiner told Healthline.
“Tighter is not always better — such as with patients at risk of falls, like the elderly, or those with hypoglycaemic unawareness during which they can’t physically feel the symptoms of a low blood sugar, those in high-risk professions, and in children.”

On the other hand, Scheiner argues that for some people, more intensive treatment is worthwhile, and the risks of low blood sugars are part of the pursuit of healthier blood sugar levels.
“For patients battling diabetes complications like retinopathy, patients entering pregnancy, or patients looking to maximize athletic performance, for example, tighter control is generally desirable.”
Scheiner added that one of the biggest mistakes he feels clinicians make is assuming that tighter blood sugar control and a lower A1c automatically reduces the long-term risk of developing a complication.
“This simply is not true,” said Scheiner. “There are multiple factors that contribute to complications — not just glucose levels — and there is a point at which tighter control just does not provide benefits. Like taking 10 aspirin for a headache instead of two.
“And of course, there is a point at which the risks outweigh the benefits. For a person taking insulin, wearing a continuous glucose monitor has helped ‘shift the curve’ by alerting patients when they are approaching a low blood sugar so they can prevent more serious hypoglycaemia,” he noted.
Again, it comes down to individualizing a patient’s treatment plan, which can’t be done properly in a five-minute appointment.
“Managing diabetes with a one-size-fits-all approach will not work,” said McCoy.

“I have the luxury of 30-minute appointments at the Mayo Clinic and sometimes that is still not enough. What is the patient’s life like? What are their resources and support system? How can we help them safely fit diabetes into their routine?”
To truly reduce the number of hypoglycaemic-related hospital visits, the bigger problem that needs addressing may be far more than changing how doctors prescribe insulin. Instead, perhaps they need more time with their patients.
“An appropriate treatment plan,” explained McCoy, “depends on a good relationship with the patient.”

https://www.healthline.com/health-news/why-its-important-to-get-a-flu-shot-soon#When-intensive-management-is-needed

Type 2 diabetes: The great sugar debate and how to naturally lower blood sugar levels

From express.co.uk/life-style/health

TYPE 2 diabetics are aware they need to be extra vigilant with what they put in their mouths. We all know about the dangers of sugar and even though it does not directly affect the condition, it can lead to weight gain and obesity risk. How can you still enjoy your favourite treats without the health risk of added sugars?

As type 2 diabetes is linked to high levels of sugar in the blood, it may seem logical to assume that eating too much sugar is the cause of the disease. But it is not that simple. Leading nutritionists, Lynn Grieger and Doctor Marilyn Glenville, discuss the effect of sugar and how you can stray away from sugary treats whilst still enjoying the sweeter things in life. “The idea that sugar affects diabetics has been around for years, but the truth is, type 2 diabetes is a multifactorial disease with many different types of causes,” explains Grieger.

“I don’t think that anybody has put their finger on what the true cause of diabetes is, or that we’re going to find a single cause.”
Diabetes.co.uk said on their website: “Having diabetes doesn’t mean you have to cut sugar out completely. We all enjoy eating sugary foods occasionally, and there’s no problem including them as a treat in a healthy, balanced diet.
"However, we are eating too much sugar, far too much, and harming our health as a result.”
Doctor Marilyn Glenville said: “Excess sugar is very harmful, and even a slight lift in glucose levels in the bloodstream can be harmful to the brain, which can result in deficits in memory and slow cognitive function.
"So, it’s time to swap those sugary cherry drops for some naturally sweet dried fruit. Raisins and dates are great to fight off your sugar fix, and if you are into your cakes and tasty bakes, add raisins or sultanas to make a pie or crumble that little bit sweeter.

"Spices like cinnamon and vanilla also add lots of sweetness and flavour, allowing you to reduce the amount of other sweeteners in a recipe or remove it altogether.

      Type 2 diabetes: You can still enjoy a wide range of foods whilst keeping blood sugar normal                                                                                    (Image: Getty Images)

"Research has also found that reducing sugar consumption and supplementing with Omega-3 fatty acids improves working memory.”
Studies have suggested that sugar massively affects mood. According to a brain imaging study in healthy young people, the ability to process emotion is compromised with elevated blood glucose.

Another study found that people with type 2 diabetes reported increased feelings of sadness and anxiety during periods of elevated blood sugar.
Glenville added: “In order to help boost your mood and keep it stable, make sure you are aware of what your are eating.
"You may be shocked to find that so many foods contain sugar, not just the sweet and obvious ones. There is sugar in soups, tomato sauces, mayonnaise, salad dressings and even baked beans. Instead of relying on pre-made sauces, try making your own. This way you can control the amount of sugar or even sea it out completely.
"Carrot and beetroot are naturally sweet vegetables; so instead of relying on salad dressings and side dishes like baked beans, use the sweet veggies instead.”
Elevated blood glucose harms blood vessels, and this can be a major cause for vascular complications such as diabetes.

