USA: The Surge in Type 1 Diabetes, and the New Ways to Fight It

From webmd.com

By Sara Novak

Cases of type 1 diabetes —  an autoimmune condition where the body attacks insulin-producing beta cells — are rising faster than ever, climbing about 42% in since 1990. That’s a huge increase in a disease that’s expensive, incurable, and still shortens lifespan by more than a decade. 

But the number of new and emerging treatments is surging too, and experts say we’re in the most promising era of type 1 diabetes treatments in history, with new medications that slow the disease’s progression, advanced insulin delivery systems, inhalable options, and drugs that improve insulin resistance. It’s a shift in the management of a chronic lifelong disease for patients who are often diagnosed in childhood.

“These patients are living much longer than they used to with an improved quality of life,” said Kupper A. Wintergerst, MD, a paediatric endocrinologist and executive director of the Wendy Novak Diabetes Institute. 

Experts attribute the rise in type 1 cases to a few factors. Genetics play a role in who will get type 1 diabetes, increasing a patient’s risk by about 40%. And in people with an increased risk, certain environmental factors may serve to nudge them toward getting the disease. For example, infections in early childhood like mumps, rubella, and influenza B as well as childhood obesity and certain environmental factors like antibiotics overuse, vitamin D deficiency, and the hygiene hypothesis — which suggests that kids who aren’t exposed to enough microorganisms in childhood may end up with an overactive immune system — may also be playing a role.

Additionally, certain chemicals found in foods and drinking water, including PFAS, dioxins, and arsenic, may jolt inflammation in the body. Once these chemicals build up in the bloodstream, it triggers a chronic inflammatory state, which contributes to the immune system mistakenly attacking and destroying its own insulin-producing beta cells in the pancreas. Over time, this lack of beta cells causes the body to stop making insulin, which starts to raise blood sugar. 

Researchers are responding with new treatment strategies that leverage a slowed progression of the disease while also more accurately monitoring and regulating blood sugars, which all work to extend lifespan. The number of patients living past 65 has tripled in the last four decades.

Slowing Progression of the Disease 

Type 1 diabetes is usually diagnosed in childhood, though it can develop in adulthood, too. A new medication, called teplizumab (Tzield), has been shown to slow the disease’s progression, potentially staving off the disease for two or three years. It’s now for patients either before they’re diagnosed or early after a diagnosis. Once patients have tested positive for two or more type 1 diabetes-related autoantibodies, they’re considered eligible for the medicine. They may also have abnormal blood sugar levels but don’t yet have other symptoms of type 1 diabetes like excessive thirst, frequent urination, slowed wound healing, and excessive hunger.

Ways to Avoid Needing Insulin

What factors play a role in your blood sugar level, and how can they keep you from needing insulin?

The medication works by binding to CD3 proteins on the surface of the white blood cell, helping to block the autoimmune attack. The medication must be started a few weeks or months after diagnosis. While it’s not good for all patients, it can be helpful especially for children in staving off this life-altering condition for up to three more years of childhood. 

“For patients who are early on in their type 1 disease, this medication can help prolong the beta cell function that is remaining and decrease how much insulin a person needs, depending on when it’s used in their disease course,” said Bethany L. Gottesman, MD, a paediatric endocrinologist at Phoenix Children’s in Phoenix, Arizona.

Patients need to visit a facility that offers infusion services over the weekend. These infusion centres are available throughout the country. You can also contact the TZIELD COMPASS Support Program to find a centre near you. 

Beyond slowing the progression of the disease, the next step would be preserving beta cell function indefinitely, which would prevent the disease. Stem cell-derived beta cells are designed to mimic the function of natural beta cells, restoring function to damaged cells before the damage can to type 1 diabetes. A stem cell-derived treatment called zimislecel has shown promising results in early trials, but it is about a decade away from being available to patients, according to experts.

