Environmental pollutants may be the reason behind development of type 1 diabetes

From news-medical.net

The environmental pollutants we consume are probably the reason why some people develop type 1 diabetes. Even low concentrations of such pollutants can result in cells producing less insulin, reveals a new study from the University of Oslo (UiO).

Around 400 children and adolescents are diagnosed with type 1 diabetes every year in Norway and the number of new cases amongst children and adolescents has doubled since the 1970s. Adults are also diagnosed with the disease.

Type 1 diabetes is an autoimmune disease characterized by a destruction of the beta cells of the pancreas that produce insulin. The body's own defence system makes the mistake of believing that these insulin-producing cells are harmful alien cells that need destroying.

What triggers the onset of type 1 diabetes remain unclear for scientists. Could it be hereditary? Environmental factors relating to diet, polluted drinking water or could it be due to a viral infection?

Researchers found more environmental pollutants in the blood of children with type 1 diabetes

In collaboration with the University of Tromsø and several research teams in the USA, scientists at UiO have studied the environmental pollutants in blood samples from American children and adolescents who have been diagnosed with type 1 diabetes. These were compared with blood samples from a control group not suffering from type 1 diabetes.

- We found that a larger proportion of those with type 1 diabetes had such pollutants in their blood. On average, they also had a higher concentration of several types of environmental pollutants, says Sophie E. Bresson, PhD student at the Department of Molecular Medicine at the Institute of Basic Medical Sciences at the University of Oslo.

In order to examine these findings in more depth, the researchers used beta cells from rats. The toxic substances were applied to these cells to find out what happened next.

- We found that the beta cells then produced much less insulin, even after only two days and with very low concentrations of environmental pollutants. When the beta cells were exposed to the pollutants for a longer period of time, they died. We therefore believe that environmental pollutants play a role in triggering the onset of type 1 diabetes, concludes Bresson.

Bresson, professor Jerome Ruzzin and the research team recently published their findings in an article in the journal Environment International.

Environmental pollutants are a global threat to mankind

Several of the environmental pollutants studied by the research team, such as PCBs and pesticides, were banned 20 years ago by the Stockholm Convention. But these substances are found in food, plastics, paints, building materials, soil and water and are only broken down naturally to a small degree. They may also have been trapped by ice, and when the ice melts due to global warming, the pollutants are released.

In addition, a number of countries that did not sign the Convention still continue to use these substances to prevent insects attacking crops.

- We consume most environmental pollutants via the food we eat. Once these pollutants enter the body, there is unfortunately nothing we can do to eradicate them, says Bresson.

As part of the study, the researchers obtained blood samples from the US. Could the level of environmental pollutants there differ from that of Norway?

- We have no reason to believe that there are significant differences. But we need to find out for sure, says Bresson.

Eat less meat and more lean fish

90% of the environmental pollutants we consume via food come from fish, meat and dairy products, explains professor Jason Matthews at the Department of Nutrition at the University of Oslo.

The scientists point out that fatty fish such as herrings, mackerel, halibut, salmon and trout contain more dioxins and dl-PCB than lean fish filets. Examples of lean fish are coalfish, cod and haddock.

So what can we do to reduce the level of environmental pollutants in our food?

- Eating less meat can be a good place to start, and choose lean fish. Ecologically cultivated foods will contain fewer trace elements of pesticides since they are not sprayed, but they will still absorb pollutants via water and the soil, reveals Matthews.

Source:

University of Oslo, Faculty of Medicine

Journal reference:

Bresson, S.E., et al. (2022) Associations between persistent organic pollutants and type 1 diabetes in youth. Environment International. doi.org/10.1016/j.envint.2022.107175.

https://www.news-medical.net/news/20220530/Environmental-pollutants-may-be-the-reason-behind-development-of-type-1-diabetes.aspx 

Memories of 50 years as a diabetic: Award-winning advice for an active life

From thecourier.co.uk

Angus man John Murphy has won a national award in recognition of living with diabetes for 50 years.

