What to know about diabetes in India

From medicalnewstoday.com

Diabetes in India is a growing health concern, with over half the population at risk of developing the condition at some point in their lives

According to one 2021 review, people who live in cities and metropolitan areas in India are more likely to develop diabetes than ever before. This is due, in part, to cities promoting a lifestyle that can increase a person’s body mass index (BMI). Having a higher BMI is a diabetes risk factor.

Rural areas in India are also experiencing a surge in type 2 diabetes cases, but more studies are necessary to fully understand how and why this is happening.

Keep reading to learn more about diabetes in India, including prevalence, some reasons it is so common, and more.

How prevalent is diabetes in India?

Dhiraj Singh/Bloomberg via Getty Images

In India, more than 77 million adults are living with diabetes. Researchers predict that this will increase to 134 million by 2045.

Overall, females have a higher risk of developing diabetes than males, but as both groups get older, this risk decreases.

Although diabetes figures are high, researchers estimate that 57% of cases remain undiagnosed. This is particularly concerning, as the risk of serious complications increases when people do not take medication to control their blood sugar.

Why is diabetes common in India?

There are several theories that attempt to explain why diabetes cases are rapidly increasing in India. The sections below look at some of these in more detail.

Physiological differences

People of South Asian ancestry tend to have a higher fat to muscle ratio than people of European ancestry. When people have less muscle than fat, insulin stays in the body for longer.

Because typical Western diets and fast foods are growing in popularity, especially in urban environments, so is fat and sugar consumption.

When the body cannot efficiently clear glucose, this increases metabolic load and insulin resistance and puts a person at risk of developing diabetes.

Perception of diabetes

People tend to view diabetes as a “new” condition in rural areas, and general awareness of the condition is low.

In a small qualitative study from 2017, people said that health check-ups were too short and that this put them off asking questions about their health and diabetes.

Because people typically view doctors as the best sources of diabetes information, and because they may not have access to other resources, these short consultations have a significant effect on the number of complications that people experience.

Changes in farming practices

Government shops, or fair price shops, are a type of public distribution system that offers rural communities low cost food to improve people’s nutritional health. These foods include white rice, wheat, sugar, and pulses.

However, some research suggests that fair price shops are unintentionally encouraging farmers to grow more commercially viable crops that are denser in calories and contain fewer nutrients.

In place of traditional foods, people are now consuming more polished white rice and refined sugar, the consumption of which causes spikes in blood glucose levels.

Sweet cuisines

The consumption of sugary sweets is a staple of Indian culture and an integral part of ancient traditions and religious festivals.

According to one study from 2014, due to increasing urbanization, people are adopting more sedentary lifestyles as well as consuming more calorie dense sugary foods and drinks.

In cities, sugary drinks and sweetened foods are cheap and readily available, which is increasing people’s risk of developing obesity and type 2 diabetes.

Social stress

Many people report that stress or tension was the cause of their diabetes.

A qualitative study from 2012 found that people in middle-to-high-earning economic groups reported that social stress, such as saving for a dowry, contributed to their diabetes. However, those with lower incomes tended not to share this belief.

As Indian doctors talk more about social stress as a risk factor for diabetes than those in the United States, these beliefs likely originate from information that people receive at healthcare consultations.

Because lower income groups typically have less access to healthcare, this could explain why they do not think that social stress causes diabetes.

Increased availability of processed foods

Like big cities, rural villages are now selling cheaper processed foods. Due to recent changes in imports and economic policies, the variety and availability of processed foods have expanded, and people’s preferences are shifting toward fatty sugary snacks and meals. This trend is particularly noticeable in younger people and children.

Diabetes symptoms

Symptoms of diabetes include:

• regularly urinating at night
• feeling thirsty all the time
• losing weight without trying
• feeling hungry all the time
• feeling tired all the time
• having sores that take a while to heal
• experiencing more infections than usual

Diabetes treatments

Treatment varies depending on the type of diabetes a person has. The following sections look at some treatment options for both type 1 and type 2 diabetes.

Type 1 diabetes

When a person has type 1 diabetes, their pancreas stops producing insulin. To treat this condition, a doctor prescribes an artificial form of insulin that a person takes several times per day and with meals.

People take insulin using a needle and syringe, or an insulin pen. If someone needs a steady supply of insulin throughout the day, they may prefer using an insulin pump.

Insulin does not come in tablet form because stomach acid destroys it.

Type 2 diabetes

Many people with type 2 diabetes need to take medication and insulin to control their symptoms. Some treatments come in tablet form, and a person may take a combination of different medications to keep their blood sugar levels stable.

Summary

Diabetes is an escalating health problem in India. One recent review suggests that the lifetime risk of males developing diabetes from the age of 20 years is 55.5.%. In females, the figure is 64.6%. However, lifetime risk does decrease as people get older.

Diabetes cases are increasing because the country is undergoing a period of urbanization, meaning that more people are moving to bigger cities for employment. Urbanized areas and cities promote lifestyle habits that are more sedentary, which is a risk factor for both obesity and diabetes.

The bodies of people of South Asian ancestry respond differently to sugary and fatty foods than the bodies of people of European ancestry, and because processed Western foods are growing in popularity in India, so is the risk of diabetes.

https://www.medicalnewstoday.com/articles/diabetes-in-india

What Is Type 4 Diabetes?

From healthline.com

You’ve probably heard of type 1 and type 2 diabetes. According to the Centres for Disease Control and Prevention (CDC), more than 34 million Americans have diabetes — but the actual number might be much higher. A 2015 study with mice indicates that diabetes might be underdiagnosed in older adults who don’t have overweight or obesity. While not an official classification of diabetes, researchers are calling this type 4 diabetes.

Type 4 diabetes isn’t an autoimmune condition like type 1 diabetes, and it’s not linked to weight like type 2 diabetes. Instead, this potential type of diabetes may be linked to the aging process. Research into this condition is ongoing, but scientists have already uncovered some connections.

Types of diabetes

Diabetes is often thought of as having two distinct types, though gestational diabetes is also quite common. All types of diabetes cause high blood sugar because your body has trouble producing insulin, a hormone that moves and stores sugar.

Most common types

• Type 1 diabetes. Type 1 diabetes is most commonly diagnosed in children and teenagers. It’s an autoimmune condition. When you have type 1 diabetes, your immune system attacks the cells in your pancreas responsible for making insulin.
• Type 2 diabetes. Type 2 diabetes happens when your body stops responding to the insulin your pancreas makes. Over time, your pancreas also stops producing enough insulin. It’s generally linked to a combination of genetic and lifestyle factors.
• Gestational diabetes. This type of diabetes is a response to the hormonal changes that happen during pregnancy. The hormones made in the placenta can lower your body’s sensitivity to insulin. This may result in high blood sugar during pregnancy.

Type 1, type 2, and gestational diabetes are very common, but they’re not the only types of diabetes. There are several other types of diabetes, and a few that are not officially classified as types.

Specific diabetes due to other causes

• Mature onset diabetes of the young (MODY). This type of diabetes occurs due to a genetic change, and runs in families. Children with the genetic change will often develop this form of diabetes by the time they are 25.
• Neonatal diabetes. Neonatal diabetes is generally diagnosed in children under 6 months old. It’s an inherited condition that’s different from type 1 diabetes because it’s not an autoimmune condition. Instead, children with this condition are born with a genetic change that affects their ability to produce insulin.
• Diabetes caused by other conditions. This type of diabetes is caused by conditions including cystic fibrosis, pancreatic cancer, or pancreatitis that damage the pancreas’ ability to produce insulin.
• Steroid-induced diabetes. This type of diabetes can happen when you take steroids that affect hormone production in your body.

Other terms you may hear

While these aren’t official types of diabetes, you may sometimes hear these terms when talking about diabetes. They include:

• Monogenic diabetes. This includes both MODY and neonatal diabetes, and refers to any type of diabetes that’s caused by genetic changes.
• Type 3c diabetes. This is sometimes used to refer to diabetes caused by other conditions, such as cystic fibrosis and pancreatic cancer.
• Latent autoimmune diabetes in adults (LADA). This is sometimes referred to as type 1.5 diabetes. Some experts think of it as a subtype of type 1 diabetes. While it is an autoimmune disease like type 1, LADA progresses more slowly. It’s often misdiagnosed as type 2 diabetes because you may still be able to produce insulin for some time.

