Is there a connection between diabetes and heart health?

From themonitor.com
By: Dileep Menon

Since diabetes is a condition that leads to narrowing of the blood vessels in every part of the body, people with diabetes often suffer from vascular complications like heart attacks, strokes , renal failure leading to dialysis , blindness , ulcers and non-traumatic amputations. They are considered to have “heart disease risk equivalent” status, meaning that they will have the same future risk of cardiac events as that of someone who has established heart disease. That’s why it’s important that people with diabetes need to be aware of their underlying risk and address this aggressively with a healthy lifestyle and risk factor modification.

The primary goal in treating and managing diabetes is to control the blood sugar, which is assessed through a blood test called Haemoglobin A1c (HgBA1c). A HgBA1c less than 7% has been shown to prevent heart attacks in people with diabetes. Blood sugar control can be achieved with diet, exercise and medications. Diet plays a pivotal role in the management of diabetes with special emphasis on calorie restriction and limiting carbohydrates, especially sugars. It’s also recommended to increase fruit and vegetable intake, avoiding saturated and trans-fats and increased fibre intake.

Regular exercise enables calorie expenditure, facilitates weight management and lowers blood pressure. There has been tremendous progress in medications for diabetes that not only lower blood sugar but also reduce heart attacks, heart failure and death among those with diabetes. With these medications, there is less dependence on insulin, which effectively lowers blood sugar but is also associated with side effects such as low blood sugar episodes and weight gain. At the same time, insulin can potentially accelerate the narrowing of the blood vessels due to its pro-atherogenic properties.

Frequently, diabetes is also associated with co-morbidities like high blood pressure and high cholesterol. Control of blood pressure to less than 130/80 mm Hg is critical in preventing development of kidney disease, kidney failure and delaying need for dialysis. Blood pressure lowering medications such as Angiotensin Converting Enzyme Inhibitors (ACE- Inhibitors ) and Angiotensin Receptor Blockers (ARB) have shown to be beneficial in diabetics with protein in their urine to prevent kidney damage. Statin medications to lower cholesterol have also shown tremendous benefits in reducing heart attacks and death in diabetics. Aspirin in doses of 75-81 mg daily may be considered to prevent heart attacks and strokes in diabetics provided they are not at high risk for bleeding complications.

As the adage goes, “an ounce of prevention is worth a pound of cure”. This could not be more apt for people with diabetes to stay heart healthy. Preventing heart disease as it relates to diabetes starts with consistent monitoring of HgBA1c, blood pressure and total cholesterol / LDL cholesterol. Adapt healthy eating and exercise routines to keep these levels as low as possible. Be sure to take your medications as prescribed by your doctor and follow up with your doctor to ensure your risk factors are under optimal control. For this Heart Month, I remind you to Live Healthy Daily, Live Heart Healthy Daily and Live Long Heart Healthy.

https://www.themonitor.com/2020/02/10/connection-diabetes-heart-health/

The Most Nutrient-Dense Low Carb Foods

From asweetlife.org

If you read ASweetLife often, you know that we believe a low-carbohydrate or ketogenic diet is key to managing both Type 1 and Type 2 diabetes. Keeping carbs low is the single best way to achieve tight, healthy, normal blood sugars, and is the best way to break the cycle of insulin resistance.
 However, people with diabetes need their diets to do more than just optimize their metabolism. They also need to derive nourishment from their diet, just like everyone else. And the keto diet can accommodate many different foods and ways of eating, ranging from fully vegan to the 100% meat “carnivore” diet, and many points in between. Some low-carbohydrate foods are nutrient dense, and some are nutrient poor, and it pays to know the difference.
Raphael Sirtoli, co-founder of Nutrita Pro, an app that tracks key foods and nutrition, explains how to get the right nutrients, and why it’s important.

What is nutrient density?

The healthfulness of any one food goes far beyond a simple accounting of its calories or macronutrients. We can examine the wholesomeness of foods with much greater detail, chiefly by looking at vitamin and mineral content.