Improved Insulin Delivery Systems 

Science has revolutionized insulin delivery systems, which now do a much better job of mimicking the pancreas — because they measure sugars beneath the skin and between cells and communicate with the insulin pump. A sensor inserted just beneath the skin measures the interstitial fluid that surrounds cells. After that, software built into the device analyzes the glucose data, sending a message to the insulin pump to deliver insulin through a small needle that penetrates the skin. The data gathered from the cells is transmitted wirelessly to a smartphone or directly to an insulin pump.

“As sugar levels rise or fall, the pump can respond by decreasing or increasing the amount of insulin that’s delivered through an algorithm,” said Wintergerst. 

The algorithm is the computer programming process that tells the glucose monitoring system when more insulin is required, all based on data it’s collected on blood sugar in the body as well as other potential inputs such as how many carbohydrates a person consumes.

The system can provide extra insulin, for example, if it looks like a patient’s blood sugar is going to spike. Still, these insulin delivery systems require the user to input the size of a meal or the amount of carbohydrates that a patient is consuming in order to know whether blood sugar is going to go up or go down in the near future, which can make it more difficult for young children.

Experts contend that these more optimized systems help patients deal with type 1 diabetic burnout — when people with diabetes become mentally and physically exhausted as a result of all the demands that are put on them in terms of diet and glucose monitoring. This can be a concerning issue especially among children with diabetes who are new to the disease and must tend to their blood sugar for years to come, said Michael Yafi, MD, director of the Pediatric Endocrinology Division at McGovern Medical School at The University of Texas Health Science Center in Houston.

When patients are better able to monitor their condition with ease, they’re more likely to be able to stay on track with their blood sugar. This way they’ll avoid experiencing the organ damage caused by elevated blood sugars, which over time damages the body’s blood vessels and nerves, leading to blurred vision, kidney failure, neuropathy, and early death as the body’s systems break down.

Inhaled Insulin for Both Kids and Adults 

The inhaled insulin Afrezza provides rapid delivery of insulin to patients after a meal or after exercise to help stabilize blood sugar levels. People with type 1 diabetes will still need insulin injections or an insulin pump to provide a steady, continuous supply of insulin for longer periods of time, but inhaled insulin can provide additional help for people who need a boost of insulin after eating a meal. It can also reduce the risk of hypoglycemia or low blood sugar after exercise because it’s faster acting than the injectable version. For example, in patients who eat carbohydrates before exercise to prevent the low blood sugar that impacts their performance, it can keep the body from overcompensating and causing high blood sugar. 

Afrezza has already been approved for adults and is likely to be approved for children by the end of 2025, giving patients additional options while also easing some of the needle fatigue. Still, it does have its drawbacks, said Gottesman.

“It’s not meant to be used if you have lung disease, and some pediatric patients have asthma. This is also true of older patients with type 1 diabetes, who are more likely to have other lung diseases,” she said. 

Gottesman added that the insulin only comes in set doses, which for the youngest children might not be appropriate. It’s typically not as exact as rapid-acting injections. 

Inhaled versions of insulin provide a convenience factor for patients. It’s also discreet for children who are embarrassed by their condition or don’t want to inject themselves with needles in public places like at school. Newer versions of inhaled insulin are also in development, perhaps supplying a version of insulin that’s liquid rather than powder, which would reduce respiratory irritation. Aerami Therapeutics has a liquid formulation in development, though it’s unclear when it will be ready for the public.

It might seem obvious: In type 1 diabetes, the problem is lack of insulin production. In type 2, it’s insulin resistance – the body still makes insulin but can’t use it effectively. 

But that clear-cut distinction doesn’t always hold. Many people, including children, with type 1 diabetes develop insulin resistance, too. Despite lacking natural insulin, their bodies can become resistant to the insulin they do receive, for a number of reasons including excess weight, medications, smoking, puberty, and pregnancy.

This overlap has led researchers to explore treatments once thought to be reserved only for type 2 diabetes — including GLP-1 medicines like Ozempic and Wegovy — to help patients drop excess weight and stave off or improve insulin resistance, said Alexandra De Lellis, a nurse practitioner at Parkview Endocrinology in Fort Wayne, Indiana. 