Recent discussion of new types

Recently, some researchers have suggested that two additional types of diabetes might exist. These aren’t yet official diabetes types or diagnoses, but that might change as more information becomes available.

• Type 3 diabetes. Type 3 diabetes is used to explain the theory that insulin resistance might cause Alzheimer’s disease, a form of dementia. A 2018 research review showed that people with type 2 diabetes are more likely to develop Alzheimer’s disease. Experts are still investigating this link.
• Type 4 diabetes. Type 4 diabetes is the proposed term for diabetes caused by insulin resistance in older people who don’t have overweight or obesity. A 2015 study with mice suggested this type of diabetes might be widely underdiagnosed. This is because it occurs in people who aren’t overweight or obese, but are older in age.

Causes

Scientists are just beginning to study type 4 diabetes, so they don’t yet have a lot of concrete information about what causes it.

A 2015 study with mice showed that the condition referred to as type 4 diabetes is linked to an excess of immune cells called regulatory T cells. Researchers have a theory that this is linked to the aging process, but studies in humans are still needed.

Symptoms

Type 4 diabetes has many of the same symptoms as other types of diabetes. However, because it generally appears in people with a moderate weight, doctors may not suspect diabetes. Common symptoms include:

• fatigue
• increased thirst
• increased hunger
• blurry vision
• sores that don’t heal
• frequent urination
• unintentional weight loss

Many of these symptoms are also linked to other conditions and might not always indicate diabetes.

It’s a good idea to make an appointment with a medical professional if you’ve been experiencing any of these symptoms. A doctor can review your symptoms and order any tests they think are needed.

Treatment

Type 4 diabetes isn’t officially a diagnosis yet. Many things about this condition, including treatment, are still being studied. However, according to Salk Center FAQ, researchers are hopeful that they will be able to develop an antibody medication. This could help reduce the number of regulatory T cells in the body and treat type 4 diabetes.

Until this medication is developed, your doctor will probably treat type 4 diabetes with the same medications prescribed to people with type 2 diabetes.

Many of the lifestyle recommendations for people with type 2 diabetes aren’t effective for people with type 4 diabetes. For example, weight loss is a common recommendation for people with type 2 diabetes. This isn’t effective for people with type 4 diabetes. They generally already have moderate weight and increased weight loss doesn’t reduce the number of regulatory T cells.

Prevention

Right now, studies in mice show that type 4 diabetes appears to be linked to the aging process. More studies in humans need to be done to support this theory. Until we know the results of these studies, we won’t know if there is any way to prevent the condition.

Where to find help

Getting medical care is important no matter what kind of diabetes you have. Talking with a medical professional about your symptoms is often the first step toward diagnosis. If you have a primary care physician, they may be a great place to start, but they might not be your last step. Other great ways to get help include:

• Contacting an endocrinologist. Endocrinologists are doctors who specialize in hormonal conditions such as diabetes. If you have insurance, your insurance provider might also be able to direct you to a local specialist.
• Finding a local diabetes education program. Diabetes education programs can help you learn to manage your condition. Educational specialists can help you make a plan and give you the tools you need to live well with diabetes. 
• Talking with a dietitian. A dietitian can develop eating plans for you that will help keep your blood sugar under control. They’ll show you how to make food choices that will help you feel better. You can search for local professionals in this guide.
• Visiting the American Diabetes Association (ADA) website. The ADA has a wealth of resources for people with diabetes, including educational information for people who have just been diagnosed.

The bottom line

Insulin resistance is a hallmark of type 2 diabetes, and is often connected with having obesity. However, Type 4 diabetes shows that this isn’t always the case.

Studies in mice have shown that the aging process can cause the body to produce too many regulatory T cells. These cells can lead to type 4 diabetes.

These results still need to be studied in humans. Finding evidence of this same pattern in humans could lead to increased diagnosis and the development of new treatments for diabetes.

https://www.healthline.com/health/diabetes/type-4-diabetes

Can You Follow a Plant-Based Diet if You Have Diabetes? Here's What You Need to Know

From eatingwell.com

Research shows cutting down on animal products can be beneficial to health. But it’s important to do it the right way if you have diabetes

Following a healthy diet that is sustainable for your lifestyle is crucial for the management of diabetes. It's important to focus on quality sources of protein, carbohydrates and fats as well as ample nutrients and fibre to keep you fuelled and functioning at your best. A plant-based diet—an eating pattern that emphasizes legumes, whole grains, vegetables, fruits, nuts, and seeds, while limiting most or all animal products—has been associated with a slew of health benefits, both in terms of physical health and environmental health. Not to mention, swapping out meat is a great way to save money. So is a plant-based diet worth trying if you have diabetes? Here's what you need to know and how to get started.

Plant-Based Diet for Diabetes 

In short, yes, a plant-based diet can be beneficial if you have diabetes. Research has shown that it can actually help people better manage their diabetes (think better blood sugar balance) and prevent dangerous complications from developing, like heart disease. Additionally, a study in Nutrition & Diabetes saw participants significantly improve BMI and cholesterol levels for people with chronic diseases like diabetes over a six month follow up (they extended the study over a full year and still saw benefits). 

That said, it's still important to incorporate the principles of healthy eating for diabetes as you shift to a more plant-based diet. As in, you can't forget about balancing your carb intake throughout the day! A little know-how goes a long way to set you up for success. Here are some tips for going plant-based, if you have diabetes.

Tips for Going Plant-Based for Diabetes

Vary your protein sources 

You might feel hesitant about getting enough protein if you cut out meat and animal products. But not to worry—most Americans get plenty of protein to meet their needs, plant-based or not (check out this guide to calculate how much protein you need in a day). The key to maximizing your intake is to diversify your sources of plant-based protein. It's more than just tofu. Foods like seitan, whole grains, legumes, nuts and leafy greens are great vegan sources of protein to help you meet your goals. Recipes like Quinoa Avocado Salad and Sweet Potato-Black Bean Burgers make it delicious. 

As with anything, you don't have to be completely plant-based to enjoy the benefits. If you are interested in testing the waters, try swapping out a few meat-based meals a week to start. Swap beef for these Beefless Vegan Tacos or skip chicken and try our Mushroom & Tofu Stir-Fry.  

Choose complex carbs 

Regardless of your animal protein intake, having a consistent intake of complex carbs is one of the most important factors for helping manage diabetes. Not only do they deliver ample vitamins and nutrients, but also they are packed with protein and fibre to help you feel full and satisfied. Fibre does much more than fill you up, too. It's important for slowing down your digestion, which in turn slows down the rate at which glucose enters your blood stream. As a result, your blood sugars will remain more consistent, unlike the energy-draining spikes and crashes you experience after eating too many simple carbs or sugar-sweetened foods and drinks.  

Luckily, complex carbs are plant-based. Choose whole grains like brown rice, oats, whole-wheat bread or whole-wheat pasta to round out your meals. Snack on popcorn or whole-wheat crackers. Other foods like fruits, vegetables and legumes are healthy sources of complex carbs that are the cornerstone of a healthy plant-based diet.

Limit highly processed snacks

Don't be fooled: vegan highly processed snacks are still highly processed snacks. Try to stick to whole foods whenever you can, like celery or fruit with nut butter, pita with hummus or roasted chickpeas, which are all great for curbing hunger and keeping you feeling energized until your next meal. Nuts and seeds are a great grab-and-go snack in a pinch, and they are shelf stable so storing them is a breeze. Try to pair a complex carb with a source of protein and fibre for a well rounded snack.

If you want to prep ahead, we have plenty of plant-based snack recipes like our Savoury Date & Pistachio Bites, Garlic Hummus, Everything Bagel Microwave Popcorn and Strawberry-Pineapple Smoothie. Make a batch in advance to get ready for the week ahead. 

That being said, there are plenty of healthy packaged snack options out there, and the convenience just can't be beat when you're in a pinch. When shopping, be sure to look at nutrition labels and go for snacks that have the least amount of added sugar, sodium and saturated fat per serving.