According to studies, frequent exposure to high glucose levels diminishes mental capacity, as higher HbA1c levels have been associated with a greater degree of brain shrinkage.
Additional research also shows that a diet high in sugar reduces the production of brain-derived neurotropic factor, a brain chemical which is essential for new memory formation and learning.

“It’s time to ditch the sugar and fuel yourself with healthy alternatives. Use fruits and vegetables in dishes and don’t be afraid of adding lots together.
"As your taste buds grow accustomed to doing without the very powerful taste of refined sugar, you will come to appreciate the natural sweetness of vegetables and fruits and even better, your health will thank you for it.”

https://www.express.co.uk/life-style/health/1165618/type-2-diabetes-diet-causes-sugar-lower-blood-sugar

True Confessions Part 2: Habits That Derail Diabetes Management

From dlife.com/diabetes-blog

They say confession is good for the soul. It’s also a good way to show others they are not alone in their challenges. Talking about what ails you can also foster a sense of community.
In this series, we’ve been taking a look into some self-sabotaging habits that commonly derail diabetes management. We’ll also share what our experts suggest to help with those challenges and give you an opportunity for you to declare, share, and move forward.

Celebration Time!

Confession: After you get a glowing report from your doctor that your tests have improved, you suddenly feel invincible. So you decide to celebrate by eating a huge meal!

Solution: Getting a glowing report from your doctor does deserve a huge celebration. However, it’s not necessary to celebrate with a huge meal. It’s true that we often feel that a “positive” accomplishment deserves a treat.
But why does that treat need to be sugar-coated? If you celebrate your accomplishment of improved health with something else that also makes you feel good, then you will feel even more accomplished.

Here are some carb- and calorie-free ways to celebrate:

• Look in the mirror and repeat your accomplishment out loud. You’ll smile when you see and hear yourself saying “your blood sugar is in good control.”
• Take some time off and read a book or see a movie. It’s a guilty pleasure that you typically wouldn’t do on a random weekday.
• Go for a long walk. If you live near a beach, go to the boardwalk.
• Buy yourself flowers or take a walk through a botanical garden (that you’ve been meaning to visit). The lovely sights and smells will make you remember why you are eating well and taking care of yourself.
• Sit in a bubble bath, schedule a massage, or treat yourself to a nice body lotion.
• You deserve to have another good blood test in three months. Rather than eat foods that you might regret later, treat yourself to activities which will make you happy and healthy.

— Susan Weiner, R.D., M.S., C.D.E., C.D.N

Good Intentions Gone Bad

Confessions: #1: Chocolate. #2: Every time I decide it’s time to eat more fruits and veggies, I eat more junk.

Solution: These problems sound like the all-too-common “deprivation backlash.” You say to yourself, “I need to eat fruits and veggies and less chocolate and junk,” or “I am being so good, I haven’t had a binge in months.”

The most compelling human needs are water, oxygen, and anything we’re told we can’t have.
My solution to this problem is to adopt a healthy eating plan that involves adding foods to your diet rather than taking things away.

Let the good crowd out the bad. Every week, add at least one new source of protein, one new vegetable, and one new fruit to your shopping cart.
Focus on low carb fruits and vegetables and high-fibre foods. Learn more about superfoods like greens.

Don’t give up chocolate. Just switch to plain, dark chocolate (if you don’t like it at first, take little pieces and suck on them from time to time; soon enough, you’ll like it more than milk chocolate).

Meet with a dietitian who specializes in diabetes. As a registered dietitian and certified diabetes educator Janis Roszler says, “You don’t have to avoid all of your favourite foods, just learn how to eat them in healthier amounts.”
 — Lynn Prowitt-Smith

Temptation, You Temptress!

Confession: Being tempted by others and giving in to it instead of standing up for myself and resisting. For instance, regardless of what junk my hubby brings home and sets in front of me, I don’t have to choose to eat it. I just wish he were “on my side.”

Solution: Temptation is tantalizing, but it doesn’t have to always win and you don’t always have to avoid it. To deal with temptation try the following:

• Treat yourself to a small taste of the tempting food
• Make your home a “junk-free” zone (which is healthy for all)
• Keep a healthy alternative snack in your purse.
• As for that unsupportive spouse? See below!

— Janis Roszler, RD, CDE, LD/N

Diabetes Police

Confession:  I just wish my spouse was “on my side.”

Solution: It can be difficult for the spouse who doesn’t have diabetes to know what to do or when. To encourage your spouse to be on your side: Bring him or her to a session with a dietitian or diabetes class to learn more about your needs. Invite your spouse to read a good book about diabetes, such as The Secrets of Living and Loving With Diabetes — a great book that helps spouses and partners learn how to support one another.
— Janis Roszler, RD, CDE, LD/N

Handling Stress

Confession: I drink alcohol; margaritas, especially after a stressful day at work.