“Nutrient density” is the best way to approach this topic, and it’s a crucial concept in nutrition. The more nutrient dense a food is, the more nutrients (vitamins, minerals) you get for a standard amount of the food, measured in grams or calories.

As far as calculations go, it’s pretty simple. In fact, it’s too simple. There are many reasons why it’s inaccurate. Here are 3 important ones:

1. With the ‘per calories’ approach we end up inflating the nutritional value of plants because they’re less energy dense than animal foods on average
2. The calculation assumes perfect absorption of vitamins and minerals, ignoring important differences in how nutrients are taken up and (processed for energy or structural roles)
3. It doesn’t account for the fact that some nutrients come in inactive forms that carry a cost for being converted into active ones.

Government and corporation food labels ignore these facts. The nutrient density score in the Nutrita Pro does not.
People are nourished not only by essential vitamins and minerals, but also by essential amino acids (protein) and fatty acids (fat).
So, with this new tool to figure out a food’s nourishing level, let’s take a look at which foods are most nutritious.

1. Organ meats (offal)
Organ meats are probably the most nutrient-dense foods available, outranking fruits, vegetables and muscle meats in pure nutrient-density. They are particularly rich in B vitamins and in important minerals, such as iron and magnesium, that can be otherwise rare in common foods. Liver, for example, is packed with vitamins A (retinol) and riboflavin, copper, niacin and Vitamin B6. Some cuts, such as beef tripe and chicken feet, are particularly rich in gelatin (collagen).

Organ meats are often considered an acquired taste at best in today’s United States, but they are cherished ingredients in much of the world, from France to Mexico to China. With the right touch they could become a delicious part of your diet too.

2. Fish, shellfish, meat, eggs and dairy
Non-organ animal products are probably the second most nutritionally-dense group.
Beef is a truly complete source of protein – many so-called “carnivore” dieters appear to thrive essentially on beef alone! Ribeyes, which have a wonderfully delicious blend of lean and fat, contain plenty of vitamin B12 and minerals like iron, zinc, selenium and phosphorus.

Chicken eggs are close to nature’s ‘perfect food’ as they might be the single best source of protein – and it’s not just the egg whites. There’s something about eating the whole egg that improves muscle protein synthesis better than eating the same amount of protein alone. Eggs are an excellent source of pantothenic acid and choline.

Full-fat dairy such as blue vein cheese has a respectable overall nutrient density score and is a great source of protein. Interestingly, its healthy fat profile and high levels of fat-soluble vitamin K2 are thought to be responsible for full-fat dairy’s apparent protection from heart disease.

We’ve all heard that we should be eating more seafood, so it should come as no surprise to hear that fish like salmon are near the top of the nutrient-density charts. Salmon, one of the most popular varieties of rich, fatty fish, is a great source of the active forms of omega-3s (DHA and EPA). It also has lots of the active form of vitamin D3 (cholecalciferol), which helps maintain overall good health and strong bones. Other vitamins found in salmon are B3 (niacin), B5 (pantothenic acid) and B6 (pyridoxal 5’-phosphate).

Shellfish are also replete with nutrients. Clams are another excellent source of complete protein, and are rich in minerals like selenium, zinc and contain a lot of cobalamin (vitamin B12). Like many shellfish, they have a slight carbohydrate content, about 6 g of carbs for 10 small clams, a sizeable helping.

3. Green leafy vegetables, fruit and legumes
There’s a big drop in the average nutrient density of foods from group #2 to group #3.
Why do animal foods dominate the top of the list? This actually makes sense: animals harvest the nutrients from their food and masterfully concentrate them in their own bodies, converting nutrients from plants (and bacteria!) into their active forms. Also, animal foods are mostly made from the essential macronutrients fat and protein. Carbohydrate, the third macronutrient, is not actually essential. Animal foods also contain virtually all the essential micronutrients humans require to live.
Plant foods can certainly fit into a healthy, nutrient dense diet, although on their own (as in vegan diets) supplements become crucial. In practice it’s difficult to eat enough of even the most nutritionally dense vegetables, because they contain comparatively so little energy and nutrition in each mouthful.

