Diabetes footcare is still important amid COVID-19 say leading charity

From diabetes.co.uk

People with diabetes are being urged not “ignore” potential problems with their feet amid the COVID-19 pandemic.

Diabetes UK is reminding people to continue seeking medical help should they notice anything different about their feet.

Over time, poorly managed diabetes can cause nerve damage, called diabetic neuropathy. This is because consistently high blood sugar levels can affect how the blood flows to the feet and legs.

Symptoms, such as tingling sensations, loss of feeling, a dull ache, wounds or sores that don’t heal and cramp in the calves when resting or walking can all be signs that there may be a problem and medical assistance should be sought.

A small cut or blister may also lead to an ulcer or infection, which if left untreated could lead to limb amputation.

People with diabetes should check their feet on a daily basis to see if any notable changes have occurred, manage blood sugar, cholesterol and blood pressure levels as well as they can and be as healthy as they possibly can.

Dan Howarth, Head of Care at Diabetes UK, said: “We know that people with diabetes may feel uneasy about seeking medical help for problems with their feet while the UK continues to deal with the coronavirus pandemic, but foot problems can deteriorate very quickly, and ignoring problems with your feet can have devastating consequences.

“People with diabetes should seek medical help quickly if they notice anything unusual.”

https://www.diabetes.co.uk/news/2020/may/diabetes-footcare-is-still-important-amid-covid-19-say-leading-charity.html

Diabetes Diet: Expert Explains How Pistachios Can Help Control Blood Sugar Levels

From ndtv.com

Diabetes diet: Nuts are loaded with multiple nutrients. Pistachio is a diabetes-friendly which can help in regulating blood sugar levels. Here's everything you need to know

Diabetes can be managed effectively with a healthy diet. It is extremely important to control blood sugars to fight the complications linked with it. Adding certain foods to your diet can result in controlled blood sugar levels. Dried fruits and nuts are a powerhouse of nutrients. It is advised to consume a certain amount of nuts every day to receive essential nutrients and micro-nutrients. Pistachio is a super healthy nut that is diabetes-friendly. If consumed in the right quantity, pistachios may help regulate blood sugar levels.

Diabetes diet: Pistachios to control blood sugar levels

The glycaemic index determines the effect of the food consumed on blood sugar levels. Foods with a low glycaemic index are beneficial for diabetics. Pistachios have a low-glycaemic index making it safe for diabetics. Studies have also highlighted that eating pistachios can help lower blood sugar levels.

Dr. Mike Roussell who is a nutritionist explained in an online panel discussion, "A diabetic will not experience a spike in blood sugar levels after consumption of pistachios. Having them before a meal may also regulate your body's response to the meal consumed."

Other benefits of eating pistachios

"Pistachio is a healthy snack. It is beneficial for kids as well. It is loaded with protein which makes it an appropriate source of plant-based protein for vegetarians. Eating them in moderation can also help you maintain a healthy weight." Dr. Roussell added.

Pistachios may also control blood pressure and cholesterol levels as well. These benefits can boost overall heart health.

However, excess of anything is bad. You can add pistachios to your diabetes diet, but in moderation. You may as well consult your doctor to know the exact quantity, to know how much nuts you should consume as per to the severity of your condition.

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-diet-expert-explains-how-pistachios-can-help-control-blood-sugar-levels-2237104

A third of COVID-19 deaths in England linked to diabetes

From diabetestimes.co.uk

People with diabetes do face a significantly higher risk of dying with COVID-19 with a third of deaths in England associated with the condition, according to new NHS research.

Published in the Lancet, the two world-leading studies led by Professor Jonathan Valabhji, National Clinical Director for Diabetes and Obesity at NHS England and Professor Kar, National Specialty Advisor, Diabetes with NHS England, have been looking in depth at the number of people who died from coronavirus in hospital also had diabetes.

The researchers discovered that those with type 1 diabetes are at three and a half times the risk, and people living with type 2 are at double the risk of dying in hospital with the virus, compared to people without diabetes.

However, by far the strongest risk factor for dying with the virus is age, and people with type 1 diabetes are on average younger than people with type 2 diabetes.
Overall, 7,466 of those who died in hospitals in England had type 2 and 365 who died had type 1 diabetes, and the research suggests that the threat for those under 40 with type 1 or type 2 diabetes is very low.

Infectious conditions
It is thought that the risk to people with diabetes and the virus is in line with the extra risk seen in other infectious conditions such as pneumonia.
The studies also show that in people with both type 1 and type 2 diabetes, even when all other known factors are taken into account, higher blood glucose levels and obesity are linked to higher risk.

The study findings also show:

• The overall death rate for people with diabetes doubled during the early stage of the pandemic.
• In both type 1 and type 2 diabetes, men, people of black or Asian ethnicity, and people living in more deprived communities, were at higher risk.
• In both type 1 and type 2 diabetes, those with pre-existing kidney disease, heart failure and previous stroke, were also at higher risk.

Professor Valabhji said: “This research shows the extent of the risk and the different risks for those with type 1 and type 2 diabetes. Importantly, it also shows that higher blood glucose levels and obesity further increase the risk in both types of diabetes.

“This can be worrying news but we would like to reassure people that the NHS is here for anyone with concerns about diabetes – and has put extra measures in place to help people and keep them safe, including online sites to support people to care for themselves, digital consultations, and a dedicated new helpline for advice and support for people treated with insulin.”

The helpline launched together with Diabetes UK and Novo Nordisk has been developed to give people with diabetes advice during the pandemic.

Video consultations and online appointments, as well as routine discussions with GPs, are among a range of measures that the NHS has also adopted so that diabetes care can continue throughout the pandemic.

People with diabetes are also advised:

• If you are concerned about your diabetes during the coronavirus pandemic, the NHS is here to help. Contact your GP Practice or Diabetes team.
• If you have diabetes and have been contacted by your specialist eye or foot care team, please go to your appointments to receive treatment to avoid these problems getting worse. Clinics are taking extra protective measures to keep people safe.
• The 4Ts – toilet, thirsty, tired and thinner – are signs of a life-threatening diabetic emergency, diabetic ketoacidosis or ‘DKA’. If you recognise these signs, seek urgent medical advice from your GP Practice (or 111 out of hours); if you already have diabetes, contact your Diabetes team; or if you feel very unwell, call 999.
• If you have diabetes and see a cut or blister on your foot, it may be a sign of a foot ulcer. Call your GP Practice to get it checked as soon as possible. If you do have an ulcer or other serious foot problem, you will be referred to see a specialist urgently.
• If you are experiencing a serious or life-threatening emergency – call 999.

https://diabetestimes.co.uk/a-third-of-covid-19-deaths-in-england-linked-to-diabetes/

High-intensity exercise can help to control type 2 diabetes

From thegardenisland.com

Unfortunately, we all know that many people are suffering from diabetes, not just in Hawai‘i but all around the world. Type 2 diabetes is very different than type 1 diabetes — whereas in type 1 diabetes the body is no longer able to produce the hormone insulin, which is mainly responsible for regulating blood sugar, in a type 2 diabetic the body can still produce insulin but is no longer able to use it efficiently.