Solution: If you are taking medication to control your diabetes (insulin or oral pills), please be aware that alcohol can lower your blood sugar (i.e., cause hypoglycaemia) for up to 12 hours after drinking.
Alcohol should not be consumed on an empty stomach, as the effects of the alcohol will be exaggerated. The symptoms of being intoxicated and having a low blood sugar are very similar (slurred speech, unsteady gait, or dizziness) and therefore the two can be easily confused.
Mixed drinks (which often contain fruit juice or sugary additives) provide additional carbohydrates, which are often not accounted for when meal planning.
Because alcohol reduces your ability to make good decisions, meal planning may be an issue if you drink too much on a regular basis.
Here are some tips to de-stress and drink a bit less:

• Always test your blood sugar before consuming any alcohol. If your blood sugar is out of range, cut up some lemons and limes and add them to a glass of sparkling seltzer. Sip on this refreshing beverage while listening to soothing music in the background.
• Have your food waiting for you when you get home. Try not to stray from your nutritious meal plan. You will feel satisfied after you eat and able to reduce your alcohol intake.
• If you do have an alcoholic beverage, sip it. Put a lot of ice in the drink. One drink equals 5 ounces of wine or a 12-ounce beer.
• Have a calorie-free beverage waiting for you in the refrigerator.
• Sit outside if possible and unwind before coming into the house.

— Susan Weiner, R.D., M.S., C.D.E., C.D.N

Bedtime Carbs

Confession: It’s the carbs before bed that do me in.

Solution: Night-time eating is perhaps the most common way people sabotage their healthy eating efforts. Research shows that people who eat more in the morning eat less, over the course of a whole day than people who eat more in the evening.

The research also shows that food consumed in the morning actually satisfies us more than the food we eat at night. Of course, at night you’re tired, you’re sitting around, there’s nothing you have to be doing. And you’ve got all those snacks in the kitchen.
What’s the easiest fix? Get those easy, grabbable snacks out of the kitchen. You’re less likely to engage in mindless eating in front of the TV or the computer if the only food available needs to be chopped or cooked.

Other ideas: Change your night-time routines. Take a yoga class or attend a lecture series at your local library. Anything that gets you out of the house cuts some of your night-time snacking hours.
Take a therapeutic bath once a week (find a spa-type bath product you love — salts, bubbles, oatmeal, etc.) The bathtub is one relaxing place where it’s very inconvenient to eat.
Change your night-time snacks to odd foods that you’re unlikely to overeat: Briney foods like pickles, olives, or veggies dipped in vinaigrette; slow-eating things like beef jerky, or spicy foods like a hot chili or stuffed hot cherry peppers.
— Lynn Prowitt-Smith
Source: Castro, John M. 2004. The Time of Day of Food Intake Influences Overall Intake in Humans. Journal of Nutrition. 134:104-111.

Cheers!

So as you can see, no one is perfect. Even the most experienced person with diabetes has their good days and their bad. The challenge is being willing to admit these slips can happen so that you can find solutions or, at the very least, cut yourself some slack!
Any time is a good time to assess your diabetes management and make a positive step forward.

https://dlife.com/diabetes-blog/true-confessions-part-2-habits-that-derail-diabetes-management/

True Confessions Part 1: Habits that Derail Diabetes Management

From dlife.com/diabetes-blog

They say confession is good for the soul. It’s also a good way to show others they are not alone in their challenges. Talking about what ails you can also foster a sense of community.
We will look into some self-sabotaging habits that commonly derail diabetes management. We’ll also share what our experts suggest to help with those challenges and give you an opportunity for you to declare, share, and move forward.

A Case of the Lazies

Confession: Not checking blood sugar often enough. Also, forgetting to bolus for small snacks. And the desire for the occasional iced cappuccinos!

Solution: Busy bee that you are, sometimes checking those numbers can be downright impossible. And if it’s the weekend — time to relax — then naturally you relax on your management too, right? Well, there is an answer to this.

Testing glucose can be a hassle. Try to find a way to have some consistency and yet, give yourself permission to skip a few tests when your situation is stable. Why? A1C correlates to self blood glucose monitoring.

Type 1s who test more than 3 times a day had an A1C on average 1 percent less than those who did not. And type 2s who test more than once a day had an A1C an average of 0.6 percent less than those who did not.

The point is to not put the meter away for most of the day on most days. Also, consider a continuous glucose monitor, so you are always in the know about what your blood sugars are doing.
As for those cappuccinos, what is life without a l-i-t-t-l-e guilt? Did you know a small, 12 oz. sized milk iced cappuccino has 39 grams of carbs and 180 calories? A large 20 oz. size has 69 grams of carbs and 320 calories.