Leafy green vegetables tend to contain the most nutrients, pound for pound, in virtue of being very low calorie. Kale contains quite a bit of the mineral manganese and vitamin C, both of which are hard to find in animal foods. Avocados are rich in the mineral potassium which helps normalize blood pressure, as well as vitamin B5 (pantothenic acid). Although avocados are known for their vitamin E content, it’s mostly in the inactive form (?-tocopherol). Only a small fraction can be converted into the active form (?-tocopherol).

You might be surprised to see that fruits are generally less nutritionally dense than commonly supposed. Typically, it is the less sweet fruits that are closer to their natural wild forms that pack in the most nutrients: blackberries and raspberries are good examples. Lemons are also a very low-sugar fruit, with lots of vitamin C.

Legumes aren’t good low-carb options, generally speaking, because of their high carbohydrate content. With some portion control, however, they can be incorporated into a healthful lower-carbohydrate diet. Consuming them after meat and greens lowers glycaemic excursions and can be a helpful technique for managing postprandial blood sugar levels.

One thing to note about legumes is that they contain a large number of anti-nutrients. Anti-nutrients are plant compounds that inhibit they body’s ability to absorb essential nutrients such as zinc, magnesium, potassium, iron and calcium. Because a typical nutrient density score does not factor in the effect of anti-nutrients, legumes may realistically be less nutrient dense than the Nutrition Facts label would have you believe.

Lima beans and black soybeans are some of the lower-carb legumes. They have similar nutritional profiles, with fair amounts of copper, manganese and magnesium.

The Least Nutritious Foods

The worst offenders are added sugar, flours, and high omega-6 seed oils. They should be avoided for three reasons.

First, they have terrible nutritional profiles, and are truly lacking in important micronutrient content. Flour, for example, needs to be fortified in order to avoid frank nutrient deficiencies. Second, they take up a large percentage of calories in the average diet and thus usually displace more nutrient dense options. Third, they interfere with normal metabolic responses and commonly induce chronic inflammation.

By eliminating the least nutritious foods, and focusing on nutrient-dense options, you increase your odds of being nutritionally sufficient. Fuelling your body with what it needs while avoiding blood sugar swings is a win for diabetes management.

https://asweetlife.org/the-most-nutrient-dense-low-carb-foods/?utm_source=ASweetLife.org+List&utm_campaign=464f8fa945-ASweetLife+Weekly+Update++-+Nov.+14%2C+2017_COPY_01&utm_medium=email&utm_term=0_5125b14cf8-464f8fa945-413392997

Type 2 diabetes symptoms: Loss of reflexes in this body part could be a sign of condition

From express.co.uk

TYPE 2 diabetes results in serious health complications if left untreated. Allowing blood sugar levels to build-up in the body for too long can cause nerve damage, among other things, so it is important to be aware of the tell-tale sign that indicates when medical intervention is needed.

Type 2 diabetes occurs when people are resistant to insulin – either the pancreas doesn’t make enough of the hormone or cells don’t respond to it. Diabetes UK says complications can begin five to six years before people find out they have type 2 diabetes.

So it’s very important to know what to look out for.

Persistent high levels of blood sugar (glucose) levels in the bloodstream can lead to nerve damage.
When this occurs, the medical name for the type 2 diabetes complication is diabetic neuropathy.
Nerves are essential for our body to be able to communicate.

To demonstrate, nerves carry messages between the brain and every part of our bodies – enabling us to see, hear, feel and move.
The bundle of fibres (nerves) also send signals to the heart, to help control heart rate and the lungs.
High blood sugar weakens the walls of small blood vessels (capillaries) that supply the nerves with oxygen and nutrients.
When nerves are starved of vital components, they become damaged.