Do you know that for many patients exercise can actually be more effective than medication? Now, of course, that doesn’t mean that you can just stop taking medication and start exercising. It’s unfortunately not that simple. However, you can gradually reduce your symptoms, feel much better, and improve your health with exercise. Your physician probably already suggested that you walk at least 3 times a week for 20 to 30 minutes, which is great, but if you can change your walking speed or the type of activity depending on your physical conditions and fitness levels, you may get three times more benefit in a shorter period of time.

Examples of this are high intensity interval training, as well as combining resistance training with endurance type of training, and with this you can see positive results in a very short time period. An example of high Intensity Interval training (HIIT) could be on a bike, going as fast as you can for 20 to 30 seconds, then resting and recovering for 1½ to 2½ minutes, and then repeating these intervals 5 to 8 times. Of course, the intensity will vary with the individual’s fitness level. HIIT can be done in 10 to 20 minutes, so it’s time efficient which can also help keep you motivated too. You can apply this HIIT principle to many activities such as walking, fast swimming, or cardio machines in the gym. Even if you don’t have access to a gym you can use bodyweight exercises such as jump jacks, increased speed squats, push-ups (you can also do wall push-ups to make them easier), so really for any situation you can find an exercise, increase intensity, and use it for your high intensity training. Do just make sure to try and push your limit and stay consistent.

Benefits of HIIT include improving oxygen in the blood, which can help with circulation, improving mental health, and regulating blood sugar levels as well as many other health benefits such as increased muscle mass. It can also help with improving post exercise oxygen consumption (EPOC), which means that even after your workout you are still burning extra calories and this can lead to an increased metabolic rate. You need to give time between HIIT sessions, with around 48 to 72 hours recovery, and no more than three strenuous workouts per week. Of course, you still need to have an otherwise active lifestyle, with things like regular walks, and trying to avoid sitting too much for long periods.

In addition to HIIT, you can of course increase muscle by regularly practicing resistance exercises such as using gym equipment, resistance bands, and even body weight exercises. It’s important that you apply some form of resistance for muscle gain, as this can help regulate your blood sugar and eventually you will become insulin sensitive, not resistant. And of course just a quick reminder that it’s still so important that you watch your diet, as exercise alone will never rescue anyone from a diet high in ultra-processed food and added sugar. I wish it were true that we could exercise regularly and then just eat anything we want, but of course unfortunately it is not!

We all know the importance of an active lifestyle, but knowing and applying are two different things. But as long as we take our own responsibility, we all have power and all the resources to heal ourselves. I really wish that one day, just like going to see your physician, you could instead go straight to the activity specialist to give you a prescription for exercise.

https://www.thegardenisland.com/2020/05/27/lifestyles/high-intensity-exercise-can-help-to-control-type-2-diabetes/

Tips for diabetes patients to manage their blood sugar

From indianexpress.com

Due to the weakened immune system, people suffering from diabetes are prone to infections, and may take a longer time to get back on track.

If one gets diabetes, not only does their blood sugar level get affected, but the insulin production level also gets compromised. People with high or unmanaged blood sugar levels tend to have less than normal blood flow, because of which the body finds it difficult to harness nutrients and heal. Thus, due to the weakened immune system, people suffering from diabetes are prone to infections, and may take a longer time to get back on track. The condition, however, is manageable, even in the wake of coronavirus.

It is the need of the hour to keep the sugar levels in check for the ones with diabetes, as the cases of Covid-19 increase stupendously.

* Stay hydrated, and eat fresh fruits and vegetables to enhance your immunity.
* “Exercise on a daily basis. Try to increase activities at home. Do exercises that will not stress you out. Opt for yoga, pranayama, and deep breathing exercises. This will improve your pulmonary function and will not cause any disturbance in breathing. Even light stretches can be done to keep your body supple and fit. You can also do simple household chores such as sweeping, mopping, and cleaning”, suggests Dr Anil Boraskar, Diabetologist, ACI Cumballa Hill Hospital, Mumbai.
* Check blood sugar level at home with the help of home glucose monitoring that is reliable machines. You can check your blood sugar levels and keep a target of less than 140 and 180 mg/dl. If your sugar is in this range then monitor the levels, every alternate day. If your sugar levels are not in this range then monitor it thrice a day, and you will have to take insulin instead of medications. Consult your diabetologist over the phone, who will set your insulin doses according to your blood sugar levels.

                                            (Source: Getty/Thinkstock/Pixabay images)

* If you are diabetic and hypertensive, them monitor your blood pressure levels from time to time and take medications.
* Washing hands is important, and so is washing feet. Clean them regularly. You can take the help of your family members and look for any cuts, ulcers, or wounds on the feet. Get immediate attention if required.
* Maintain good personal hygiene. Upgrade your skin, oral, and intimate hygiene. Practice social distancing.
* “The spread of COVID-19 is via asymptomatic patients in whom symptoms are not seen. But if you are a diabetic and have a seasonal cough or cold then pay attention to it. Other symptoms that people with diabetes may have is hypoglycaemia (can be described as a condition in which your blood sugar (glucose) level is lower than normal). This can be dangerous so help yourself with sugar if your sugar is less than 70 mg/dL. Make a note of what has caused a drop in your sugar level”, says Dr Boraskar, Diabetologist.

https://indianexpress.com/article/lifestyle/health/healthy-practices-for-people-with-diabetes-to-manage-their-blood-sugar-6425228/

Blood test could predict female diabetes years before it strikes

From newswise.com

Blood markers can identify women with history of gestational diabetes who will go on to develop type 2 diabetes years after delivery

Newswise — Scientists have identified metabolites in the blood that accurately predict whether a woman will develop type 2 diabetes after experiencing a transient form of illness during pregnancy. This discovery could lead to a test that would help doctors identify patients at greatest risk and help them potentially avert the disease through interventions including diet and exercise.

The research was led by Michael Wheeler, a professor of physiology at U of T's Faculty of Medicine, in collaboration with Hannes Röst, an assistant professor of molecular genetics and computer science at the Donnelly Centre for Cellular and Biomolecular Research, Feihan Dai, a research scientist of physiology and Erica Gunderson, a research scientist at the Kaiser Permanente Division of Research in Northern California. Mi Lai, a post-doctoral fellow in Wheeler's group performed much of the analyses.

"There is a metabolic dysregulation that occurs in the group of women that will go on to develop type 2 diabetes that is present in the early postpartum period, suggesting that there is an underlying problem that exists already and we can detect it," says Wheeler, who is also a senior scientist at Toronto General Hospital Institute at University Health Network.

The identified metabolic signature can predict with over 85 per cent accuracy if a woman will develop type 2 diabetes (T2D), as described in a study published in the journal Plos Medicine.
About one in 10 women will develop gestational diabetes (GD) during pregnancy which puts them at higher risk of T2D, with 30 to 50 per cent of these women developing the disease within 10 years after delivery. The disease hampers the body's ability to regulate blood sugar levels and can lead to serious complications including vision loss, neurological problems, as well as heart and kidney disease.

