I am diabetic

Do you have diabetes? Are you struggling to live with diabetes? Are you looking for information online about diabetes? Are you unsure as to what types of foods you should now be eating to help keep a check on your glucose levels? If you have answered yes to any of these questions this article may well be of interest and benefit to you.

Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. The cause of diabetes continues to be a mystery, although both genetics and environmental factors such as obesity and lack of exercise appear to play roles.

There are 20.8 million children and adults in the United States, or 7% of the population, who have diabetes. While an estimated 14.6 million have been diagnosed with diabetes, unfortunately, 6.2 million people (or nearly one-third) are unaware that they have the disease.

In order to determine whether or not a patient has pre-diabetes or diabetes, health care providers conduct a Fasting Plasma Glucose Test (FPG) or an Oral Glucose Tolerance Test (OGTT). Either test can be used to diagnose pre-diabetes or diabetes.

With the FPG test, a fasting blood glucose level between 100 and 125 mg/dl signals pre-diabetes. A person with a fasting blood glucose level of 126 mg/dl or higher has diabetes.

In the OGTT test, a person’s blood glucose level is measured after a fast and two hours after drinking a glucose-rich beverage. If the two-hour blood glucose level is between 140 and 199 mg/dl, the person tested has pre-diabetes. If the two-hour blood glucose level is at 200 mg/dl or higher, the person tested has diabetes.

Major Types of Diabetes

Type 1 diabetes
Results from the body’s failure to produce insulin, the hormone that “unlocks” the cells of the body, allowing glucose to enter and fuel them. It is estimated that 5-10% of Americans who are diagnosed with diabetes have type 1 diabetes.

Type 2 diabetes
Results from insulin resistance (a condition in which the body fails to properly use insulin), combined with relative insulin deficiency. Most Americans who are diagnosed with diabetes have type 2 diabetes.

Medications for Type 2 Diabetes

Sulfonylureas:
- GLUCOTROL XL (Glipizide)
- AMARYL (Glimepiride)

Meglitinides:
- PRANDIN (Repaglinide)
- STARLIX (Nateglinide)

Biguanides:
- GLUCOPHAGE (Metformin)

Thiazolidinediones:
- ACTOS (Pioglitazone)
- ACTOPLUS MET (Pioglitazone/Metformin)
- AVANDIA (Rosiglitazone)
- AVANDAMET (Rosiglitazone/Metformin)

Other medications:
- KARELA and DIABECON

Gestational diabetes
Gestational diabetes affects about 4% of all pregnant women - about 135,000 cases in the United States each year.

Pre-diabetes
Pre-diabetes is a condition that occurs when a person’s blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes. There are 54 million Americans who have pre-diabetes, in addition to the 20.8 million with diabetes.

Additional Information

Recently Diagnosed
You or someone you love has just been diagnosed with diabetes — chances are you have a million questions running through your head. This area of our Web site can help ease your fears and teach you more about living with diabetes or caring for someone with diabetes, and connect you with others affected by diabetes who will listen and share their own experiences.

Diabetes Symptoms
Often diabetes goes undiagnosed because many of its symptoms seem so harmless. Learn what they are in this section.

Diabetes Risk Test
More than 20 million Americans have diabetes — nearly one in three does not know it! Take our diabetes risk test to see if you are at risk for having diabetes. Diabetes is more common in African Americans, Latinos, Native Americans, Asian Americans and Pacific Islanders.

Diabetes Myths
Find the truth about some of the most common myths about diabetes.

The Genetics of Diabetes
You’ve probably wondered how you got diabetes. You may worry that your children will get it too. Unlike some traits, diabetes does not seem to be inherited in a simple pattern. Yet clearly, some people are born more likely to get diabetes than others.

By Andrew Stern Thursday, Apr. 10, 2008; 4:26 AM

CHICAGO (Reuters) - Aggressive use of drugs to lower cholesterol and blood pressure helped reverse heart disease in people with diabetes, U.S. researchers said on Tuesday.

The 3-year study of 499 Native American adults with type 2 diabetes showed that lowering blood pressure and cholesterol more than is usually recommended helped reverse thickening of the arteries and damage to the heart.

This is good news for everyone with diabetes, the researchers said — especially Native Americans, who have high rates of the disease.

“These patients are two to four times more likely than people without diabetes to die from heart disease,” said Dr. Elizabeth Nabel, director of the National Heart, Lung and Blood Institute.