But if you go for the mocha iced cap (large, 20 oz. chocolate milk) it has 101 grams of carbs and 500 calories!
If enough of these “weaknesses” add up, they can certainly derail your diabetes wellness train. Choose wisely and ditch the guilt.
— Theresa Garnero, APRN, BC-ADM, MSN, CDE

Mishandling Lows

Confession: Gummy candies to prevent night-time lows, which I have been having a lot of lately.


Solution: It’s never a bad habit to do your best to prevent night-time lows. Using gummy bears or candies to treat a low may work just fine (5 gummy bears have about 15 grams of carb), but to use them to prevent lows may not be the best approach.

In order to prevent night-time lows, consider the following:

1. Know the early warning signs. If you know the very first inkling of low blood glucose, you can treat it before it goes even lower. Early recognition is important in preventing worse lows. Some people have symptoms such as tingly lips or mild dizziness, sweating, shakiness, etc.

2. Eat a well-balanced diet. Eating consistent, carb-balanced meals is important in preventing lows. When people skip meals or suddenly eat less for a meal, combined with taking insulin and certain diabetes medication, it may increase your risk for lows.

3. Have a bedtime snack if needed.
Based on your blood sugar patterns and recommendation from your registered dietitian or healthcare provider, a bedtime snack may be the key to preventing lows in the night. Have a small snack that has some protein along with carbs.
Examples include a small serving of yogurt with a sprinkling of nuts, a piece of whole-grain toast with peanut butter, a half cup of fruit with cottage cheese, a small serving of popcorn, a glass of milk, a few whole-grain crackers with cheese, a small protein bar.

4. Exercise moderately early in the morning before breakfast. In the morning, your body is most insulin resistant. Since lows are most likely within 4 hours after exercise, you can reduce your risk of night-time lows by exercising earlier in the day.

5. Test of monitor your blood sugar regularly. This will help you identify patterns that can reveal your risk for lows. You can also set your alarm for the middle of the night on a couple of occasions (3 a.m.) to make sure you are not going low.

Some people sleep through their lows, so this is important information to bring back to your provider. Be sure to keep quick-acting sugar (like a small box of juice or glucose tablets) at your bedside.
6. Limit alcohol, especially on an empty stomach. Alcohol can cause low blood sugar, especially the following morning. Best to have with food, and have a plan in place regarding medications on the nights that you do drink (your doctor may suggest a little less long-acting insulin, for example).
— Theresa Garnero, APRN, BC-ADM, MSN, CDE

Incorrect Correcting

Confession: Under-counting carbs when bolusing and then correcting two hours later.

Solution: The best way to feel comfortable about controlling your diabetes is to become familiar with the carbohydrate content of foods you are commonly eating on a day-to-day basis.

Foods that contain carbs (starches and sugars) tend to raise blood sugar levels. Rather than having to constantly correct a high or low-blood sugar, it’s very important to figure out the right amount of carbs for you (or your child) to eat throughout the day.
Daily activities don’t always go according to plan, but if you familiarize yourself with the carb content of various foods that you enjoy and eat most often, you will be less like to have to correct your blood sugar.

Becoming comfortable with reading food labels, and understanding portion sizes can help you determine carb intake more easily. If you double up on a serving, you’re consuming twice the amount of carbs!
If a food doesn’t have a food label (for example fresh fruit and produce), you can approximate the number of carbs in the food.
More ideas to prevent frequent blood sugar correction:

Know your schedule, so you can adjust your meal plan accordingly. If your child has an unexpected play date, offer to bring the snacks, so that you are in control of the carb content.

Use measuring tools (at least initially). If you are constantly guessing and correcting insulin dosages, chances are you are not familiar with correct portion sizes as it relates to your carb intake. You won’t have to measure forever! Measure portions for a little while, until you are seeing an improvement in your target blood sugar levels.

This will show you visually what 15g of carbs look like (for example 1/2 cup of oatmeal).

Use an online tool or smartphone app to quickly look up the carb content of “sometimes” foods that you might not have been prepared to eat. That way there will be less guesswork involved in medication coverage.

Keep a food log, and make an appointment with a registered dietitian and certified diabetes educator to help you figure out the best way to navigate your meals and snacks.

Working with a professional who is well-versed in diabetes meal planning will help you make sure that you are eating an overall balanced and nutritious diet.

— Susan Weiner, R.D., M.S., C.D.E., C.D.N

Irregular Exercise

Confession: Not exercising regularly.

Solution: The best thing to do is to stop thinking about exercise and start moving more daily. Just being active all day long — standing, taking steps, moving whenever and wherever you can —will help build your fitness and keep your blood sugar under better control.
Consider getting an inexpensive pedometer or fitness tracker and setting daily goals, too. Physical activity of any kind is the best medicine for diabetes.
Sign up for some dance classes, start taking walks on your breaks, and stand up more every day to get started on being more active.
— Sheri Colberg, Ph.D.

Dis-proportion

Confessions: The food that usually sabotages my sugars is pizza. Eating too much peanut butter.