Women with GD are recommended to have an annual oral glucose tolerance test after delivery, which measures the body's ability to remove sugar from the bloodstream. But the procedure is time and labor consuming and fewer than half of the women follow through with it.

"If you've got a newborn at home one of the last things you are thinking about or have time for is your own health," says Wheeler. "This is one of the main reasons why we performed this study, to potentially develop a simple blood test reducing the number of hospital visits."

Wheeler and Gunderson first uncovered metabolic signatures predictive of T2D in their 2016 pilot study of 1033 women with GD Gunderson recruited for the Study of Women, Infant Feeding and Type 2 Diabetes After GDM Pregnancy (SWIFT), one of the largest and most diverse studies of its kind. All of the women delivered their babies at Kaiser Permanente Northern California hospitals between 2008 and 2011.

The new study builds on prior research, following the same cohort of women over a longer time period during which more women developed T2D.

Baseline blood samples were collected between six and nine weeks after birth and then twice over two years. The women's health was followed through their electronic medical records for up to 8 years. During this time, 173 women developed T2D and their blood samples were compared to 485 women enrolled in the study, matched for weight, age, race and ethnicity, who had not developed the disease.

"This study is unique as we are not simply comparing healthy people to people with advanced disease," says Röst, who holds Canada Research Chair in Mass Spectrometry-based Personalized Medicine and led the statistical data analysis. "Instead, we are comparing women who are clinically the same--they all had GD but are back to being non-diabetic post-partum.
"This is the holy grail of personalized medicine to find molecular differences in seemingly healthy people and predict which ones will develop a disease," says Röst.

Röst said that, unsurprisingly, sugar molecules feature prominently among the identified compounds. But amino-acids and lipid molecules are also present, indicating underlying issues in protein and fat metabolism, respectively. In fact, the predictive power of the test dropped if amino-acids and lipids were excluded, suggesting that processes beyond sugar metabolism may occur very early in the development of the disease. The finding may help explain why complications occur in T2D patients even when blood sugar is tightly controlled with medications.

The researchers hope to turn their discovery into a simple blood test that women could take soon after delivery, perhaps during an early visit to the doctor with their baby.

The women from the SWIFT study are being invited back for a 10-year follow-up visit, where they will be tested for T2D. "The information we glean from this study will bring us even closer to our goal of developing this blood test," says Gunderson.

"It will also help us to identify metabolic differences among race and ethnic groups that this test will need to take into account. The test is intended to help obstetricians and primary care providers identify the women with recent gestational diabetes who are most at risk for developing type 2 diabetes and to support them with breastfeeding and other healthful lifestyle habits during the first year postpartum that may reduce their risk."

https://www.newswise.com/articles/blood-test-could-predict-diabetes-years-before-it-strikes

How cycling’s Team Novo Nordisk turned type 1 diabetes into its ‘greatest strength’

From kslnewsradio.com

   (CNN) — Phil Southerland wasn’t supposed to live past 25, but as a boy he happened upon a treatment that he says helped him to defy medical expectations.
“It’s my very strong opinion that exercise is the billion-dollar drug that never gets prescribed,” he tells CNN Sport. “I think the bike saved my life.”
Southerland was just seven months old when his parents learned he had type 1 diabetes and doctors said he would end up blind or with kidney failure if he survived into his 30s.

But after taking up cycling and embarking on what had previously seemed an unlikely professional career, Southerland discovered a reliable means of controlling his diabetes.
“When I was on the bike, I didn’t have to check blood sugar, I didn’t have to get insulin,” he says.
“All I had to do was eat so I didn’t bonk and that was what every other cyclist was doing. So I was absolutely normal and that felt really, really cool.”

Type 1 diabetes is a disease which causes the body’s immune system to destroy cells required to make insulin, a hormone that regulates blood glucose levels. Type 1 diabetics inject themselves with insulin so cells can take glucose from the blood for energy.

According to the International Diabetes Federation, more than 1.1 million children and adolescents worldwide are living with type 1.
Southerland says cycling made him “obsessed about glucose control.” He launched Team Type 1 alongside a friend in 2006, which eventually became Team Novo Nordisk in 2013 — an all-diabetic professional cycling team of 16 riders competing on the UCI World Tour.

“I started thinking — sport is such a powerful platform. I thought the bike could be a way to promote our story and inspire people to take control of their diabetes and go and pursue their dreams,” says Southerland, who today serves as CEO of Team Novo Nordisk.
“We took what 10 years ago would have been perceived as our greatest weakness and turned diabetes into our greatest strength, which is the unity it brings our team, the family bond it gives to all of our athletes.
“Diabetes is not an excuse for our athletes. We own the control. We have challenging days on the diabetes front, but these guys work really hard to be the best they can at their diabetes management.”
Having lost key riders, Southerland admits there have been “plateaus” in the team’s progress since climbing to 83rd in the world rankings in 2015.

Team Novo Nordisk had previously set a goal of competing at the Tour de France — the holy grail of road cycling — by 2021, which also marks 100 years since the discovery of insulin. But the timeline on that goal has been adjusted.
“For me, the Tour de France is still very much the dream,” says Southerland.
“I’m not putting a hard timeline on when we have to get there. It’s more the journey and the process for us to do it. One day, we will be there. And we’ll be there when the time is right.”

‘Best thing that ever happened’

The dream of competing at one of cycling’s three Grand Tours is shared by Team Novo Nordisk rider Sam Brand.
“I’d love to be on the start line of any of the Grand Tours with a team made up purely of type 1 diabetics,” the Isle of Man native tells CNN Sport.

“It would be unbelievable. That is the ultimate goal. I mean, to toe the start line of the Giro, Vuelta or the Tour would be unbelievable.”

Brand has a background in triathlon but switched to cycling full-time in 2016. He was diagnosed with type 1 aged 10, coincidentally on November 14 — World Diabetes Day.
“It was 18 and a half years ago now, and I kind of don’t remember anything before, really,” says Brand.
“I have memories of childhood, but not living without diabetes. For me, I always say this and some people just laugh, but it’s the best thing that ever happened to me.
“It’s given me a mission; it’s given me a route in life to take for the better. I always see it as a positive. It’s not always straightforward, but it’s manageable … developing my routine and my regime to fit what I want to do, not it controlling me.”

Building a team

Brand had previously been contacted by Team Novo Nordisk after posting a race photo on social media with #changingdiabetes.
The team often finds new riders through social media who then feed into a talent pipeline. While many cycling teams have the luxury of cherry-picking riders, Team Novo Nordisk has to develop its own.
“The challenging part for us is the recruitment process,” says General Manager Vassili Davidenko.
“Where I used to manage before, you have to have good budgets; once you have a budget, you start shopping around … In our case, it’s different. There are not many riders who have diabetes.”