“For the first time, we have evidence that aggressively lowering LDL cholesterol and blood pressure can actually reverse damage to the arteries in middle-aged adults with diabetes.”

But other experts said the study, published in the Journal of the American Medical Association, did not resolve the debate over how low to go.

Advocates of aggressive treatment with cholesterol-lowering statins and blood pressure drugs argue the lower, the better, though conclusive data to support that view is lacking, wrote Duke University’s Eric Peterson in a commentary.

“We know now that it’s important to control risk factors for heart disease in people with diabetes, yet we don’t know how far to aim,” said Barbara Howard, who conducted the U.S. government-funded study with colleagues at MedStar Research in Hyattsville, Maryland.

The group receiving standard care had targets of low density lipoprotein — “bad” LDL cholesterol — of 100 milligrams per deciliter or lower, and systolic blood pressure (the higher number when the heart contracts) of 130 or lower. Those treated more aggressively had targets of 70 milligrams of cholesterol and blood pressure level of 115 or lower.

Blood pressure and statin drugs were provided to patients by Merck and Co and Pfizer Inc.

Ultrasound measurements taken of the carotid artery in the patients’ necks — a reliable indicator of hardening or thickening of the arteries that is a precursor to heart disease — showed improvement in those treated aggressively with statins.

“We found that in the aggressive group there was actually a reduction in the thickness of the vessel in the neck as compared to the standard group whose neck vessels got a little bit worse … That has not been seen in most studies,” Howard said.

Measures of the heart’s main pumping chamber found enlargement at the beginning of the study — a sign of potential heart trouble — was reduced by the blood pressure drugs, and shrinkage was greater in the aggressive group.

Howard predicted the observed changes would lead to fewer heart attacks and strokes among aggressively treated patients.

The study did not last long enough to find such a difference, though patients will continue to be tracked and additional research may draw a firmer conclusion.

Diabetes kills an estimated 284,000 people in the United States each year, up to 65 percent of them from heart and artery disease, according to the NHLBI.

Thursday, Apr. 10, 2008; 4:26 AM

WASHINGTON (Reuters) - Middle-aged men who ate seven or more eggs a week had a higher risk of earlier death, U.S. researchers reported on Wednesday.

Men with diabetes who ate any eggs at all raised their risk of death during a 20-year period studied, according to the study published in the American Journal of Clinical Nutrition.

The study adds to an ever-growing body of evidence, much of it contradictory, about how safe eggs are to eat. It did not examine what about the eggs might affect the risk of death.

Men without diabetes could eat up to six eggs a week with no extra risk of death, Dr. Luc Djousse and Dr. J. Michael Gaziano of Brigham and Women’s Hospital and Harvard Medical School found.

“Whereas egg consumption of up to six eggs a week was not associated with the risk of all-cause mortality, consumption of (seven or more) eggs a week was associated with a 23 percent greater risk of death,” they wrote.

“However, among male physicians with diabetes, any egg consumption is associated with a greater risk of all-cause mortality, and there was suggestive evidence for a greater risk of MI (heart attack) and stroke.”

They urged more study in the general population.

Eggs are rich in cholesterol, which in high amounts can clog arteries and raise the risk of heart attack and stroke.

One expert on nutrition and heart disease said the study suggests middle-aged men, at least, should watch how many eggs they eat.

“More egg on our faces? It’s really hard to say at this point, but it still seems, if you’re a middle-aged male physician and enjoy eggs more than once a day, that having some of the egg left on your face may be better than having it go down your gullet,” said Dr. Robert Eckel of the University of Colorado and a former president of the American Heart Association.

“But, remember: eggs are like all other foods — they are neither ‘good’ nor ‘bad,’ and they can be part of an overall heart-healthy diet,” Eckel wrote in a commentary.

The Harvard team studied 21,327 men taking part in the much larger Physicians’ Health Study, which has been watching doctors since 1981 who have agreed to report regularly on their health and lifestyle habits.

Over 20 years, 1,550 of the men had heart attacks, 1,342 had strokes, and more than 5,000 died.

“Egg consumption was not associated with (heart attack) or stroke,” the researchers wrote.

But the men who ate seven eggs a week or more were 23 percent more likely to have died during the 20-year period.

Diabetic men who ate any eggs at all were twice as likely to die in the 20 years.

Men who ate the most eggs also were older, fatter, ate more vegetables but less breakfast cereal, and were more likely to drink alcohol, smoke and less likely to exercise — all factors that can affect the risk of heart attack and death.

