Category: Diabetes 101

If you’ve ever watched a survival type show on television then you know there are extremes in food availability that people endure and they seem to come out of these issues safely. There is a chromosome protein that acts as a rescue device and the discovery of how it functions may have a huge impact on how diabetes is treated.

According to Medical News Today, “Researchers at McGill University and University of Pennsylvania have uncovered new insights into how a protein known as the AMP-activated protein kinase, or AMPK, a master regulator of metabolism, controls how our cells generate energy.”

Imagine if you will, a drill sergeant in the Army. He commissions soldiers to go from one place to the next to fulfill the needs of the overall operation. He’s in charge of many soldiers and each is told what to do and when to do it. This is a picture of what AMPK is like in the human body.

If the AMPK determines the body’s resources are not required for energy then it will not willingly allocated energy resources without just cause.

McGill Professor Russell Jones is quoted in Medical News Today as saying, “”The discovery that AMPK goes directly to the DNA to affect gene transcription is a breakthrough in our understanding how signals from outside the cell are transmitted to change gene expression. It is like an electrical circuit. We have figured out how AMPK mediates the connection.”

If you’re wondering why this is big news the answer lies in what medical science can potentially do with this information. They may be able to effectively send new orders to the AMPK allowing the use of energy cells to be used in metabolism – even during times when the AMPK would not normally do so.

As a society we’ve encountered an alteration in our overall lifestyle. Where once we were more active in physical labor today we are much more sedentary so our bodies are not used to the idea of needing to burn added fat or energy cells.

Medical News Today helps explain the process. “AMPK’s main role is to sense cell stress. In this study, cells were stressed with ultraviolet radiation and low levels of glucose, a common source of cell energy. In the sequence of events after stress, AMPK picks up the cell-stress signal and travels to the nucleus to bind to the tumor suppressor gene p53. This in turn, causes a phosphate to be added to a histone near the p21 gene, which activates transcription. The function of the p21 protein is to stop or slow down the cell cycle.”

If medical science can simulate cell stress then it may be possible to induce a more effective use of glucose and a fat burning metabolism as it works to encourage AMPK to regulate a change that gains benefit from an effective use of blood glucose.

Medical News Today reports, “The work conducted by the researchers holds promise for new therapies for a number of diseases including diabetes and cancer. For example, AMPK is a target of metformin, the most commonly prescribed drug for the treatment of Type II diabetes. By understanding how AMPK can directly change gene expression, this may lead to the identification of new disease-associated targets and potential therapies.”

In the end this is one more potential therapy that may result in improved care for those who live with diabetes.

What would happen if medical science could put a tight reign on blood glucose levels? Would it have a significant impact on those living with diabetes? If so, how would it help? A five-year study provides some interesting insight.

According to Voice of America (VOA), “The government-funded study is called ACCORD, which stands for Action to Control Cardiovascular Risk in Diabetes. The study included high-risk diabetes patients – typically older and obese, with a history of complications.”

Conventional medical wisdom has been that tight control of blood glucose is helpful in all phases of diabetic self-management. However the findings pointed in a different direction, “Some patients got medicine to aggressively reduce cholesterol or blood pressure or their blood sugar levels. They were compared with patients in a control group who got standard treatments.

“None of the aggressive treatments significantly reduced the risk of heart attacks, strokes, or other cardiovascular complications,” reported the VOA.

Voice of America cited ACCORD researcher William Cushman who said, “Our composite cardiovascular outcome of dying from cardiovascular events or having a non-fatal heart attack or a non-fatal stroke, that combined outcome was not significantly reduced.”

We have reported similar finding in the past, but this research did uncover a benefit that perhaps they had not anticipated from tight blood glucose control. The VOA report stated, “One positive outcome from the ACCORD study was evidence supporting ways to improve what doctors call diabetes patients’ microvascular conditions. The disease affects small blood vessels in a way that can damage nerves, kidneys and the eyes. So, Emily Chew of the National Eye Institute noted that aggressive lowering of blood sugar or cholesterol levels helped control the progression of eye disease.”