While type 1 diabetes is mostly an autoimmune disease, insulin resistance can be a secondary issue that causes additional complications when the body resists insulin, causing an increase in the amount of insulin required for patients. This happens when the cells don’t react efficiently to insulin as a result of excess body weight, a genetic predisposition, or certain medications. 

“Insulin resistance plays a large role especially for type 1 patients diagnosed in adulthood but also those who were diagnosed younger,” said De Lellis. It can be frustrating for these patients who feel like their insulin isn’t having the impact it should because the body is resisting it. 

A study published this year in Frontiers in Endocrinology found that GLP-1s were a “potential adjunctive therapy in [type 1 diabetes] to reduce weight and improve insulin resistance.” Studies have shown that GLP-1s can reduce blood sugars levels by between by 0.21% and 0.96%, while also reducing weight and the amount of insulin that’s required of type 1 patients.

https://www.webmd.com/diabetes/news/20250819/surge-type-1-diabetes-new-ways-fight 

7 Drinks To Lower Blood Sugar, from a Metabolic Health Expert

From thehealthy.com

To help prevent or manage metabolic disease, here are drinks that science has shown can help keep your blood glucose stable.

Highlights

• Keeping blood sugar in check can help prevent diabetes complications, maintain steady energy, and support overall long-term health.
• Certain beverages have been shown to help safely bring down blood sugar values.
• Whether you’re managing diabetes or trying to prevent it, simple lifestyle strategies like this can make a big difference.
• In this article, the terms “blood sugar” and “glucose” are used interchangeably.

Maintaining healthy blood sugar is key for overall wellness, and it’s something more people are paying attention to than ever before. In the U.S., more than 38 million people have diabetes, and millions more are living with prediabetes without realizing it, according to health experts.

This growing awareness has many seeking out simple, everyday changes, including drinks to lower blood sugar, as a way to help keep glucose levels steady.

“Blood sugar is finally getting the attention it deserves as a key marker of metabolic health, and as one of the most accessible ways to track insulin dynamics at home,” says Sarah Steele, MS, RDN, registered dietitian and metabolic specialist at Signos. With that focus has come a surge of supplements, diet plans, and drink trends, all claiming to offer solutions.

But which supposed blood sugar-lowing drinks are actually backed by science? “As it turns out, certain beverage strategies can meaningfully support a healthy lifestyle, reduce the risk of insulin resistance, and even blunt post-meal glucose spikes,” says Steele.

Below, she shares seven research-backed drinks to lower blood sugar, and how to make them an easy part of your daily routine.

7 drinks to lower blood sugar

1. Water

When it comes to the top drink to lower blood sugar, Steele says nothing beats plain water. “Good hydration supports better glucose metabolism and can even lower blood glucose levels in the short term by increasing blood volume.” This dilution reduces blood viscosity, which is one reason elevated glucose can contribute to inflammation.

According to guidelines from the National Academies of Sciences, Engineering, and Medicine, women should aim for about 11.5 cups (92 ounces) of fluids daily, while men should target around 15.5 cups (124 ounces). The Mayo Clinic states that these totals include water, other beverages, and moisture from food (as about 20% of daily fluids typically come from food).

Unless your healthcare provider has advised a fluid restriction, keeping a refillable water bottle on hand and sipping regularly is an easy way to stay hydrated, support healthy blood sugar, aid digestion, and maintain steady energy throughout the day.

2. Cinnamon-infused water

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Steele says, “Simply adding a teaspoon of ground cinnamon or a cinnamon stick to a glass of water and letting it sit for about 30 minutes before you drink it can increase your body’s ability to process glucose more effectively and, over time, help maintain or improve insulin resistance.”