The common denominator here is portion control — or lack of it. Pizza and savoury snack foods are some of the hardest to eat in moderation. What can you do?

Pizza usually causes a delayed blood sugar rise, which can wreak havoc with your management. It’s the big dose of carbs from the crust combined with the blood-sugar moderating fat in the cheese.
The best strategy with pizza is to allow yourself to eat the first few bites of the thin part of the pizza and then use a fork to scrape off the rest and leave the big, thick part of the crust right on your plate (or better yet, throw it away so you don’t start nibbling on it without thinking).

Eat slowly, too, to give your body time to get the message up to your brain that you’re satisfied.
And here’s one piece of good news about the peanut butter: Two tablespoons of peanut butter (the popular brands, with added sugar) contain just 7 grams of carbs, and 2 of those grams are beneficial fibre.
It’s calorie-dense but delivers healthy fats, antioxidants, vitamins, and minerals.

Here’s what I do to help me not overeat snacks: Buy some mini ramekins or other condiment-size containers that you like (I have little wooden bowls in different shapes that I love).
At snack time, get into the habit of always pulling out your mini-size dishes and never eating out of a jar or package.
— Lynn Prowitt-Smith
Updated 8/14/19.

NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.

https://dlife.com/diabetes-blog/true-confessions-part-1-habits-that-derail-diabetes-management/

David Crosby Answers Your Questions About Learning to Play Guitar, Living With Diabetes and More

From rollingstone.com

Rolling Stone’s new advice columnist faces the tough issues with wit, wisdom, and candour

                                                                         Anna Webber

Hi Dave. Long time fan. I just got diagnosed with diabetes and I have trouble with what to eat. What do you eat daily? Need help.
Tim Moore, Michigan

I can explain it to you. I am diabetic. I have been for about 40 years. I will explain the whole thing to you. Now, people do these complex diets where you can only eat the third grape and other nonsense. But you eat it, you burn it. What you don’t burn, you wear. It’s that simple.

Now when you start out [in life], you’re burning like crazy since you’re young and you’re just starting out and you’re also building a new body. It takes lots of juice. So then you get old and you’re not burning anywhere near as much, but you’re still eating the same amount, which means you get fat. Simple. So you have to cut down on what you eat.

My doctor said to me, “Crosby, you have to do better.” I said, “I’m trying doc.” He said, “Eat less food!” I said, “Oh, thanks Doc, that clears it right up for me.” He said, “I’m not kidding!” Well it turns out the grumpy old guy was right. You eventually get full when you eat, but your stomach doesn’t tell you for another 20 minutes. There’s a delay before its tells you that you’re full. You kept eating because it tasted good, but you didn’t need that food. You just ate food you’re going to wear.

What I did was cut my portions in half. In America, they give you too much food in a portion in a restaurant. It’s food for two people. I cut it in half and I only eat that. I went from 240 to 180 and I’ve stayed there for three years. I haven’t been more than three pounds on either side of 180 for three years, so I think I did the right thing.

With Diabetes, your goal is to have a haemoglobin a1C of under 7. I’ve been there for three years. The weight thing is central critical to diabetes. That’s why people are going type 2 diabetic all over the country now. It’s just because they are eating crap food largely because all of the packaged foods, all of them, every cereal they make, is full of high fructose corn syrup. Bad. The worst kind of sugar. And they put it in all the packaged foods, all of the bread. It’s bad for you. It’s crap. But they also are just feeding you too much food. The portions are too big. The Western Europeans have got it right. You shouldn’t be eating more than what you can fit in your hand.

https://www.rollingstone.com/music/music-news/david-crosby-ask-croz-answers-questions-play-guitar-diabetes-870645/

Diabetes and hot weather

From diabetes.org.uk

Enjoying the sun is one of the things many people look forward to in the summer and on holiday. But if you have diabetes, it can be harder to manage your blood glucose (sugar) levels in the hot weather.

Long periods of inactivity in the sun can affect diabetes control, making blood sugar levels higher than usual. On the flipside, insulin will be absorbed more quickly from the injection site in warm weather, and this increases the risk of hypos.
If you are vigilant about your diabetes control then there is no reason you can't have fun in the sun like anybody else.
Take the following steps to ensure you can safely enjoy the warm weather.

Monitor your levels

People with diabetes will need to monitor their blood glucose levels more often and be ready to adjust their diet or insulin dose accordingly.

Keep meters and test strips away from the sun

Extremes of temperature can also affect your blood glucose meter and test strips. Keep your meter and test strips as close to normal room temperature as possible and out of direct sunlight, but don’t refrigerate them as cold temperatures can also lead to misleading results.