Since one of the major long-term symptoms of diabetes is blindness and retinopathy this is actually very significant. In many cases diabetics must undergo eye surgery to save their vision as diabetes progresses. This new information suggests it is possible to either delay or perhaps even stop the advance of retinopathy and blindness in diabetics through effective blood glucose control.

As we reported earlier the VOA report confirms yet again, “In another part of the ACCORD study, patients got intensive therapy to lower their blood sugar. After three and a half years, the group getting intensive therapy was switched into the control group, to standard therapy, because they were dying at a higher rate.”

Some researchers suggest that the study should be expanded to see what results might be seen in younger patients who live with diabetes. Perhaps, it is theorized, there can be positive results from very tight control when a patient is younger. The treatment could then be altered as they age.

What most are concluding from the new information found in recent editions of The Lancet and The New England Journal of Medicine is that tight blood glucose control may be problematic for those who are known to have cardiovascular issues. The same is true for those who have diagnosed kidney disease.

As medical science continues to explore the causes and control of diabetes more becomes known about the treatment of the disease. While this information is counter to general thought it can and should result in better long-term care for diabetic patients.

As with all of life working toward a better balance of control and outcome is the best-case scenario for diabetes.

Recently the U.S. Government Subcommittee on Health convened to discuss the overall progress on diabetes in the United States. What follows are highlights from that subcommittee meeting.

Ann Albright, PhD, RD
Director, Division of Diabetes Translation

“Several research studies… have demonstrated that a structured lifestyle program, which results in a modest weight loss of 5 to 7 percent while encouraging a healthy diet and increasing physical activity, can reduce risk for type 2 diabetes by 58 percent in those at high risk for diabetes or who have pre-diabetes. Based on the findings of the Diabetes Prevention Program clinical trial and subsequent NIH-supported studies that have translated these research findings into real world settings, CDC and our partners are implementing the National Diabetes Prevention Program. This program focuses on delivering the proven intervention in-group settings for a cost of about $250 to $300 per person per year. The National Diabetes Prevention Program takes a four-pronged approach: training the workforce, a recognition program for quality assurance, funding sites to deliver the intervention, and health marketing to increase the program’s utilization.”

Judith E. Fradkin, M.D.
Director, Division of Diabetes, Endocrinology, and Metabolic Diseases

“One approach to combat the diabetes epidemic in the U.S. is to prevent the disease. The Diabetes Prevention Program (DPP) clinical trial showed that people with pre-diabetes-defined as having blood glucose levels that are higher than normal but not yet high enough to be diagnosed as diabetes–can dramatically reduce their risk of developing type 2 diabetes through lifestyle changes that achieve modest weight loss or through treatment with the drug metformin, although the metformin intervention was much less effective than the lifestyle intervention. The interventions worked in all ethnic and racial groups studied, in both men and women, and in women with a history of gestational diabetes. Research now shows that, after a 10-year period of following DPP participants, the interventions result in long-term benefits: people still had a lower risk of developing type 2 diabetes and those who made lifestyle changes also had reduced cardiovascular risk despite taking fewer drugs to control their heart disease risk factors?”

Robert A. Goldstein, M.D. PH.D.
Senior Vice President, Scientific Affairs for the Juvenile Diabetes Research Foundation International

Promising research include(s):

• Vaccine to Prevent Type 1 Diabetes Onset: Research toward the development of a vaccine to reverse the immune attack that causes diabetes holds great promise for type 1 diabetes patients. NIH- and JDRF-funded researchers have successfully cured and prevented type 1 diabetes in mice using a vaccine made of nanoparticles thousands of times smaller than the size of a cell, coated with proteins involved in immune cell communication. Thanks to NIH funds from the Special Diabetes Program, researchers have shown that these particles are safe for use in humans.

“The NIH, JDRF and privately-funded researchers are also working on promising vaccine therapies to preserve beta cell function in people newly diagnosed with type 1 diabetes.”

If you read articles on this site you know there are plenty of promising research statistics along with new discoveries that are providing hope and answers to diabetics. This subcommittee hearing was designed to bring top minds together to point out new avenues in which diabetic research can go and applaud those things that have been successful in facilitating change in the way we deal with the disease.

There will always be something to work on, but as demonstrated above there are also hurdles that have already been crossed.