Cinnamon contains bioactive compounds like cinnamaldehyde, polyphenols, and methylhydroxychalcone polymer (MHCP), that help improve insulin receptor signalling. This process allows muscles to absorb glucose more efficiently, using it for energy rather than storing it as fat.

Steele notes that Ceylon cinnamon (“true” cinnamon) is preferred over Cassia for safer, more effective results. For extra flavour, try adding lemon or fresh mint leaves to create a mocktail-like blend.

3. Chia seeds in water

Chia seeds are a powerful source of fibre that can benefit blood sugar control. “The seeds’ formation of a viscous gel helps slow glucose absorption, giving your body a chance to better utilize the glucose from your meal,” says Steele.

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To make this fibre-rich option, she recommends adding a tablespoon of chia seeds to a tall glass of water with a squeeze of lemon or lime and consuming it before a meal.

4. Black, unsweetened coffee (for some)

Coffee has long been studied for its potential health perks. “The chlorogenic acids reduce glucose absorption, leading to lower post‑prandial glucose responses when consumed near a meal (and without added sugar and milk),” says Steele.

Research supports this connection. A large analysis of data from more than 7,000 Korean adults, published in the peer-reviewed journal Nutrients in April 2025, found that drinking two or more cups of black coffee daily was associated with improved insulin sensitivity and reduced insulin resistance, particularly in women and older adults. Just be sure to skip added sugars and creamers to maximize the benefits.

5. Green tea

Light, soothing, and packed with antioxidants, green tea has earned a reputation as one of the healthiest beverages you can drink. “The popular polyphenol EGCG in green tea is shown in research to help with glucose metabolism by enhancing insulin receptor activity,” says Steele. This boost to insulin function can help the body use glucose more efficiently, supporting stable blood sugar levels.

6. Vegetable juices (blended, not pressed)

“The polyphenols and prebiotic fibres in non-starchy veggies help keep our gut bacteria thriving, which in turn helps keep glucose metabolism working well and can keep us out of insulin resistance,” Steele says.

                                                                                     wera Rodsawang/GETTY IMAGES                

For one of the most nutrient-packed drinks to lower blood sugar, she recommends blending vegetables such as cucumber, celery, or spinach with water, then adding fresh lemon or lime juice along with mint or ginger. Blending keeps the fibre intact, which helps slow glucose absorption and supports digestive health. She cautions to avoid pressed vegetable juices, as the fibre is removed and they’re often mixed with fruit juice, which can cause a rapid spike in blood sugar.

7. Apple cider vinegar

Apple cider vinegar (ACV) has earned a place among the best drinks to lower blood sugar. “Research shows it can help lower glucose by improving insulin sensitivity,” Steele says.

In an eight-week randomized trial published in Frontiers in Clinical Diabetes and Healthcare in 2023, patients with type 2 diabetes who consumed 30 millilitres of ACV daily saw significant reductions in fasting blood glucose, haemoglobin A1C, and LDL cholesterol compared to a control group.

To make apple cider vinegar more enjoyable, Steele suggests adding one tablespoon to sparkling water with fresh mint, ginger, and lemon for a refreshing, blood sugar–friendly mocktail. Just be sure to dilute it well to protect your teeth and stomach lining.

Drinks that raise blood sugar

Knowing what to drink is just as important as knowing which beverages to avoid. Certain drinks can cause rapid spikes in blood sugar, which may lead to energy crashes, increased hunger, and long-term health risks. Some common drinks that raise blood sugar include:

• Regular soda: These beverages are packed with added sugar and lacking fibre or protein to slow absorption.
• Fruit juices (especially store-bought or concentrated): Even 100% fruit juice can cause a spike because it contains natural sugars without the fibre from whole fruit.
• Sweetened coffee drinks: Lattes, frappuccinos, and flavoured coffees often contain multiple pumps of syrup and whipped cream.
• Energy drinks: Many combine high sugar content with caffeine, leading to a sharp glucose rise.
• Sweetened iced tea or lemonade: Bottled and restaurant versions can contain as much sugar as soda.
• Alcoholic mixed drinks: Cocktails made with juice, soda, or syrups can cause blood sugar spikes, especially without food.