Eight years ago, the team started talent ID camps where young cyclists are invited to a summer training camp in Atlanta. Some progress to the junior team, which in turn feeds into the development team and the professional team.
“We do have this great pipeline but it’s a long way before you bring a rider from point one to point two — point two being a professional cycling team,” says Davidenko.

“We need to find riders, we need to create them, and we need to guide them to the top level,” he went on.
“I knew [when I joined] I was going into something very, very challenging but my personality is that I like challenges … I knew there would be challenges to win races in the beginning. I knew we were going to miss this feeling of winning races.
“But most important to me was that it was something that was very good outside of the sport that [could] help people affected by diabetes to understand that right management can achieve goals.”

Dedicated support

While finding riders has been testing at times, finding fans has been rather more straightforward for Team Novo Nordisk.
“We are very popular on social media, we do have fans around the bus (at races) pretty much all the time,” says Davidenko.
“In Poland, this girl took a day off and travelled like 300 kilometers just to meet us at the start and to say, ‘I have type 1 diabetes, because of you guys I took control of my management. You really inspired me.'”

The coronavirus pandemic means there are currently no races for fans to cheer at, but Team Novo Nordisk has kept its riders occupied during the lockdown.
Some are relying on indoor training, while others have been able to cycle outdoors with the team delivering training sessions via online platforms.

As well as staying sharp on the bike, the riders are encouraged to take up other pursuits, including cooking and yoga.
“When you cycle a lot, you don’t have the mental energy to learn and to improve your knowledge, because you are just very tired — you eat, you go to sleep, you rest,” says Federico Fontana, head of performance at Team Novo Nordisk.
“Your brain is kind of lazy, but now (during lockdown) your brain is very active and it’s drooling to do something. So we are trying to find food in terms of knowledge, to let riders focus on a new aspect.”

Training 342 days a year

Fontana is an exercise physiologist who oversees data organization and analysis at Team Novo Nordisk, as well as leading a group of three coaches.
Monitoring training for a team of type 1 diabetics, he says, is much the same as with any cycling team.

However, adjustments are made if riders experience an episode of hypoglycaemia, for example — when the blood has low sugar levels.
“The guys are professional cyclists first, and then they also have diabetes. The way we manage their routine, it’s like for an athlete without diabetes,” says Fontana.

“I’m not saying it’s more difficult than working with an athlete without diabetes, but it has an extra layer of complexity — how your body is responding to exercise and how you are going to face exercise, having diabetes in a particular moment of your day.
“The training volume is pretty much aligned with other pro teams … Last year, they did as a group 342 days of training, on average, meaning they span a couple of weeks without training over a year.”

A wider calling

Each rider is equipped with a glucose control system that provides team scientists like Fontana with an abundance of data in relation to the impact diabetes has on training, racing, traveling, jet lag and sleep.
It’s hoped that the monitoring systems being developed will be beneficial to all type 1 diabetics.
“My job is working for Team Novo Nordisk, but my calling is the diabetes community,” says Fontana.
“We are showing that with good commitment and a basic level of education and dedication … people with diabetes can do pretty much everything in terms of exercise.”

It’s a sentiment that’s carried throughout Team Novo Nordisk.
“There’s no other team in the world that changes lives like our team changes lives,” says Southerland.

“Our staff could definitely go to other teams and make more prize money over the course of the year, but when you change someone’s life, the feeling is priceless.
“That keeps our family really strong. Diabetes is the biggest strength that our riders and our organization possess.”

https://kslnewsradio.com/1925523/how-cyclings-team-novo-nordisk-turned-type-1-diabetes-into-its-greatest-strength/

Study shows dairy products are linked to lower risks of diabetes and high blood

From news-medical.net

Researchers have found in a large study that having at least two servings of dairy products can lower the risk of getting diabetes and high blood pressure as well as metabolic syndrome. Metabolic syndrome is a mixture of more than one condition that raises the risk of getting cardiovascular diseases.

The study titled, “Association of dairy consumption with metabolic syndrome, hypertension, and diabetes in 147,812 individuals from 21 countries,” was published in the latest issue of the BMJ Open Diabetes Research & Care. The Primarily Population Health Research Institute funded this study.

What was the study about?

The researchers wrote that several studies look at the risk of metabolic syndrome, hypertension, and diabetes among those who consumed dairy products. These studies have been reported from North America and Europe mainly, and there has been little evidence from India, China, Africa, and South America.

Five conditions, including high blood pressure, characterize metabolic syndrome, obesity around the abdomen, raised triglycerides, low high-density lipoprotein (HDL) cholesterol, and blood sugar. Metabolic syndrome raised the risk of heart disease, diabetes, and related diseases and death. There have been studies that show that dairy products, including whole-fat foods and fermented dairy products, including yogurt and cheese, can have a beneficial effect on metabolism and can lower the risk of metabolic syndrome and high blood pressure. This was part of the Prospective Urban Rural Epidemiology (PURE) study to see the effects of dairy product intake and prevalence of metabolic syndrome, diabetes, and high blood pressure after an average of 9.1 years of follow up.

What was done?

This was part of the Prospective Urban Rural Epidemiology (PURE) study that included persons aged between 35 and 70 years residing in 21 different nations on five continents. The countries were, “Argentina, Bangladesh, Brazil, Canada, Chile, China, Colombia, India, Iran, Malaysia, occupied Palestine territory, Pakistan, Philippines, Poland, South Africa, Saudi Arabia, Sweden, Tanzania, Turkey, United Arab Emirates, and Zimbabwe.” The participants were followed up for a median time of 9.1 years. Association of intake of dairy products with the prevalence of metabolic syndrome and its components was seen. This was tested in 112,922 participants. For the follow-up, a total of 57,547 persons who did not have high blood pressure at the start of the study were checked if they developed high blood pressure. Similarly, 131,481 persons who did not have diabetes at the start of the study were followed up, and it was assessed if they developed diabetes.

Food specific questionnaires (food frequency questionnaires – FFQ) were given to the participants. Dairy products consumed within a day included “milk, yogurt, yogurt drink, cheese, and mixed dishes prepared with dairy.” Food was also classified based on constituents including those with “whole milk, whole fat yogurt, whole fat cheese, whole fat yogurt drinks, and mixed dishes prepared with whole-fat dairy products” as well as those with low-fat dairy products such as those with 1 to 2 percent milk, “skimmed milk, low-fat yogurt, low-fat cheese, and low-fat yogurt drink.”

                                          Image Credit: Alexander Prokopenko / Shutterstock

Other parameters such as age, sex, smoking status, education level, weight, height, waist and hip circumference, waist to hip ratio, and blood pressure. Blood samples were analyzed for blood sugar, “total cholesterol, low-density lipoprotein cholesterol (LDL-C), HDL cholesterol (HDLC), triglycerides, apolipoprotein A1, and apolipoprotein B.”
Baseline cut off were:

• 130/85 mm Hg blood pressure
• waist circumference above 80 cm
• HDL less than 1-1.3 mmol/l
• Triglycerides more than 1.7 mmol/dl
• Fasting blood glucose more than 5.5 mmol/l

From the questionnaires, average daily dairy consumption was found to be 179g, of which 124.5g was full fat, and 65 g was low fat.