                        Type 2 diabetes can have serious health complications (Image: Getty)

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) reported that around half of people with diabetes have neuropathy.
Signs of diabetic neuropathy usually take several years to appear, with the loss of reflexes in the ankle being one alarming symptom.
There are four main types of diabetic neuropathy: peripheral, autonomic, radiculoplexus and mononeuropathy.

Peripheral neuropathy

Peripheral neuropathy is the most common type of diabetic neuropathy and affects the feet and legs first, followed by the hands and arms.

Symptoms of the complication tend to be worse at night, which include:

• Numbness or reduced ability to feel pain or temperature changes
• Tingling or burning sensation
• Sharp pains or cramps
• Increased sensitivity to touch — for some people, even the weight of a bedsheet can be painful
• Muscle weakness
• Loss of reflexes, especially in the ankle
• Loss of balance and coordination
• Serious foot problems, such as ulcers, infections, and bone and joint pain

Autonomic neuropathy

Autonomic neuropathy denotes the nerves within the autonomic nervous system – that controls your heart, bladder, stomach, intestines, sex organs and eyes – have been affected.
This leads to a whole array of consequences, which can be:

• A lack of awareness that blood sugar levels are low
• Bladder problems
• Constipation, uncontrolled diarrhoea or both
• Slow stomach emptying (gastroparesis), causing nausea, vomiting, bloating and loss of appetite
• Difficulty swallowing
• Increased or decreased sweating
• Problems controlling body temperature
• Changes in the way your eyes adjust from light to dark
• Increased heart rate at rest
• Sharp drops in blood pressure after sitting or standing that may cause you to faint or feel lightheaded
• Erectile dysfunction
• Vaginal dryness
• Decreased sexual response

Radiculoplexus neuropathy (also known as diabetic amyotrophy)

Radiculoplexus neuropathy affects the nerves in the thighs, hips, buttocks or legs.
Usually, symptoms occur on one side of the body but, sometimes, it can spread to the other side. Symptoms include:

• Severe pain in a hip and thigh or buttock that occurs in a day or more
• Eventual weak and shrinking thigh muscles
• Difficulty rising from a sitting position
• Abdominal swelling, if the abdomen is affected
• Weight loss

Mononeuropathy (in other words, focal neuropathy)

Mononeuropathy is specific nerve damage in the face, torso or leg.
Commonly, this type of diabetic neuropathy can strike suddenly and can cause severe pain.

      Nerve damage is a type 2 diabetes complication called diabetic neuropathy (Image: Getty)

The painful sensation can be felt in the shin or foot, lower back or pelvis, front of thigh, chest or abdomen.
This sort of diabetic neuropathy can also lead to the following:

• Difficulty focusing
• Double vision
• Aching behind one eye
• Paralysis on one side of your face (Bell's palsy)

The best way to avoid this diabetic complication in the first place is to visit your GP to check blood sugar levels.
The sooner diabetes is under control, the better the chances of living with diabetes without further health complications, such as diabetic neuropathy.

https://www.express.co.uk/life-style/health/1239892/Type-2-diabetes-symptoms-loss-of-ankle-reflexes-diabetic-neuropathy-types

Smart Insulin Patch Could Revolutionize Diabetes Treatments

From biospace.com

A smart insulin device under development could revolutionize how glucose levels are monitored in diabetes patients and deliver insulin doses when necessary.

Researchers from University of California, Los Angeles (UCLA), the University of North Carolina and Massachusetts Institute of Technology (MIT) are working on an adhesive patch, about the size of a quarter, and are planning to take their device and move it into human studies soon. The scientists have published their preclinical research conducted on mice and pugs in Nature Biomedical Engineering. A statement from UNC notes that the research team is seeking approval from the U.S. Food and Drug Administration to advance the study into human trials.