Why is it important to manage blood sugar? An expert’s answer:

“Maintaining healthy glucose levels sets the stage for long-term metabolic success and helps prevent chronic diseases before they start,” says Steele. “Glucose instability fuels inflammation, raises the risk for conditions like diabetes, heart disease, high blood pressure, kidney disease, and cancer, and speeds up the aging process.”

Stable blood sugar also supports clear thinking and steady energy because it fuels the brain and body more effectively. This stability also makes it easier to stick with healthy habits over time.

https://www.thehealthy.com/diabetes/drinks-to-lower-blood-sugar-from-metabolic-specialist-clinician/ 

Honey or artificial sweeteners: What’s better for diabetes?

From rollingout.com

Natural doesn’t always mean better when blood sugar control matters 

The great sweetener debate has diabetics and people fighting obesity caught between two seemingly impossible choices. On one side sits honey, nature’s golden nectar that feels wholesome and natural. On the other lurk artificial sweeteners with scary chemical names that promise zero calories but deliver controversy and confusion.

Here’s the truth about honey vs artificial sweeteners for diabetics that cuts through marketing hype and gets to what actually matters: blood sugar control and sustainable weight management.

                                                                                                                 Image generated by AI

Honey hits your blood sugar like a freight train

Let’s start with the harsh reality about honey that health food enthusiasts don’t want to hear. Despite being natural, honey vs artificial sweeteners for diabetics isn’t even close when it comes to blood glucose impact. Honey is essentially concentrated sugar that spikes blood levels just as aggressively as table sugar.

One tablespoon of honey contains about 17 grams of carbohydrates and 64 calories, most of which comes from fructose and glucose. Your body processes these sugars quickly, sending blood glucose levels soaring within 15-30 minutes of consumption.

For people with diabetes or insulin resistance, honey creates the exact blood sugar roller coaster you’re trying to avoid. The initial spike triggers insulin release, followed by a crash that leaves you hungry, tired and craving more sugar within a few hours.

The glycaemic index of honey ranges from 45-64 depending on the variety, which puts it in the moderate to high category for blood sugar impact. This means honey affects blood glucose almost as dramatically as eating straight sugar.

Artificial sweeteners keep blood sugar stable

When examining honey vs artificial sweeteners for diabetics from a purely blood sugar perspective, artificial options win decisively. Stevia, erythritol, monk fruit and even aspartame don’t raise blood glucose levels at all, giving diabetics the sweetness they crave without the metabolic chaos.

This blood sugar stability is crucial for people managing diabetes, especially those trying to lose weight. When blood sugar stays steady, insulin levels remain low, allowing your body to access stored fat for energy instead of constantly storing new fat.

Artificial sweeteners also don’t trigger the hunger and cravings that follow blood sugar spikes and crashes. You can satisfy sweet cravings without starting the cycle of sugar addiction that sabotages weight loss efforts.

The zero-calorie aspect of most artificial sweeteners provides obvious advantages for weight management. You can enjoy sweetness without the 64 calories per tablespoon that honey adds to your daily intake.

The antioxidant argument doesn’t change diabetes math

Honey proponents often argue that natural sweeteners provide antioxidants and nutrients that artificial sweeteners lack. While honey does contain small amounts of vitamins, minerals and antioxidants, the quantities are negligible compared to the blood sugar damage it causes.

When considering honey vs artificial sweeteners for diabetics, the tiny nutritional benefits of honey can’t justify the massive blood glucose disruption. You can get far more antioxidants from a handful of berries without the sugar crash.

The “natural is better” argument falls apart when natural substances cause more harm than artificial alternatives. For diabetics, blood sugar control trumps philosophical preferences about natural versus synthetic ingredients.

Raw honey, manuka honey and other premium varieties still contain the same blood sugar-spiking sugars as regular honey. The processing method doesn’t change the fundamental metabolic impact on people with diabetes or insulin resistance.