Store your insulin properly

If your blood sugar levels are consistently higher than expected, it is worth considering whether your insulin could have been damaged in the sun. Insulin, in the hot weather especially, is best kept in the fridge or a cool bag (taking care that it does not freeze).
When damaged by heat, clear insulin generally becomes cloudy and cloudy insulin becomes grainy and sticks in the side of the glass. Insulin that has been exposed to bright sunlight sometimes has a brownish colour. Do not use insulin that shows these changes. Speak to your GP or healthcare professional if you are unsure.

Other top tips

When you're out and about in the sun, remember to:

• wear long sleeves, loose trousers, a hat and sunglasses with a UV 400 label
• apply sunscreen to exposed areas of your body 15–30 minutes before going out in the sun
• If you have neuropathy, you may not be aware your feet are burning, so apply sunscreen and wear flip flops on hot ground.

Heat exhaustion

Heat exhaustion can develop when the body finds it difficult to keep cool. Symptoms include headaches, dizziness, nausea and vomiting, tiredness, muscle cramps, stomach cramps and pale skin. As some of these could also be due to unstable blood glucose levels, it's important to test regularly.
Heat exhaustion needs immediate treatment. Move to a cool place to rest and sip a cold drink. If left untreated, heat exhaustion can lead to the more severe and potentially life-threatening condition heat stroke, so take action straight away.
Symptoms of heat stroke include confusion, hallucinations, rapid breathing and convulsions, all of which require immediate medical attention.

https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/hot-weather?utm_source=bronto&utm_medium=email&utm_term=Image+-+Diabetes+UK&utm_content=Image+-+Diabetes+UK&utm_campaign=Enewsletter+August+2019

How to manage your diabetes and remain healthy for life

From azbigmedia.com

Your diabetic condition need not impact you physically, and you still have every opportunity to live a long, wholesome life.

True, diabetes might make staying fit and well a little bit tougher for you. If you devote yourself to the task of managing your condition, though, you will be sure to make everything a lot easier for yourself.

To find out what you need to do to manage your condition and remain healthy for life as a person with diabetes, be sure to read on.

Step 1: Understand diabetes

You can’t seek to manage your diabetes if you don’t actually understand what it is. Before you move forward with your quest to stay healthy, you need to study the condition and truly get to grips with what it is and what it does.

First and foremost, you need to understand that there are three main types of diabetes and that each of them brings about their own specific problems. These three types and the challenges they cause are:

• Type 1 diabetes — This stops your body from making insulin and, ultimately, generating energy.

• Type 2 diabetes — This common form of the condition makes it difficult for your body to make and/or use insulin.

• Gestational diabetes — Commonly brought about by pregnancy; this strand of the condition goes once the baby is born. It does, however, significantly increase the chances of both mother and baby suffering from a permanent form of diabetes later in life.

Step 2: Know your healthcare team

During the initial stages of your condition, you are going to need to rely on your diabetic healthcare team. Knowing who forms this team is essential that you know who you can turn to when you’re in need of assistance. This team is comprised of:

• Your diabetes doctor

• Your diabetes educator

• A dietician

• An eye doctor

• A foot doctor

• A mental health nurse

• A pharmacist

• A dentist

It’s important to point out, however, that YOU are the most important member of your healthcare team. The professionals listed above will provide you with extensive amounts of support, but ultimately it comes down to you and what you do to manage your condition day in, day out.

Step 3: Take it seriously

You aren’t going to manage your diabetes or stay healthy as a diabetic if you don't take your condition seriously. This means that you have to follow all the guidelines imposed on you by the doctor that is treating you, and that you have to make the right health choices at the right times. Importantly, this means not eating any more sugary foods if your sugar levels are already a little high at any point.

By taking your condition seriously, you will stand to reap the following benefits:

• You’ll feel more energized

• You’ll be less thirsty

• You won’t have to pass urine as often

• You’ll heal better

• You will fend off skin and bladder and infections more often

• You’ll lower your risk of suffering a heart attack and/or stroke

• You’ll avoid eye problems that have the potential to blind you

• You’ll avoid nerve damage (and the painful tingling sensation that it causes)

Step 4: Know your ABCs

You know the alphabet, but do you know your diabetes ABCs? It’s crucial that you do, as it could just save your life.

Here are the ABCs you need to remember at all costs:

A — A1C test

This is a test that measures your blood sugar level and allows you to keep track of your condition.

B — Blood pressure

You need to control your blood pressure and keep it below a specific millimetre of mercury (typically 140/90mmHg).

C — Cholesterol

Avoiding bad cholesterol (LDL) is pivotal because it can lead to heart attacks and strokes. As a person with diabetes, you are more at risk than most when it comes to these problems.

Step 5: Eat well

Managing your condition will keep you alive, but it won’t necessarily keep you healthy. Just like everybody else, you have to make a conscious effort to get and stay healthy. Unfortunately, however, your diabetes will throw a number of curveballs your way in this instance, one of the biggest being the way you react to certain foods.

