Author: Chris

Identifying Barriers to Diabetic Self Management: If you’ve ever wondered what barriers exist for the proper care of individuals living with diabetes then recent research conducted by scientists from Ireland and Hong Kong might help.

The reason for the development of this study has to do with the prevalence of the disease and the rapid growth of diabetes. The World Health Organization indicates that by 2025 there will be 380 million cases of diabetes. Researches wanted to identify the barriers in an effort to address and eliminate as many of those obstacles as possible.

There were 9,000 patients from 28 countries that participated in the study. Here are some of the highlighted obstacles.

• Financial – even if healthcare was free or funded by insurance, patients still had to spend more money on healthy food and transport to and from healthcare appointments.
• Social support – patients who received support from family, friends and diabetes clinics appeared to handle self-care better than those who did not.
• Patient provider gaps – care was more effective when patients and healthcare providers worked together to devise treatment plans that patients could stick to.
• Meals out – eating out in restaurants was a frequently mentioned problem and being offered inappropriate food when visiting others was also an issue.
• Favourite foods – healthcare professionals did not always appreciate that patients disliked being denied their favourite foods and would cope better if they were incorporated into eating plans.
• Exercise – attitudes toward exercise, physical limitations and discomfort prevented people from taking regular exercise. These need to be taken into account when devising exercise programmes.
• High risk lifestyles – behavioural and psychiatric disorders and cultural and language barriers, among both patients and family members, can impede effective treatment.
• Medication – some patients forgot to take their medication and others ran out. Others were reluctant to carry out regular glucose tests.
• Psychological wellbeing – psychological problems are common among people with diabetes, but healthcare providers do not always have the resources to manage this aspect of their patient’s care.
• Understanding – patients often lack knowledge about their condition and do not always understand the relevance of diet and care plans.
• Frustration – Being unable to maintain good glucose control can cause helplessness and frustration, as can the progression of the disease. (Source: IrishHealth.com)

While it may seem that many of these roadblocks to managed care would be common sense there is a strong indication that identifying them can help in the education of newly diagnosed diabetics as well as their health care providers. It may help provide signs family members and friends can look for in their diabetic loved one. Knowledge is always important to the success of any endeavor – including diabetes.

Professor Vivien Coates of the University of Ulster reported, “Our review found that there are various barriers to achieving optimal self-care in type 2 diabetes. Some stem from limitations within the healthcare team, some from ineffective communication between providers and patients and some from the patient’s lack of empowerment, motivation and involvement in their treatment.”

Researchers are also urging health care providers to learn more about the specific needs of their patients by taking into account the following five factors.

• Physical
• Psychosocial
• Cultural
• Financial
• Environmental

These factors can contribute to a more holistic approach to care that includes a broad range of conditions affecting the diabetic patient.

Treating Type 1 Diabetes with – Tobacco: What if you were told that by eating a small amount of tobacco on a regular basis you could reduce the likelihood of developing Type 1 diabetes? Recent research is indicating that a genetically altered strain of tobacco may have the capacity to aid in the possible prevention of Type 1 diabetes.

European researchers at the University of Verona, “Set out to create transgenic tobacco plants that would produce biologically-active interleukin-10 (IL-10), a potent anti-inflammatory cytokine,” according to a recent report in ScienceDaily.com.

The National Institute of Health says, “Evidence suggests that an imbalance in Th1/Th2 responses may play a key role in the development of autoimmune diabetes. Since interleukin-10 (IL-10) modulates immune and inflammatory responses and has been implicated in many autoimmune diseases [including Type 1 diabetes].”

Scientists discovered that the IL-10 was genetically adaptable using the common tobacco plant. This discovery is new and yet related to developments in recent years that seem to show substantial promise in the use of plant proteins to manage potential IL-10 therapies for Type 1 diabetes.

ScienceDaily.com reported on July 31, 2007, “Capsules of insulin produced in genetically modified lettuce could hold the key to restoring the body’s ability to produce insulin and help millions of Americans who suffer from insulin-dependent diabetes, according to University of Central Florida biomedical researchers.”