Zhen Gu, a professor of bioengineering at the UCLA Samueli School of Engineering, said in a statement that the goal of the project, which began in 2015, is to “enhance health and improve the quality of life for people who have diabetes.” The patch is intended to remove the need for diabetes patients to constantly check their blood sugar levels and then take insulin when needed. Gu said the patch “mimics the regulatory function of the pancreas” but remains easy for patients to use.

The experimental patch monitors glucose levels and has doses of insulin pre-loaded in micro-needles. The microneedles are made with a glucose-sensing polymer that's encapsulated with insulin. Each microneedle penetrates about a half millimetre below the skin, which is sufficient to deliver insulin into the body. When applied, the microneedles penetrate under the skin and can sense blood sugar levels. As the researchers describe, when glucose levels reach a certain threshold, the insulin is released. When the blood sugar levels return to normal, the insulin delivery slows. The researchers said this is designed to ensure there is not an overdose of insulin, which can lead to hypoglycaemia, seizures, coma or even death.

In the experiments, one quarter-sized patch successfully controlled glucose levels in pigs with type I diabetes for about 20 hours, the researchers said. The pigs weighed about 55 pounds on average.
John Buse, director of the UNC Diabetes Centre, said having an insulin-delivery device in a “smart and convenient manger” has always been a dream.

“This smart insulin patch, if proven safe and effective in human trials, would revolutionize the patient experience of diabetes care,” Buse said in a statement.

If the FDA accepts the application to begin testing the patch in humans, the research team said trials could begin within the next few years. The team believes that the smart microneedle patch could be used beyond diabetes. The researchers believe it could be adapted with different drugs to manage other medical conditions as well.

https://www.biospace.com/article/researchers-develop-coin-sized-smart-insulin-patch-as-potential-treatment-for-diabetes-patients/

Yale studies suggest new path for reversing type-2 diabetes and liver fibrosis

From news.yale.edu

In a pair of related studies, a team of Yale researchers has found a way to reverse type-2 diabetes and liver fibrosis in mice, and has shown that the underlying processes are conserved in humans.
The studies appear in the Feb. 4 edition of Cell Reports and in the Jan. 17 edition of Nature Communications.

In the earlier study, researchers found an important connection between how the body responds to fasting and type-2 diabetes. Fasting “switches on” a process in the body in which two particular proteins, TET3 and HNF4a, increase in the liver, driving up production of blood glucose. In type-2 diabetes, this “switch” fails to turn off when fasting ends, as it would in a non-diabetic person.

Researchers hypothesized that if they could “knock down” the levels of these two proteins, they could stop diabetes from developing. Yingqun Huang, M.D., Yale associate professor in Obstetrics, Gynaecology, and Reproductive Sciences and her team injected mice with genetic material known as small interfering RNAs (siRNAs) packaged inside viruses that targeted TET3 or HNF4a. They found that blood glucose and insulin dropped significantly — effectively stopping diabetes in its tracks. 

                                                           (© stock.adobe.com)

In the Feb. 4 Cell Reports study, researchers looked at how TET3 contributed to the development of fibrosis in the liver, and found that the protein was involved in fibrosis on multiple levels. Almost all fibrosis, regardless of the organ involved, starts from abnormal protein signalling, Huang said.

She and colleagues discovered that TET3 plays a role in the fibrosis signalling pathway in three different locations — and acts as an important regulator in fibrosis development. This means there are likely opportunities to develop drugs that inhibit TET3 to slow or reverse fibrosis, said Da Li, associate research scientist in genetics and co-author on both studies.

Both diseases — type-2 diabetes and fibrosis of the liver and other organs — are common, but have few treatment options. Around 28 million people in the U.S. have type-2 diabetes, characterized by high blood sugar levels, a condition that can lead to many other health problems, including heart disease, stroke, and kidney failure.

Cirrhosis is one of the leading causes of death worldwide and is marked by liver fibrosis — a build-up of scar tissue on the liver, said co-author James Boyer, M.D., professor and emeritus director of the Yale Liver Centre.

