Recipe: Keto Quiche Lorraine Muffins

From asweetlife.org

The quiche made famous by Julia Child now comes in a portable keto form! These easy egg muffins have all the classic flavour, and a great for on-the-go breakfasts. Make them ahead and have them ready to heat up easily in the morning. And at only 1.5g of carbs per muffin, you can have two!

Ingredients

• 4 slices bacon, chopped
• ¼ cup chopped white onion
• ½ tsp salt
• ¼ tsp ground pepper
• ½ tsp dried thyme
• 4 large eggs
• ¼ cup heavy cream
• ½ cup shredded gruyere cheese
• Pinch ground nutmeg

Instructions

1. Preheat the oven to 375 and line 6 muffin cups with silicone liners (or grease the muffin pan very well).
2. In a medium skillet over medium heat, cook the chopped bacon until crisp. Using a slotted spoon, transfer to a mixing bowl.
3. Add the onion to the bacon grease and sprinkle with salt, pepper, and thyme. Lower the temperature and cook until the onion is translucent, about 3 minutes. Transfer to the bowl.
4. Add the eggs and heavy cream, and whisk until well combined, then stir in the cheese and nutmeg.
5. Divide the mixture evenly among the prepared muffin cups and bake 15 to 20 minutes, until completely set. Remove and let cool at least 10 minutes before serving.

Yield: 6

Food energy: 200 kcal

Total fat: 16.07g

Carbohydrate: 1.56g

Protein per serving: 9.09g

Total dietary fibre: 0.14g

https://asweetlife.org/keto-quiche-lorraine-muffins/?utm_source=ASweetLife.org+List&utm_campaign=3cbac35465-ASweetLife+Weekly+Update++-+Nov.+14%2C+2017_COPY_01&utm_medium=email&utm_term=0_5125b14cf8-3cbac35465-413392997

FDA approves first triple combination pill for type 2 diabetes

From healio.com

The FDA on Monday approved the first oral therapy to combine three type 2 diabetes medications into one pill: the SGLT2 inhibitor empagliflozin, the DPP-IV inhibitor linagliptin and metformin hydrochloride extended release, according to a press release from Boehringer Ingelheim and Eli Lilly and Co.

The triple combination therapy (Trijardy XR) is approved to lower blood glucose for adults with type 2 diabetes along with diet and exercise.

“Many adults living with type 2 diabetes who are already on a treatment plan including multiple medications still struggle to keep their blood sugar under control, and may require additional agents to reach their [HbA1c] targets,” Ralph A. DeFronzo, MD, director of the diabetes research unit at the University of Texas Health Science Centre at San Antonio, said in the release. “Adding new medicines to an individual’s plan can be challenging for some, which is why new treatment options that can help improve blood sugar without the burden of an increased pill count are important. In addition, type 2 diabetes is a complex disease that often requires the use of multiple antidiabetic medications to improve glycaemic control. Having three different diabetes medications in a single tablet is an important advance in diabetes treatment.”

In the U.S., empagliflozin (Jardiance, Boehringer Ingelheim/Eli Lilly) and linagliptin (Tradjenta, Boehringer Ingelheim/Eli Lilly) are both once-daily tablets also approved to lower blood glucose for adults with type 2 diabetes. In 2016, the FDA approved a new indication for empagliflozin to reduce the risk for cardiovascular death among adult patients with type 2 diabetes and CVD. In June, the FDA granted fast track designation to empagliflozin for the reduction of risk for CV death and hospitalization for heart failure in people with chronic heart failure.

In findings from the CARMELINA trial presented at the American Diabetes Association Scientific Sessions in June and reported by Healio, researchers found that linagliptin did not increase risks for a new CV event or progression of renal disease among adults with type 2 diabetes, established CVD and renal impairment vs. placebo, regardless of age or the level of renal impairment. Additionally, a head-to-head comparison of the sulfonylurea glimepiride against linagliptin in a cohort of more than 6,000 adults with type 2 diabetes demonstrated no between-group differences for incidence of nonfatal myocardial infarction, nonfatal stroke and CV death during a median of 6 years, according to data from the CAROLINA trial, also reported at ADA.

https://www.healio.com/endocrinology/diabetes/news/online/%7B8ed9d16d-7185-431c-a413-f80bd53fdc68%7D/fda-approves-first-triple-combination-pill-for-type-2-diabetes

Signs Your Type 2 Diabetes is Getting Worse (And What to do About it)

From counselheal.com

Diabetes is a life-altering disease that impacts millions of people around the world. While it is a manageable condition with the right treatment plan, most fail to stick to it causing their health to get worse. Others, unfortunately, have no idea that they have diabetes and continue to live life as they always have. When blood sugar levels aren't carefully monitored and controlled, however, it can lead to a number of problems such as those listed below: 

High Blood Sugar Levels

One of the most obvious signs that your diabetes is out of control or getting worse is high blood sugar levels. When your glucose levels stay high on a regular basis, this is a tell-tale sign that you need to seek medical assistance.