First diagnosed with diabetes at the age of nine, he’s seen many changes in the treatment of the condition.

Now John, who grew up in Carnoustie, has been awarded the prestigious Alan Nabarro medal for courage and perseverance in managing diabetes for five decades.

Here, John looks back at how things have changed and how he never let diabetes hold him back from living a fully active, sporting life.

“Before I was diagnosed in 1972, I was drinking gallons of water or orange juice, constantly going to the toilet and losing weight,” John explains.

“I spent eight weeks in hospital while they stabilised my blood sugar levels.

Boiling the syringe

“I was put on one insulin injection a day. And my first insulin syringe was made of glass: to sterilise it my mum had to boil it before each injection!”

John remembers in those days there was no blood monitoring – instead he did urine tests. Though this didn’t stop him playing football for Kinloch Primary’s team.

John with teammates from Kinloch Primary school football team, Carnoustie 1972/73.

“It was a difficult time for me,” says John. “My diabetes was out of control and I ended up in Maryfield hospital in Dundee.

“I missed a lot of schooling during that first year – but it didn’t stop me being told off for playing football in the hospital corridors and between the beds!”

John was also involved in other sports, making it more difficult to control his diabetes in those early years.

John in the Carnoustie rugby team, 1986.

“During my teenage years, I came into contact with a young diabetic consultant, Ray Newton, at Ninewells Hospital,” says John.

“He was a great role model for me – very active and a keen rugby player. He and his team helped me understand how best to monitor my diabetes after physical exercise.”

Coming to terms with diagnosis

“I had difficulty coming to terms with my diagnosis,” John continues. “And so I didn’t communicate to people when I was beginning to get low in my blood sugar. The result of course was many hypos."

In the 1980s, the first blood glucose monitor became available.

“It gave some benefit but was very sore on the fingers,” John explains.

“I remember my lovely mum gave me plenty of Mars bars to put in my pockets and down my socks for when I played football and rugby!”

John with wife Jane and sons Michael and Euan.

John’s love of sport continued after he married Jane and became dad to twins Michael and Euan.

“In 1986, I moved onto the Novapen to injecting four times a day: Wonderful progress after the glass and disposable syringes!”

This was replaced by an insulin pump in 2015 – a small electronic device automatically releasing insulin into the body 24/7.

Glucose readings on an app

John says: “This made such a difference to my diabetes control – particularly during exercise – and you’d hardly even notice it.

“Three years on I was using the Free Style Libre system. It measures blood glucose through a small white sensor, the size of a 10p piece, on my upper arm.

John and friend Ewan McGuire finishing a duathlon in 1994.

“It provides real time glucose reading, both day and night. Average readings track to my phone via an app.”

Throughout these advances in treatment John has stayed active – cycling in Spain, walking the West Highland Way, duathlons, half marathons and playing rugby.

Advice for others with diabetes

He and Jane have moved to Shetland, where they’re active members of the leisure centre – enjoying squash, spinning, yoga and regular walks with their dog Louis.

The recognition of his 50 years thriving with diabetes from DiabetesUK, is something John is rightly proud of.

John Murphy getting his award from Alison Irvine, lead diabetes specialist nurse and Dr Pauline Wilson.

“I thank the health teams, my family, friends and colleagues for their time and patience during some difficult periods in my life. They’ve always supported me and help in my determination to lead a happy and healthy life!”

After 50 years successfully managing diabetes, John is clear what he’d tell his younger self now.

“Keep active and healthy, tell friends and teachers you are a type 1 diabetic and what to do if you have low or high blood sugar levels. And don’t be scared to ask for help.

“Do regular blood and Free Style Libre tests especially when you go to bed and before doing sporting activity or exercise.

“Here’s to the next 50 years!”

https://www.thecourier.co.uk/fp/lifestyle/health-wellbeing/3331038/memories-50-years-diabetic-award-winning-angus-man/?commentCount 

What Should Be in a Care Plan for Diabetes?

From healthline.com

Whether you have type 1 or type 2 diabetes, a care plan can help you identify how you’ll treat your condition. This plan can serve as a roadmap to managing your condition.

