Author: Staff Writers

Creation of an Artificial Pancreas for Type 1 Diabetes: What if a Type 1 diabetic could return to life as it was before diagnosis? What if they could control their blood sugar with less personal intervention? This may have been on the mind of researchers who are testing an artificial pancreas of sorts.

Every day Type 1 diabetics are testing their glucose levels and are injecting themselves with insulin to keep their blood sugars in balance. For many diabetics frustration is a constant companion.

Stanford is a participating University in a study that is providing about 75 Type 1 diabetic patients with an artificial pancreas. Early reports from ABCNews.com suggest it is proving very successful for many patients.

One such patient is Sarah Carlow who told ABC, “I test my blood sugar on average maybe ten or more times a day. I check it before breakfast, lunch and dinner. You have to check your blood sugars while you’re playing sports. I also have to count carbohydrates.” However, with the new technology Sarah is living life without glucose tests and constant carb counting.

How does it work?

According to ABCNews.com, “The sensor, just under the skin, sends a signal to the transmitter. It goes to a so-called control box, which tells the pump how much insulin to release.”

Essentially the embedded sensor would send a wireless signal to an insulin pump. The sensor monitors glucose and the pump supplies the needed insulin for glucose regulation. It would happen automatically, and patients like Sarah report no knowledge of when the insulin dose is made.

Reader tlkshultz commented, “This is something that has algorithms that tell the pump how much insulin to give the body based on the blood sugars given by the CGM (Continuous Glucose Monitoring). This would give insulin as well as glucagon to save people from going low. This would keep your BS [blood sugar] in target all the time and eliminate the complications. This is a huge step until we can get a true cure.”

This new process would link the steps involved in monitoring glucose levels with a pump that supplies insulin and all the communication to provide the same function as a pancreas. The sensor placement is not invasive and could allow patients to return to a relatively normal life.

U.S. News & World Report describes current methods of glucose control by saying; “The human pancreas meets the body’s immediate need for insulin and even anticipates it from, for example, the smell, sight, or thought of food. Conventional insulin pumps, on the other hand, are dumb: They dispense the hormone according to a preset program or when triggered manually, not by assessing the body’s needs.”

U.S. News and World Report also described some of the best news from the study, “The algorithm’s insulin-dosing instructions led to a drop of nearly 80 percent in the rate of overnight blood sugar crashes.”

The Food and Drug Administration (FDA) had specific guidance for the study and doctors had to be involved in every facet of insulin release through the program. The response from physicians has been largely positive especially in overnight glucose regulation.

The Juvenile Diabetes Research Foundation is sponsoring the study, and if the results are positive you can expect researchers to continue to press for automated glucose control among Type 1 diabetics.

Fourteen year-old Sarah Carlow sums it up well, “It would be amazing. Not having the every day, every minute, every hour hassle of worrying about my blood sugars.”

Camryn Adams Goes to Washington: A Diabetes Lobbyist: Many children dream of one day meeting the President of the United States, but how many 9 year-old lobbyists do you know? I’d like to introduce you to Camryn Adams.

Last month Camryn joined 151 other children who live with Type 1 diabetes to encourage President Obama to fund research into juvenile diabetes.

The Amherst Bulletin first covered this report and describes the life of this young lady; “Camryn must check her blood sugar level eight to 10 times a day by pricking her finger and testing the blood with her pump. When her blood sugar is too low, she must consume something the body can easily turn into glucose, like fruit juice. When her blood sugar is too high, she must calculate the amount of insulin the pump should supply to lower it to a healthy level.”

Camryn was not quite six years old when she was diagnosed with Type 1 diabetes. As she recalled that day she said, “At first I really didn’t know what the word (diabetes) meant. The only part I recognized was ‘die,’ so I thought I was going to die, but that didn’t happen.”

The lobbying effort that Camryn participated in was part of the Juvenile Diabetes Research Foundation’s Children’s Congress. Camryn was a delegate this year. The Juvenile Diabetes Research Foundation (JDRF) reports, “The delegates had the opportunity of a lifetime to visit the White House and meet with President Barack Obama. While standing on the portico steps on the South Lawn, the delegates were surprised with VIP visits from Mary Tyler Moore, Sugar Ray Leonard, and Nick Jonas.