How do you know when your blood sugar levels are too high? It is best to utilize a blood glucose monitor before and two hours after having a meal. If the numbers are consistently higher than 70-130 mg/dl and 180 mg/dl two hours later there are a few things you should do. First, contact your primary care physician to get the right dosage of insulin. Then, you may need to speak with a nutritionist to learn how to eat a diet that helps to keep your blood sugar levels under control.

Increased Infections

High blood sugar levels can increase a person's ability to develop infections. You may notice that you're having more ear infections, yeast infections, or urinary tract infections than usual. As infections are nothing to play around with, the first thing you want to do is get to your doctor to get some antibiotics. The longer you go without treatment, the higher your chances are of needing an amputation or developing sepsis which can be life-threatening. Take the antibiotics as prescribed and then work with your doctor to come up with an effective treatment plan and lifestyle changes going forward to better manage your diabetes.

Vision Problems

Over time, diabetes can wreak havoc on your eyes causing a number of problems. This is especially true for individuals who do not properly care for their diabetes. Essentially, uncontrolled diabetes can lead to what is known as diabetic eye disease. This is a group of eye diseases like cataracts, glaucoma, and more which can impair your vision. If you start noticing issues with your ability to see and you suffer from diabetes, it is imperative that you visit an ophthalmologist to get an exam and to discuss possible surgeries or treatment options to prevent the condition from getting worse.

Kidney Problems

High glucose levels can damage red blood vessels throughout the body and vital organs such as the kidney. When this happens kidney disease can develop. Signs of kidney disease might include a sudzy urine, pain in the lower back region, blood in the urine, or intense urinary tract infections. While some damage may already be done by the time you start experiencing these signs, you don't want to hold off getting medical treatment for your diabetes and kidney disease to prevent the matter from getting worse.

Numbness or Tingling Sensations

Prolonged high blood glucose levels can ultimately lead to nerve damage throughout the body. While it can happen anywhere, most people report numbness or tingling sensations in the hands and feet. This is often diagnosed as diabetic neuropathy which is a condition that can get progressively worse with time impacting daily function. Though the nerve damage cannot be reversed, there are things patients can do to prevent it from getting worse. This includes managing their blood sugar levels, taking medications as prescribed, managing their weight, taking care of their feet, eating a healthy diet, incorporating physical activity, and quitting bad habits like smoking which only makes nerve damage and pain worse.

Millions of people around the world are suffering from diabetes. There are those that become aware of the diagnosis and strive to make the necessary lifestyle changes to keep it under control and those who either undiagnosed or ill-informed on how to cope with or manage their diabetes. The ladder, unfortunately, end up suffering from conditions like those described above and more. To prevent things from getting worse, it is important to get informed, develop a treatment plan, and make the necessary lifestyle changes to keep your blood sugar levels under control.

https://www.counselheal.com/articles/40369/20200125/signs-your-diabetes-is-getting-worse-and-what-to-do-about-it.htm

Recipe: Low Carb Thai Pork Salad

From asweetlife.org

In this exciting low carb Thai recipe we take grilled pork and treat it more or less exactly as you might treat lettuce, slicing it thin and tossing it in a bowl with dressing and toppings. A meat salad: why not? This recipe is a hit at Los Angeles hotspot Night + Market, where it’s called Moo Sadong, or “Startled Pork,” suggesting that the pig itself is shocked at the intense flavours surrounding it.

Spicy, tangy, funky, punchy, it’s a classic Thai explosion of tastes.

Use the fattiest pork chops you can find – or even better, boneless pork shoulder chops. Grilling adds the perfect smoky touch to the dish, but searing or broiling in a pan is a fine substitution.

This dish serves four as a side dish or appetizer but you can easily increase the portions to have it as a main course. I’ve removed the sugar from the original recipe, and streamlined the process. The original recipe is quite sweet, and you can add some sweetener to the dressing, but I don’t think it’s necessary.