Researchers noted that several drugs, such as metformin, are currently available to control blood sugar levels in patients with diabetes. But these have a range of unpleasant side effects, and patients can develop resistance to these drugs.

And there is little medical relief for fibrosis sufferers.

“Right now, there are no effective drugs for the treatment of fibrosis,” said Xuchen Zhang, M.D., associate professor in pathology and co-author on the fibrosis study.
Huang has filed for a patent related to her discoveries with support from the Yale Office of Cooperative Research.

The next step, she said, will be to identify where to best target TET3 and HNF4a and to develop the most effective siRNAs or small molecules to treat type-2 diabetes or fibrosis.

Both studies were supported by the National Institute of Diabetes and Digestive and Kidney Diseases at the U.S. National Institutes of Health.

https://news.yale.edu/2020/02/04/studies-suggest-new-path-reversing-type-2-diabetes-and-liver-fibrosis

Take back control of your life: Living with Type 2 diabetes

From mirror.co.uk/lifestyle

It's predicted that more than 5m people will have Type 2 diabetes in the UK by 2025 with 10% of the entire annual NHS budget spent on the disease

According to the International Diabetes Federation, more than 400 million people around the globe already have diabetes.
Of  this figure, around 90 per cent will have Type 2.

If nothing changes, more than five million people will have diabetes in the UK by 2025.
Here in the UK, Type 2 diabetes already soaks up a whopping 10% of the entire annual NHS budget – equivalent to an astonishing £1.5million an HOUR.
But how has a condition which was only properly identified and named little more than a century ago come to be such an enormous threat to our health?
And more importantly, what can you do to protect yourself against this rising epidemic?

What exactly is diabetes?
Around 10% of all diabetes cases are due to Type 1, a condition brought on by a malfunctioning immune system, often
in childhood.
Type 1 is largely random, usually striking because a mild infection has sent the immune system haywire, although those with a family history of the illness are more at risk.
Although the numbers affected are rising, the rate of increase is comparatively slow – about 3% a year.
The big problem is Type 2 diabetes, an altogether different form of the illness which is more commonly associated with obesity, poor diet and sedentary lifestyles.

           Type 2 diabetes can be prevalent in those who struggle with their weight (stock photo)                                                                (Image: Getty Images/Blend Images)

“Type 2 diabetes is now an epidemic and we are extremely concerned at the rate at which it’s increasing,” says Natasha Marsland, senior clinical adviser at the charity Diabetes UK.
“Around 3.8 million people in Britain have been diagnosed, but it’s estimated that another million or so also have it but do not realise it.”
In both types of diabetes, the body loses its ability to make use of glucose, a type
of sugar released when we eat food which is turned into a source of energy for
the muscles.

The F word
To get into the muscles, glucose needs insulin, a hormone produced by the pancreas – a large gland just behind the stomach. Insulin acts a bit like a key that unlocks the door into muscle cells, so that glucose can be taken on as fuel.
Type 2 is caused when excess fat ­interferes with the mechanism of this lock. The pancreas senses the insulin it is producing is not being used effectively and tries to compensate by making even more of the hormone.
This can go undetected for years until the pancreas becomes exhausted and can no longer produce enough, or any, insulin.

Meanwhile, blood glucose levels rise, which can affect circulation and cause ­irreversible damage to vital vessels all over the body.
Left untreated, Type 2 can raise the risk of heart attacks, blindness and amputation. In fact, it is the most common reason for limb removal in the UK and the numbers are soaring.

The reason for this is that high glucose levels restrict blood flow to the feet and lower legs – where blood vessels are smaller and narrower.

The tiniest cut or scratch can then turn into a gaping wound that will not heal because ­insufficient oxygen-rich blood is reaching it to kick-start the repair process.
“A lot of people, including some doctors, have this misperception that Type 2 is not as serious as Type 1, when in fact it’s just as dangerous,” says ­Marsland.
“The tragedy is many cases could be prevented with the right advice and support on how to live a healthy lifestyle.”