Gut health complications add another layer

Recent research reveals that honey vs artificial sweeteners for diabetics involves more than just blood sugar considerations. Some artificial sweeteners may disrupt gut bacteria in ways that could affect glucose metabolism over time.

However, the evidence on gut microbiome disruption remains mixed and inconclusive. Some studies suggest negative effects while others show neutral or even positive impacts on gut health from certain artificial sweeteners.

Honey also affects gut bacteria, potentially feeding harmful bacteria that thrive on sugar. For people with diabetes who often have compromised gut health, adding more sugar through honey might worsen bacterial imbalances.

The gut health argument doesn’t provide clear guidance for choosing between honey and artificial sweeteners, making blood sugar impact the more reliable decision-making factor.

Weight loss reality check

For people battling obesity alongside diabetes, honey vs artificial sweeteners for diabetics becomes even more clear-cut. The calories in honey add up quickly when you’re trying to create the caloric deficit necessary for weight loss.

Those 64 calories per tablespoon of honey might seem insignificant, but they accumulate rapidly in coffee, tea, baking and cooking. Using honey throughout the day can easily add 200-400 calories without providing satiety or nutritional value.

Artificial sweeteners allow people to enjoy sweet flavors while maintaining caloric deficits essential for weight loss. This psychological satisfaction helps adherence to weight loss plans without sabotaging metabolic goals.

The practical middle ground approach

The honey-vs.-artificial sweeteners for diabetics debate doesn’t have to be all-or-nothing. The key is understanding when each option might be appropriate and using both strategically.

For daily sweetening needs in coffee, tea and regular food preparation, artificial sweeteners provide the best blood sugar control and weight management support. Save honey for occasional treats where the flavour is essential and you can account for the blood sugar impact.

When using honey, pair it with protein or fibre to slow sugar absorption and minimize blood glucose spikes. Use the smallest amount necessary to achieve the desired flavour, and monitor your blood sugar response carefully.

The verdict for diabetics and weight loss

When evaluating honey vs artificial sweeteners for diabetics based on the most important factors — blood sugar control and weight management — artificial sweeteners provide significant advantages. The natural appeal of honey doesn’t outweigh its metabolic drawbacks for people managing diabetes.

This doesn’t mean artificial sweeteners are perfect or without concerns, but for diabetics prioritizing glucose control and weight loss, they offer practical benefits that honey simply can’t match. Choose your sweeteners based on your health goals rather than marketing claims about natural versus artificial ingredients.

Your blood glucose meter will tell you everything you need to know about which sweetener works better for your diabetes management.

https://rollingout.com/2025/08/16/honey-vs-artificial-sweetener-diabetes/

Mangoes and type 2 diabetes: what recent studies actually show

From diabetes.co.uk

Each summer the same question resurfaces for people living with diabetes: are mangoes off the menu? The fruit’s sweetness and reputation for spiking blood glucose have led to firm views at both ends of the spectrum. 

Some avoid mango altogether while others hope it might even help their diabetes. The truth sits between these positions and new evidence helps to clarify it.

Two recent clinical studies from India examined how mango affects blood glucose when it is used as a replacement for other carbohydrate rather than an addition.

In a pilot study of 95 adults, three common Indian varieties – Safeda, Dasheri and Langra – produced similar or lower glycaemic responses than white bread during standard two-hour tests.

A separate three-day assessment using continuous glucose monitoring found that, in participants with type 2 diabetes, post-meal glucose swings were smaller after eating mango than after eating bread.

These findings suggest that a measured serving of mango can be incorporated into a meal plan without worsening short-term glucose control.

An eight-week randomised trial has added longer-term context. Thirty-five adults with type 2 diabetes replaced breakfast bread with about 250 g of fresh mango, roughly one small fruit. Mango was not added on top of the usual meal.