Ideally, a care plan helps you identify how you will manage your diabetes daily, whom to call if you have concerns, and goals to improve your overall health.

Keep reading to learn more about what your plan should include, plus tips for building an ideal care plan for diabetes.

What should a diabetes care plan include?

Diabetes management requires a balance of healthy eating, regular physical activity, and blood sugar monitoring. 

Your diabetes care plan should include your blood sugar management goals and methods, such as insulin dosages, device settings, and medications.

The Centres for Disease Control and Prevention (CDC)Trusted Source outlines a diabetes care plan based on your daily, monthly, and other regular-interval activities. The daily parts of your diabetes care plan should include:

Points	Considerations
Blood sugar checks	• How often will you check your blood sugar? • What is your desired blood sugar range? • How will you correct high or low blood sugars? • When do you call your doctor for blood sugar results?
Medications	• What are the medications you take daily to manage your diabetes? • How will you manage low blood sugars (e.g., will you carry glucose tablets)? • At what times of day will you take your diabetes medications? • What happens if you accidentally skip a medication dose?
Food	• What is your daily carbohydrate recommendation? • What are some foods you can eat that keep your blood sugars in target range? • If you can’t eat, how do you adjust your insulin or medications?
Physical activity	• What is your daily goal for physical activity? • When do you adjust medication dosages or blood sugar for physical activity?
Foot checks	• How or who will help you check your feet daily for cuts, sores, or swelling? • When should you call your doctor about what you see?

Your diabetes care plan should also include longer-term checks and management plans. Examples of these include the following:

How often?	Considerations and monitoring
Every 3 months	• Get an A1C test if your doctor recommends it. • Consult a doctor if you are in the beginning stages of diabetes management.
Every 6 months	• Get a dental check-up. • Get an A1C test if your blood sugar levels have been in range. • Have your weight checked, review your care plan, and check your blood pressure.
Every 12 months (yearly)	• Get your flu shot. • Get a dilated eye examination. • Get a cholesterol test. • See a doctor for a complete foot check.

At every phase of your care plan, it’s important to identify when you should call your healthcare team and who else will help you manage your health daily or in case of an emergency.

Why is a care plan important for diabetes?

While you don’t have to be perfect, managing your health requires a plan.

Organization and planning can make all the difference. A plan helps take some of the guesswork out of your daily activities and keeps you aware of when you should seek care.

You can make your plan and manage your diabetes in different ways. Examples include:

• purchasing a journal or notebook and creating dedicated pages for different management aspects (such as medications, blood sugar goals, etc.)
• using American Diabetes Association (ADA) resources, which feature write-in areas, or a Diabetes Medical Management Plan for school use.
• downloading an app to manage your diabetes, such as MySugr, which offers carbohydrate counting and glucose tracking options

Research from 2020 suggests that using written (or online) plans helps improve clinical management of type 2 diabetes, including decreases in cholesterol, high blood pressure, and body mass index.

How is a type 1 diabetes care plan different?

When you have type 1 diabetes, you must take insulin by either injection, subcutaneously through an insulin pump, or with an inhaled powder form. 

Some people with type 2 diabetes use insulin in these ways, but others do not and can manage their condition through other medications, food choices, and exercise.

That’s why a type 1 diabetes care plan often differs from a type 2 care plan. A type 1 plan will almost always include instructions for insulin dosage and management.

Because you are taking insulin and essentially calculating how your body might perform that same task if it could, there is more risk of both low blood sugars (hypoglycaemia) and rebound high blood sugars (hyperglycaemia). A diabetes care plan for type 1 diabetes should include hypoglycaemia and hyperglycaemia management strategies.

Insulin, medications, and diabetes supplies

An important part of your diabetes care plan is how you use the supplies and medications you have. Tracking how often you need to get refills can help you avoid being without necessary medications.