Now studies show that obesity is the main driving force behind the global spread of the disease.
An estimated 80% of Type 2 cases are directly connected to excess weight.
When doctors assess a patient’s risk, they test for impaired glucose tolerance – a sign that blood sugar levels are higher than normal – and measure the body mass index.
This is a calculation that takes account of weight compared to height.

For patients of white or Caucasian origin, a BMI score of 30 (officially obese) ­indicates you’re at serious risk and in the need for lifestyle changes, such as a healthy diet and more exercise.
An example would be a man who is 5ft 10in and weighs 15st.
But for patients of South Asian origin – who are genetically more susceptible to the effects of diabetes – the BMI warning flag starts to fly at a score of just 23, or a 5ft 8in man weighing 11st. But BMI is not a perfect alarm system as it doesn’t measure actual body fat levels.
This is why, for example, strong, fit rugby players can be classed as obese – they are large, but much of that bulk is muscle, not fat.

Hidden dangers
Instead, a more accurate indication of diabetes risk is what doctors call visceral fat – hidden fat that lies around the heart, liver, kidneys and pancreas.
Visceral fat is thought to be a major factor in the 20% or so of Type 2
cases where patients appear to be relatively slim and don’t consider themselves to be at risk.

One indicator of visceral fat is a spare tyre – or pot belly in men – which points to a build-up of fat in the abdomen.
But if you are slim and your waistline is not necessarily bulging, how would you know if diabetes is setting in?
“There are many patients who are not overweight but have abdominal fat sitting around the pancreas,” says ­Marsland.

                                          Woman using a diabetes test kit (Image: Getty)

“They need to look out for other ­symptoms, such as increased thirst, fatigue, urinating more often than usual and genital itching – all these symptoms can be signs of Type 2.
“Some patients end up walking around for 10 years with the disease before they actually get diagnosed.”

Now there is a major push to catch patients before they get to this stage.
Scientists have identified a condition called “pre-diabetes”, where blood sugar levels are high but full-blown Type 2 diabetes has not yet developed.

At this point, experts say, simple ­lifestyle changes such as a healthier diet, increased physical activity and weight loss can stop diabetes in its tracks.
“Our blood sugar levels tend to creep higher as we age,” says Marsland.
“So it’s very ­important that this is picked up early enough to do ­something about it.

“Exercise helps because it makes the body more sensitive to insulin and this will help to reduce the amount of sugar in your blood. “But this doesn’t mean you have to run marathons to improve your health.
“Instead, it’s much better to set ­yourself realistic goals that you know you can achieve, rather than unrealistic ones that are probably out of reach.”

https://www.mirror.co.uk/lifestyle/health/take-back-control-your-life-21415833

Could resetting our internal clocks help control diabetes?

From innovations-report.com

Researchers from UNIGE and HUG were able to demonstrate the link between disturbances of the circadian clocks in pancreatic cells and type 2 diabetes, then to correct these disturbances

The circadian clock system (from Latin "circa diem", about a day) allows the organisms to anticipate periodical changes of geophysical time, and to adjust to these changes. Nearly all the cells in our body comprise molecular clocks that regulate and synchronize metabolic functions to a 24-hour cycle of day-night changes.

Today, increasing evidence show that disturbances in our internal clocks stemming from frequent time zone changes, irregular working schedules or ageing, have a significant impact on the development of metabolic diseases in human beings, including type-2 diabetes.

Such disturbances seem to prevent the proper functioning of the cells in the pancreatic islet that secrete insulin and glucagon, the hormones that regulate blood sugar levels. By comparing the pancreatic cells of type 2 diabetic human donors with those of healthy people, researchers at the University of Geneva (UNIGE) and at the University Hospitals of Geneva (HUG), Switzerland, were able to demonstrate, for the first time, that the pancreatic islet cells derived from the Type 2 Diabetic human donors bear compromised circadian oscillators.