By the end of the study, the group who made this swap recorded improvements in fasting glucose and HbA1c, as well as measures linked to insulin resistance, body weight, waist circumference and HDL cholesterol.

The consistent message across both pieces of work is substitution. Mango took the place of bread. It did not sit alongside it.

Portion size remains central. A 250 g serving of mango contains in the region of 180 kilocalories and around 30 to 40 g of carbohydrate.

If you add this to a meal that already includes bread or rice you will increase both carbohydrate and energy, which is likely to raise glucose and total intake. If you use mango in place of an equivalent amount of carbohydrate from starch, the overall effect can be easier to manage.

Many people aiming for tighter control prefer to start with a smaller portion that provides nearer 15 to 20 g of carbohydrate and to adjust from there.

How you eat mango matters. Pairing it with protein or fibre, such as plain yoghurt, cottage cheese, nuts or seeds, can slow digestion and smooth the rise in glucose.

It is sensible to choose fresh or frozen mango without added sugar and to avoid juices, milkshakes and tinned fruit in syrup.

Timing helps too. Having mango with or between meals usually works better than a large dessert after a heavy, carbohydrate-rich plate.

These studies relate to type 2 diabetes. They do not tell us how mango fits for people with type 1 diabetes, where carbohydrate counting and insulin dosing are required for every carbohydrate-containing food.

Anyone with persistently high readings, recent medication changes, pregnancy, kidney disease or other complex conditions should seek personalised advice before changing their diet.

For those who enjoy mango, the message is reassuring.

https://www.diabetes.co.uk/news/2025/aug/mangoes-and-type-2-diabetes-what-recent-studies-actually-show.html

Diabetes Is a Crisis — and Extreme Heat Heightens Risks

From wordinblack.com

By Theresa Renart

New York City is sizzling and the extreme heat presents a significant threat for New Yorkers living with diabetes that we don’t talk about nearly often enough.

Dehydration spikes blood glucose levels and can reduce kidney function. Diabetes damages nerves in the sweat glands, and overall, is a condition harder to manage in the heat.

Combatting the mounting diabetes crisis in New York City amid this era of rising temperatures requires more public awareness, proactive policy changes, and investments in public health.

Dehydration spikes blood glucose levels and can reduce kidney function. Credit: RDNE Stock Project/Pexels

As a nurse specializing in diabetes education, I’m on the frontlines and see how this disease alters lives — often in ways that could have been prevented with earlier intervention. Black New Yorkers are particularly vulnerable and more likely to succumb to the disease than their white counterparts. 

More than a million New Yorkers live with diabetes, and 1 in 6 has blood sugar levels high enough that their diabetes is considered “uncontrolled,” resulting in increased risk of kidney failure or stroke. New Yorkers living in neighbourhoods suffering from the urban heat island effect, where a lack of tree cover and air-conditioning can make it feel significantly hotter, are particularly vulnerable.

Due to longstanding inequities, many of these neighbourhoods also suffer from higher rates of diabetes — including in the Bronx, where as many as 1 adult in 5 has been diagnosed with the condition.

We want at-risk New Yorkers to get tested. At the same time, the city and state must commit to expanding access to resources, medical technologies, and education that can help people manage and control this condition.

Having treated 20 patients on average per week over the past 25 years, I’ve seen the trends shaping this crisis and how New Yorkers are suffering severe complications at younger ages.

In one upsetting case, I worked with a 20-year-old patient who lost his vision, had a limb amputated, and is now on dialysis. Sadly, the rate of toe and lower-limb amputations has increased about 75% between 2009 and 2017, and researchers expect both type 1 and type 2 diabetes to increase in young people over the next 40 years.

Many of my patients struggle to follow their medication regimens or make necessary lifestyle changes — not because they do not care about their health, but because they have never received the proper education, including guidance about how to take insulin, store their medication, and test their blood sugar. 

Through my work, I’ve found that we need to meet people where they are to motivate them to make the proper lifestyle changes, whether that’s swapping out white rice with brown or just making a brisk walk a part of their everyday routine.