”Before the President arrived, these superstars interacted with the delegates, shaking hands and signing autographs. Children’s Congress Chair Cynthia Ford made opening remarks and passed over the floor to President Obama. President Obama encouraged the kids to “keep up the great work” and posed for a photo with all 152 delegates and the role models.”

Camryn’s life has not been easy. The Amherst Bulletin indicates that, “Since she no longer produces insulin, Camryn needs a pump to supply her body with the hormone all day, everyday, or she – and all others suffering from type I diabetes – would die.”

This is part of her story and perhaps part of what she told her political representatives. According to the JDRF, “Delegates dispersed to meet with their congressmen. Each delegate was scheduled to meet with their representative and both of their senators. Delegates went before their respective leaders telling their stories of what it is truly like to live with diabetes and asking them to ‘promise to remember me’ when making decisions concerning diabetes and, specifically, diabetes research.”

According to information from the Amherst Bulletin Camryn and her family have raised thousands of dollars for the JDRF and, “Know the money will be put toward important research, including financing development of an artificial pancreas, which will automatically provide a constant amount of insulin; it is still being tested. Barbara (Camryn’s mother) said she raises money for research in the hope Camryn will be wearing one when she leaves for college.”

Camryn’s family is hoping for changes in America’s health care policy that will allow for coverage of items that would make life much easier for Type 1 diabetics, but are often considered luxury items by traditional insurance carriers. Ultimately they are hoping that Camryn’s trip to Washington might just result in a quicker trip to a cure for Type 1 diabetes.

MichCanSka 2010: Snowmobiling for a Cure: The upper peninsula of Michigan is known for cold winters and lake effect snow. It can be beautiful country in winter with a thick blanket of snow providing a picture perfect backdrop for snowmobiling. This sport may also hold promise for diabetics.

UPSnowmobiling.com suggests, “Snowmobiling the Upper Peninsula of Michigan is the greatest and most exciting sport there is in the Great Lakes Region!”

Groomed trails allow many snowmobilers to engage the great outdoors while enjoying a well traveled sections of the U.P.

Sault Ste. Marie is a city which claims to be, “The place where Michigan was born” with plenty of attractions along the St Marys River. Sault Ste. Marie is also the starting point for a unique fundraising effort on behalf of diabetes research.

SOOEveningNews.com reports, “Starting on February 15, 2010 some 72 snowmobile riders from across the country will be coming together in Sault Ste. Marie and beginning their quest to help support the discovery of a cure to diabetes. Covering over 4,000 miles, MichCanSka 2010 participants will end their journey 20 days later in Tok, Alaska.”

MichCanSka 2010 is the brainchild of Michigan resident Bill Bradfield who first considered the idea in 2006. Bradfield’s idea was to encourage avid snowmobile enthusiasts to make an unusual and very cold trek from the lower 48 states to Alaska by way of Canada.

Bradfield understands that there will be many who consider the trek personally fulfilling, but was compelled to emphasize the beneficiaries of the money raised from this project. Bradfield told SOOEveningNews.com, “The Diabetes Research Institute is a world-recognized research facility located on the campus of the University of Miami and on the campus of the University of Alberta-Edmonton, where great strides have been made by the medical staff and researchers to defeat this deadly disease.”

While you might think this trek would be something for the young reports suggest the average ago of 2010 participants is 60 with two participants in excess of 80 years of age. The group plans to travel 200 miles a day to complete their adventure. Less than 10 plan to ride only a portion of the way.

Reports suggest several individuals have already signified an interest in participating in 2011.

The published itinerary includes, “Marquette, Mi., Ironwood, Mi., Wisconsin, Minnesota, Canada, Trans Canada Trail, Manitoba, Saskatchewan, Alberta, British Columbia, the Yukon territory, Dawson city, and TOK Alaska.”

According to its website the Diabetes Research Institute (DRI), “ Is a recognized world leader in cure-focused research. Since its inception in the early 1970s, the DRI has made significant contributions to the field of diabetes research, pioneering many of the techniques used in islet transplantation. From innovations in islet isolation and transplant procedures to advances in cell biology and immunology, the DRI is now harnessing the power of emerging technologies to develop new cell-based therapies to restore insulin production.”