Prioritize certain nutrients 

It's totally possible to meet your nutrient needs on a plant-based diet, but if you are fully plant-based it can take a little strategizing. There are a few nutrients that can be scarce in a fully plant-based diet, so here are some things to make room for on your plate. 

Vitamin B12 is often found in animal foods, like eggs, meat and fish. It's less common in plant-based foods, but there are still plenty of ways to meet your needs. Some fortified breads, cereals and soy products have vitamin B12 added to them. Plant-based milks, like almond, rice, hemp and coconut milks, can have added vitamin B12 as well, but be sure to check the label. Nutritional yeast is another great plant-based source of vitamin B12. It is delicious sprinkled on popcorn. 

Iron is another nutrient of concern for people following a fully plant-based diet. Being sure to include plenty of leafy greens, whole grains and legumes to help you meat your needs. Vitamin C is a nutrient that helps with the absorption of iron, so pair iron-rich foods with high-vitamin C foods like citrus, tomatoes, bell peppers and berries. 

For other nutrients like vitamin D, calcium, omega-3s and zinc, check out this guide on how those following a plant-based diet can meet their needs. 

Bottom Line 

You absolutely can try out a more plant-based eating pattern or go fully plant-based if you have diabetes. In fact, it might even help you manage your diabetes if it is a way of eating that you enjoy. It's important to be strategic and a little know-how can go a long way. These tips will help you pursue your plant-based goals while meeting your nutritional needs. For more recipe inspiration, check out this Vegan Diabetes Diet Plan. 

https://www.eatingwell.com/article/7911723/can-you-follow-a-plant-based-diet-if-you-have-diabetes/

No more finger pricks: Continuous glucose monitoring shows better results for diabetes patients

From studyfinds.org

ANN ARBOR, Mich. — Diabetes patients know all too well about the unpleasantness of constant finger pricks. It’s a painful reminder that they’ll be watching their blood sugar levels for their entire lives. Now, however, a new study finds there’s a better way of monitoring diabetes without needing a drop of blood. Researchers at the University of Michigan say continuous glucose monitoring helps patients do a better job of controlling the condition long-term.

In a study of 175 diabetes patients, the team discovered that using a continuous glucose monitor — instead of finger pricking — helped to significantly decrease haemoglobin A1C levels. Over eight months, the group lowered this measure of blood sugar by 1.1 percent. Participants using the standard blood glucose meter only lowered their blood sugar by 0.16 percent.

Until now, scientists have mainly examined the benefits of continuous glucose monitors in patients with type 1 diabetes or type 2 diabetes patients who take multiple insulin injections each day. This study is among the first to look at type 2 diabetes patients who use basal insulin, the long-lasting insulin taken once or twice a day.

“Not only does this trial demonstrate the benefits of continuous glucose monitoring for these patients, a technology that hasn’t been covered by many insurers for those with type 2 diabetes, but these benefits were seen across a broad spectrum of socio-economic status and racial backgrounds,” says study author Rodica Busui, M.D., Ph.D., vice chair of clinical research at Michigan Health’s Department of Internal Medicine, in a university release.

(© Andrey Popov - stock.adobe.com)

A better life for diabetes patients

Study authors started enrolling volunteers in the randomized clinic trial in 2018. Each participant took either one or two daily injections of basal insulin. Some also took non-insulin medications to help control their blood sugar levels as well.

Along with testing how well continuous glucose monitoring works, Busui’s team also studied the impact it has on how diabetes patients manage their condition and its effect on their life satisfaction. With a continuous monitor in place, the group was better able to manage their blood sugar levels throughout a full day. As a result, life satisfaction scores went up as well.

“For me, what’s most exciting is that this work demonstrates that using continuous glucose monitoring is effective in substantially improving blood sugars levels and decreasing the risks of hypoglycaemia in those that were randomized to use a continuous glucose monitor compared with the usual finger-prick,” Busui concludes.

“This may open the door for broader coverage of this game-changing technology for all patients with diabetes. More patients can manage their diabetes if they have access to this resource and their primary care physicians are educated on the benefits of their patients utilizing it.”

The team adds that their findings will come as a big relief to Medicare patients. The insurance program recently announced it is dropping the requirement of needing finger pricks four times a day to qualify for a continuous glucose monitor.

The findings appear in the journal JAMA.

https://www.studyfinds.org/finger-pricks-glucose-monitoring/

In the diabetic’s toolbox: diet, exercise and blood sugar control

From mininggazette.com

By Keith Roach, M.D.

DEAR DR. ROACH: I’m a recently diagnosed diabetic. Can you please give me advice on how to reverse it if possible? – H.M.

ANSWER: I’m assuming you have been newly diagnosed with Type 2 diabetes, which is caused by resistance to insulin. Type 1 diabetes, usually diagnosed in childhood or adolescence, is an autoimmune disease caused by destruction of the insulin-producing cells in the pancreas. It requires insulin.

Type 2 diabetes is a “stable” diagnosis: Once the diagnosis is made, you always have diabetes, even if your blood sugars become perfectly normal and you are off medicine, which is what I think you are asking about when you want to “reverse” diabetes. (This situation is called “Type 2 diabetes controlled with lifestyle.”) Most people can dramatically improve their control of Type 2 diabetes, even if they don’t get all the way to the point where blood sugars are perfectly normal without medicine.

Diet is the first pillar of Type 2 diabetes treatment. Reducing simple sugars and starches, which become simple sugars rapidly in your body, is the first step. Protein, healthy fat and carbohydrates from vegetables and (not too much) fruit is the mainstay of dietary treatment, but you really should get the personalized advice of a registered dietitian nutritionist.

Exercise is the second pillar. Exercise helps your body metabolize sugar more effectively. Any kind of regular exercise helps, but moderately intense aerobic exercise is probably most important from the standpoint of sugar metabolism.

Food intake and exercise output together help to address the third pillar, which is weight control. A significant majority of people with Type 2 diabetes are overweight, but by no means all. If your weight is higher than it should be, then weight loss is critical to diabetes control.

Finally, medications are helpful. There are many new options, some of which (such as metformin, liraglutide, and semaglutide) help to promote weight loss. Many people with diabetes need medications when diagnosed but may still be able to get off medicines if they start a healthy lifestyle addressing all three pillars.

Not all medications are helpful. Some medicines (certain blood pressure and psychiatric medicines, especially) are not ideal for people with diabetes, as they promote weight gain and insulin resistance. An expert in diabetes should review all medicines, and people may need to consider changing medicines.

https://www.mininggazette.com/news/features/2021/07/in-the-diabetics-toolbox-diet-exercise-and-blood-sugar-control/

Managing type 1 diabetes: Voices of the underserved

From scopeblog.stanford.edu

It's one thing to be aware that patients with type 1 diabetes in vulnerable communities often face hurdles to care. It's another to hear these patients' frustrations, in their own words. 

That's what David Maahs, MD, PhD, a Stanford Medicine professor of paediatrics, and his colleagues found when they moderated a series of 16 focus groups -- eight each in rural northern California and Florida -- to illuminate barriers to diabetes care and technology use among underserved communities in the United States. 

Eighty-six adult participants agreed to be interviewed in hour-long Zoom sessions. Many were recruited through Federally Qualified Health Centres; others were patients recently hospitalized for diabetic ketoacidosis, and some had high blood sugar -- levels of haemoglobin A1c, a glucose marker, above 9% -- but had skipped two or more endocrinologist visits in a row.

Maahs and his colleagues from the University of Florida have been piloting a project called ECHO Diabetes, based on the Extension for Community Health Outcomes model developed at the University of New Mexico for hepatitis C.

The goal of the project, Maahs said, is "to raise, through tele-education, the level of care primary doctors can provide in their own communities." As part of this effort, the Stanford and Florida teams wanted to hear directly from underserved type 1 diabetes patients, which is why they conducted focus groups, recording and transcribing the interviews.

Often, when asked about challenges they encountered in trying to manage their disease, participants made revealing comments. One, for example, was repeatedly denied a continuous glucose monitoring device, and reported being "in a diabetic coma three times this year because they won't give me what I need to maintain" healthy blood sugar levels.