Ingredients

• 16oz fatty boneless pork chops
• salt
• 1 large shallot
• 2” lemongrass stalk, sliced very thin
• 1-2 small chilies, as spicy as you can handle
• ½ bunch cilantro
• ½ cup basil leaves (Thai basil if possible)
• 2 cloves garlic, peeled
• 2 tablespoons fish sauce
• 3 tablespoons lime juice
• 2 tablespoons avocado or other neutral oil
• 2 teaspoons crushed red pepper
• 1 teaspoon preferred sweetener (optional)

Instructions

1. Cut the shallot in half and divide. Cut the stems off the cilantro and reserve.
2. Combine half shallot and cilantro stems with garlic, fish sauce, lime juice, oil, dry chili and optional sweetener in a blender. Blend into a smooth dressing.
3. Salt pork and grill or sear over very high heat to develop a flavourful char. Pork cooked to the recommended temperature of 145°F will still be slightly pink inside. Let pork rest.
4. Meanwhile, slice remaining half shallot, chilies and lemongrass as thin as possible.
5. Roughly chop cilantro leaves. Roughly tear basil leaves.
6. Slice pork as thin as possible. Combine in a mixing bowl with all remaining ingredients: shallot, lemongrass, chilies, basil, cilantro, and dressing. Massage the dressing into the meat and serve on one large plate to share.

Yield: 4

Food energy: 380 kcal

Total fat: 32g

Carbohydrate: 4.7g

Protein per serving: 20g

Total dietary fibre: 1.6g

https://asweetlife.org/low-carb-thai-pork-salad/?utm_source=ASweetLife.org+List&utm_campaign=bf7453171b-ASweetLife+Weekly+Update++-+Nov.+14%2C+2017_COPY_01&utm_medium=email&utm_term=0_5125b14cf8-bf7453171b-413392997

Type 2 diabetes: The sign in your shoulder that could signal the chronic condition

From express.co.uk

TYPE 2 diabetes is a common condition yet many people in the UK will not realise they have it because the symptoms do not necessarily make you feel unwell. Symptoms are caused by consistently high blood sugar levels, and, overtime, this can affect different parts of the body, including the shoulder.

Type 2 diabetes is the direct result of either not producing enough insulin or not producing any at all. Insulin, which is produced by the pancreas, plays an essential role in regulating the body’s blood sugar levels and unregulated blood sugar levels poses a number of health concerns. If left untreated, uncontrolled blood sugar levels hike the risk of developing potentially irreversible complications, such as heart disease.

It is therefore vital that you know and act on the warning signs associated with high blood sugar levels and seek the appropriate treatment to stave off the risks.

One warning sign is frozen shoulder, also known as adhesive capsulitis, which occurs when ligaments around the shoulder joint swell and become stiff.

As Diabetes.co.uk explains, the inflammation of this tissue can make normal healing hard and result in your shoulder being so stiff that everyday activities can be troublesome, such as buttoning your shirt.
“Patients with frozen shoulder can ease their symptoms, but this can sometimes take several years,” notes the health site.

           Type 2 diabetes symptoms: Frozen shoulder is a sign of consistently high blood sugar levels                                                                          (Image: Getty Images )

How is frozen shoulder connected to diabetes?

Research has shown that people with diabetes are up to twice as likely to suffer from frozen shoulder.
Dr. Richard Bernstein, a pioneer in the field of diabetes, reports this is due to effects on collagen in the shoulder, which holds the bones together in a joint.
Collagen can become sticky if sugar molecules become attached, resulting in movement being restricted and the shoulder beginning to stiffen. This process is known as glycosylation.

As Diabetes.co.uk explains, poorly controlled diabetes has long been linked to muscular and skeletal problems, with consistently high blood sugars likely to increase the risk of complications such as frozen shoulder.

How to treat it

In the short-term, treatment for frozen shoulder focuses on controlling the pain and helping restore some movement. This can vary across levels of severity, explains Diabetes.co.uk.
Shoulder exercises and stretching is commonly advised to keep the shoulder from further stiffening, and anti-inflammatory painkillers may be advised to ease the pain, as well as ordinary painkillers such as codeine, says the health body.

“A steroid injection to reduce inflammation can provide relief from symptoms, while surgery may be considered when all other treatments are not helping,” it adds.

Long-term treatment involves overhauling your lifestyle to bring your high blood sugar levels under control.

There are two key aspects of blood sugar management: diet and exercise.