You may wish to create a section for supplies in your care plan that includes the following:

Supplies	Considerations
insulin	• What type(s) of insulin do you use? • How much insulin do you take? • When do you take this insulin? • How often do you need medication refills?
medications	• What medication(s) do you use? • When do you use them? • How often do you need refills? • Who obtains your refills (are they mailed to you or do you need to call your pharmacy or doctor)?
continuous glucose monitors (CGMs) and insulin pumps	• What brand is your insulin monitor/pump? • What are the device settings, such as insulin doses and carb ratios? • Where do you keep the instructions? • Are there different CGM supplies you need to use this device? • Does the CGM use a mobile app, and what are the log-in settings? • How often do you change its position? • What is your backup plan for insulin injections if the pump fails or stops working?
lancets and testing supplies	• What brand is your fingerstick glucose meter? • How many test strips, alcohol swabs, and lancets do you get at a time? • How often do you clean your meter? • What type of batteries does your meter take? Do you have extra batteries to replace them? • How and when do you obtain additional testing supplies?

These are just some examples of the considerations you can make surrounding your diabetes management supplies.

Whom should you involve in your diabetes care?

Several specialists may be involved in your diabetes care. These may include:

• a certified diabetes care and education specialist, formerly known as a diabetes educator
• a doctor, nurse practitioner, or physician assistant
• an exercise specialist, such as a personal trainer
• an eye doctor
• a mental health professional, such as a psychologist or counselor
• a pharmacist
• a podiatrist
• a registered dietitian or nutritionist

Your family and friends are also an important part of your care team.

Using your diabetes care plan in school and at work

When you have diabetes, you can experience episodes of high and low blood sugar. When this occurs, you may not be able to care for yourself.

It’s a good idea to share your diabetes care plan with a trusted co-worker, school nurse, or other individual who could help you if you need medical attention (even if it’s just explaining that you have diabetes and how you treat it).

What is a 504 plan for diabetes care in school?

If you or a loved one is in school and have diabetes, you are protected by section 504 of the Rehabilitation Act of 1973 to create a 504 plan. This plan ensures that the school provides a medically safe environment and fair treatment. The ADA provides sample 504 plans, and the school may have examples as well.

Your diabetes care plan isn’t just for an emergency. You may also need school or work contacts to know your plan if you need extra help or time. Examples could include:

• letting a cafeteria or meal plan know you need low carbohydrate foods or are counting carbohydrates
• making sure you have regular breaks to check your blood sugar and inject insulin (if needed)
• identifying a refrigerator where you can store your meals or insulin (if needed) safely

Employment rights can also be a big issue when it comes to diabetes care, and Americans have many different employment rights via the Americans with Disabilities Act of 1990. Some of those rights under federal law might include questions relating to the following:

• What are reasonable accommodations at work?
• Do I have a right to medical leave to take care of my diabetes?
• Can my employer require me to get a medical examination because of my diabetes?
• What if my employer fires me over my diabetes management?

The ADA is a key organization that addresses employment and school rights for the Diabetes Community, and it has an entire division aimed at legal advocacy for those who might be facing these workplace or school situations.

Often, elements of these resources provided by the ADA are found in diabetes care plans — especially for those living with type 1 diabetes.

Navigating insurance with your diabetes care in mind

When you have diabetes, you require medications and supplies. But you may have insurance limitations or plans that require a certain pharmacy, refill schedule, or even writing on prescriptions to ensure your insurance will reimburse you.

Your insurance policy should include an explanation of benefits (EOB). This is often a very long document, and it should describe your coverage for several conditions and medications. You can also contact your insurance company if you have specific questions.

Some aspects related to insurance and diabetes care planning include:

• How often can I get my prescriptions refilled?
• How do I receive my medicines? Does my plan require online ordering and delivery or can I visit my local pharmacy?
• How often do I need to get new prescriptions written by my doctor for my medications?
• Do I need my doctor to certify a need for certain diabetes medications, testing equipment, or supplies? What wording does the insurance company need to accept the prescription?

Understandably, navigating insurance with diabetes can be overwhelming. Remember that your doctor’s office navigates insurance on a daily basis and can be a great source of guidance to help you make sure you have the supplies and medications you need when you need them.