How much effort would you put into spreading the message about diabetes and its impact on you and those who love you? For one New Jersey resident the answer is running more than 3,000 miles in about 3 months. Learn more about Yijoo Kwon.

Kwon immigrated to the United States from South Korea. In fact, the New York Times indicated Kwon was a soldier for South Korea during the Vietnam War.

Diagnosed in 1996 as a Type 2 diabetic, Kwon was overweight and under challenged. He was a successful business owner, but diabetes presented it’s own difficulties. One diagnosis proved Kwon to be a fighter to be admired.

Kwon took up running and dropped his weight by about 60 pounds. Running became something of an obsession for Kwon who has participated in more than 100 marathons. However, no race to date held more personal interest than a recent trip from Los Angeles to New York.

The purpose of this trip was to raise awareness to the disease that is Type 2 diabetes. Kwon ran through rain, cold and heat averaging around 30 miles per day. For Kwon there were no days off.

Kwon made stops in large and small towns from Riverside, California to Meade, Kansas. Kwon discovered areas both largely urban and ultra rural. Resting each night in an RV. His wife provided the leg massages he needed to endure another long day on the road.

Often Kwon’s days started by 4 AM and he stopped running by 2 PM. This helped him avoid the hottest portion of any particular day. By the time the personal race was finished he held a news conference at the United Nations to talk about his trek and the need to be vigilant about diabetes.

Christopher McDougall is a fellow marathon enthusiast who followed Kwon’s journey with interest and even planned on joining him for a portion of the run. McDougall posted on his blog June 2nd, 2010, “Catch him while you can. Just check out his numbers: May 26, 34.01 miles; May 27, 34.01 miles; May 28, 34.04 miles…

Unreal.

“Yijoo Kwon, the 64-year-old diabetic who began beating his disease the day he began running, is still blazing across the U.S. on his solo transcontinental run. He expected to be back home in Queens by July 9, but he’s moving so fast, he’ll almost certainly be early. He’s in Ohio right now, but at an average pace of 34 miles a day, he won’t be for long.”

Kwon’s own website bears witness to the transformation that led to such an endurance runner, “At the age of 51, Mr. Kwon was diagnosed with type 2 diabetes and was given an effective death sentence by doctors. The disease was an inevitable consequence from his unhealthy diet and sedentary lifestyle, and his future looked bleak. Mr. Kwon did not give up, however. He began walking, and little by little worked up to jogging and finally running. With sheer determination in the face of a potentially terminal illness, Mr. Kwon was able to fight his diabetes and claim back his life through running. These days, he runs several marathons a year and fully controls his diabetes through exercise and a healthy diet, without medication.”

While forgoing medication is not advocated in most instances Kwon was resolute in his determination to wage a lifelong war with the disease.

Kwon has indicated an interest in writing a book about his cross-country journey and how his own diabetes provided the motivation for the trek.

In the same way asthmatics use rescue inhalers to reduce bronchial issues a new product may allow similar assistance for the symptoms of diabetes.

According to WebMD, Inhaled insulin proved to be as effective at lowering blood sugar levels as standard insulin injection treatment, and with minimal side effects, among patients with uncontrolled type 2 diabetes.

“Reporting in this week’s American Diabetes Association meeting and in The Lancet, researchers compared two approaches to managing type 2 diabetes among patients ages 18 to 80 from 10 different countries. The patients were nonsmokers and had poor control of blood sugar despite insulin therapy.”

There were just over 200 participants in this experimental distribution method while a slightly higher number of patients in the control group received standard diabetic treatment. At the end of the one-year study there were several findings that may be of interest to those living with diabetes.

• Blood sugar levels were similar in the two groups; 22% of patients in the inhaled insulin/insulin glargine group reached a goal A1c level of 7% or less while 27% of those solely on insulin injections reached the goal.
• Patients using the inhaler gained less weight — a major concern among diabetes patients. The inhaler group gained only an average of about 2 pounds, whereas the control group gained an average of about 5.5 pounds.
• Patients using the inhaler had fewer episodes of hypoglycemia — a sudden drop in blood sugar — than those in the comparison group, occurring in 31% of patients on inhaled insulin/insulin glargine group vs. 49% of those in the insulin injection group.
• Patients using the inhaler reported more side effects with coughing and upper respiratory infections. Most of the coughing occurred within the first 10 minutes of inhalation and primarily during the first week of treatment and declined as treatment continued.
• Prior use of metformin, an oral drug commonly taken to manage blood sugar, did not affect results among the two groups of patients. (Source: WebMD)

Of particular interest is the fact that blood sugar was controlled more tightly when the inhaled insulin was used. Weight gain was less problematic with the inhaled insulin and hypoglycemia incidence was reduced.