The Emphasis of DRI research includes…

• Constructing tissue-engineered barriers and bio-devices
• Generating new, small molecules to eliminate the need for immune suppressing drugs
• Developing sophisticated techniques to assess islet viability and predict long-term function
• Transforming select cells of the body into insulin-producing cells
• Exploring methods to regenerate islets within the native pancreas

MichCanSka 2010 is now described as an, “International snowmobiling charity ride.”

Did you know: Diabetes kills more people than AIDS and breast cancer combined.

Former NFL Player Known as a Diabetologist: Former NFL player Jay Leeuwenburg played the sport while living with Type 1 diabetes. He refused to let his disease get in the way of his dreams. He provides inspirational encouragement in his book, “Yes I Can! Yes You Can! Tackle Diabetes and Win!” co written with Denny Dressman.

Leeuwenburg’s website YesICanYesYouCan.com provides an opportunity to purchase the book and related materials, but it also provides some great tips for families and schools who deal with diabetes. While the information is abridged here you can find more tips at Leeuwenburg’s website.

Remember this advice was written for athletes who have Type 1 diabetes.

For the athlete

1. Educate
Educate yourself to the signs and symptoms of insulin reactions. Know the first signs and each progressive sign as they change your body and thoughts.

2. Anticipate
Know the activity you are engaged in, and know when the problems may arise before they occur.

3. Hydrate
Dehydration can not only lead to physical problems but also result in false blood glucose readers of higher numbers. Dehydration can often be misunderstood as high blood sugars (the symptoms of dehydration and extreme high blood sugars are very similar).

4. Use Restraint
Don’t overreact. A blood sugar of 200 is just fine. It is much safer to have slightly elevated sugars than to constantly fight lows throughout the activity. KNOW YOUR BODY!

5. Communicate
Tell someone else what is gong on. Tell a coach, a trainer or a teammate that you need to treat your sugar low.

For Teacher/coaches

1. Know who your diabetics are.
Don’t wait until the diabetic student in your classroom, or diabetic athlete on your team, is having a low blood sugar to find out they are diabetic. It’s okay to ask.

2. Have a plan for lows.
In the classroom, decide on a plan before your student has a low. Decide if it is okay to eat in the classroom. If not, where can they eat?

3. Don’t eat the food!
Emergency food is Off Limits to everyone, including diabetic students or athletes – unless they are low.

4. Check and replenish supplies.
Restock before you run out completely.

5. Know the signs of hypoglycemia.
Just because you may have taught or coached a diabetic in the past, don’t think they are all the same.

6. Have a plan for treating high sugars.
Know or find out if your diabetic student or athlete gives their own shots. Remember, you are not the doctor. But at times children need extra insulin.

7. Make the student/athlete part of the process.
It is not up to the teacher or coach to manage their student’s or athlete’s diabetes. It is the diabetic’s responsibility to identify lows. The teacher or coach is the diabetic’s support.

For Parents

1. Create a diabetic family.
Encourage everyone in your family to accept diabetes as a part of everyday life.

2. Have a schedule!
You don’t have to have everything at the same time every day, but meals especially help if they are at a consistent time.

3. Always have emergency food handy.
As an adult, never forget to have some fast-acting food ready for your child in case he or she is having a low blood sugar.

4. Don’t overreact, especially to high sugars.
Use blood tests as a tool, not to “catch” your diabetic child sneaking extra food.

5. Slowly give your child more responsibility.
Depending on your child’s age and their maturity level, start making them aware and responsible for their own care.

6. Let your child make mistakes, and help them learn from them.
Talk to your diabetic child about the choices they make and how those choices affect their body.

7. Don’t treat your diabetic child differently.
If your diabetic child is out of line, call them on it. If they do a good job, praise them. But don’t give extra praise just because the child has diabetes.

(Source: YesICanYesYouCan.com)

Pig Potential in Type 1 Diabetes Treatment: What do pigs; isolated Pacific islands and Type 1 diabetes have in common? A controversial new approach to a treatment for Juvenile diabetes.

Medical researchers in New Zealand are moving forward with a study that includes a science known as xenotransplantation – the use of animal cells and organs to develop medical approaches within humans.