What was found?

The key findings of this study were that higher consumption levels of whole fat (not low fat) dairy products were associated with a higher risk of development of metabolic syndrome and its five contributing factors. It also led to a lower risk of high blood pressure and diabetes. High consumption of dairy was defined as at least two servings per day compared to no intake of dairy. Those that took more of whole fat dairy along with low-fat dairy also had a lowered risk of metabolic syndrome. Those that consumed only low-fat dairy had an unaltered risk of metabolic syndrome development. Those taking at least two servings of dairy per day had an 11 to 12 percent reduced risk of high blood pressure and diabetes. The risk was lowered by 13 to 14 percent among those taking three servings.

Among the participants, 13,640 and 5,351, with no high blood pressure and diabetes, respectively at the start of the study, developed the conditions during follow up.

Conclusions and implications

The researchers concluded that “Higher intake of whole fat (but not low fat) dairy was associated with a lower prevalence of MetS and most of its component factors, and with a lower incidence of hypertension and diabetes.” They call for more extensive randomized controlled trials to see the effects of whole-fat dairy products and the risk of development of high blood pressure, diabetes, and metabolic syndrome. They signed off saying, “If our findings are confirmed in sufficiently large and long term trials, then increasing dairy consumption may represent a feasible and low-cost approach to reducing MetS, hypertension, diabetes, and ultimately cardiovascular disease events worldwide.”

https://www.news-medical.net/news/20200518/Study-shows-dairy-products-are-linked-to-lower-risks-of-diabetes-and-high-blood-pressure.aspx

Crank up your fibre intake to manage blood sugar and diabetes

From health.harvard.edu

Struggling with high blood sugar or diabetes? A study published online March 6, 2020, by PLOS Medicine suggests that increasing your daily fibre intake may help. British researchers combed through dozens of studies with about 10,000 participants who had prediabetes, gestational diabetes, type 1 diabetes, or type 2 diabetes. Compared with people who ate low-fibre diets (19 grams of fibre per day), people who ate another 16 grams of fibre per day (a total of 35 grams per day) weighed less and had lower levels of blood sugar, cholesterol, and inflammation. There were also 14 fewer deaths per 1,000 people among those who ate high-fibre diets.

If you'd like to increase your fibre intake, try to eat more fibre-rich foods at each meal. Good sources include whole-grain cereals, legumes, and nuts. For example, a cup of bran cereal has up to 47 grams of fibre, depending on the brand; half a cup of white beans has about 10 grams of fibre; and an ounce of almonds has about 13 grams of fibre. Increase fibre intake slowly, to give your digestive tract time to adjust, and remember to increase your water intake as well.

Disclaimer:As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

https://www.health.harvard.edu/staying-healthy/crank-up-your-fiber-intake-to-manage-blood-sugar-and-diabetes

Does diabetes increase your risk from COVID-19?

From covid.joinzoe.com

Is everyone with diabetes at high risk from COVID-19, or does it depend on your individual circumstances?‍

Research is starting to show that people with diabetes are more at risk from COVID-19. But SARS-CoV-2, the novel coronavirus that causes COVID-19, can affect people very differently. Some have no symptoms at all, while others can develop life-threatening complications.
We spoke to our expert, Dr Paul Franks from Lund University Diabetes Centre in Sweden, to find out more about how COVID-19 affects people with diabetes, and what people with diabetes can do to protect themselves during the pandemic.‍

What are the risks for people with diabetes from COVID-19?‍

‍Early reports suggest that people with diabetes are at increased risk from severe complications of COVID-19.

Studies from China also report that around 7% of patients with COVID-19 and diabetes died from the disease, compared with 2% of the general population, suggesting that people with diabetes suffer worse outcomes from COVID-19 than the general population. ‍

Are people with Type 1 and Type 2 diabetes affected differently by coronavirus?‍

There are two main types of diabetes: Type 1, which affects fewer than one in 10 people with diabetes, and Type 2, which accounts for 90% of cases. Both conditions lead to problems with controlling the levels of sugar in the body, but they have different underlying causes.

Reports from Stockholm over the last month suggest that Type 2 diabetes is more common in patients developing severe COVID-19. And data from New York also suggests that people who were hospitalized with COVID-19 were more likely to have Type 2 diabetes.

The correlation could also be due to other factors such as age, weight, high blood pressure and ethnicity, which affect the risk of developing Type 2 diabetes as well as the chances of becoming severely ill from COVID-19.
For example, people who are very overweight are much more likely to develop Type 2 diabetes than those who maintain a healthy weight. And those who are obese are more likely to suffer severe symptoms of COVID-19 and end up in hospital, particularly younger people under the age of 60.
More research is needed to understand how all these risk factors interact together. ‍

Are people with diabetes more likely to catch COVID-19?‍

Even in highly-contained environments infected with coronavirus, like the Diamond Cruise ship and infected Navy ships, some people on board never developed the disease. But right now we don't fully understand why some people catch the virus while others don't, or why some people can be infected but never show any symptoms at all (known as asymptomatic infection).
If you’d like more in-depth information, Paul and his colleagues have recently published an overview of what we know so far about COVID-19 and diabetes in the scientific journal Diabetes Care. ‍

How people with diabetes can protect themselves during the pandemic‍

The NHS, health authorities, and charities have developed guidelines for people with diabetes during the pandemic. Guidance may vary depending on your individual circumstances, so it is essential to discuss your situation with your care team. But in general, if you have diabetes you can protect yourself by:

• Maintaining good control of your blood glucose levels - studies suggest that properly-controlled blood sugar levels might improve the chances of surviving COVID-19 and avoiding invasive treatments like ventilation.
• Reducing the risk of catching coronavirus by following social distancing advice and staying at home as much as possible
• Maintaining good levels of hygiene and frequent hand washing
• Eating healthily and taking regular physical activity
• Getting influenza and pneumonia vaccinations when they are offered to you, to reduce the risk of catching a second infection on top of coronavirus
• Checking in with your healthcare team to discuss your treatment plan and the risks and benefits of any medications you are taking

What to do if you have diabetes and get COVID-19‍

Being sick can make it difficult to control your blood sugar levels, making your diabetes harder to manage and increasing your risk of developing complications.  As a result, if you catch coronavirus, it's crucial to talk to your diabetes care team for advice.