Photo by Diabetesmagazijn.nl 

Another was prescribed insulin shots, but not informed about how to move to advanced care, such as an insulin pump. Instead, the patient said, her clinician "complained the whole time, telling me, 'You're going to die, your kids are going to not have a mama.'" 

To Maahs, who is division chief of paediatric endocrinology, these kinds of responses were upsetting, but not surprising. "It's always so powerful to hear patients' voices on how such barriers have affected their lives," he said. "Many had never been asked about their experiences before, and, well, they sure told us."

Maahs' research was published in July in Diabetes Care. Ashby Walker, PhD, from the University of Florida Diabetes Institute, is the first author.

Improving bedside manner, educating more providers

Of the barriers that patients identified, unsympathetic endocrinologists topped the list. One participant said, "I prep myself to go in for what feels like an attack when I am looking for help and support." Another heard, "You're using way too many blood glucose strips." But later, when the same patient asked for a continuous glucose monitor, the doctor asked, "Well, are you too lazy to test your blood sugars?"

The researchers also found that, at the time they were interviewed, more than 50% of participants hadn't seen an endocrinologist in a year, never mind following through on the recommended four check-ups annually.

"It's unfortunate, and a reminder to physicians that how they speak with patients is really important," Maahs remarked. "We're doing a lot of research on ways to reduce implicit biases at the provider level."

Meanwhile, he and his colleagues have expanded the project, launching a clinical trial focused on training primary care physicians who may lack expertise in general diabetes management. Often, they are the main or only health care providers in underserved areas, Maahs said. The team is testing whether weekly tele-education sessions "leads to improvements in both provider job satisfaction and patient health," he said.

Diabetes management is two-tiered, he said. "Some patients, based on insurance status and where they live, receive cutting-edge care; others who lack insurance or live in rural areas receive outdated or minimal care."

"With our program, we aim to equip more providers with the relevant knowledge so patients in disadvantaged communities receive better care than what they currently have," he said.

https://scopeblog.stanford.edu/2021/07/26/managing-type-1-diabetes-voices-of-the-underserved/

People who eat a healthy diet including whole fruits may be less likely to develop diabetes

From sciencedaily.com

Research links fruit but not fruit juice to lower type 2 diabetes risk

A new study finds people who consume two servings of fruit per day have 36 percent lower odds of developing type 2 diabetes than those who consume less than half a serving. The research was published in the Endocrine Society's Journal of Clinical Endocrinology & Metabolism.

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Diabetes is a disease where people have too much sugar in their bloodstream, and it is a huge public health burden. Approximately 463 million adults worldwide were living with diabetes in 2019, and by 2045 this number is expected to rise to 700 million. An estimated 374 million people are at increased risk of developing type 2 diabetes, the most common form of the disease. A healthy diet and lifestyle can play a major role in lowering a person's diabetes risk.

"We found people who consumed around 2 servings of fruit per day had a 36 percent lower risk of developing type 2 diabetes over the next five years than those who consumed less than half a serving of fruit per day," said study author Nicola Bondonno, Ph.D., of Edith Cowan University's Institute for Nutrition Research in Perth, Australia. "We did not see the same patterns for fruit juice. These findings indicate that a healthy diet and lifestyle which includes the consumption of whole fruits is a great strategy to lower your diabetes risk."

The researchers studied data from 7,675 participants from the Baker Heart and Diabetes Institute's Australian Diabetes, Obesity and Lifestyle Study who provided information on their fruit and fruit juice intake through a food frequency questionnaire. They found participants who ate more whole fruits had 36 percent lower odds of having diabetes at five years. The researchers found an association between fruit intake and markers of insulin sensitivity, meaning that people who consumed more fruit had to produce less insulin to lower their blood glucose levels.

"This is important because high levels of circulating insulin (hyperinsulinemia) can damage blood vessels and are related not only to diabetes, but also to high blood pressure, obesity and heart disease," Bondonno said.

https://www.sciencedaily.com/releases/2021/06/210602091404.htm

COVID-19 may bring a new wave of diabetes: Tips to manage your blood sugar this monsoon

From timesnownews.com

A recent study suggests that a wave of diabetes among people may be triggered by COVID-19. Here is what you need to know about it

New Delhi: Diabetes is a widespread issue that affects millions of people across the world. According to a recent study published in the journal Nature Metabolism titled “Acute and long-term disruption of glycometabolic control after SARS-CoV-2 infection”, a wave of diabetes among people may be triggered by COVID-19. The study was conducted on 551 patients and cases of hyperglycaemia were witnessed. Hyperglycaemia is a condition that is marked by unhealthy high levels of blood glucose in the body. The World Health Organization published a video in the series “Science in 5” that talked about ways to tackle diabetes during the COVID-19 pandemic.

Here is what the author said

Paolo Fiorina, MD, PhD from the Division of Nephrology at Boston Children's Hospital and the lead author of the study said, “These people were not diabetic before. But during admission, about 46 per cent of the patients were found to have new hyperglycemia.”

“This study is one of the first to show that COVID-19 has a direct effect on the pancreas. It indicates that the pancreas is another target of the virus affecting not only the acute phase during hospitalization but potentially also the long-term health of these patients,”, she added.

Calling for the need to develop better anti-inflammatory and antidiabetic treatments, Fiorina said, “If you keep targeting and blocking insulin, but you have a strong and chronic inflammation, it may lead to chronic damage. When you consider how many patients have been hospitalized with COVID-19, and continue to be worldwide, we may see a huge increase in the diabetic population."

Monsoon diabetes management tips

Here are some ways in which you can manage diabetes this rainy season:

1. Keep a track of our blood glucose levels to avoid unprecedented spikes. Eat immunity building foods to build a healthier and stronger body to fight infections and diseases.
2. Make sure that you wash the fruits and vegetables that you purchase thoroughly before consuming them. Do not forget to cook them well before eating them and avoid consuming them raw.
3. Maintain proper home and personal hygiene. Surrounding may end up getting damp during the monsoon season which can be a breeding ground for several harmful bacteria and viruses. To avoid this from happening, make sure that you keep your surroundings dry.
4. Heavy rain may often cause hindrance to travel, therefore, Keep sufficient stock of your diabetes essentials such as medications, insulin kit, and sugar monitoring devices so you don't end up in a difficult situation in case of an emergency. 
5. Always remember to stay hydrated. This will not only help manage diabetes but can also aid the regulation of essential bodily functions.

Disclaimer: Tips and suggestions mentioned in the article are for general information purpose only and should not be construed as professional medical advice. Always consult your doctor or a dietician before starting any fitness programme or making any changes to your diet.

https://www.timesnownews.com/health/article/covid-19-may-bring-a-new-wave-of-diabetes-study-tips-to-manage-your-blood-sugar-this-monsoon/790124

Are you diabetic? Learn about the scientists who discovered insulin

From bradenton.com

This month of July, we celebrate one of the most important medical discoveries in world history: the discovery of insulin for the treatment of diabetes. For decades, the primary treatment for diabetes had been a no-carbohydrate, low-calorie diet (as low as 500 calories a day) But this strict regime caused repercussions of low energy and fatigue, making it even more difficult for the body to fight the disease.

On July 27, 1921, two Toronto researchers completed an experiment that would revolutionize diabetes treatment.

A Canadian surgeon and a medical student worked in research together at the University of Toronto. Dr. Frederick Banting and Charles Best were able to isolate the hormone insulin for the very first time. A year prior, in 1920, Banting read an article that he had checked out from the medical library titled, “The Relation of the Islets of Langerhans to Diabetes, with Special Reference to Cases of Pancreatic Lithiasis.

The article’s findings gave him the idea to experiment with pancreatic secretions and diabetes. Using diabetic dogs to test their theories, Banting and Best injected the dogs with a substance from the Islets of Langerhans (hormone-producing pancreatic cells), which effectively lowered their blood sugar levels. While they achieved success with the first experiment, problems arose in subsequent trials concerning irregular levels of purity in the mixture. University physiologist John Macleod brought in chemist James Bertram Collip to join the team and help with purification. Macleod had been conducting his own studies into glucose metabolism and diabetes prior to meeting Banting and was sceptical of his methods. However, he gave Banting a chance to test out his theories.