There's nothing you cannot eat if you have type 2 diabetes, but you'll have to limit certain foods to keep rising blood sugar levels at bay.
Foods with a high carbohydrate content pose the greatest risk to blood sugar levels because carbohydrates are broken down into blood sugar relatively quickly, causing blood sugar levels to soar.
Restricting your carb intake is therefore a necessary precaution and this is easily achieved by following the Glycaemic Index (GI).
The Glycaemic Index (GI) is a relative ranking of carbohydrate in foods according to how they affect blood glucose levels.
Carbohydrates with a low GI value (55 or less) are more slowly digested, absorbed and metabolised and cause a lower and slower rise in blood glucose and therefore insulin levels.
A food's GI ranking is usually displayed on the front of food packets in supermarkets to help you navigate this area.

The other key component is keeping physically active and you should aim for 2.5 hours of activity a week, according to the NHS.
You can be active anywhere as long as what you're doing gets you out of breath.
This could be:

• Fast walking
• Climbing stairs
• Doing more strenuous housework or gardening

https://www.express.co.uk/life-style/health/1230686/type-2-diabetes-symptoms-signs-frozen-shoulder-diet-exercise-lower-blood-sugar

Report: To reverse diabetes, surgical weight loss tops diet, exercise

From mercurynews.com

“The best option for medically uncontrolled type 2 and (obesity) is the Roux-en-Y gastric bypass”

People who have weight-loss surgery are more likely to achieve remission of diabetes than those who try to shed excess pounds by dieting and exercising, a recent study suggests.

Researchers randomly assigned 61 participants with type 2 diabetes to one of three weight-loss interventions: an operation known as Roux-en-Y gastric bypass; a type of surgery known as laparoscopic adjustable gastric banding; or an intensive weight-loss program focused on cutting calories and increasing exercise.

After five years, six people who got the Roux-en-Y procedures, or 30%, achieved partial or complete diabetes remission, compared with four people, or 19%, of the participants who had gastric banding, the study found. None of the people in the diet-and-exercise group achieved remission.

“Any degree of weight loss, even that achieved by non-surgical means (typically about 5% of starting weight as shown in this study), can be helpful in controlling health issues such as diabetes, lipids, and hypertension,” said Dr. Anita Courcoulas of the University of Pittsburgh Medical Centre, the study’s lead author.

“Nevertheless, the head-to-head comparison of lifestyle treatment versus surgical procedures, as in this study, shows (the) superiority of the surgical treatments for diabetes-control endpoints and weight loss,” Courcoulas said by email.

Laparoscopic adjustable gastric banding, also known as lap-band surgery, is a less-invasive procedure that involves placing an adjustable inflatable belt around the upper portion of the stomach. The band can be made of silicone and tightened by adding saline, and the effects are reversible. It effectively reduces the amount of food the stomach can hold, and people are advised to eat portions about the size of a shot glass post-surgery.

Roux-en-Y gastric bypass is a more invasive procedure in which a surgeon staples off the upper portion of the stomach and reroutes food to bypass the rest of the stomach and the small intestine. The working part of the stomach is reduced to the size of an egg, and this cannot be reversed.
Everyone in the study had type 2 diabetes, which is associated with aging and excess weight. Patients were 47 years old, on average, obese and living with dangerously elevated blood sugar levels.

Five years after the procedures, people who had the Roux-en-Y bypass surgery lost an average of 25% of their body weight, compared with about 13% with the lap-band and 5% in the group assigned to intensive lifestyle management.
In addition, 56% of the people who had Roux-en-Y procedures had stopped taking medications to manage diabetes by the end of the study, compared with 45% of the people who had laparoscopic adjustable gastric banding and none of the participants in the lifestyle group.

One limitation of the study is that researchers only tested one approach to diet and exercise for weight loss, and other approaches might have achieved different results, the study team notes in the Journal of Clinical Endocrinology & Metabolism. The study was also small, and done at a single medical centre, so results might differ with more people or in other locations.

Still, the findings add to evidence suggesting that surgical weight loss may be the best approach to achieving diabetes remission, said Dr. Michel Gagner of Herbert Wertheim School of Medicine at Florida International University in Miami.


“It decreases the overall caloric intake more efficiently and sustainably than just diets,” Gagner, who wasn’t involved in the study, said by email.

Patients with poorly controlled diabetes should consider surgery when they’re obese and unable to lower their blood sugar enough with medications, said Dr. Ricardo Cohen, director of the Centre for the Treatment of Obesity and Diabetes at Hospital Oswaldo Cruz in Sao Paulo, Brazil.