Yogurt is one of the few probiotic foods that Americans regularly eat. When we get enough probiotics — friendly bacteria that help to drive out their bad counterparts and some yeasts — we get a health benefit, according to a definition of the World Health Organization and the Food and Agriculture Organization of the United Nations cited by the U.S. Government’s National Center for Complementary and Alternative Medicine.

But we get little probiotic benefit from some of the yogurt we eat. Probiotic foods are fermented, and fermented foods don’t survive pasteurization. To get the probiotic benefit from yogurt we have to avoid any that say on the label that they were heat treated after culturing. This means that they were pasteurized, killing the active cultures.

Good yogurts have only active cultures and milk. But unless it’s plain yogurt, it probably has a lot of sugar.

The best yogurts also remove most, if not all, of the whey. Why?

Two reasons:

1. When they strain out the whey, the yogurt has less lactose, which is the sugar in milk products. Except for the water in whey, almost all of it is sugar, according to the USDA National Nutrient Database.

2. Whey spikes insulin levels in people with type 2 diabetes and in healthy people, according to a research report last year in The American Journal of Clinical Nutrition. Insulin spikes make us hungry, which may make us gain weight.

If that were not enough for me, I have been checking out a cholesterol-reducing program here in Boulder, Colorado. This program, BalancePoint Health, limits diary products to strained yogurt.

What we call “Greek-style yogurt” is the most commonly available strained yogurt in America. Four brands of Greek-style yogurt are on the market where I live. They have lower levels of carbohydrates — which raise our blood glucose levels and make us gain weight — than other types of yogurt.

The very best Greek-style yogurt is organic. But I’ve found only one brand of Greek-style yogurt that comes from organic farmers who don’t use antibiotics or artificial growth hormones. Stonyfield Farms products this Oikos organic yogurt. It’s readily available at both natural food stores and supermarkets.

Ever since I read The Four Corners Diet, four years ago, I have been eating more and more probiotic food (and less and less other food). Gretchen Becker, my friend and colleague, wrote that book with Dr. Jack Goldberg and Dr. Karen O’Mara.

In addition to yogurt, they emphasis the probiotic benefits of a drinkable yogurt called kefir, which may be even healthier, because it also contains friendly yeast. Buttermilk can also be probiotic, but only if it’s unpasteurized.

Aside from these dairy products, The Four Corners Diet, also mentions sauerkraut. This is the fermented vegetable that Americans are most likely to know, but unless the sauerkraut is raw (unheated) it won’t be probiotic.

But several recent food imports from Asia are also potent probiotics. These include miso, kimchi, and tempeh. All of these foods also have a prized place in my probiotic diet. But Greek-style yogurt remains my favorite.

Article by: David Mendosa.

Thursday, Apr. 10, 2008; 4:26 AM

NEW YORK (Reuters Health) - Impaired insulin response appears to be involved in the development of Alzheimer’s disease, according to findings from a long-term population-based study conducted in Sweden.

Dr. Elena Uronema and colleagues at Upscale University analyzed data for 2,269 men who underwent glucose (blood sugar) tolerance testing at 50 years of age. After a follow-up at an average of 32 years, 394 men developed dementia or mental impairments, including 102 with confirmed Alzheimer’s disease and 57 with confirmed vascular dementia.

A low insulin response to intravenous glucose at the beginning of the study was associated with a 30 percent higher risk of Alzheimer’s disease.

Ronne AA’s group notes that an impaired insulin response is a predictor of Alzheimer’s disease. The risk, however, was not statistically significant only from subjects negative for the high-risk APOE-4 gene.

In contrast, impaired glucose tolerance was associated with vascular dementia, but not Alzheimer’s disease.

Overall dementia and cognitive risk was associated with high fasting serum insulin, insulin resistance, impaired insulin secretion, and glucose intolerance in subjects without dementia.

The study findings stress the importance of short- term and insulin, both were associated with short- and long-term exposure in the normal brain,” researchers conclude.

SOURCE: Neurology, April 9, 2008. (Online)

Thursday, Apr. 10, 2008; 4:26 AM

NEW YORK (Reuters) - Clinical trials of the inhaled insulin Exubera found increased cases of lung cancer, Pfizer Inc and Nektar Therapeutics said on Wednesday.