In this most recent case scientists are extracting pig cells that produce insulin and injecting those cells into a human study participant. In previous trials there seems to have been some positive signs that this approach would work.

Neighboring Australia has a ban in place that prevents the study from taking place there.

The Controversy
Much of the discussion surrounding this type of scientific study has to do with the introduction of animal cells into humans. Theoretically speaking it could be possible for individuals who participate in this trial to develop viruses previously confined to swine. The most discussed virus is known as the retrovirus, which can create conditions for cancerous tumor growth.

The Pigs
Swine used in these trials were isolated for 150 years on at least one island off the coast of New Zealand. Doctors believe this pristine environment provides the best source of insulin producing swine cells available.

The Struggle Creating the Need
In Type 2 diabetes the body’s immune system misidentifies cells within the pancreas as invaders and sends destroyer cells to kill them. It isn’t that the body doesn’t do its job it just mistakes cells in the pancreas for an enemy and begins to work tirelessly to kill them.

This controversial therapy suggests it is possible to introduce insulin-creating cells from pigs and allow those cells to regenerate insulin creation within the human body.

The Potential
If pig cells could allow a Type 1 diabetic to begin the development of insulin it would minimize or even eliminate the need for insulin injections. Researchers have been quick to point out that even if everything goes the way they believe possible this therapy would still not eliminate all Type 1 diabetes symptoms.

Some scientists remain adamant that this type of study should be banned while others believe a ban needlessly narrows the field of potential therapies. At present New Zealand is the only country in the region that would allow this procedure. Australia may review their ban by year’s end.

Some research in xenotransplantation has taken place in the U.S., but according to WebMD, “Several obstacles to the success of xenotransplantation have been identified. These include, but are not limited to, (1) preventing hyperacute rejection, (2) preventing acute vascular rejection, (3) facilitating immune accommodation, (4) inducing immune tolerance, (5) preventing the transmission of viruses from xenografts into humans, and (6) addressing the ethical issues surrounding animal sources for xenografts and the appropriate selection of recipients (given that xenotransplantation remains experimental).”

WebMD Suggests, “Organs from pigs have been the focus of much of the research in xenotransplantation, in part because of the public acceptance of killing pigs and the physiologic similarities between pigs and human and nonhuman primates.”

SkyNews indicates the insulin producing pig cells used in the study will be, “Coated in a seaweed-derived membrane to discourage the volunteers’ immune systems from rejecting them.” There are eight patients in the trial and all have severe cases of Type 1 diabetes.

If Type 2 is Tied to the Immune System Can a Cure Be Found: Type 2 diabetes has always been thought of as something linked to metabolism dysfunction. Some recent research suggests this may be incorrect thinking.

The latest issue of Nature Medicine indicates the link may not metabolic, but one that involved the immune system. It has always been thought that it was the metabolism that might be to blame for Type 2 diabetes while the immune system was only responsible for issues related to Type 1 diabetes. What if immune issues were to blame for both forms of the diabetic condition?

Researchers dare to hope that if this link is true then a cure for 23 million Americans who suffer with the disease might not be as far away as we thought.

Dr. Vivian Fonseca, professor of medicine at Texas A&M Health Science Center College of Medicine and director of the Diabetes Institute at Scott & White is quoted in AJC.com as saying, “The authors [of this research] do suggest that if you change the inflammatory response by changing the way the body cells respond to a trigger for inflammation, you might be able to get at the real heart of diabetes and that suggests you could cure it.”

The research actually comes in the form of four separate studies and all concentrated on the immune system as it pertains to Type 2 diabetes.

What researchers found was that obesity seems to signal a decline in T-cells. One researcher describes the result as cells that leak. Inflammation of fat cells effectively renders them less able to use insulin.

When T-cells were restored to normal levels weight came off even without a change in diet or exercise and improved the way the body uses insulin.

You should understand this research was done on mice, and a human trial would be needed before any therapy could be made available.

A separate study looked at Mast cells in mice. Research headed by Guo-Ping Shi, Biochemist from the Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School created diabetic conditions in the mice they studied.

Shi seems to suggest that inflamed tissue in Type 2 diabetes may be responsible for allergy sensitivities and may create the secondary chronic condition asthma.