Within six weeks, the team felt confident in testing their treatment trials on humans. On Jan. 23, 1922, 14-year-old Leonard Thompson, who was dying of diabetes at Toronto General Hospital, was given the isolated insulin shot as the first human test subject. The initial injection did not achieve the results the team had hoped for, but after chemist James Collip developed a more effective concentration, the boy’s dangerously high blood glucose levels significantly lowered. Success! This breakthrough transformed diabetes treatment for the years to come.

In 1923, Macleod and Banting received the Nobel Prize for Physiology or Medicine. They shared their prize winnings with Collip and Best. By the end of that year, insulin was mass-produced at laboratories across the world. The discovery of insulin for diabetes treatment gave people of all ages a new lease on life. This Toronto team of researchers paved the way for future developments and treatments of other diseases in medicine.

https://www.bradenton.com/news/local/health-care/article252948448.html

Read more here: https://www.bradenton.com/news/local/health-care/article252948448.html#storylink=cpy

Self-care tips for diabetics during Covid-19 pandemic

From freepressjournal.in

Are you a diabetic? Wondering how to stay safe and sound during the pandemic? Here are some vital tips to manage it

People with diabetes will have to stay in top shape during mid the pandemic. Owing to a weakened immune system, people suffering from diabetes can are prone to develop infections and may get sick because of Covid-19, and take a longer time to recover. Reportedly, preliminary data from China has revealed that the ones with diabetes and other pre-existing conditions like heart problems may encounter fatal health complications or even loss of life if they get infected with Covid-19. Various studies have also confirmed that the patients can get diabetes even after getting infected with Covid-19 and even once they recover.

A study published in the European Journal Of Clinical Nutrition suggests that the ones with diabetes contract Covid-19 are at risk of a severe disease course and mortality. Several factors like the impaired immune response heightened inflammatory response and even hypercoagulable state are responsible for increased disease severity. Not only this, pre-existing comorbidities tied to diabetes such as hypertension, coronary artery disease, and chronic kidney disease further worsen the prognosis. Even hypoglycaemia may occur during the treatment of diabetes and negatively impact the clinical outcomes.

Those with diabetes must follow these essential tips to stay fit:

Stick to a well-balanced diet: Try to eat mindfully and see to it that you include protein, good fats, and vitamins in the diet. If you have diabetes, then stay away from food that is high in carbohydrates, calories, and sugar. This means you have to practice healthy eating inclusive of fresh fruits, vegetables, pulses and legumes. Say NO to junk, spicy, oily, processed, junk and foods with additives.

Daily exercise: Opt for walking at home, aerobics, yoga, planks, push-ups, and pull-ups. Speak to your doctor about the exercises that you can do at home. Do not forget to stretch throughout the day. If you are working from home then work out sitting at your desk.

Proper meal planning: You can plan your meals with the help of a dietician. Try to make a list of food items that you have to eat and delete from your diet. You must buy food or snacks only after reading the nutrition label. Avoid foods that are high in salt and calories. Include a bowl of salad or soup to help you deal with insulin resistance.

Do not skip medication: If you have pre-existing diabetes or insulin resistance and stock up your medication. Do not self-medicate as it can be risky for you. Avoid being around sick people and strictly following the Covid protocol. You will have to make sure that you use a mask, maintain social distance and sanitise your hands from time to time. You will have to monitor your diabetes and stay in touch with your doctor if you notice any fluctuations in the blood sugar levels or changes in the body.

Follow a proper sleep routine: Those with diabetes will be able to manage their blood sugar levels by getting sound sleep at night. Resting can lower the cortisol (a stress hormone). Cortisol is indirectly responsible for high blood sugar levels. A minimum of 8 hours of sleep is essential for people to stay active and energized.

Stay stress-free: You can do so by doing meditation and yoga. Take out some quality time for yourself, do not sit lonely, and try to mix around with other family members. Those with diabetes fall into the high-risk category and can get sick with Coronavirus. Hence, you will have to be vigilant and take charge of your health.

https://www.freepressjournal.in/health/self-care-tips-for-diabetics-during-covid-19-pandemic

Diabetes early symptoms: The 13 warning signs you shouldn't ignore

From express.co.uk

DIABETES is a disease that, despite available mitigating treatments, remains debilitating for the planet's tens of millions of sufferers. People should familiarise themselves with early signs to get the best and most effective treatment

Diabetes sufferers now have a range of potential treatments available to them, including medicine and dietary changes. While they can help with some of the symptoms, these often don't distract from the harsh reality of the life-changing disease. Those who get in early enough can help prevent the condition or catch symptoms before they cause other health issues.

What are diabetes warning signs?

Whether type 1 or 2, diabetes can develop at any age, but they are different conditions.

Type 2 is the most common and affected roughly 90 percent of sufferers, while type 1 affects eight percent.

In type 1 diabetes, the body attacks cells in the pancreas, preventing it from making insulin, while type 2 results from a bodily inability to make the substance.

Type 1 diabetes warning signs

Type 1 diabetes warning signs will develop quicker than those of its sister condition.

Health officials state they can appear "relatively suddenly" prompted by several intersecting conditions and factors.

These include genetics, exposure to viruses and environmental impact.

Early symptoms include:

• Blurred vision
• Increased thirst
• Excessive urination
• Unexplained weight loss
• Mood changes or irritability
• Excessive hunger
• Bedwetting in children who haven't before
• Weakness
• Fatigue

Diabetes early symptoms: Excessive thirst also broaches both diabetes types (Image: GETTY)

Type 2 diabetes warning signs

Type 2 diabetes is often more gradual and can take months or years to fully manifest.

As such, symptoms aren't as sudden as type 1 and may initially indicate other conditions.

Consistently high blood sugar causes a range of conditions, so it is crucial to identify early diabetes signs.

Some type 2 diabetes early warning signs match those from type one, such as frequent urination, increased thirst, excessive hunger, tiredness and blurry vision.

Symptoms traditionally associated with type 2 alone include:

• Slow healing of cuts or wounds
• Tingling, pain or numbness in hands and feet
• Dark patches of skin
• Itching and yeast infections

What happens if diabetes advances?

Without identification and treatment, high blood sugar levels could also cause:

• Sexual performance issues
• Stroke
• Nerve damage
• Neuropathy
• Eye disease and loss of vision
• Foot problems
• Kidney disease
• Heart disease

https://www.express.co.uk/life-style/health/1463965/Diabetes-early-symptoms-warning-signs-type-1-type-2-evg

How Diabetics Should Treat Cuts and Scrapes

From hackensackmeridianhealth.org

If you have diabetes, even a minor cut or scrape can turn into a serious problem. Here’s how to treat a wound properly to protect your health.

For most people, a nick or a scrape is no big deal. But for someone with diabetes, even a minor cut or scrape can turn into a very serious problem if not treated properly.

“Diabetes impacts white blood cell function, which obstructs the body’s ability to fight bacteria and close wounds,” says Asaad H. Samra, M.D., director of the Centre for Wound Healing at Bayshore Medical Centre. In addition, people with uncontrolled diabetes may develop poor circulation, making it difficult for the body to deliver nutrients to injured areas, which hinders the healing process.

That’s why it’s crucial for people with diabetes to correctly treat any wound, no matter how minor it seems. Here’s some advice from Dr. Samra:

Wash the wound thoroughly. Use an antibacterial soap and warm water to clean out the wound. Then pat dry with a clean cloth and apply over-the-counter antibacterial ointment.

Cover the wound. Use a bandage to keep the wound clean, moist and protected. “It’s now considered old, inaccurate information to let a wound dry out,” says Dr Samra.

Redress it daily. Take off the bandage and make sure nothing has significantly changed since the last time you saw the wound. Use soap and water to wash away the old ointment, then pat dry and apply a fresh coat. If, after a few days, you feel the wound is healing well, you can stretch the redressing to every other day.

Inspect it every time you change the bandage. If you don’t see improvement over the course of a week, or if any redness or foul smell develops, call your doctor. Also contact your doctor if the wound fails to heal within four to six weeks.