Controlling your blood sugar and trying to eat healthily at the same time is never easy. Throw in the fact that you’re too busy to cook up wholesome meals, and everything becomes a whole lot harder. Fortunately, however, there are diabetes meal delivery services that meet ADA guidelines, meaning it is now possible to have healthy, diabetes-friendly meals dropped straight to your door. This makes eating well as a person with diabetes a lot easier!

Take the above advice, and you’ll be sure to live a long and healthy life no matter what type of diabetes you suffer with.

https://azbigmedia.com/lifestyle/health-fitness/how-to-manage-your-diabetes-and-remain-healthy-for-life/

Do not fear online peer-support networks in diabetes care

From healio.com

HOUSTON — People with diabetes and their caregivers are increasingly turning toward online peer support communities to share and exchange information and experiences that affect outcomes and emotional health. However, it is crucial that diabetes care and education specialists begin to integrate evidence-based online peer-support networks into mainstream diabetes care, according to a speaker here.

The diabetes online community is loosely defined as online spaces where people gather, such as website forums and blogs, or via social media channels like Facebook, Twitter, Instagram and YouTube, Ashley Ng, PhD, APD, RD, a lecturer in dietetics and human nutrition at La Trobe University in Melbourne, Australia, said during a presentation at the American Association of Diabetes Educators annual meeting. The spaces offer health care providers and diabetes care and education specialists opportunities to engage with people with diabetes in new ways; however, any potential clinical and emotional benefits must be balanced with important safety and privacy concerns online, she said.

“The pros are [going online] does empower people with diabetes in their self-care management,” Ng said. “You get information, you don’t feel alone, you see people out there can achieve amazing things and you can do that, too. And, you have someone to talk to and relate to. Out of all of that, the better you feel about yourself and your care ... naturally, your time in range and your HbA1c targets improve. Emotional wellbeing improves as well. It’s the power of shared experiences.”

Ng said she often hears providers who worry about misinformation that could potentially be spread in such online communities, putting people with diabetes at risk. Such risks, Ng said, are overblown, as the communities tend to be self-regulating.
“People will say, ‘It’s online, are things regulated online? People can share misinformation,’” Ng said. “To that, when we look at the research, less than 10% include serious cases of misinformation. Yes, you can find information about risky behaviours, like ‘diabulimia’ or binge eating ... but this actually starts that conversation and makes people aware that this is a conversation you have to have with your health care provider.”

The bigger concerns, Ng said, involve personal safety and privacy while online. She encouraged social media users in particular to “be smart,” check privacy settings, and avoid sharing personal details or photos online. Providers and educators should remember that “you’re not anyone’s health care provider when you’re online,” she said.

The organization Beyond Type 1 offers a list of community forums and advocacy organizations that have an online presence as a starting point for providers who want to become more involved in the diabetes online community, Ng said. The community can offer opportunities for providers to have more informed discussions with patients.

“They feel like they’re going to be left out, but, no,” Ng said. “As providers, we are so privileged to be the gateway of information ... translating that into something that is meaningful. As clinicians, you have your own expertise as well. Don’t underestimate your role for the person with diabetes care. You can then help keep them safe online as well, as well as keeping yourself safe.” – by Regina Schaffer

https://www.healio.com/endocrinology/diabetes-education/news/online/%7B9455d2f7-553b-425f-b7e5-51fc03b1b945%7D/do-not-fear-online-peer-support-networks-in-diabetes-care

Gifts For Diabetics

By Keith E Barker

If you know someone with diabetes, you know their condition impacts many aspects of their life. Depending on their symptoms, they may need special equipment to manage their health. This may include a blood sugar monitor or special shoes, for example, which make great gifts for diabetics.
Fortunately, companies are manufacturing more gifts for diabetics to make their lives easier. Below, we'll look at some of the best gifts for diabetics in 2019 and how they could help someone you love manage their symptoms.
These may include tools to improve their health or diabetic-friendly snacks to satisfy cravings. Whether it's a birthday, graduation, or holiday, you'll know exactly what to get someone with diabetes for their next gift-giving celebration.

7 GIFTS FOR DIABETICS:
DIABETIC-FRIENDLY SOCKS AND SLIPPERS
Foot care is crucial for people with diabetes. They're prone to foot injuries at home. With proper care and a good pair of diabetic socks or slippers, it can really be a huge help.
If you're buying slippers, we recommend buying a pair with hard soles and a closed-toe design. For men, the UGG Men's Ascot Slipper is a great choice - it's made with 100% leather and the inside features soft, comfortable wool.
For women, the LongBay Furry Memory Foam Diabetic Slippers are a great choice. They're affordable, featuring a plush, comfortable design ideal for people managing edema.
Diabetic socks are another great gift, helping diabetics manage swelling in their feet. Socks are an affordable diabetic gift and they're relatively easy to find - Amazon features dozens of listing, including value packs of various colours and styles.