Follow the ‘sick day rules’ to help you manage your condition if you fall ill with COVID-19 - they are different depending on whether you have Type 1 or Type 2 diabetes.‍

How your data can help us understand diabetes and COVID-19‍

Information about COVID-19 is changing almost daily as we continue to learn about the virus and how it interacts with other conditions like diabetes. But we still need a lot more research into how the type, duration and treatment of diabetes affects COVID-19 outcomes. ‍
Our COVID Symptom Study app is collecting data about how COVID-19 is affecting people with diabetes in the UK, US, and Sweden. You can see the data we have collected so far on our website.
We’re researching how COVID-19 interacts with diabetes and other health conditions so that we can help to improve health advice and redirect resources to where they are needed most, to help save lives.‍

Diabetes and COVID-19 - what do we know so far?‍

• People with diabetes are more likely to suffer severe effects from COVID-19, particularly if they are very overweight and/or have high blood pressure
• COVID-19 is so new that we don’t have much information about how it affects people with different types of diabetes
• Some people with diabetes may be at higher risk than others, depending on the type of diabetes they have, the medication they take and many other factors
• Our COVID Symptom Study app is collecting information about how COVID-19 affects people with diabetes, helping us to learn more about how both diseases interact and identify who is at high risk.

https://covid.joinzoe.com/us-post/diabetes-covid-risk

People urged to improve diet and exercise to help reduce risks of type 2 diabetes during pandemic

From standard.co.uk

Questions have been raised over whether people with diabetes should shield during the coronavirus pandemic.
After the NHS found 26 per cent of patients who have died in hospitals in England after contracting coronavirus had diabetes, the Government was asked whether people with the condition should be added to the list.

Speaking on the matter at the daily Downing Street briefing on Saturday, England's deputy chief medical officer advised those with type 2 diabetes to think about their diet and exercise to help minimise the risks.

“We are reviewing all of these different risk factors together to try and give a much more proportional representation of who might be at risk," Dr Jenny Harries said.

“Type two diabetes, not type one, is one which many of us in the population can perhaps do something about to reduce our risk.
“Again, a great plug from a public health doctor perhaps, to think during this pandemic about diet and exercise and what you can do to help there.”

Dr Harries said that the previous data looked at individual diseases, rather than looking at other risk factors.

She said: “For example, we know that individuals who are obese will have high rates of type two diabetes, and we also know that they may have some other underlying health conditions.

“It’s really important that we put all these variables together to understand risk.”
Some groups of “clinically extremely vulnerable” people have been instructed to stay in their homes to protect themselves from the virus, initially for a period of 12 weeks.
Some people on the list include those who have had organ transplants, people with specific cancers and those with severe respiratory conditions.

Published on Thursday, figures from NHS England show that of the 22,332 patients who have died in England’s hospitals since March 31, when pre-existing conditions began to be recorded, some 5,873 (26 per cent) had diabetes.

It was the first time NHS England included a breakdown of deaths by pre-existing conditions in its statistics.

Charity Diabetes UK said the figures show an “urgent” need for more information to ensure the safety of those with diabetes as lockdown measures are eased.
While official advice recognises people with diabetes can be more vulnerable to becoming seriously ill with the virus, those with the disease were not included in a group told to “shield” themselves by staying at home.

Data published by NHS England does not specify whether those who died had type 1 and type 2 diabetes.

Professor Partha Kar, national speciality adviser for diabetes for NHS England, said: “It is clear that people with diabetes are more at risk of dying from Covid-19 and more detailed analysis is currently under way to understand the link between the two, although initial findings indicate that the threat in people under 40 continues to be very low.

“The NHS has put extra measures in place so that people living with diabetes can manage their condition better during the pandemic, including a range of online services, video consultations with your local clinical team and a dedicated helpline for those who need advice.”

https://www.standard.co.uk/news/health/diet-diabetes-warning-coronavirus-pandemic-a4442551.html

New English statistics on coronavirus and diabetes: What are they telling us?

From diabetes.org.uk

We know many of you will have seen the news yesterday reporting on the new statistic published that shows that 26% of those who have died from coronavirus in England had diabetes. We wanted to give you as much information as we currently have about this data, as well as update you on what we’re doing to support you

What the coronavirus statistics tell us

The statistic released on Thursday showed that one in four people (26%) who have died in hospital in England following a diagnosis of coronavirus also had diabetes. The data also showed that the other most common conditions relating to deaths from coronavirus are dementia (18%), serious breathing problems (15%) and chronic kidney disease (14%). One in 10 (10%) suffered from ischaemic heart disease.

We know that if you’re living with diabetes, or care for someone that does, you may be worried about what this statistic means for you – but we need to understand more about the detail that sits behind the numbers.

What the statistics don't tell us

This new data reports on the proportion of people who died from coronavirus who had diabetes, but it doesn’t say anything about what type of diabetes they had, how old they were, or what other health conditions they may have had.

This means that it raises more questions than it answers at the moment. We need to know much more about the potential risks of coronavirus infection for people with diabetes, and for this to be used so that advice from government can be tailored to meet your needs and keep you safe.

There have been some studies published suggesting a link between diabetes and increased risk of death from coronavirus, but it’s still very early days for scientific understanding and a lot of questions raised by the NHS England statistic still remain. It’s incredibly important that the government continues to review this latest research on coronavirus and diabetes and bases its policies on the best evidence. We’ll continue to review the evidence and data that is published to ensure we’re sharing the most up to date information with you.

What does the UK Government need to do?

The government needs to urgently review all of the emerging evidence and data about the risks to people with diabetes, to inform their policies around social distancing, employment guidance, and any measures around easing lockdown.

Most importantly, the government must ensure that their policies consider the specific needs and individual risks of people with diabetes, so that they are protected and supported, and provided with clear and consistent advice on keeping safe.  

In addition to calling on government to urgently review the emerging evidence, we want them to ensure the two following things.

People with diabetes must be kept safe at work

People with diabetes should not be put in a situation that puts them at risk at work. Employers must put measures in place to keep people with diabetes safe, either by supporting people to work at home, or where this is not possible by putting people with diabetes on furlough, or by putting measures in place to allow stringent social distancing for those key workers who absolutely must be at work.

The government must ensure this guidance for employers is clear, consistent, and enforced so it is focused on the safety of their employees above all else. We’ve heard loud and clear that safety at work is one of your biggest concerns. We need to make sure that the new government workplace guidelines work for people with diabetes.

People with diabetes must be able to access support to manage their diabetes and keep themselves safe

Having access to healthy food is important to people with diabetes and this has not always been easy when there has been such pressure on delivery slots. We are raising this matter urgently. It’s also important that people with diabetes have access to other forms of support, for example to help with collecting medication from pharmacies where needed and for transport to urgent hospital appointments, which can’t be conducted remotely.

Health and social care services are dealing with a challenging situation and must be supported to ensure people with diabetes can continue to access the services, information and care they need during this difficult time, including emotional and psychological support.

What about shielding?

We need to know much more about the potential risks for people with diabetes so that advice can be tailored, and this is particularly important in relation to shielding.

It’s incredibly important that advice around shielding is proportionate, and so equally important that the advice is balanced against the level of risk. The psychological implications of shielding – by asking everyone with diabetes to essentially cut themselves off for many months – could be very great.

Equally, the impact on diabetes management – either through the stress of being shielded, or by restricting someone’s ability to go outside – could also be significant. It’s important to remember that everyone with diabetes is different, so without robust evidence to support it, a blanket call for everyone with diabetes to be shielded wouldn’t be appropriate.