However, these efforts must be augmented by strong institutional support, including ongoing public investments in initiatives and programming designed to promote healthy lifestyle changes. We must improve and expand access to nutritional foods and boost educational and counselling programming, particularly in high-risk neighbourhoods where many residents lack access to proper medical care and healthy foods — gaps that may become more pronounced with cutbacks to federal funding.

We must also invest in policies and programs that promote physical activity and social connection in communities

These and other initiatives were outlined in a plan released by the city earlier this year focusing on tackling health inequities and reducing deaths from chronic illnesses like diabetes. It’s a great start. Now, we collectively — policymakers; lawmakers; non-profit, clergy, and community leaders; and healthcare organizations like ours — must work to ensure it doesn’t just sit on a shelf collecting dust. 

City agencies must continue to engage with community groups and partners as they work to implement these proposals. At a broader level, we must continue to expand access to diabetes management technology, including devices like continuous glucose monitors that allow people to check their blood sugar in real time without pricking their fingers, that provide New Yorkers, regardless of income, with the best available tools to manage their condition.

Diabetes is a mounting crisis — but it doesn’t have to be. Let’s work to make it the beginning of the end when it comes to reversing these disturbing trends.

Theresa Renart serves as a clinical education diabetic nurse specialist at ElderServe Health. She lives in Queens.

https://wordinblack.com/2025/08/diabetes-is-a-crisis-and-extreme-heat-heightens-risks/ 

Dear Doctor: Should a person with diabetes supplement their intake of vitamin B-12?

From oregonlive.com

DEAR DR. ROACH: How much vitamin B12 should I take as a diabetic? -- T.H. 

ANSWER: Many people have strong feelings that vitamin B12 can dramatically improve their health, but it only helps to take vitamin B12 if you are deficient. Vitamin B12 deficiency isn’t too common. Still, there are a few situations where supplemental vitamin B12 should be considered, and two of them are specific for people with diabetes.

People with Type 1 diabetes, which usually presents itself during childhood, are at a high risk for other autoimmune diseases, including pernicious anaemia -- an autoimmune destruction of the cells in the stomach that make a protein called intrinsic factor. This protein is necessary for the absorption of vitamin B12. Multiple autoimmune diseases are often diagnosed in the same person.

People with Type 2 diabetes who take metformin are at risk for vitamin B12 deficiency due to poor absorption. I recommend testing vitamin B12 in people who have been on metformin for a long time. Proton-pump inhibitors (like omeprazole) may also reduce B12 absorption to the point of deficiency.

People who are very strict with avoiding any type of animal products will develop B12 deficiency over the years unless they use supplements. Finally, people who can’t absorb nutrients for a variety of reasons (such as bariatric surgery, Crohn’s disease, celiac disease, bacterial overgrowth, fish tapeworm, and disease of the pancreas) may all become B12-deficient.

Treatment of B12 deficiency depends on the underlying cause. For example, a vegan only needs about 1 mcg a day to avoid B12 deficiency. By contrast, people with pernicious anaemia need 1,000 times the usual oral dose of B12 or B12 injections. Measuring B12 levels to ensure adequate supplementation is wise in people who have difficulty absorbing it.

For healthy people (apart from the above and a few other rare conditions) with a non-vegan diet, it is not necessary to supplement B12, nor is testing necessary. B12 toxicity is essentially unheard of since the body simply excretes the B12 that you don’t need.

Apart from severe absorption problems like pernicious anaemia, the dosing of B12 supplementation is the same whether a person has diabetes or not. Fifty micrograms a day is almost always more than enough.

Dr. Keith Roach is a physician at Weill Cornell Medical College and New York Presbyterian Hospital. He writes an educational column on infectious diseases, public health and sports medicine.North America Syndicate

https://www.oregonlive.com/advice/2025/08/dear-doctor-should-a-person-with-diabetes-supplement-their-intake-of-vitamin-b-12.html