This research team looked at two over the counter drugs used to treat allergic reactions – Zaditor and cromolyn. In their study on mice they discovered that a change in diet along with the addition of one of these allergy medications resulted in a near 100% recovery from diabetic conditions.

This suggests that by targeting the immune function of the body it may be possible to stop and reverse diabetes.

Shi’s team looked at Mast cells as a culprit. When the team stripped Mast cells from a group of mice they discovered no weight gain and no diabetes even after placing the mice on a diet rich in fat and sugar.

Perhaps by paying attention to the immune function as relates to T-cells and Mast cells researchers can begin to find a cost-effective way to actually stop diabetes.

If Shi’s research is correct then common over-the-counter allergy medications could play a key role in the reversal of diabetes by using these medications that have already proven safe.

Advances in medical science provide new insight into better methods for treatments, therapies and medications for diabetes management and stability.

It’s refreshing to bring a report that points so strongly at something that may have been overlooked.

Tuberculosis, Beta Cells and Type 1 Diabetes: In this article we bring two stories that affect Type 1 diabetics. The information covers Tuberculosis in Type 1 as well as new research that could result in either a therapy or cure for this pancreas destroying disease.

Researchers consider the prevalence of Tuberculosis (TB) in Type 1 diabetics to be worth further consideration. Does TB signify diabetes or does diabetes point to developing TB?

While researchers can’t answer that question definitively what they do know is that TB shows up in Type 1 diabetics 3 times more frequently than those who do not have this disease.

The research is compiled from more than 40 years worth of collected data. “These studies consisted of over 1.7 million participants who had 17,698 cases of TB,” details from PloS Medical indicate. “Diabetes mellitus is characterized by abnormally high blood sugar level due to insufficient amounts of the insulin hormone, and TB is an infectious disease that usually attacks the lungs.”

In emerging countries like India and China this potential link may provide a reason to push for diabetic screenings in order to reduce the spread of TB. The PloS report developed by Jeon CY, Murray MB further states, “TB kills about 1.6 million people every year, a number that may decrease if diagnosis and treatment of diabetes can interrupt TB as well.”

Meanwhile American and European researchers are pushing forward with research that may allow dormant cells to be switched on to active beta cells. This is getting the attention of researchers because this could be a crucial step to effectively kick starting the pancreas in Type 1 diabetics.

Researchers have been able to successfully reprogram cells in mice to become active beta cells following the destruction of those cells in Type 1 diabetics. According to a press release from the Juvenile Diabetes Research Foundation International (JDRF), “In type 1 diabetes, the immune system attacks beta cells, stopping a person’s pancreas from producing insulin, the hormone that enables people to get energy from glucose. One pathway towards a cure for type 1 diabetes may be to restore insulin production through regeneration of insulin-producing beta cells within a person’s body, an alternative to transplanting functional beta cells from a donor.”

Richard Insel, M.D., Executive Vice President of Research of JDRF is quotes as saying, “This study suggests that regenerating beta cells may be a viable pathway towards restoring beta cell function in type 1 diabetes. It reinforces the concept that there are progenitor cells in the mouse pancreas that can generate new beta cells under special circumstances. And it points to some potential cellular targets for beta cell regenerative therapeutics – both the pancreatic progenitor cells and the alpha cells. Further, the research identifies a critical protein and pathways that can be used to screen for small molecule drugs for developing beta cell regenerative therapeutics that target these cells.”

The critical protein mentioned is called Pax4 and it appears to enable the body to alter certain cells to enable effective management of Type 1 diabetes from within your own body.

The JDRF press release concludes by saying, “By forcing expression in the pancreatic alpha cells of the protein Pax4 – a so-called transcription factor capable of modifying expression of multiple genes to regulate patterns of development or other key cellular functions – the researchers drove the conversion of alpha cells into insulin-producing beta cells in mice. The resulting reduction of alpha cells triggered the activation and differentiation of progenitor cells to replace the alpha cells that had switched to beta cells.”

Diabetes Quiz and Statistics – Part 1: PLoS Medicine is an open source directory of medical information. I recently encountered a ten-question diabetes quiz developed by Gavin Yamey and Virginia Barbour that really should be shared. Please feel free to see how much you know about diabetes and how it affects people around the world and in your own home.