Check your feet daily. Diabetes can lead to neuropathy, which limits sensation in the extremities. “So someone with diabetes could have an injury on their foot and not even know it,” says Dr. Samra. This, plus poor blood flow, puts you at risk for developing an infection from a foot sore. Be on the lookout for any cuts, sores, blisters, swelling or any changes to the skin or nails. Don’t forget to check the bottom of your feet (use a mirror). And never go barefoot, even inside your house.

https://www.hackensackmeridianhealth.org/HealthU/2021/07/16/how-diabetics-should-treat-cuts-and-scrapes/

Type 1.5 Diabetes Is a Controversial Diagnosis—Here's What to Know

From health.com

Diabetes as we know it is typically organised into two neat categories: type 1 and type 2. In reality, diabetes is much more complicated

Diabetes as we know it is typically organized into two neat categories: type 1 and type 2. In type 1 diabetes, antibodies from your own immune system destroy the cells which produce insulin. The disease starts suddenly and is usually diagnosed in children. Type 2 diabetes most often develops in adults as a result of insulin resistance (your cells don't use the insulin well), not insulin production.

In reality, diabetes is much more complicated, and it can manifest in at least one other form, often referred to as type 1.5. This type of diabetes, explains Ping H. Wang, MD, chair of the department of diabetes, endocrinology, and metabolism at City of Hope in Duarte, California, has features of both type 1 and type 2.

What is type 1.5 diabetes?

Like Type 1 diabetes, type 1.5 has an autoimmune component, which means antibodies from your immune system mistakenly destroy the pancreatic beta cells which produce insulin. Insulin is the hormone needed to get blood sugar out of the bloodstream and into the cells. Without it, glucose accumulates in the blood, leading to potentially life-threatening complications.

Unlike type 1, though, type 1.5 does not have to be treated with insulin right away, and is generally diagnosed in younger adults, not kids. This makes it more like type 2, as does the fact that it progresses much more gradually than type 1, says John B. Buse, MD, PhD, chief of endocrinology at the University of North Carolina School of Medicine in Chapel Hill.

While type 1 diabetes is primarily a problem of insulin production and type 2 one of insulin resistance, type 1.5 seems to include both of those issues. "It's a term used to describe patients who have some level of decreased insulin production due to decreased functioning of the beta cells of the pancreas," explains Deena Adimoolam, MD, a specialist in endocrinology and preventative medicine in New Jersey. "Patients with Type 1.5 diabetes are able to produce some insulin, but not enough insulin, and over time they may not produce any insulin at all."

To be clear, type 1.5 is not a medical term and some experts object to its use. The term can describe Maturity Onset Diabetes of the Young (MODY), a genetic condition which occupies another grey area between type 1 and type 2. But it's perhaps most commonly associated with latent autoimmune diabetes in adults (LADA) and is often used synonymously with that condition.

Causes of type 1.5 diabetes

No one knows exactly why antibodies which normally guard against foreign invaders decide instead to destroy the body's own insulin-producing cells. Genetics plays a role in all forms of diabetes. The first genome-wide association study of type 1.5 diabetes found that the genetic signature overlapped both type 1 and type 2 diabetes but had more in common with type 1 than with type 2.

Even when genes are involved, an environmental trigger usually sets the process in motion, regardless of what the disease is. "You have to have the right genetic predisposition, but something has to set your immune system off on a course to destroy the cells that make insulin," explains Dr. Buse. "It's unclear what those are."

Researchers have discovered links with weight gain, viral infections and stress but nothing is certain. It's also possible that type 2 diabetes morphs into type 1.5. "Some patients with type 2 diabetes who are not well-controlled for. Years may develop 'beta cell burnout' over time where their pancreas produces less insulin," says Deena Adimoolam, MD, a specialist in endocrinology and preventative medicine in New Jersey.

Symptoms of type 1.5 diabetes

There are usually no symptoms in the beginning of type 1.5. That's because the beta cells are destroyed so gradually, life seems to continue as normal. Adults diagnosed with autoimmune diabetes usually develop symptoms when they're down to about 10% of the normal number of beta cells, says Dr. Buse.

Once symptoms do appear, they are similar to those for other forms of diabetes. "They're all related to high levels of blood glucose—blurred vision, increased urination, increased thirst, increased yeast infections (mainly in women), weight loss, feeling hungry and feeling tired," says Dr. Adimoolam.

The first symptom of type 1.5 and type 1 can be diabetic ketoacidosis (DKA), when stratospherically high blood sugar levels lead to dangerously high levels of acid in your bloodstream.

Long-term complications of diabetes are also similar for all forms of diabetes and include heart disease. People with type 1.5 or adult autoimmune diabetes are more likely to develop microvascular complications (problems in the small blood vessels) such as neuropathy. Diabetes complications in general, says Dr. Buse, "generally develop over decades."

Type 1.5 diabetes diagnoses

Part of diagnosing so-called type 1.5 or any other form of diabetes is to check for abnormally high blood sugar levels. But this test alone won't tell you what type of diabetes you have. To help pinpoint type 1.5, doctors will also test for the presence of glutamic acid decarboxylase antibodies (GAD). These are the most common antibodies to destroy insulin-producing pancreatic cells in people with type 1.5

"Antibody tests are positive in about 70% of cases but there are antibody negative patients," says Dr. Buse.

When investigating LADA, doctors also look for traits of "atypical diabetes," says Dr. Buse. "If everything aligns—if someone has a strong family history of type 2 and they're overweight, they have high blood pressure and high triglycerides and a lot of features of metabolic syndrome—they likely have type 2." Being diagnosed in younger adulthood suggests type 1.5, as does weight loss, being under the age of 30 or so and having a family history of autoimmune disease.

Another tip-off is that people with LADA typically don't respond as well to oral diabetes medications, but they do respond well to insulin, says Dr. Buse.

The differences can be subtle and, as a result, LADA or type 1.5 is often mistaken for type 2 diabetes. As many as 3%-12% of all diabetes in adults may be LADA, according to one estimate. This means that many folks with so-called type 1.5 are funnelled into the wrong kind of treatment.

Treatment and prevention options for type 1.5 diabetes

Like everything else about type 1.5, treatment has settled on a halfway mark between type 1 and type 2 diabetes. People with type 1.5 will eventually need insulin but usually not right away. This may seem strange given that diagnosis usually takes place when patients have only had one-tenth the number of original beta cells. But, says Dr. Buse, "the pace at which those remaining cells die is much slower [than type 1] so you can get away with diet modification at the beginning." A carbohydrate-restricted diet often works well, as it does in type 2, he adds. 

Oral medications can also help in those early days, but most will need insulin eventually, says Dr. Adimoolam.

While there's no known way to prevent type 1 diabetes, you may be able to stave off 1.5 with lifestyle factors like maintaining a normal weight, sticking to healthy foods and exercising.

https://www.health.com/condition/endocrine-conditions/type-1-5-diabetes

Scientists develop pain-free blood sugar test for diabetics

From aljazeera.com/news

Australian researchers hope low-cost saliva test will replace current needle-based test for diabetes sufferers

Australian scientists say they have developed pain-free blood sugar testing for diabetics, a non-invasive strip that checks glucose levels via saliva.

For diabetics, managing their blood sugar levels typically means pricking their fingers multiple times a day with a lancet and then placing a drop of blood on a testing strip. Understandably, some diabetes sufferers avoid the painful process by minimising their tests.

However, this latest test works by embedding an enzyme that detects glucose into a transistor that can then transmit the presence of glucose, according to Paul Dastoor, professor of physics at the University of Newcastle in Australia, who led the team that created it.

He said the tests create the prospect of pain-free, low-cost glucose testing which should lead to much better outcomes for diabetes sufferers.

“Your saliva has glucose in it and that glucose concentration follows your blood glucose. But it is a concentration about 100 times lower which means that we had to develop a test that is low cost, easy to manufacture, but that has sensitivity about 100 times higher than standard glucose blood test,” Dastoor told Al Jazeera.

Professor of Physics Paul Dastoor holds up a non-invasive, printable saliva test strip for diabetics at the University of Newcastle, New South Wales, Australia [Courtesy of University of Newcastle via Reuters]

Since the electronic materials in the transistor are inks, the test can be made through low-cost printing.