The impact of these developments may be most keenly felt in the pocketbook of the medical consumer. For instance the genetically modified tobacco could be taken in an unprocessed form (i.e. eating the actual plant) instead of producing something in a pill form. The result is a product that costs less and can be more quickly made available to patients. With the lettuce it would be possible to simply use this in a salad or as a sandwich topping although capsules could also be made available. According to Professor Mario Pezzotti of the University of Verona, “Transgenic plants are attractive systems for the production of therapeutic proteins because they offer the possibility of large scale production at low cost, and they have low maintenance requirements. The fact that they can be eaten, which delivers the drug where it is needed, thus avoiding lengthy purification procedures, is another plus compared with traditional drug synthesis.”

The idea behind using these plants is that they are easily grown and can provide a meaningful harvest. While it is true that tobacco has a social stigma attached to it this plant does seem to be one of the most adaptable to genetic modification for potential medical benefit.

This process of medical plant proteins is called molecular farming and is a growing field that effectively bridges the gap between what is commonly thought of as medicinal with more natural applications.

While multiple plants have been studied for use in delivering the needed medicine it is the tobacco plant that has impressed most researchers due to the ease of genetic manipulation and the fact that an entirely new tobacco plant can be developed using a single cell from an existing plant.

Tobacco is also a very hearty plant that can grow in many locations. While it may be viewed negatively with respect to cigarette manufacturing, the plant can perhaps be redeemed as a means of delivering potent plant proteins that can aid in the prevention or therapy of Type 1 diabetes.

A Visual Diabetes Diagnosis: When it comes to diabetes it may be possible that the eyes have it. There has always been support for the idea that eyes may be an indicator of the body’s ability to manage blood glucose prior to a diabetes diagnosis and become an important tool in eye management once diabetes is diagnosed. However, some more recent research suggests that it may be possible for your eye care professional to monitor and correctly diagnose the existence of the disease.

Researchers at the Kellogg Eye center at the University of Michigan have developed a new device that, “Captures images of the eye to detect metabolic stress and tissue damage that occur before the first symptoms of disease are evident.”

This device has been considered a positive and non-invasive way to check for diabetes in patients as part of a normal optical screening. Results are available in less than five minutes.

The UMHS report indicates, “Metabolic stress, and therefore disease, can be detected by measuring the intensity of cellular fluorescence in retinal tissue.”

With the onset of diabetes cell structures can die due to uncontrolled blood glucose. Those conditions can be monitored by this eye test and may alert your eye care professional to provide instruction on further steps you can take to monitor your condition.

Retinal changes in general can provide clues to the existence of diabetes, but it can also help diagnose other issues. An article by the Boston Health New Examiner indicates that Dr. Tien Wong of the University of Singapore has confirmed, “Early retinopathy signs are also associated with metabolic and vascular risk factors, and are strong markers of subclinical and clinical CVD events such as stroke, coronary heart disease and heart failure.”

Wong further states, “With the advent of sophisticated computer and imaging techniques, doctors can now measure with precision the arteriolar and venular diameters of retinal blood vessels to gain new understanding of early retinal vascular changes. Studying early retinopathy and retinal vascular changes may offer new insights into the vascular basis of diabetes, new avenues for prevention and treatment.”

Many scientists have been working diligently to find improved screening methods that remove the fears generally associated with diabetes blood tests. If they can match a peripheral method that is non invasive (such as a routine eye test) then it might not be as difficult to identify and treat the millions of undiagnosed cases around the world.

The University of Michigan report indicates, “Some 24 million Americans have diabetes and an additional 57 million individuals have abnormal blood sugar levels that qualify as pre-diabetes, according to the latest report from the Centers for Disease Control and Prevention. In addition, 4.1 million people over the age of 40 suffer from diabetic retinopathy, an eye-related complication of diabetes that is the leading cause of blindness among working-age adults.”

There may remain some debate over the exact method and acceptable parameters for diabetes detection. No matter the reservations some may have about the actual testing procedure there seems to be broad acceptance that this idea not only has merit, but also may be the common diagnostic testing procedure for diabetes in the future.

Like dental health the health of the eye can help doctors spot symptoms that can help answer other health questions. The result of this holistic approach can help multiple health practitioners work together to diagnose and treat illnesses before they become unmanageable.

Health Insurers Offer Concessions For Change: Imagine a world where your health insurance costs would not rise simply because you had a medical condition as financially taxing as diabetes? America’s Health Insurance Plans and Blue Cross Blue Shield offered a plan last week that would effectively end their, “Long-standing practice of charging sick customers higher premiums. [This is] a significant concession in the face of mounting criticism of the industry in Washington,” according to an LATimes.com report.