“The best option for medically uncontrolled type 2 and (obesity) is the Roux-en-Y gastric bypass,” Cohen, who wasn’t involved in the study, said by email.

https://www.mercurynews.com/2020/01/16/report-to-reverse-diabetes-surgical-weight-loss-tops-diet-exercise/

Diabetic retinopathy: Understanding diabetes-related eye disease and vision loss

From health.harvard.edu/blog

By Leo Kim, MD, PhD

Over 30 million people in the United States live with diabetes, and approximately 7.7 million people have diabetic retinopathy, making it the most common cause of vision loss in working-aged adults. The prevalence of diabetic retinopathy has increased significantly over the past 20 years, due to the rise in the number of people diagnosed with diabetes.

How does diabetes affect the retina?

The retina is the light-sensing component located in the back of the eye. It is composed of blood vessels, nerve cells (neurons), and specialized cells called photoreceptors that are involved in directly sensing light. The ability of the retina to sense light requires energy, which is dependent on the oxygen supplied by blood circulating through blood vessels.

In diabetes, elevated blood sugar levels damage the blood vessels of the retina. These damaged blood vessels leak fluid, bleed, and do not provide adequate oxygen to the retina, leading to retinal ischemia. As a result, retinal cells begin to die and the retina is unable to function properly. In addition, diabetes also damages the neurons of the retina directly. Together, these effects cause diabetic retinopathy.

Vision loss associated with diabetic retinopathy may initially affect central vision due to a condition called diabetic macular edema. This swelling of the macula, a portion of the retina responsible for sharp, central vision, can lead to blurry vision and distortion of images.

Advanced diabetic retinopathy is characterized by the formation of irregular blood vessels that can bleed inside the eye, causing a rapid loss of vision. This results in a sudden, curtain-like vision loss as blood fills up the inside of the eye. Further worsening of advanced diabetic retinopathy can lead to retinal detachment, which requires urgent surgical intervention and can result in permanent, irreversible vision loss if not promptly treated.

What can I do to prevent diabetic retinopathy?

The American Diabetes Association recommends that most people with diabetes keep their A1c level (a measure of average blood sugar levels over the previous two to three months) below 7% to prevent the risk of complications. As blood glucose directly damages retinal blood vessels, there is strong epidemiological evidence that blood sugar control translates to decreased incidence and severity of diabetic retinopathy.

In order to reduce the cardiovascular and microvascular complications of diabetes, which include retinopathy, nephropathy (kidney disease), and neuropathy (nerve damage), it is recommended that people achieve and maintain a normal blood pressure. Blood pressure reduction can delay the onset of diabetic retinopathy, but it is unclear if controlling blood pressure can alter the course of established diabetic retinopathy. Similarly, managing cholesterol is advocated for overall diabetes management, but it is not clear whether doing so reduces the risk of diabetic retinopathy.

How can I find out if I have diabetic retinopathy?

An ophthalmologist can diagnose and begin to treat diabetic retinopathy before sight is affected. In general, people with type 1 diabetes should see an ophthalmologist once a year, beginning five years after the onset of their disease. People with type 2 diabetes should see an ophthalmologist for a retinal examination soon after their diagnosis, and then schedule annual exams after that. You may need to see an ophthalmologist more frequently if you are pregnant or have more advanced diabetic retinopathy.

What can I do to prevent or slow down vision loss if I have diabetic retinopathy?

As mentioned above, damage to the blood vessels deprives the retina of oxygen. Insufficient oxygen leads to production of a signal protein called vascular endothelial growth factor (VEGF). VEGF and its role in eye disease were first discovered at Harvard Medical School.

Currently, there are medications that can bind VEGF and subsequently improve the symptoms of diabetic retinopathy. These “anti-VEGF” agents are injected directly into the eye and can improve diabetic macular edema, and can even improve the severity of diabetic retinopathy. In some people, steroids injected directly into the eye may also improve diabetic macular edema. In some advanced cases of proliferative diabetic retinopathy (the most advanced form of diabetic retinopathy), patients may require retinal laser therapy or retinal surgery to stop or slow bleeding and leakage, to shrink damaged blood vessels, or to remove blood and scar tissue.

https://www.health.harvard.edu/blog/diabetic-retinopathy-understanding-diabetes-related-eye-disease-and-vision-loss-2020011618394