“The materials that we work with are remarkable, they are electronic inks that can act as electronic material, but the difference is that we can print them at massive scale using a reel-to-reel printer, the same that you use to make newspapers,” Dastoor said.

The project secured A$6.3 million ($4.7m) in funding from the Australian government to establish a facility to produce the test kits should clinical trials be passed.

Dastoor says the technology could also be transferred to COVID-19 testing and allergen, hormone and cancer testing.

The university is already working with Harvard University on a test for COVID-19 using the same technology.

https://www.aljazeera.com/news/2021/7/13/scientists-develop-pain-free-blood-sugar-test-for-diabetics

Is diabetes disrupting your sleep? Why it's important

From unionleader.com

  

When NFL offensive lineman Ryan Jensen was waking up more than 13 times a night, he developed mood swings, fatigue and lost weight — jeopardizing his career. Once he was diagnosed and treated for sleep apnoea, he was back on track. But he’s not alone; it’s estimated that 33% to 50% of elite athletes are poor sleepers. That’s about the same number of folks with Type 2 diabetes who have sleep problems and that threaten to derail their life too.

Diabetes is associated with sleep issues because out-of-whack blood sugar levels can cause frequent urination (when they’re too high), anxiety, even nightmares (when they’re too low). Then poor sleep, especially less-restorative slow-wave sleep, interferes with insulin regulation and blood sugar levels — and it goes round and round.

A study in the Journal of Sleep Research lays out the consequences: Participants who had diabetes and also experienced frequent sleep disturbances were 87% more likely to die of any cause (car accident, heart attack, etc.) during the nine-year study follow-up than people who didn’t have diabetes and slept well, and were 12% more likely to die than those who had diabetes but no sleep issues.

If you have diabetes and sleep issues: Get your glucose levels under control 24/7. Consider using a continuous glucose monitor to keep track and ask your doctor for a referral to a diabetes educator. Talk to your doctor about the new diabetes-control medications that are available. And then ... get evaluated for sleep disturbances. You can turn this around!

https://www.unionleader.com/news/health/is-diabetes-disrupting-your-sleep-why-its-important/article_33ebf784-c1e1-5265-9e22-b8d196a429d9.html

Australia: New agreement to help people manage life with diabetes

From health.gov.au

To mark National Diabetes Week, the Australian Government is announcing a new three-year $140 million agreement with Diabetes Australia to continue delivering the National Diabetes Services Scheme (NDSS)

Diabetes directly affects approximately 5 per cent of Australia’s population. Sadly, 80 per cent of people report feeling shame or blame because they have the disease.

This year’s National Diabetes Week – from 11 to 17 July – seeks to address this, by changing the conversation and reducing diabetes-related stigma.

Diabetes Australia is spearheading the campaign, which asks people “Would you mind?” if you were made to feel ashamed because of a health condition.

The NDSS helps people understand and self-manage their life with diabetes. It also gives them access to services, support, and subsidised diabetes products like blood glucose testing strips, insulin syringes, insulin pump consumables, and continuous glucose monitoring (CGM) products.

The NDSS currently supports nearly 1.4 million Australians with diabetes. It delivered more than 5.7 million diabetes products in 2019–20, at a cost of more than $188 million.

In addition to the NDSS, the Government subsidises essential medicines, like insulin, under the Pharmaceutical Benefits Scheme (PBS). In 2019–20, PBS expenditure on medicines for diabetes was over $632 million.

Since 2017, the scheme has also provided fully subsidised CGM products to eligible people. The Government has expanded the eligibility criteria to allow more people to benefit, and now provides fully subsidised CGM products to:

• children and young people, under 21 years of age, with type 1 diabetes
• children and young people with conditions very similar to type 1 diabetes, such as cystic fibrosis-related diabetes and neonatal diabetes, who require insulin
• women with type 1 diabetes who are planning for pregnancy, pregnant or immediately post-pregnancy
• people with type 1 diabetes aged 21 years or older who have concessional status.

These changes mean more than 58,000 Australians with type 1 diabetes are eligible to access CGM products, with funding of more than $300 million over four years.

The new agreement with Diabetes Australia also secures the future of successful programs which are making a real difference for people with diabetes, including:

• KeepSight, a program to help prevent diabetes-related blindness by making it easier for people with diabetes to get their eyes checked
• Diabetes in Schools, which provides nationally consistent information and training for parents and families, principals, school staff and health professionals, so students with type 1 diabetes can be supported to manage their condition at school, and
• FootForward, a new program to help people with diabetes understand the importance of getting their feet checked, to avoid foot problems that can lead to amputation.

The Government’s commitment to supporting Australians with diabetes extends well beyond the NDSS.

We recognise the importance of clinical research and how it provides an important opportunity to identify better ways to prevent, treat and manage diabetes.

Since 2010, the National Health and Medical Research Council has provided $626 million for diabetes research. Since its inception, the Medical Research Future Fund has invested $78 million in diabetes research. This includes $25 million to JDRF Australia (formerly known as the Juvenile Diabetes Research Foundation) for the Australian Type 1 Diabetes Clinical Research Network.

Work is also under way on an updated Australian National Diabetes Strategy to outline the national response to diabetes and better coordinate and target existing resources across all levels of government. The strategy will span 2021–2030 and is expected later this year.

https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/new-agreement-to-help-people-manage-life-with-diabetes

The Differences (and Similarities) Between Type 1 and Type 2 Diabetes

From health.com

Both can be treated, but only one can be prevented

Type 1 and type 2 diabetes may share a name, but there are as many things different about them as there are similar.

At their core, both diseases involve abnormally high levels of sugar in the bloodstream, which is a dangerous, if not life-threatening situation. That occurs as the result of deficiencies in the hormone insulin. In a healthy body, insulin, which is produced by your pancreas, heads to the bloodstream after you eat to break down the sugars from food before escorting them into your cells where they wait to be used as energy.

In type 1 diabetes, the body no longer makes any insulin at all, which means that blood sugar levels rise to sometimes stratospheric levels in the blood. Type 2 is a completely different physiology, with the insulin getting less and less effective over time, rather than shutting down abruptly, Mary Vouyiouklis Kellis, MD, an endocrinologist at the Cleveland Clinic, tells Health. This is called insulin resistance.

Type 1 diabetes represents less than 5% of diabetes cases, and type 2 diabetes 90 to 95%. Other, rarer forms of the condition, make up the rest.  

The Differences and Similarities Between Type 1 and Type 2 Diabetes

Credit: Getty Images

The causes of type 1 and type 2 are different

Type 1 diabetes is an autoimmune condition, which means that your immune system mistakenly attacks your body. In the case of type 1 diabetes, immune-system cells go after the insulin-producing beta cells in the pancreas, which causes insulin production to suddenly turn off.

No one knows exactly why your body goes on the offensive, but there are probably many contributing factors. "We don't completely understand why this happens but there is some data that a viral infection can trigger the process if you already have a predisposition," says Dr. Vouyiouklis Kellis. "You may already have antibodies [the immune-system cells that attack the pancreas] but the second hit is a viral infection." That predisposition could also be genetic.

With type 2 diabetes, genetics, including family history, can also play a role, but here the main risk comes from being obese or overweight, as well as other lifestyle factors, such as not being active and eating unhealthy foods, Jasmine D. Gonzalvo, PharmD, director of the Centre for Health Equity and Innovation at Purdue University in West Lafayette, Indiana, tells Health. "The body still has some ability to produce insulin, but the body has a resistance to the insulin." In type 2 diabetes, the cells may also have difficulty using the insulin effectively, called insulin resistance.

Type 1 and type 2 affect different groups of people

Type 1 diabetes used to be called "Juvenile Onset Diabetes" because, although it can affect anyone, it most often strikes kids aged four to six and those aged 10 to 14.

Type 2 diabetes, originally called adult-onset diabetes, mostly affects adults, but the age at diagnosis is getting younger. 

"There's been more of a grey area within the last decade or so, where you see an older onset of what actually is type 1 and a younger onset of type 2 diabetes," says Gonzalvo. "There has been more of a merging rather than a separation."