Over the course of the clinical trials, Pfizer said 6 of the 4,740 Exubera-treated patients versus 1 of the 4,292 patients not treated with Exubera developed lung cancer. One lung cancer case was also found after Exubera reached the market.

Pfizer updated the Exubera labeling to include a warning with safety information about lung cancer cases found in patients who used Exubera, which U.S. regulators approved in January 2006.

The warning states all patients who developed lung cancer had a history of cigarette smoking and that there were too few cases to determine whether the development of lung cancer is related to Exubera use.

Pfizer said it will stop marketing Exubera in October. Sales of the drug have been negligible.

The warning in the label stemmed from an ongoing review of data from the Exubera clinical trial program and post-marketing experience by Pfizer and the U.S. Food and Drug Administration, Pfizer said.

Tuesday, Apr. 8, 2008; 4:00 AM
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MONDAY, April 7 (HealthDay News) — Use of the antipsychotic medication olanzapine may put a person at an increased risk for heart disease and type 2 diabetes, new findings show.

A team of French researchers studying the drug’s effect on male rats found that, after consuming olanzapine over several weeks, the rodents’ blood sugar levels rose significantly compared to rats not on the drug. This was especially noticeable after the rats ate meals with glucose in them. The rats consuming olanzapine did not gain weight or increase their food intake; however, the proportion of fat stored in their abdominal cavity was notably higher.

These changes are increased risk factors of metabolic syndrome, which puts an individual at greater risk of heart disease and type 2 diabetes.

“Based on these findings, we concluded that male rats treated with olanzapine experienced an early disruption of energy metabolism. This was a result of the fat tissue we observed and the impairment in blood sugar regulation which are both associated with metabolic syndrome and subsequent risk of diabetes,” senior study author Dominique Hermier, of the Department of Human Nutrition, INRA, in Paris, said in a prepared statement.

The study was to be presented Monday at the Experimental Biology annual meeting, in San Diego.

Olanzapine is a part of the second generation of antipsychotics known as atypical antipsychotics being used to treat schizophrenia. These newer medicines have proven as effective as their predecessors in treating the delusions and hallucinations that accompany psychotic mental illness and even more effective in combating other symptoms, such as apathy. Side effects, though, include weight gain and a greater chance for developing metabolic syndrome. Physicians fear these side effects may cause their patients to stop taking their medicine.

“Atypical medications like olanzapine are of tremendous value in treating individuals with certain kinds of mental illness. Our hope is that through discoveries such as this one, such life-enhancing medicines can be further optimized,” Hermier said.

Sunday, Apr. 6, 2008; 4:26 AM

NEW YORK (Reuters Health) - Overeating is likely the greatest contributor to the weight gain that can occur when a diabetic begins using insulin, new research suggests.

However, overeating can be difficult for doctors to recognize since diabetics may underreport their food intake, according to the findings in the journal Diabetes Care.

Dr. Miriam Ryan, from CHU Angers, France and colleagues assessed the impact of food intake on weight gain in 23 type 1 and 23 type 2 diabetic adults starting insulin therapy.

During the study, the type 1 diabetics gained weight gained an average of 10.3 pounds and type 2 diabetics gained an average of 4.0. The weight gain could not be explained by a slowing of the body’s metabolism, decrease in physical activity, or increase in sugar in the urine, leaving the authors to conclude that it was primarily due to overeating.

They also report that accurate assessment of calorie intake was “severely hampered by the underreporting of food intake, with (reported calorie) intakes being insufficient to meet even (the body’s lowest) energy requirements.”

Overeating during insulin therapy may be a response to low blood sugar episodes, the researchers speculate.

The underreporting of food intake in diabetic patients “requires more concerted effort to detect its presence and magnitude,” Ryan and colleagues conclude.

SOURCE: Diabetes Care, March 2008.

Saturday, Apr. 5, 2008; 4:00 AM
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FRIDAY, April 4 (HealthDay News) — Elevated levels of uric acid in the blood may be an early sign of diabetic kidney disease in people with type 1 diabetes, a new study suggests.

Researchers at the Joslin Diabetes Center in Boston noted that increased uric acid levels may appear before any significant change in urine albumin levels, the standard screening test for diabetic kidney disease.

In the study, the researchers checked serum uric acid concentration and urine albumin levels in 675 patients with type 1 diabetes. The results showed that 311 patients had microalbuminuria (small amounts of the protein albumin in the urine), an early sign of diabetic kidney disease. The other 364 patients had normal urine albumin levels.