BOOKS ABOUT DIABETES
Learning about diabetes is important for people managing the condition. The more they learn about their symptoms, triggers, and ways to prevent complications, the easier it is for them to live well.
If someone you love was recently diagnosed with diabetes, books about the illness can be great gifts for diabetics. They'll learn about diabetes from the perspectives of experts and other people who understand.
Diabetic cookbooks are especially helpful. When a person has diabetes, they have special dietary needs. Accommodating these needs is crucial - if they don't eat healthy meals without excess carbohydrates, they could exacerbate their symptoms.
By giving a diabetic-friendly cookbook, you give the person access to meals they need to sustain their health.
The Complete Diabetes Cookbook by American's Test Kitchen is one of the best, offering a wide variety of diabetic-friendly meals. It includes appetizers, main meals, and desserts including recipes like Lemony Penne Pasta with Chicken and Creamy Broccoli Cheddar Soup.
If you're looking for a non-fiction book, the 2004 classic Think Like a Pancreas is a great option. It covers all the diabetes basics, giving readers a lot of actionable information to manage their symptoms.

WEARABLE FITNESS TRACKER
When a person has diabetes, its especially crucial they incorporate fitness into their daily routine. Adequate fitness can minimize diabetes' impact on a person's life but it can be a challenge to create healthy exercising habits.
If you want to be encouraging and help someone achieve their fitness goals, a wearable fitness tracker makes a great gift.
Giving someone a fitness tracker is a two-fold gift:
It'll help them monitor their daily activity
It'll inspire them to be more active
Wearable fitness trackers used to be a niche product but today, you can buy them from assorted brands in various shapes, sizes, and colors.
The Fitbit is an obvious choice if you're buying a wearable fitness tracker. It's one of the most reliable on the market, showing users details like steps taken and stairs climbed.
With a wearable fitness tracker, diabetics can feel more confident about their daily routine. They'll have easy access to their vital signs whenever they need it, giving them tools to stay healthy while they exercise and keep themselves from "overdoing it."

AN EXERCISE CLASS
We mentioned above that daily exercise is crucial for people with diabetes. If you're considering a fitness tracker for their next birthday or holiday, consider an exercise class to go along with it.
Exercises classes can be a fun way for people with diabetes to manage their symptoms and improve their health. They can meet other people who live with similar conditions, learning their favorite methods of managing symptoms.
Giving someone a gift card to a yoga class or Zumba can be an excellent way to support their diabetes journey.

BACKPACKS/BAGS FOR CARRYING DIABETIC SUPPLIES
Diabetics need to carry certain types of equipment with them when they leave the house. This may include a blood sugar monitor or insulin injection shots.
It can be hard to carry all those supplies around - fortunately, there are specially-made bags and carrying cases designed for diabetes equipment.
Myabetic is one of the most popular brands for diabetic carrying cases, offering a wide selection of compacts, crossbody bags, and backpacks in various materials and colours.
Getting your loved one with diabetes a bag for their carrying supplies is a great way to say you care. They'll feel more secure knowing they have everything they need in one place and they won't worry about leaving vital equipment at home.

MEDICAL BRACELET
Having diabetes means health complications can happen suddenly. If a person's blood sugar spikes or drops too low, it can lead to dizziness, fainting, and other serious health conditions.
In these cases, having a medical bracelet is vital. When diabetics go in public alone, they need something to tell others about their condition in case of an emergency.
This is where a medical bracelet comes in.
The medical bracelet tells passers-by the individual has diabetes in case they need help from strangers.
You can buy stylish, quality medical bracelets on the web or get something special from a premium retailer. Affordable medical bracelets are available for sale on Amazon, but Tiffany's offers truly special tag chain bracelets your loved one can custom engrave.

LOW-CARB SNACK BASKETS
Minimizing carbohydrate intake plays a key role in managing diabetes. Today, sugary treats dominate the foods for sale at grocery stores - in fact, many diabetics feel stressed when they go shopping because low-carb snacks can be hard to find.
You can make it easier by gifting a low-carb snack basket, full of treats they can enjoy guilt-free.
The Sugar-Free Movie Night Bucket, available on Amazon. It contains a large assortment of sugar-free and low-carb snacks, including popcorn, chips, and more. It also features a handy tote bag so your loved one can take their snacks on the go!

FINAL THOUGHTS
Living with diabetes can be challenging. There are certain types of equipment they must use, foods they must eat, and exercises they must do to stay healthy.
You can help your loved one manage their diabetes symptoms by giving them thoughtful gifts for birthdays, holidays, and other celebrations. Remember - people with diabetes often feel like they are alone and by giving them the right gift, you can show them you care about their journey and want to help along the way.
If you know anyone else who is looking for gifts for diabetics, please share this article on social media. With plenty of birthdays and celebrations approaching, it's a great time to start thinking about what you'll get your loved ones.

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