Other distinctions remain. "Type 1 diabetes tends to be diagnosed in younger individuals of normal weight, though they may have a personal or family history of autoimmune disease," Deena Adimoolam, MD, a specialist in endocrinology and preventative medicine, who practices in New Jersey, tells Health. "Type 2 diabetes tends to be diagnosed in older individuals who are overweight or obese."

The symptoms and complications are similar

Consistently high levels of blood sugar cause the symptoms of both types of diabetes and many of those symptoms are the same. "Presenting symptoms are similar in all forms of diabetes—increased thirst, increased urination, blurred vision, worsening fatigue, weight loss," says Dr. Adimoolam. "Since patients with type 1 diabetes produce very little or no insulin at the time of diagnosis, they are more likely to present to the hospital with a life-threatening condition called diabetic ketoacidosis (DKA)." People with type 1 may also lose weight.

One unique symptom of type 2 diabetes is a condition called acamphotisi nigricans, says Vouyiouklis Kellis. That's when you see a darkening of the skin at the back of the neck or back of the arm, places where there are folds under the skin. This is a sign of insulin resistance, which is a hallmark of type 2 diabetes but not type 1 diabetes.

Chronically high levels of blood glucose can lead to serious complications which, says Dr. Adimoolam, are similar for both types of diabetes. These include heart disease, kidney problems, nerve damage, amputation, and eye damage that can result in blindness.

Diagnosis is the same

Diagnosing type 1 and type 2 diabetes is based on tests to determine how high your blood sugar is. There are several different types of tests, including the A1C test, a blood test which looks at your average blood-sugar levels over the past two to three months, and a fasting plasma glucose test, a blood test which measures levels after you've been fasting for at least eight hours.

If your doctor thinks you have type 1 diabetes, he or she may also order certain antibody tests. 

The treatments are different

There's only one treatment for type 1 diabetes: insulin replacement. "Without insulin, people with type 1 diabetes may die from complications like diabetic ketoacidosis," says Dr. Adimoolam.

There are a wide range of treatment options for type 2 diabetes, starting with oral and injectable medications to control blood sugar, then moving on to insulin when those things stop working. "Many people with type 2 diabetes are on a combination of these treatments," says Dr. Adimoolam.

A healthy diet and regular exercise are a cornerstone of managing both forms of diabetes.

Only type 2 diabetes can be prevented

There's no way to prevent type 1 diabetes, but you can help prevent type 2 with lifestyle modifications. "We're talking about making healthier food choices, engaging in physical activity, and taking medication," says Dr. Gonzalvo.

https://www.health.com/condition/endocrine-conditions/difference-between-type-1-type-2-diabetes

Snacking Strategies for People with Type 2 Diabetes

From aarp.org/food

Great advice — and yummy ideas — for snacks that help lower blood sugar or keep pounds off

Getty Images

When the stay-at-home orders began back in March, plenty of people predicted that it would affect people's eating habits, and no surprise, it has. Results of an online survey conducted in April and published last month in the medical journal Obesity found that 70 percent of nearly 8,000 respondents admitted to snacking more.

They say that like it's a bad thing.

While snacking often gets maligned as an unhealthy habit, it can have an upside, particularly if you're one of the more than 34 million Americans with type 2 diabetes. For many people, snacking can help prevent overeating at meals and keep energy levels steady throughout the day, says Erin Palinski-Wade, a registered dietitian and author of 2 Day Diabetes Diet. “For people with diabetes specifically,” she says, “snacking can be a great way to help manage appetite and space carbohydrates out during the day. Eating frequently may also help prevent the blood sugar lows that can occur when you haven't eaten for an extended period of time."

Most people have experienced some of the effects of wonky blood sugar levels: sudden lethargy, mood swings or ravenous hunger. People with type 2 diabetes are more sensitive to these effects, as well as long-term risks including vision problems, nerve damage, and heart and kidney issues. That's because a diabetic pancreas fails to release insulin, or at least enough of it to deal with the aftermath of eating. Normally, your body breaks food down into glucose, a sugar and the main energy source for your cells. Insulin helps deliver that energy to cells; without that hormone, or enough of it, the sugar stays in your blood. Chronically elevated blood sugar can cause organ and tissue damage over time.

Previously, when a short-acting injectable insulin was the only option for people with type 2 diabetes, experts pushed a three-meal, two-snack-a-day regimen, says Amy Kimberlain, a registered dietician and spokesperson for the Academy of Nutrition and Dietetics. But now that there are other injectables and oral medications that work differently, those restrictions have loosened up. Still, she says, timing and consistency are key when it comes to managing blood sugar, and therefore when eating.

Eating at regular intervals throughout the day is one key — Palinski-Wade recommends her clients with type 2 diabetes have some food every three to four hours. And, ideally, roughly the same amount of food. Big meals are a no-no when you have diabetes because they dump far too much glucose in your system at once. Skipping meals is ill-advised for similar reasons — your blood sugar will plummet. Sensible snacking can help in both scenarios. Palinski-Wade's helpful guide for “sensible": Make sure your snacks are no more than one-third to one-half the calories of your meals. So if you typically eat 500 calories at a meal, your snacks should be between 160 and 250 calories each.

Of course, what you eat matters, too. Your body digests carbohydrates, proteins and fats at different rates. Simple carbs — things like refined white bread and processed sugary snacks — turn into glucose the fastest, flooding your system with more sugar than it can handle. Ideally, you want a steady drip of carbs throughout your day, says Kimberlain. “We overeat carbs in general,” she says. “Strive to make half of them whole grains, which have fiber to slow digestion, and pair them with proteins and healthy fats.” For instance, try adding peanut butter to oatmeal, or beans to rice. And remember, you don't get to double up on carbs at one meal because you skipped them at a previous meal. Your goal is balance and consistency.

It may seem tough not to stress-eat carbs right now, but that Obesity study did have some encouraging data: While 44 percent of respondents were snacking on junk food, 26 percent had increased their intake of healthful snacks while quarantining. You can, too. Need more inspiration? Check out these expert-recommended suggestions for whatever you're craving:

Savoury:

• Hummus (we like Sabra singles, which are pre-portioned in 150 calorie containers) with veggies (sliced cucumber, bell pepper, celery or carrots). There's some evidence that fiber from plant-based sources may help with insulin sensitivity in as little as three weeks.
  
  
• Avocado toast or crackers. “One-third of a medium avocado contains just 4 grams of carbs, 79 percent from fiber, which slows down food digestion and prevents rapid rises in blood glucose following a meal,” says Palinski-Wade. They also have 6 grams of heart-healthy fats per serving. Try spreading avocado on crisp whole grain crackers or a slice of whole grain toast for a tasty midday fiber and nutrient boost. Sprinkle with a little garlic salt, cumin or red pepper flakes.

Salty:

• Cheese crisps. Reach for these crunchy protein treats instead of potato chips. You can make them easily yourself by baking small piles of grated cheese (cheddar and Parmesan both work well) on a parchment-lined baking sheet in a 400-degree oven until golden and crisp, about 5 minutes. Whisps also makes a variety of flavors.
  
  
• DIY snack mix. Mix some low-calorie whole-grain popcorn (sugar-free Pop Zero, SkinnyPop, and heirloom Pipcorn are among our fav brands) with 1 ounce of nuts, such as Wonderful Pistachios No Shells Roasted & Salted or Diamond of California's first-ever ready-to-eat Snack Walnuts line. You can season with spices like cinnamon or cayenne if you prefer. The protein-fiber-fat trio will help keep you fuller longer.

Sweet:

• Ricotta cheese with dark chocolate chips. Stir some dark chocolate (it has less sugar and antioxidants) into some part-skim ricotta for a creamy, protein-packed, low-carb way to satisfy a sweet tooth.
  
  
• Prunes. Naturally occurring sugar is typically bound with fibre, so it won't spike blood sugar levels, says Palinski-Wade. Prunes (or dried plums, as they've been rebranded) are one of the lowest-sugar dried fruits, and, she says, eating five to six prunes per day may help prevent bone loss — a great benefit especially as people with diabetes are at a greater risk of developing osteoporosis. She even uses them as a sugar substitute in baked goods, such as her chocolate chip prune cookies. 

https://www.aarp.org/food/healthy-eating/info-2020/smart-diabetes-snacks.html