Question 1. In the year 2000, roughly how many adults (20 years of age and older) worldwide had diabetes mellitus?
_ 50 million
_ 170 million
_ 500 million

Question 2. What is the approximate annual direct cost of intensive insulin treatment?
_ About $3,500 per patient
_ About $7,000 per patient
_ About $10,000 per patient

Question 3. What is the approximate cost of islet cell transplantation?
_ $50,000 per patient, per transplant
_ $150,000 per patient, per transplant
_ $250,000 per patient, per transplant

Question 4. After 20 years of type 1 diabetes, what is the estimated cumulative risk of albuminuria?
_ Around 5%
_ Around 16%
_ Around 30%
_ Around 50%

Question 5. Which of the following interventions for reducing the risk of progression of early diabetic neuropathy is best supported by evidence?
_ Tight blood pressure control
_ Protein restriction
_ Lipid lowering

Now let’s take a close look at the answers and statistics for each of these questions.

Answer 1. 170 million
Experts estimated that the number of cases of diabetes worldwide in the year 2000 among adults 20 years of age and older was about 171 million. Data on the prevalence of diabetes according to age and sex from a limited number of countries were extrapolated to all 191 World Health Organization member states and applied to United Nations’ population estimates for the year 2000 and the year 2030. The authors estimated that there will be 366 million people with diabetes in the year 2030.

Answer 2. About $3,500 per patient
In one study performed in Israel, the approximate annual direct cost of intensive insulin treatment was around $3,300 per patient, which is about three times more than that of standard insulin treatment. However, when other factors such as the reduction in complications are taken into account, such treatment appears to be cost-effective.

Answer 3. $150,000 per patient, per transplant In the United States, islet cell transplantation costs approximately $150,000 per patient, per transplant.

Answer 4. Around 30%
One study showed that the cumulative risk of proteinuria is similar in type 2 and type 1 diabetes—27% and 28%, respectively, after 20 years of diabetes. Another showed that around 30% of patients with type 1 diabetes had developed sustained microalbuminuria within 20 years.

Answer 5. Tight blood pressure control
Although there have been no systematic reviews that prove the benefit of any of these three interventions, there is, nevertheless, evidence to support a correlation between tight blood pressure control and a decreased rate of nephropathy progression. Importantly, the United Kingdom Prospective Diabetes Study Group found that the control of blood pressure was a far more important intervention to prevent mortality than blood glucose control.

Five more questions about diabetes will be presented in part 2 of this two-part series as we continue to work to provide solid and timely information for diabetics and their families.

Diabetes Quiz and Statistics – Part 2: This is the second part of a quiz developed by PLoS Medical and Gavin Yamey and Virginia Barbour. The intent is to provide statistics in the form of a quiz that can enable diabetics and the ones they love to have a better understanding of the struggle they face on a daily basis.

Question 6. Which of the following best reflects the association between blood glucose level and mortality in people with type 2 diabetes?
_ There is a positive, although weak, association between increased glucose and increased mortality
_ There is a positive, and very strong, association between increased glucose and increased mortality
_ There is no association between glucose level and mortality

Question 7. For people with healed diabetic foot ulcers, what is the 5-year cumulative rate of ulcer recurrence?
_ 15%
_ 30%
_ 45%
_ 66%

Question 8. Which of the following interventions for preventing foot complications in people with diabetes is best supported by evidence?
_ Therapeutic footwear for preventing ulcer recurrence
_ Screening and referral to foot care clinics to prevent major amputations in those at high risk
_ Education programs for preventing ulcer recurrence, serious foot lesions, and major amputations

Question 9. What proportion of patients with type 1 diabetes have thyroid peroxidase autoantibodies?
_ About one in five
_ About one in ten
_ About one in 100

Question 10. Which of the following best reflects the evidence from randomized controlled trials on the optimum HbA1C for people with diabetes?
_ These trials found that development or progression of complications increases progressively as HbA1c increases above the nondiabetic range, and that there is a glycemic threshold above which there is a risk of complications
_ These trials found that development or progression of complications increases progressively as HbA1c increases above the nondiabetic range, but there is no lower glycemic threshold for the risk of complications

Let’s take a look at the answers.