A Langerhans Islet with insulin-producing cells (in green), and glucagon-producing cells (in red). Cell nuclei in blue.
Credit: © UNIGE , Dibner Lab

The disruption of the circadian clocks was concomitant with the perturbation of hormone secretion. Moreover, using clock modulator molecule dubbed Nobiletin, extracted from lemon peel, the researchers succeeded in "repairing" the disrupted cellular clocks and in partial restoring of the islet cell function. These results, published in the Proceedings of the National Academy of Sciences of the United States, provide a first insight into innovative approach for diabetes care.

Two years ago, the team led by Charna Dibner, Principle Investigator in the Departments of Medicine and of Cell Physiology and Metabolism, and Diabetes Centre at UNIGE Faculty of Medicine, and at HUG, has already shown that in rodents the perturbation of pancreatic cellular clocks led to disrupted insulin and glucagon secretion, thus promoting the onset of diabetes. But what is the situation in human beings?

"We had also previously observed that if the clocks of human pancreatic cells were artificially disrupted in the cellular culture in vitro, secretion of the key islet hormones - insulin and glucagon - was compromised,» says Volodymyr Petrenko, a researcher in Dr. Dibner's lab and the first author of these publications. Hence our next step, that we report here, was to unravel whether the circadian rhythms were perturbed in human pancreatic islets in type 2 diabetes, and, if so, how would this perturbation affect the islet function."

Using combined bioluminescence-fluorescence time-lapse microscopy, a technology that allows tracking the molecular clock activity in living cells very precisely over time, the scientists compared the behaviour of pancreatic cell of type-2 diabetic donors and those of healthy subjects throughout the day.

"The verdict is indisputable", says Charna Dibner. The biological rhythms of the islet cells in type-2 diabetes exhibit both reduced amplitudes of circadian oscillations and poor synchronization capacity. «As a result, hormone secretion is no longer coordinated. Moreover, the defects in temporal coordination of insulin and glucagon secretion observed in patients with type-2 diabetes were comparable to those measured in healthy islet cells with artificially-disrupted circadian clock."

It's all in the timing!

Circadian clocks represent the daily cycles governing the various cellular functions. There are several interlocking levels of synchronization of these clocks, the main one being light, which in particular regulates the central clock located in the cerebral hypothalamus. Like a conductor in the orchestra, it regulates peripheral clocks present in organs and cells. The latter are therefore partly centrally regulated, but function differently in each organ, and even in each cell, depending on their functions.

"Pancreatic cells are also subject to the rhythm of fasting and food intake, and to a tight hormonal regulation", says Charna Dibner. "Coordinating all levels of regulation therefore allows the optimization of metabolic functions. Clocks deregulation in pancreatic islet leads to a compromised function: they are not anymore anticipating food-derived signals. Indeed, if you eat the same food but at night rather than during the day, you may gain weight much faster, due to a suboptimal response of your metabolism."

Setting the right time again

Step two of their research: the Geneva scientists used Nobiletin, a small clock modulator molecule - a natural ingredient of lemon peel whose impact on circadian clocks has been recently discovered - in order to resynchronize the clocks. "By acting on one of the core-clock components, it resets efficiently the amplitude of the oscillations in the human islets" says Volodymyr Petrenko. "And as soon as we got the clocks back in sync, we also observed an improvement in insulin secretion."

"This is the first proof of principle that repairing compromised circadian clocks may help improving the function of the pancreatic islet hormone secretion", says Charna Dibner. "We will continue by exploring this repair mechanism in vivo, first in animal models. Our society experiences epidemic growth in metabolic diseases, concomitant with shifted working and eating schedules, and lack of sleep. By re-synchronizing the perturbed molecular clocks, either by personalized eating and exercise schedules or with the help of clock modulator molecules, we hope to ultimately be able to provide an innovative solution to an epidemical metabolic problem affecting an ever-increasing proportion of the world's population."

https://www.innovations-report.com/html/reports/medicine-health/could-resetting-our-internal-clocks-help-control-diabetes.html