The bottom line

Diabetes care plans can improve your health by helping you understand how you’re managing your condition and where you could potentially improve.

They provide a roadmap for yourself and your loved ones to how you will manage and treat your diabetes.

Talk with your doctor about how you can create a diabetes management plan that will best benefit you.

https://www.healthline.com/health/diabetes/care-plan-for-diabetes#whats-in-a-care-plan 

Hypoglycaemia and Type 2 Diabetes

From healthline.com

About hypoglycaemia

Blood glucose (or blood sugar) is your body’s main energy source. When you have an abnormally low level of blood sugar, your body’s ability to properly function may be impaired as a result. This condition is called hypoglycaemia, and it’s officially defined as a blood glucose level of below 70 milligrams per deciliter (mg/dL).

Hypoglycaemia is most common in people with diabetes. However, a few other conditions — most of them rare — can also cause low blood sugar. 

Symptoms

Your brain needs a constant, steady supply of glucose. It can’t store or manufacture its own energy supply, so in the event your glucose level drops, your brain may be affected by the hypoglycaemia. You may experience some of these symptoms:

• unusual behaviour, confusion, or both (this may manifest as an inability to complete routine tasks or remember information you would otherwise have no trouble recalling)
• loss of consciousness (uncommon)
• seizures (uncommon)
• visual disturbances, such as double or blurred vision

Hypoglycaemia may also cause other physical symptoms:

• anxiety
• heart palpitations
• hunger
• sweating
• tremors

Because these signs aren’t specific to hypoglycaemia, it’s important that you measure your blood sugar level when these symptoms occur if you’re diabetic. It’s the only way to know if they are caused by a blood glucose problem or another condition.

Causes

If you have diabetes, your body’s ability to use insulin is impaired. Glucose can build up in your bloodstream and may reach dangerously high levels (hyperglycaemia). To correct this, you may take insulin injections or a series of other drugs that will help your body lower your blood sugar level. In the event you take too much insulin relative to the amount of glucose in your bloodstream, you may experience a blood sugar level drop, which can result in hypoglycaemia.

Another possible cause: If you take your diabetes medication or give yourself an insulin injection, but you don’t eat as much as you should (taking in less glucose) or exercise too much (using up glucose), you may also experience a drop in blood glucose.

Treatment

The approach to treating hypoglycaemia is twofold: what needs to be done immediately to bring your blood sugar level back to normal, and what needs to be done in the long term to identify and treat the cause of hypoglycaemia.

Immediate treatment

The initial treatment for hypoglycaemia depends on what symptoms you’re experiencing. Typically, consuming sugar, such as candy or fruit juice, or taking glucose tablets can treat early symptoms and raise your blood sugar back to a healthy level. However, if your symptoms are more severe, and you’re unable to take sugar by mouth, you may need an injection of glucagon or an IV with glucose given either at the hospital or by emergency medical service.

Long-term treatment

Your doctor will want to work with you to identify what has caused your hypoglycaemia. If they believe it’s related to your diabetes, they may suggest you begin using medication, adjust your dosages if you’re already on medicine, or find a new approach to lifestyle management. If your doctor determines your hypoglycaemia is the result of another issue unrelated to your diabetes, such as a tumour or illness, they may recommend you to a specialist to treat that problem.

Complications

Ignoring the symptoms of hypoglycaemia can be costly. A lack of glucose may shut your brain down, and you may lose consciousness.

Untreated hypoglycaemia can lead to:

• loss of consciousness
• seizure
• death

If you’re a caretaker for someone with diabetes who begins experiencing one of these symptoms, seek emergency help immediately.

If you have diabetes, take care to not over-treat low blood sugar. You may end up causing your blood sugar level to rise too high. This fluctuation between low and high blood sugar may cause damage to your nerves, blood vessels, and organs.