That’s why it is so important that we have the most detailed picture of what the emerging evidence is telling us, and that government bases their advice on what the science tells us.

https://www.diabetes.org.uk/about_us/news/coronavirus-statistics?utm_source=bronto&utm_medium=email&utm_term=Read+more&utm_content=Read+more&utm_campaign=Enewsletter+May+2020+pt+1

Essential Do’s & Don’ts to Consider While Planning a Diabetic Diet

From dlife.com

Living with diabetes doesn’t have to mean giving up on certain foods altogether and feeling deprived. People can learn about a  healthy balance and make smart choices while selecting the food that they put into their body! Choosing a healthy alternative will allow you to satisfy your cravings for your favourite food.

The Centres for Disease Control and Prevention (CDC) estimates that over 1.5 million Americans are diagnosed with diabetes every year. According to The American Association of Diabetes Educators (AADE) weight loss and exercise have shown enormous potential for preventing, treating, and in some cases even reversing type 2 diabetes! Diet plays a significant role in weight loss and keeping the blood sugar levels in check, but maintaining a diabetes-friendly diet is more complex than just cutting carbs. It gets easy to follow a diabetes-friendly diet once you get in the habit of meal planning and making smart choices for your health and body! 

A large, long-term study at The Diabetes Prevention Program (DPP), asked the question: we know an unhealthy diet and lifestyle can cause type 2 diabetes, but can adopting a healthy diet and lifestyle prevent it? And the answer it got was: Yes! A vast number of pre-diabetes and type 2 diabetes cases can be prevented through diet and lifestyle change. 

A healthy diet, especially one that keeps the weight off, can also help reduce the need for medications in people with type 2 diabetes. The National Institutes of Health (NIH) recommends the following calorie guidelines for people with diabetes: 

• About 1,200 to 1,600 calories a day for women with small build
• About 1,600 to 2,000 calories a day for large women and small men
• About 2,000 to 2,400 calories a day for men with large or medium build

A good diabetic diet should consist of carbohydrates, protein, fat, vitamins and minerals to stay fit and to keep the blood sugar levels in check. Erin Palinski-Wade, RD, CDE, author of 2 Day Diabetes Diet and Belly Fat Diet For Dummies says, ‘Aim for a well-balanced diet limited in simple sugars and rich in whole plant-based foods, such as vegetables and fruit, along with lean proteins, whole grains, and healthy, plant-based fats’. It gets easier to manage your diet if you stick to a set of “Do’s” and “Don’ts” that are not hard to remember and easy to follow!

Starch
Although people with diabetes tend to avoid starch as it gets converted into glucose, which raises blood sugar levels, a daily dose of carbs is essential to meet energy requirements of an individual.

• Do Include: Whole-wheat bread and pasta, brown rice, and oats. Whole-grain starch gives you vitamins, minerals, and fibre than its white or refined versions. They’re also less likely to spike up your blood sugar.
• Avoid Consuming: White bread, chips, and pastries, deep fried foods which may quickly increase your blood sugar.
• Pro tip: Homemade oatmeal for breakfast is a simple source of whole grain, which can be a healthier choice.

Fruits
A great source of carbohydrates, fibre, minerals, and vitamins, fruits are a great source of energy for a human body. Fibre-rich foods can also help you feel full for a longer period of time, aiding weight loss, help prevent obesity, and maybe even help in warding off conditions such as heart disease and colon cancer.

• Do Include: Small servings of peaches, apples, oranges, berries, kiwi, and other fruits. Fruits are low-calorie, high-fibre, nutrient-rich source of carbohydrates.
• Avoid Consuming: Jellies and fruit juices with added sugar.
• Pro tip: Layer berries with low-fat, unsweetened yogurt to whip up a tasty delight!

Vegetables
Vegetables are a great source of nutrients as they provide fibre and contain very little fat or salt. Opt for steamed vegetables instead of deep-fried ones to avoid the extra calories.

• Do Include: Spinach, tomatoes, cucumbers, broccoli, brussels sprouts, cauliflower, and asparagus which are packed with nutrients and are relatively low in carbohydrates. 
• Avoid Consuming: Fried and breaded vegetables – they add extra calories, carbs, and fat.
• Pro Tip: Try roasting vegetables with a sprinkle of olive oil, pepper, a pinch of salt, and a little lemon juice to add flavour with minimal calories.

Protein
When it comes to protein, there is a wide variety of plant and animal sources that you can choose from! It is said that one-quarter of your plate should contain a source of lean protein.

• Do eat: Skinless poultry, fish, tofu, beans, and lean cuts of red meat.
• Avoid Consuming: Fatty cuts of meat and processed meat, like sausages and hot dogs.
• Pro tip: Trim visible fat from meat and poultry and incorporate a low-fat cooking method, such as roasting or broiling.

Dairy
Milk and milk products has always been a debatable subject for people with diabetes, as they are loaded with extra calories and saturated fats that raise low-density lipoproteins (LDL) or bad cholesterol levels, but you can include healthy amounts of dairy products that are non-fat or low-fat (1 percent) to avoid saturated fat. 

• Do Include: Unflavoured and low-fat yogurt, milk, and cheese. Low-fat dairy provides protein, calcium, vitamins, and minerals in every serving.
• Avoid Consuming: Full-fat dairy products. They come with extra calories and saturated fat, which raises LDL or “bad” cholesterol. Remember diabetes increases your risk of heart disease.
• Pro Tip: Low-fat or plain yogurt can be a healthy substitute for sour cream in many recipes.

Fats & Oils
Cutting out fats and oils is important when you have diabetes. But this doesn’t mean you avoid them altogether!

• Do Consume: Opt for natural vegetable fats and oils such as sesame seed oil, olive oil, and mustard oil. Tuna fish and mackerel are great sources of omega-3 fatty acids which contribute to a healthy heart!
• Don’t Include: Abstain from consuming saturated and partially hydrogenated fats that come from animal products and plant oils.
• Pro Tip: The key is to choose healthy fats from unhealthy fats every time and enjoy them in moderation, as all fats are high in calories!

Diabetes is a serious medical condition and controlling sugar levels with a proper diet and an average amount of workout or exercise is an important part of managing it. But in the end you can just cut through the noise by considering a few suggestions and making a few changes when you actually sit down to eat. Making incremental changes in your existing diet will ultimately lead you to your desired goal! Also, always follow your physician or dietician’s dietary recommendations and consult with them if you are unsure about what may be good or bad for your health and body!

https://dlife.com/diabetes-blog/essential-dos-donts-to-consider-while-planning-a-diabetic-diet/

New study suggests blueberries can help with type 2 diabetes

From supermarketperimeter.com

FOLSOM, CALIF. - A new study conducted at the Stratton Veterans Affairs Medical Centre in Albany, N.Y., found that one cup of fresh blueberries resulted in significant improvements in Haemoglobin A1c (HbA1c) and fructosamine—measurable indicators of type 2 diabetes.  