While none of the patients had higher levels of albumin (albuminuria), one in five did have some impairment of kidney function.

“Our research showed that loss of kidney function takes place even in the absence of albuminuria in patients with type 1 diabetes,” study author Dr. Elizabeth T. Rosolowsky said in a prepared statement.

But she and her colleagues found that serum uric acid level was consistently related to kidney function. The higher the levels of uric acid in the blood, the lower the kidney function.

“The serum concentration of uric acid in these patients varied in a manner consistent with its having played a role in this early loss of kidney function,” Rosolowsky said.

The findings, published in the May issue of the Clinical Journal of the American Society of Nephrology, suggest that treatments to reduce uric acid may help slow the decline of kidney function in diabetes patients.

“Thus we have the hope of having a means to thwart the loss of kidney function while function is still a relatively preserved stage,” Rosolowsky said.

She noted that serum acid levels can be modified using drugs or by decreasing the amount of protein in a person’s diet.

“If follow-up studies, already under way, demonstrate that serum uric acid concentration predicts the course of early decline in kidney function, then clinical trials would be justified to test whether modifying serum uric acid concentration also modifies the course of renal function decline in type 1 diabetic patients with high normoalbuminuria or microalbuminuria,” Rosolowsky said.

By Steven Reinberg
HealthDay Reporter Wednesday, Apr. 2, 2008; 4:00 AM
Copyright © 2008 ScoutNews, LLC. All rights reserved.

TUESDAY, April 1 (HealthDay News) — The controversial diabetes drug Avandia appears to slow the progression of atherosclerosis in diabetic patients who have undergone cardiac bypass surgery, thus protecting them from new cardiac problems, according to the results of a small study.

Avandia (rosiglitazone) has been associated with increased risk of heart attack and heart failure among patients receiving the drug. In November, the U.S. Food and Drug Administration, while calling the evidence for heart attack inconclusive, agreed to keep the drug on the market, but with a black box warning about the heart attack risk.

In the new study, which included almost 100 patients taking Avandia, the study authors said they found the drug was safe and had no more cardiovascular risks than a placebo.

The VICTORY (Vein Coronary Atherosclerosis and Rosiglitazone After Bypass Surgery) study included 193 patients with type 2 diabetes who had undergone cardiac bypass surgery. They were randomly assigned to receive Avandia or a placebo. The trial was paid for by GlaxoSmithKline, the maker of Avandia.

The researchers found that after one year, patients taking Avandia had better blood sugar control, compared with those on a placebo. In addition, patients taking Avandia showed improved cholesterol levels, fewer signs of inflammation of blood vessels, and lower blood pressure than those patients taking a dummy pill.

Also, there was no significant difference in cardiovascular events between the two groups, the researchers noted.

“The enrollment of high-risk cardiovascular patients with type 2 diabetes in a placebo-controlled trial with rosiglitazone was found to have an acceptable safety profile,” the researchers concluded.

The findings were presented Tuesday at the American College of Cardiology annual meeting, in Chicago. The presenter was Dr. Olivier F. Bertrand, assistant professor at Laval University in Quebec City, Canada.

Despite the study findings, one heart expert said the results were insignificant and didn’t really show that Avandia was safe.

“How exactly can they establish the safety of rosiglitazone in a short-term study with less than 100 patients receiving the drug?” asked Dr. Steven Nissen, chairman of the department of cardiovascular medicine at the Cleveland Clinic Foundation, who was the first to report the risk of heart attack associated with Avandia. “This was an intravascular ultrasound study, not a morbidity-mortality study.”

Dr. Gregg C. Fonarow, a professor of cardiology at the University of California, Los Angeles, agreed with Nissen that the study was too small to make any valid claims about the safety of Avandia.

“This study with only 193 patients is too small to draw any conclusions regarding the potential benefits and risk of rosiglitazone in this patient population,” he said.

Dr. Paul Aftring, senior director of metabolic research at GlaxoSmithKline, said, “We recognize the limitation of the size of this study, but the safety data were very reassuring. They are consistent with other data in high-risk populations.”

The safety data of any trial is never defined by a population of less than 100 patients, Aftring said. “But the longer-term data in longer-term studies in high-risk populations is actually quite reassuring,” he added.

Aftring noted that the current labeling of Avandia says that the drug should be used with caution in high-risk populations. “Victory adds to the knowledge base that in well-managed populations, careful use of rosiglitazone is appropriate, and there are no safety issues,” he said.

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