On the other hand there were the side effects that caused some patients initial problems although it was noted those symptoms subsided following regular use.

WebMD quotes researcher Julio Rosenstock, MD as saying “Our findings show that inhaled insulin plus insulin glargine, alone or in combination with an oral antidiabetes drug such as metformin, is an effective alternative to conventional insulin therapy (biaspart insulin) in uncontrolled type 2 diabetes.”

In an effort to provide full disclosure WebMD further reported, “This research was funded by MannKind Corp., a California-based bio-pharmaceutical company that manufactures Technosphere, the inhaler device used to deliver the insulin in this study. MannKind is using Technosphere to administer an inhaled insulin drug called Afreszza, which has not yet been approved by the FDA.”

The primary voice of caution in this case has to do with the side effects of respiratory discomfort. Some in the field of medical science are concerned about the effects of this new distribution method on miniature air sacs in the lungs known as alveoli.

It’s a safe bet that more tests will follow to help determine if the findings can be replicated and to learn more about the potential side effects and how they may ultimately influence those who may choose to use this product should it become available.

The Centers for Disease Control (CDC) suggests that a better understanding of what prediabetes is could help prevent the expansion of diabetes. Knowing what leads to diabetes can be a powerful tool of disease avoidance.

The following information was provided by the CDC to help identify issues related to prediabetes.

Prediabetes: Impaired glucose tolerance and impaired fasting glucose

Prediabetes is a condition in which individuals have blood glucose levels higher than normal but not high enough to be classified as diabetes. People with prediabetes have an increased risk of developing type 2 diabetes, heart disease, and stroke.

• People with prediabetes have impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). Some people have both IFG and IGT.
• IFG is a condition in which the fasting blood sugar level is 100 to 125 milligrams per deciliter (mg/dL) after an overnight fast. This level is higher than normal but not high enough to be classified as diabetes.
• IGT is a condition in which the blood sugar level is 140 to 199 mg/dL after a 2-hour oral glucose tolerance test. This level is higher than normal but not high enough to be classified as diabetes.
• In 1988–1994, among U.S. adults aged 40–74 years, 33.8% had IFG, 15.4% had IGT, and 40.1% had prediabetes (IGT or IFG or both). More recent data for IFG, but not IGT, are available and are presented below.

Prevalence of impaired fasting glucose in people younger than 20 years of age, United States

• In 1999–2000, 7.0% of U.S. adolescents aged 12–19 years had IFG.

Prevalence of impaired fasting glucose in people aged 20 years or older, United States, 2007

• In 2003–2006, 25.9% of U.S. adults aged 20 years or older had IFG (35.4% of adults aged 60 years or older). Applying this percentage to the entire U.S. population in 2007 yields an estimated 57 million American adults aged 20 years or older with IFG, suggesting that at least 57 million American adults had prediabetes in 2007.
• After adjusting for population age and sex differences, IFG prevalence among U.S. adults aged 20 years or older in 2003–2006 was 21.1% for non-Hispanic blacks, 25.1% for non-Hispanic whites, and 26.1% for Mexican Americans.

Prevention or delay of diabetes

• Progression to diabetes among those with prediabetes is not inevitable. Studies have shown that people with prediabetes who lose weight and increase their physical activity can prevent or delay diabetes and return their blood glucose levels to normal.
• The Diabetes Prevention Program, a large prevention study of people at high risk for diabetes, showed that lifestyle intervention reduced developing diabetes by 58% during a 3-year period. The reduction was even greater, 71%, among adults aged 60 years or older.
• Interventions to prevent or delay type 2 diabetes in individuals with prediabetes can be feasible and cost-effective. Research has found that lifestyle interventions are more cost-effective than medications.