Answer 6. There is a positive, although weak, association between increased glucose and increased mortality A systematic review of 27 studies examining the relationship between blood glucose level and mortality in type 2 diabetes found a positive but weak association between high glucose and increased mortality.

Answer 7. 66%
Although the incidence of new ulcers is relatively low—around 2% per year—the risk of recurrence for people with healed diabetic foot ulcers is very high: the 5-year cumulative rate of ulcer recurrence is 66%, and the rate of amputation is 12%.

Answer 8. Screening and referral to foot care clinics to prevent major amputations in those at high risk One randomized, controlled trial, involving 2002 patients
attending a general diabetes clinic, found that a diabetes screening program (involving referral to a foot clinic if high-risk features were present) reduced the risk of major amputation compared with usual care after two years.

Answer 9. About one in five
The Belgian Diabetes Registry indicated that the prevalence of thyroid peroxidase autoantibodies is 22% in patients with type 1 diabetes.

Answer 10. These trials found that development or progression of complications increases progressively as HbA1c increases above the nondiabetic range, but there is no lower glycemic threshold for the risk of complications.

Two large randomized, controlled trials in people with type 1 and type 2 diabetes found that development or progression of complications increases progressively as HbA1c increases above the nondiabetic range. The data suggested the better the glycemic control, the lower the risk of complications.

We hope this information has been beneficial in questions that may not routinely come up in conversation about Type 1 or Type 2 diabetes.

Anatomy of Obesity: As we age we understand that our bodies tend to gain weight much easier. We also find that it can be much harder to take that weight off. Is there a reason why this is true? If so, is there anything that can be done to reverse the effects?

Metabolism
This has typically been thought of as the culprit in weight gain. If a person gains weight it is often said that their metabolism has become slower with age. While this might be true it doesn’t appear to be the full story.

Introducing Leptin
The secretion of leptin is a function of various glands within the body. The role of insulin is to manage excess blood glucose by determining how to use the glucose (either stored fat or immediate fuel for energy). The role of leptin is to work to suppress hunger (leptin means thin). This may be that magic element that could help us all lose weight, but when we feed our appetite to excesses leptin does something drastic.

The Scars
According to ScienceDaily.com Leptin released a protein called SPARC. “It is thought that leptin, in an attempt to balance energy levels in the body, could trigger SPARC to limit the storage of fat. SPARC can do this by increasing the formation of scars in fat tissue, which can prevent fat being stored safely in the body.”

The researchers are from the University Hospital Aintree, the University of Warwick and Sweden. They discovered that diabetics have an increased level of SPARC, which essentially adds insult to injury.

The Cycle
Insulin is released to manage blood glucose. Leptin is released to suppress the appetite. SPARC is released to stop excess energy from storing as fat. The resulting effect is internal scarring in the fat cells that reduces the effective use of insulin and leptin and potentially the over production of both.

When fat is not stored safely in the body the individual becomes more prone to Type 2 diabetes. Professor John Wilding explains, “We tested fat tissue of patients at University Hospital Aintree and found that an increase in leptin also increases SPARC levels, which reduces the safe storage of fat through the development of abnormal tissue scarring. Scarring of fat tissue is known to increase as we gain weight and we found that this is exacerbated by leptin, as well as an increase in insulin, produced by the pancreas.”

Dr Katarina Kos was the lead author of the research, and she further explained, “Leptin is produced in fat cells to regulate appetite, but the body becomes resistant to the effects of appetite reduction in obese patients. Leptin continues to increase in response to overall fat mass and promotes scarring through increased SPARC levels. Once scarring occurs, the excess nutritional energy from fat cannot be taken up by fat cells and so remains in the blood and begins to gather around organs. As a result, fat cells of people classified as obese, may not fulfill their natural purpose to store fat.”

As a body becomes more obese it is less sensitive to Leptin. When Leptin has to work too hard it releases SPARC that may serve to make fat cells less receptive to accepting fat. This leaves excess blood glucose flowing through the veins, which signals the pancreas to send more insulin. The result of this tiered approach to normal body management is a body that is more susceptible to Type 2 diabetes.

Researchers recommend a reduced calorie diet, which has proven to lower levels of SPARC in the bloodstream. This may also lead to new medical advances in treating both obesity and diabetes.