It may be safe to say that the insurance industry as a whole is feeling threatened by President Obama’s push towards nationalized medicine. As with other issues this may be a scenario that exists simply because the U.S. government has pushed so strongly toward reform in health care. Some have concluded that the choice may be to either provide radical reform in order to keep health care in the private sector or be bound by government run health care in the future.

A letter sent to senior U.S. lawmakers read, “By enacting an effective, enforceable requirement that all Americans assume responsibility to obtain and maintain health insurance, we believe we could guarantee issue coverage with no pre-existing condition exclusions and phase out the practice of varying premiums based on health status in the individual market.”

Forbes.com quoted Sheryl Skolnick a CRT Capital Group analyst as saying, “When you know you’re going to be regulated, then everyone knows it’s better to propose it yourself then have someone impose something on you. [Private insurers] are scrambling for anything that will get them a mandate because then everyone will be covered and that keeps the insurers in the game.”

As with everything in life there are provisions that must be met with this proposal. The American Health Insurance Plans indicate they can actively create this environment based on the government’s ability to bring all Americans to the health insurance table. The indication is that if the costs are distributed among a much larger pool then it is possible to provide insurance without many of the limitations in place today.

However, some provisions would remain unchanged. The fees the insured would have to pay are still contingent on age, family size and geographical location. As a bonus the group is indicating a willingness to provide health conscious discounts. This might reward those who quit smoking with a reduction in premium costs or in the case of the diabetic following a closely monitored self-management plan that include changes in diet and exercise.

This plan is not without opposition. There are some that remain uncertain that private health insurance plans can deliver, but others suggest it may be better to revamp an existing system than completely shift to a government based program that may not be fully equipped to handle the job of health coverage.

For years insurance carriers have argued that a variation in premiums was necessary because some individuals would wait until they were really sick before purchasing health insurance. They argue that if health insurance were mandatory then it would eliminate the need for price variations in policy coverage.

Some politicians remain skeptical and call the move a point of desperation by the insurance industry to attempt to stall any competition from a government run plan. Sen. Charles E. Grassley, “Dismissed the letter as simply reiterating the industry’s positions,” according to the LATimes.com. This comment was in reference to two previous attempts by the industry to garner governmental support.

Research Opportunity for Individuals with Diabetes: Interface Analysis Associates (a leading consumer research firm) is currently looking for individuals with diabetes who are in the northwest Illinois area to participate in a paid consumer research study.

The following are the particulars of this study:

To initially qualify for the study, one must:

1) Have Type I or Type II diabetes
2a) Manage their diabetes by taking insulin via pump (Paradigm REAL-Time, OneTouch Ping , OmniPod, Animas 2020, Medtronic paradigm 522 or 722)
2b) OR take at least 4 injections of insulin daily and have seriously considered using a pump.

The study will be conducted at a market research facility in Skokie, IL (near Old Orchard w/convenient access to Edens Expressway), will take no more than 1 hour and 45 minutes, and pays $150 CASH.

Participants will be exposed to a new diabetes product, will be asked to interact with it and provide their feedback about it. It is a very easy way to make some money and have a positive impact on a product that may influence the lives of millions who suffer from diabetes.

If interested, please contact us at [email protected] or call us at 408-834-8443. At that time we can answer any additional questions you may have.

An Alternative to Medic Alert Bracelets: Jillian Rokowski was tired of feeling she as if she didn’t fit in. As a Type 1 diabetic she lived for several years having to explain her medical ID bracelet. Some may argue the explanations are at worst an inconvenience and at best the opportunity to share information about your diabetic condition – for many teens it can simply be a source of consistent embarrassment and hassle.

Jillian understood the need for the bracelet in alerting medical technicians about her diabetes, but it seemed to call attention to something that made her feel as if she wasn’t normal. Jillian told the St. Petersburg Times, “Everybody was always weirded out by it, and the teachers didn’t help. I remember in fourth and fifth grade, I didn’t go on any field trips because the teachers were like, ‘Well, we don’t really feel comfortable at this point.’”