The best news in this prediabetic information is that type 2 diabetes can be prevented through certain lifestyle adjustments. These adjustments can lead to a longer life and a significantly better quality of life.

This information is important as the number of undiagnosed diabetes continues to rise. Because a diabetic can have the disease the not know it until the disease is well entrenched it is important to know what signs to look for as an indicator of what you may need to do to avoid the disease.

Table salt has been linked to hypertension (high blood pressure), but there may be another side to salt that can make it more ominous for those who either are or may become diabetic.

The reason this is a concern is based on the link of diabetes and obesity. Salt apparently plays a role in both hypertension and weight gain.

In a recent interview with HealthCastle.com Registered Dietitian and author Tammy Lakatos Shames provides some interesting connections with salt, “We used to always blame carbs or sugar or often whatever else it may be. And sure, these are partially responsible, but now we know that salt is playing a key role as well. First of all, salt makes us both hungrier and thirstier. But an interesting thing that most people don’t know that research shows that it actually makes your fat cells fatter.”

Salt is often used as a taste enhancer that can be used in self proclaimed moderation, but Shames indicates, “Most people don’t think they have a salt problem and the truth of the matter is, a large percentage of us are actually getting two to three times the salt that we actually should. So the bottom line is most of us do have a salt problem.”

Consumers may attempt to do the right thing by purchasing low sodium products and resisting the urge to put too much salt on our foods, but Shames says there may really only be one way to ensure a low salt diet, “Stick to really wholesome foods like fruits and vegetables, whole grains and beans. You have to keep in mind that even foods like bread contain a lot of salt.”

If you’re curious as to the most probable food offenders when it comes to salt Shames says, “Most of us know about the pickled foods but really it’s also those bacon, sausages, the processed meats are really high. Canned foods, processed foods too. Unfortunately, anytime you go to a restaurant or fast food restaurant, usually there is a lot of salt in there as well.”

Shames suggests that humans aren’t born with a taste for salt. This is acquired through diet, “Cut back the salt for about three weeks (21 days), your taste buds like other cells in your body turn over. So that salt that you used to really like, you no longer will like so much. In fact, we have seen this with clients of time and time again where they have salty foods and then they cut back on the salty foods. Then go back to adding salt back in their diet, and suddenly they can’t stand the salt and think that everything tastes too salty.”

Not surprisingly Shames points to processed foods as a primary culprit for excess dietary salt. When cooking fresh meat try adding spices instead of salt and work through small steps to eliminate one source of processed food each day, “Read the label. If you see a snack food that has 400 mg of sodium per serving, you know that it’s going to be too much when you should only be getting a maximum of 2300 mg of sodium a day,” said Shames.

Shames is the author of “The Secret to Skinny” in which she deals extensively with salt in our diets and effective ways to reduce its instance at both mealtimes and snacks.

Are there habits you can embrace that place you more at risk for diabetes? According to one author the answer is a definitive, “Yes!”

We all tend to understand there are habits that we can develop that can be helpful to long-term health, but according to Dr. Timothy Church, M.D there are things that we do as part of a ritual or habit that can place us in line with diabetes development.

Church spoke with abc15.com, a television station in Arizona. What follows is the list Church provided.

#5 BREAKFAST SKIPPER
A Harvard Medical School study found that people who eat breakfast were one-third less likely to be obese or have blood sugar problems, which increase the risk of developing diabetes, compared to those who skipped the meal.

#4 STRESSED OUT
Stressful situations can release hormones that will raise your blood sugar levels directly. For people with Type 2 diabetes, mental stress often raises blood glucose levels.

#3 NIGHT OWL
Suppression of slow-wave sleep, or “deep sleep,” in healthy young adults significantly decreases their ability to regulate blood-sugar levels and increases the risk of Type 2 diabetes according to researchers at the University of Chicago Medical Center.

#2 BEER BELLY
Weight is distributed differently on everyone. However, contrary to what most people think, it’s not what you weigh, it’s where you weigh that can increase your risk for diabetes. The amount of fat in the belly area can be a key indicator. A waist measurement larger that 35 inches for women and 40 inches for men constitute a high risk for diabetes.