The two indicators measure glycaemic control in those living with diabetes with HbA1c levels providing insight on long-term glycaemic control and fructosamine giving information on average blood glucose levels over two-to-three-week periods. 

                                                            Source: Adobe Stock

Over an eight-week period the study examined 52 overweight male participants between the ages of 51 and 75 who had been diagnosed with type 2 diabetes for at least six months. Through the course of the study all participants prescribed non-insulin diabetes medications and did no heavy exercise.  

Participants were either assigned 22 g of freeze-dried blueberries (the equivalent of one U.S. cup/d fresh blueberries) along with their regular diet; or 22 g of a placebo powder (matched in energy and carbohydrate content to the freeze-dried blueberries) along with their regular diet. 

The results showed decreased levels of serum triglycerides after blueberry consumption compared to the placebo. Left untreated or uncontrolled, elevated blood triglyceride levels increase the risk of serious complications such as cardiovascular disease – the leading cause of morbidity and mortality for individuals with diabetes. 

“To date few human clinical trials have evaluated the potential beneficial health effects of blueberries in populations with type 2 diabetes,” said Kim Stote, who has a research appointment at the Albany Stratton VA Medical Centre and is the study’s lead investigator. “While the results cannot be generalized to all populations, they point to the evidence that a dietary intervention with a realistic serving of blueberries may be an effective strategy to improve metabolic factors associated with type 2 diabetes.” 

The research was funded by the US Highbush Blueberry Council. The council had no role in study design, data collection, data analysis, data interpretation or writing of the study. 

https://www.supermarketperimeter.com/articles/5104-new-study-suggests-blueberries-can-help-with-type-2-diabetes

Diabetes management: How researchers are looking at new approaches from insulin patches to an artificial pancreas

From zdnet.com

New software and hardware types are just some of the changes that engineers hope could help insulin-using diabetics to manage their condition

For some diabetics, keeping blood sugar at the right level means several injections a day, every day. Injecting insulin is no fun, but for type 1 diabetics, it's the difference between life and death. Could technology be poised to offer a way to take some of the pain and stress out of managing diabetes?

People with type 1 diabetes don't make a hormone called insulin, which lets glucose into the blood to enter cells and gives the body energy. Instead of using the insulin made by their pancreas, type 1 diabetics get their insulin by regularly injecting it themselves. Apart from the pain of the needle, injections can cause the skin to get irritated, and over time it can shrink or thicken up. Get the dose wrong, and a type 1 diabetic can end up seeing their blood sugar plunge to the extent that they need to be hospitalised. 

Could an end to the constant injections be in sight? Researchers have been exploring whether swapping one big needle for lots of tiny ones could help. 

"For people who are using insulin... the treatment is done as a subcutaneous injection. It's a daily injection that can be quite painful, and also not convenient," says Zhen Gu, professor in UCLA's department of bioengineering.

Gu and his team are working on a wearable patch that can pass insulin through the skin. The patch is made up of a suite of insulin-carrying microneedles. The microneedles, just 800 micrometres long, are composed of a polymer matrix of an enzyme called phenylboronic acid (PBA). They sit just under the top layer of the skin, and react to changes in blood sugar. When the patch's wearer starts to get high blood sugar, a reaction takes place that alters the electric charge of the PBA molecules, causing the microneedles to swell and release insulin into the skin. Once the glucose has dropped back to normal levels, the needles stop releasing the insulin.

The patch would be around the size of a quarter (around two-and-a-half centimetres), and would either be replaced every day, or two or three times a day, in line with how often the wearer would typically take their insulin injection. The system is painless, according to Gu, "and it can enhance people's quality of life".

Other research efforts are also looking into the potential of microneedles for insulin delivery. MIT and pharma company Novo Nordisk have developed a pill for insulin. Normally, insulin can't be taken as a tablet because it would be broken down by the highly acidic stomach environment before it can be taken up into the blood. In the MIT system, once the pill reaches the small intestine, the outer casing breaks down and dissolvable microneedles anchor it to the gut wall to deliver the insulin.

Patches and pills still rely on the user to take their insulin at the right time, and make sure they have the right amount of insulin to hand when it's time to take it. Medical device companies are hoping to overcome the problem by taking the user out of the equation altogether with 'artificial pancreas' systems.

The artificial pancreas, also known as 'closed loop' insulin delivery systems, are worn on the body continuously. A tiny plastic tube that sits under the skin samples the glucose level in the interstitial fluid, the liquid that surrounds the body cells. The glucose monitor relays the user's blood sugar level to the pump, and it changes the amount of insulin it dispenses to keep the wearer's blood sugar in the right range.

Most systems available at present are known as 'hybrid' closed loop systems. Such systems deliver the 'basal' or background level of insulin. However, the user has to feed additional information on their meals and manual blood-glucose readings into the system in order to get 'bolus' doses – the quick shots of rapid-acting insulin taken around meals. Insulin pump hardware companies are working on full closed loop systems that can automatically deliver both basal and bolus doses without the need for human intervention. 

According to James Hayward, IDTechEx's principal technology analyst, the question about how big the difference is between hybrid closed loop and full closed loop is still out there. The full closed loop system including bolus doses would be the ultimate ideal he says, because then it's a full artificial pancreas approach: "But in practice, you're still pretty close with the hybrid closed loop. I don't think it's even so much a specific hardware or technology change [from one to the other]. It's just a case of getting the algorithms efficient enough and the sensor responsive enough."

While the full-on artificial pancreas may be a few years away from commercial distribution, the market for hybrid devices is still likely to increase.

"Do I see the insulin pump market growing? Yes, I do, absolutely," says Siddharth Shah, program manager in Frost and Sullivan's transformational health practice. But Shah points to the costs, which can climb to as much as $7,000: "For one person, that's almost an impossible cost to bear on their own completely."

It's a problem the makers appear to have recognised and have struck up new ways of billing to address the high cost. Rather than just striking deals for a given number of units, deals between hardware vendors and insurers – such as the agreement between UnitedHealthcare and Medtronic – focused instead on the health outcomes. According to the two companies, patients using the closed loop systems had 27% fewer hospital admissions that those without.

There are signs in the wider healthcare world that the closed loop systems are better at keeping blood sugar under control than manual alternatives: one study in the New England Journal of Medicine found that type 1 diabetics with closed loop systems spent a lot more time in the normal blood sugar range than those getting their insulin solely through injections.

Another factor that may help boost take-up is an increasing move towards interoperability. Companies such as Tidepool are offering software to manage closed loop systems that include glucose monitors and insulin pumps from different manufacturers, so users of closed loop systems can now pick the exact mix of sensor, pump, and controller software that suits them best. As well as handling glucose delivery, such apps can also allow users to feed in data on their lifestyle, food, and other events to learn about managing their blood sugar better. "The entire industry ideally needs to move towards the data-driven approach," says Shah.

https://www.zdnet.com/article/diabetes-management-how-researchers-are-looking-at-new-approaches-from-insulin-patches-to-an-artificial-pancreas/