Her experience caused Jillian and her mother to create the company Watch and Alert. This company provides a variety of stylish watches that allow the wearer to blend in with their peers while still having identification needed to ensure safe care from health practitioners. The face of each watch bears variations of the traditional medic alert bracelet. It also includes the individual’s primary health issue on the face of the watch. Additional information can be engraved on the back. There are nearly 40 conditions for which doctors will recommend patients consider wearing a medical alert bracelet or necklace.

On her website [WatchAndAlert.com] Jillian says, “When I was seventeen I found a watch at a specialty store that had a medical symbol on the face and an engraveable plate on the back for information about my condition. For the first time since my diagnosis I was able to wear a stylish watch instead of my old bracelet. The last thing teenagers want to do is look or feel different from their peers. I honestly felt relieved and more comfortable in my own skin. When that watch broke I was devastated. I tried to find another watch but it turned out to be an impossible task to find a trendy watch with the medical alert symbol in the face. I decided I would have to create one for myself. I created a stylish watch and I got many compliments. People would ask me where I got it so they could get one for themselves or someone they knew who had a medical condition. We kept hearing over and over that people would not wear a bracelet. Unfortunately there are too many people who would rather risk their health and safety in an emergency situation then to be uncomfortable wearing a piece of jewelry they don’t like.”

Jillian told the Tampa Bay Times that she would like to get one of her watches to Nick Jonas who also suffers from Type 1 diabetes saying, “If I got it in the hands of a JoBro then every preteen in the world would want to wear it whether they had a condition or not.” Seven different watches are currently available with prices less than $45.

Many individuals who have a medical condition like diabetes refuse to wear the bracelet or necklace. Some have resorted to tattoos although health professionals caution diabetics about some of the medical issues related to getting a tattoo. Jillian is hoping that these timepieces will provide the style many are looking for with health benefits diabetics need when a crisis hits.

What Iditarod May Teach Us About Energy in Diabetics: There are so many answers to complicated questions locked up in our own bodies and in things that occur naturally in the world around us. This is true with plants and it’s true with animals. Herbs, vegetables and fruit are all used to provide food along with offering a variety of vitamins, minerals and an enormous amount of potential healing properties.

Sometimes learning more about diabetes may be as simple as watching the Iditarod sled races held each year in Alaska. This race covers over 1,100 miles and many of the participants can finish the race in as few as nine days. That means the dogs used in the race must pull a sled more than 100 miles each day in very difficult circumstances (wind chill readings can be as low as –100 degrees F), yet these animals seem eager to perform the task in the harshest of weather.

Aside from any objections you might have as to the treatment of these dogs there is intriguing thought behind their willingness to ‘mush’ in the frozen tundra of Alaska.  USAToday.com recently posed a question that is on the minds of diabetes researchers, “Could their fat-burning prowess help uncover ways to prevent and treat obesity in type 2 diabetes?”

It has become apparent that these sled dogs are very efficient at converting fat to energy and resisting any hint of diabetes. Researcher Michael Davis from Oklahoma State University rode along in the 2009 Iditarod to continue his personal research in physiology of sled dogs.

USAToday.com reported, “In January, Davis and collaborators Ray Geor of Michigan State University and Shannon Pratt of North Carolina State University chose 16 dogs in Iditarod-worthy shape from the kennel of one of this year’s competitors and had them run 22 miles at a healthy clip of 8 mph.”

Their research calculated metabolic stress by examining muscle tissue samples of those animals. This was done during times when the animals were worthy of running in the race and during summer months when they were not engaged in strenuous activity. The USAToday report indicated, “Davis hopes to understand how the cells are reacting under different physical conditions.”

Oklahoma State University provides the following background information on Davis. It helps explain his interest in this subject, “Dr. Davis has been a licensed veterinarian for over 20 years, and a board certified specialist in veterinary internal medicine since 1999. Dr. Davis has received over $4 million in research funding to study the effects of exercise stress in animal models, particularly racing sled dogs. This work has resulted in detailed metabolic studies of the occult effects of stress, including mechanistic descriptions of the effects of occult stress on various organ systems.” It then appears his research has naturally progressed to diabetes, a causal agent in the deterioration of multiple organs.

While animal rights activists have been opposed to the research Davis is doing he indicates the DNA between dogs and humans are a close match. There may be more to learn from these dogs than critics might expect. For instance these animals have proven to be insulin sensitive, which allows their bodies to be extremely adept at energy creation.