#1 COUCH POTATO
Research has shown that physical activity can lower your blood sugar level and plays an important part in preventing Type 2 diabetes. A major government study, the Diabetes Prevention Program (DPP), showed that modest weight loss of 5 to 7 percent—for example, 10 to 15 pounds for a 200-pound person—can delay and possibly prevent Type 2 diabetes.

Church is the author of “Move Yourself” and he has a passion for eliminating reasons to develop diabetes. He suggests there are things you can do to help yourself. Again, from abc15.com we see a secondary list of helpful tips.

1. Move Yourself More
Whether you lose weight or not, any type of physical movement, or activity, lowers blood sugar and boosts your sensitivity to insulin — which helps keep your blood sugar within a normal range.

Church says if you just schedule 30 minutes of walking into your daily routine you’ll drastically reduce your risk to major diseases including diabetes.

2. Mulberry Before Big Meals
Chruch says blood sugar levels are at the highest and have the potential to cause substantial damages during the first 30 to 45 minutes after big meals.

You can counteract that with a traditional natural remedy: mulberry leaf extract.

Used by many cultures around the world for centuries, mulberry leaf extract is taken to reduce the rise in blood sugar that occurs after meals.

Evidence from multiple clinical studies show mulberry leaf extract can help with blood sugar maintenance.

3. Maintain a Healthy Weight
Weight is distributed differently on everyone. However, according to Dr. Church contrary to what most people think, it’s not what you weigh, it’s where you weigh that can increase your risk for diabetes.

The amount of fat in the belly area can be a key indicator.

A waist measurement larger that 35 inches for women and 40 inches for men constitute a high risk for diabetes.

Taking 10 minutes a day to log what you eat and manage your calorie intake can be critical. As little as a 5 percent weight reduction can make a difference in avoiding diabetes.

In some diabetic circles the mere mention of the word carbohydrates can send off massive internal alarms. However, it may be possible that certain carbs may actually be beneficial once you understand how they deliver blood sugar to your system.

There are many carbs that flood your system with excess blood glucose. This can be especially difficult for diabetics, which is why there tends to be an intentional shift away from carbs in most instances.

The good news is there may be carb alternatives that can assist in the management of blood glucose due to their ability to act in a time released way. For instance plain white bread delivers carbs quickly to your system while dark whole-grained breads deliver valuable fiber while minimizing the potential of glucose overload due to carbs.

Interestingly pasta may actually better for you than rice when it comes to carbs simply because rice provide a quick release of blood glucose that can overload your system. Pasta may still not be the absolute best alternative, but you can offset this struggle by electing to use whole-wheat pasta that provides an incredible alternative low in glucose.

Sometimes those who aren’t diabetic tend to believe that it is sugar that causes the majority of problems for those who have diabetes. The truth is the carbs found in candy are the real culprit. There needs to be a distinction between sugar and blood glucose. Sugar doesn’t automatically become blood sugar. It is excess carbs that create the excess blood glucose. As far as fruit is concerned the worst offender in high carbs is watermelon. This is important to note simply because most dietitians will suggest fruit is something a diabetic can have within a regulated diet.

In those who are either not diabetic or prediabetic the role of carbs can play an important role in determine how best to eat for the greatest long-term benefits. It simply makes sense for all of us to work at keeping blood sugars from spiking, and one of the best ways to manage this is through education.

For those wanting to get a better handle on their glycemic index it just makes sense to work at regulating a diet that aids in digestion and long-term health.

For those who have diabetes it makes sense to follow a low-glycemic diet, Research indicates there is a decreased reliance on medication for those who follow such a management plan.

One of the most violent carb offenders is the potato. These white starch filled veggies add an immediate boost to your glycemic index and can leave you feeling a little sluggish.

Soluble fiber can be a great friend to the diabetic if for no other reason than the fiber is useful in the digestion of carbohydrates. Again, there are carbs that may be acceptable to eat, and added fiber can further reduce the impact of carbs.

If all of this seems to be a bit too much you need to know that it is knowledge that can allow you to not only understand the disease of diabetes, but also the opportunity to mitigate the damage and bring a better sense of order to your personally directed self management care.

Following this advice could result in a decrease in the instance of diabetes, heart disease as well as aiding in weight reduction goals.