Prevention

If you have previously experienced hypoglycaemia, the key to preventing a future problem is understanding what caused the issue in the first place and then carefully following your diabetes management plan.

https://www.healthline.com/health/type-2-diabetes/hypoglycemia

Hundreds fitted with artificial pancreas in NHS type 1 diabetes trial

From theguardian.com/society

Adults and children wear device that monitors glucose level and adjusts amount of insulin delivered 

Hundreds of adults and children with type 1 diabetes in England have been fitted with an artificial pancreas that experts say could become the “holy grail” for managing the disease, in a world-first trial on the NHS. 

The ground-breaking device uses an algorithm to determine the amount of insulin that should be administered and reads blood sugar levels to keep them steady. The NHS trial has so far found the technology more effective at managing diabetes than current devices and that it requires far less input from patients.

Managing type 1 diabetes can be challenging, especially in young children, owing to variations in the levels of insulin required and unpredictability around how much patients eat and exercise. Children are particularly at risk of dangerously low blood sugar levels (hypoglycaemia) and high ones (hyperglycaemia), which can damage the body or even lead to death.

Now a new artificial pancreas worn next to the body – which continually monitors blood glucose levels and automatically adjusts insulin delivered via a pump – is being tested in 30 NHS diabetes centres. About 875 people have benefited so far in the first nationwide study of its kind in the world.

The technology can eliminate finger-prick tests to check blood sugar levels and prevent hypoglycaemic and hyperglycaemia attacks. Although most of the NHS’s estimated £10bn annual spending on diabetes treatment goes on type 2 diabetes, it is also hoped the devices will help cut costs by ensuring less need for interventions for type 1 cases.

“Having machines monitor and deliver medication for diabetes patients sounds quite sci-fi-like, but when you think of it, technology and machines are part and parcel of how we live our lives every day,” said Prof Partha Kar, the NHS national speciality adviser for diabetes.

“A device picks up your glucose levels, sends the reading across to the delivery system – AKA the pump – and then the system kicks in to assess how much insulin is needed. It is not very far away from the holy grail of a fully automated system, where people with type 1 diabetes can get on with their lives without worrying about glucose levels or medication.”

Charlotte Abbott-Pierce, six, was diagnosed just over a year ago and initially started on insulin injections but has now become one of the first people to benefit from an artificial pancreas.

She has been fitted with an insulin pump and a continuous glucose monitor that, as part of the world first pilot, now work together.

Charlotte Abbott-Pierce, six, has become one of the first people to benefit from an artificial pancreas. Photograph: NHS

Her mother, Ange Abbott-Pierce, said: “Before the hybrid closed loop system was fitted, my husband and I would be up every two hours every night having to check Charlotte’s blood sugars and most times giving insulin, sometimes doing finger pricks or dealing with ketones due to quick rises in blood sugar.” She said the new system was a “godsend to us as we were at our wits’ end with worry, not being able to catch the highs before they got dangerous”.

Chris Askew, chief executive of Diabetes UK, said: “This technology has the potential to transform the lives of people with type 1 diabetes, improving both their quality of life and clinical outcomes.”

The data collected from the pilot, along with other evidence, will be considered by the National Institute for Health and Care Excellence when it looks at rolling the device out more widely.

Separately, new research on Friday reveals that even slim people can get remission from type 2 diabetes by managing their calorie intake.

A trial led by Prof Roy Taylor of Newcastle University found 70% of participants with a low body mass index (BMI) went into type 2 remission thanks to diet-controlled weight loss, despite not being obese or overweight. Obesity raises the risk of type 2 diabetes, but 10% of sufferers have lower BMIs.

His previous landmark research gave hope to millions of type 2 diabetics who were overweight by showing it was possible to go into remission through careful weight loss. It showed that shedding fat from inside the pancreas and liver – the two key organs involved in blood sugar control – was key to remission from type 2 in people living with obesity or being overweight.

Now researchers have found it also works for slimmer diabetics – with a BMI at or just above the healthy range, below 27. Taylor said: “This is very good news for everyone with type 2 diabetes.”

https://www.theguardian.com/society/2022/apr/01/hundreds-fitted-with-artificial-pancreas-in-nhs-type-1-diabetes-trial