No one would argue that intense exercise has been very instrumental in the prevention and management of diabetes, however the research Davis is looking at may provide additional answers as to how the transformation of fat to energy can be accelerated in diabetic patients.

New Information for Diabetics in Critical Care: Diabetics anticipate hearing physicians call for tight control over their blood glucose levels. That’s what makes a March 24th, 2009 article by the New England Journal of Medicine interesting with respect to their conclusion. This report suggests that in critically ill patients it may actually be counterproductive to effective recovery to insist on blood glucose control. The medical journal indicates mortality rates are higher among critically ill diabetics when hyperglycemia is treated using strict blood glucose oversight.

On the same day the American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists (AACE) issued a press release indicating, “Findings of the Normoglycemia in Intensive Care Evaluation-Survival Using Glucose Algorithm Regulation (NICE-SUGAR) study should NOT lead to an abandonment of the concept of good glucose management in the hospital setting. Uncontrolled high blood glucose can lead to serious problems for hospitalized patients, such as dehydration and increased propensity to infection.”

Dr. Etie S. Moghissi, AACE Chair of Inpatient Glycemic Control Task Force said, “Since 2003, AACE and the ADA have worked together to provide recommendations for treatment of inpatient hyperglycemia, and these efforts have contributed to a growing national movement viewing the management of hyperglycemia in hospitals as a quality care measure.”

Further recommendations from the ADA and AACE in regards to this issue will be made available later in the spring. Dr. Mary Korytkowski, ADA Chair of Inpatient Glycemic Control Task Force indicated, “The central goal of the ADA/AACE inpatient task force is to identify reasonable, achievable, and safe glucose targets, and to describe the protocols, procedures, and system improvements needed to achieve inpatient optimal glucose control efficiently and safely.”

The NICE-SUGAR study suggests that mortality rates in patients with intense glucose control while also in critical condition was 14% higher than those receiving standard or conventional glucose care.

The ADA or AACE press release stated, “More than 6,100 patients with hyperglycemia in critical care units were randomized to either intensive glucose control (insulin infusion with target blood glucose between 80-108 mg/dl) or to conventional glucose control (insulin infusion begun if blood glucose was over 180 mg/dl, and discontinued if blood glucose dropped below 144 mg/dl). Severe hypoglycemia (blood glucose below 40 mg/dl) occurred in approximately 6.8 percent of intensively treated patients compared to 0.5 percent of conventionally treated patients. The study showed no difference in length of time in the intensive care unit or in the hospital, or in other major outcomes such as time on ventilators or need for dialysis.”

It seems clear from the information provided by these two health organizations that they are asking for caution in the wake of these new findings.

For those unfamiliar with the American Association of Clinical Endocrinologists (AACE) it is a, “Professional medical organization with more than 6,200 members in the United States and 92 other countries.

Mary Tyler Moore Speaks Out on Diabetes: “Chronic disease, like a troublesome relative, is something you can learn to manage but never quite escape. And while each and every person who has type 1 prays for a cure, and would give anything to stop thinking about it for just a year, a month, a week, a day even, the ironic truth is that only when you own it–accept it, embrace it, make it your own–do you start to be free of many of its emotional and physical burdens.” That’s how Mary Tyler Moore started her new book, Growing Up Again: Life, Loves, and Oh Yeah, Diabetes.

For the last four decades this well loved actress has been living with Type 1 diabetes. This new book was not an idea she pitched to a publisher, but rather the other way around. BuffaloNews.com reports that Philip Revzin, senior editor at St. Martin’s Press was the one who convinced Mary to write the book.

The idea for the book was apparently hatched during a conversation Revzin had with his daughter who just so happens to have Type 1 diabetes. The preface to Mary’s book relates the young lady’s words, “I wish I had a diabetic best friend, someone to talk to about what it’s like to have diabetes, Sometimes I feel, I don’t know, alone. Ya know?”

So Mary Tyler Moore wrote a book about life with diabetes and added memorable moments from her life along the way. The book seemed a better response to Revzin’s daughter than a simple phone call or conversation over tea. It’s also something that can be shared with thousands of others who also suffer from Type 1 diabetes.

The 72 year-old Moore continues to act, but what most television viewers may not know is that her diabetes has given her what she describes as “Tunnel Vision”. The BuffaloNews.com report related an event Mary attended and the difficulties she faced due to her vision problems caused by diabates. “The chic Manhattan restaurant where the soiree is held is dimly lighted, and the partygoers are almost all dressed in black. After climbing a set of stairs in the dark and bumping into people she can’t see, Moore turns to talk to someone, only finding out later that “I was facing away from her, the side of my head being all she could see, as I chatted easily with the darkness. Heaven knows what she thought of the encounter!”

The Internet Movie Database reports that Moore, “Recently testified before Congress calling for an increase in funding for diabetes research and support embryonic stem cell research, which she called ‘truly life affirming.’”

Moore’s new book is not a straight shot at Type 1 diabetes, but how diabetes fit into the life she has lived. In times past Moore was quoted as saying, “Diabetes is an all-too-personal time bomb which can go off today, tomorrow, next year, or 10 years from now – a time bomb affecting millions like me and the children here today.”

Growing Up Again: Life, Loves, and Oh Yeah, Diabetes is part memoir and part cautionary tale. More has endured more than her fair share of pain losing both siblings and her only son to a variety of incidents. The common thread of forty years has been her diabetes. It appears this has simply been a very heavy thread weaved in her personal tapestry that has created a fond brilliance we always see when Mary takes the stage – or writes a book.

Schizophrenia and Diabetes: A Bigger Picture: We recently reported that the schizophrenia drug Seroquel might be linked to cases of diabetes due to what appears to be noticeable weight gain in patients that use the AstraZeneca drug. Since obesity is often linked to diabetes the research indicated the weight gain might be the causal link to diabetes.

While many have considered hidden research on the subject to cast a very negative light on the drugs effectiveness there is new research that may point to a bigger picture. ScienceDaily.net reported that, “People with schizophrenia are at increased risk for type 2 diabetes.” This was the finding of researchers at Medical College of Georgia along with scientists at the University of Barcelona in Spain and the University of Maryland.

This research was conducted on 50 patients newly diagnosed with schizophrenia prior to taking any medications used for the treatment of the condition. What researchers found was, when no other risk factors were present, “16 percent [of patients] had either diabetes or an abnormal rate of glucose metabolism.” This was the finding of Dr. Brian Kirkpatrick, vice chair of the MCG Department of Psychiatry and Health Behavior.

This is significant because a separate control group of similar size, utilizing patients without schizophrenia, indicated no signs of diabetes.

Kirkpatrick told ScienceDaily.net, “These findings point toward there being some shared environmental factors or genetic factors between the development of schizophrenia and diabetes.” Those conditions had to be something other than a drug used to treat schizophrenia since none in the control group had ever used the drug.

The information concerning Seroquel and other drugs was important to researchers because they knew that the drug seemed to have a weight gain side effect. Catching patients before drug treatment for schizophrenia seemed to be the only logical way to determine what links might exist between schizophrenia and diabetes.

It has long been thought that depression and diabetes go hand in hand. It has also been long believed that schizophrenia and diabetes might be connected. This research sought to answer that question in some definitive way.

A second study indicates, “The prevalence rate of metabolic syndrome, a group of risk factors that include abdominal obesity, high lipid and cholesterol blood levels and insulin resistance, is more than 50 percent in women and about 37 percent in men with schizophrenia.” These factors are significant in the development of diabetes.

There is a third facet to the potential development of schizophrenia. This dynamic happens before a child is born. Dr. Kilpatrick noted, “Many people focus on the brain function part of the disease, but patients also have other medical problems that can’t be attributed to other factors. Bad things that happen in utero and at birth, such as prenatal famine and low birth weight, have both been shown to increase the risk of diabetes and schizophrenia. Problems in early development can leave a lasting impact.”

Add to this the recent discovery that Alzheimer’s may be diabetes of the brain and you can begin to see the impact insulin has on every facet of the body.

It appears the care of the human body must begin in utero. Low birth weight babies and the care the mother takes with her own health appear to be common threads in the long-term health success of the child. In most cases this is simply common sense, but it’s interesting to see research that tends to support many of the ideals passed along by earlier generations. The advantage we have is the accumulated knowledge of why the care is important and how it may affect all individuals involved.