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Diabetes Developments - A blog on latest developments in diabetes by David Mendosa

Eat the Carbs Last

September 24th, 2016 · Comments Off

When you eat protein and vegetables before eating food that’s high in carbohydrates, your blood glucose and insulin levels won’t spike as much after the meal as when you eat the carbs first. This is the main message of a new study previewed in June.

Alpana Shukla, MD, presented her findings in a poster, “Food Order Has a Significant Impact on Postprandial Glucose and Insulin Excursions,” at this year’s annual convention of the American Diabetes Association in New Orleans. This is the world’s largest scientific meeting focused on diabetes, and I represented HealthCentral.com.

The findings make an important point for those of us who have Type 2 diabetes. Until now, the conventional nutritional advice has been mostly negative — what not to eat, eat less, and so on. But it turns out the timing of what we eat matters too.

This new study is a small one, involving only seven people with Type 2 diabetes who are overweight or obese. Dr. Shukla and her seven Cornell associates measured the blood glucose levels of these participants every half hour for three hours after they ate the same amount of calories in protein, vegetables, and carbohydrates in a different order on separate days.

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Comments OffPosted in: Diabetes Diet

High-deductible Health Insurance Can Be Expensive

September 23rd, 2016 · Comments Off

Every day more people with diabetes sign up for high-deductible health insurance in hopes that they will save money. Because they have low monthly premiums, these plans are increasingly popular.

But instead of being less expensive, they are more costly for most people with diabetes. This is the conclusion of a study that Frank Wharam, an associate professor at Harvard Medical School, presented this June at the annual convention of the American Diabetes Association in New Orleans. This is the world’s largest scientific meeting focused on diabetes, and I was in the audience to represent HealthCentral.com.

The proportion of people who have high-deductible health insurance is skyrocketing, partly due to the Affordable Care Act. In 2006, only 10 percent of insured Americans had deductibles of $1,000 or more. But this proportion shot up to 46 percent last year, and Professor Wharam says that it is “likely to explode.”

The way that high-deductible health coverage works is by charging a lower monthly premium than what you would have to pay for a standard plan. But when you use your health care coverage, your out-of-pocket costs are higher.

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Comments OffPosted in: Diabetes Basics, Diabetes Medication, Psychosocial

This Device Can Warn You If You Will Get a Foot Ulcer

September 22nd, 2016 · Comments Off

Foot ulcers can have an their early warning system, and this is probably the only good thing about them. When one of these ulcers are developing developing, it may not be obvious even to a doctor. But it will likely be a warmer spot on your foot.

To take advantage of this warning, a new medical system uses temperature data to predict that an ulcer will develop more than a month before it surfaces. With this system, doctors would have more time to treat it.

Foot ulcers can follow neuropathy, which 60 to 70 percent of people with diabetes have. But neuropathy is not an inevitable consequence of diabetes.

“The best way to prevent neuropathy is to keep blood glucose levels as close to the normal range as possible,” the U.S. National Institute of Diabetes and Digestive and Kidney Diseases states. “Maintaining safe blood glucose levels protects nerves throughout the body.”

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Comments OffPosted in: Diabetes Complications

This New Meter Is Accurate and Can Be Yours Free

September 18th, 2016 · Comments Off

I hope you are already using a blood glucose meter, if you have diabetes or prediabetes. Using one of these meters is the only way that you can know how you are doing with the food you eat, the exercise you get, and the medicine you take may be sending your levels too low or too high.

Do you already have a meter? If you do, you may want to consider a new one. I remember an endocrinologist telling me 20 years ago that we should get a new one every year. Because the technology is much better nowadays, we probably can keep using a meter longer than that. But any meter can go out of whack — for example, if you drop it. And the newer ones keep getting better.

The new Jazz Wireless 2 meter from AgaMatrix of Salem, New Hampshire, is likely to be superior to the one you are using. It’s one of the most accurate and certainly the smallest blood glucose meter that you can use. It’s also one of the least expensive on the market.

AgaMatrix isn’t one of the Big Four meter companies. LifeScan, Accu-Chek, Abbott, and Panasonic Healthcare (which early this year bought Bayer Diabetes) dominate the health insurance formularies, so many people with diabetes fail to look beyond them.

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The Stigma of Having Type 2 Diabetes

August 28th, 2016 · Comments Off

Many of us who have Type 2 diabetes feel the stigma of our condition. For most of the 22 years that I have known I had it, I was reluctant to tell anyone that I have diabetes. Until a few years ago, I would describe myself, if asked, as a medical writer, even though my full-time work is writing about diabetes and advocating for people who have it.

Likewise, only recently have researchers begun the scientific study of the stigma of diabetes and the physical and mental effects that it has on us. Until now, quantitative research has been limited by the absence of reliable and validated measures of perceived and experienced diabetes stigma.

Serious study of diabetes stigma is just beginning

Compared to what we know about the stigma affecting people with other chronic conditions, the diabetes evidence is sparse. We know much more about how people with HIV/AIDS, obesity, and epilepsy are stigmatized. I know directly about the stigma of having epilepsy because my mother was so ashamed of having it that she never told her children.

Now, researchers can use the new Diabetes Stigma Assessment Scales to systematically study the effects of stigma on people with Type 1 or with Type 2 diabetes. These scales were reported in a late-breaking poster presented at the American Diabetes Association’s convention of about 16,000 professionals in New Orleans this June. I represented Health Central there.

We do have some quantitative research about diabetes stigma. I also found narrative reviews and reports of personal experiences, including job discrimination, restricted opportunities in life, and unfair judgments.

Three-fourths feel judged

A survey just reported that 76 percent of adults with diabetes have felt judged by family members or friends for how they manage their diabetes. And 54 percent of them frequently feel judged. I obtained a copy of this survey of 500 adults with diabetes from a representative of Roche, which commissioned it from Wakefield Research.

In 2013, the researchers who developed the new assessment scales reported what they think was the first qualitative study of diabetes stigma. Noting then that they needed more research in how to measure stigma, they published their findings of this small study in the professional journal BMJ Open. Their key conclusion was that of the 25 adults with Type 2 diabetes in the study, 84 percent reported that they felt their condition was stigmatized or they reported evidence of stigmatization.

The things we need to do can lead to stigma

When someone has Type 2 diabetes, it’s not immediately obvious, the study points out. But needing to take diabetes drugs or insulin injections, checking blood glucose levels, and following a different diet may be conspicuous. When people inject insulin in public, others may assume they are drug addicts. The symptoms of low blood glucose can include confusion and dizziness, which can be mistaken for drunkenness. Any of these activities can lead to diabetes stigma.

But what do researchers mean by stigma? The research often quotes what Professors Mitchell Weis and Jayashree Ramakrishna published a decade ago in the influential journal The Lancet:

“A social process or related personal experience characterised by exclusion, rejection, blame, or devaluation that results from experience or reasonable anticipation of an adverse social judgment about a person or group identified with a particular health problem. The judgment is medically unwarranted.”

Stigma can lead to poor self-management

The most comprehensive narrative review that I discovered was a 2013 study in the journal Patient, “Social Stigma in Diabetes.” It concluded that the stigma “has a significant impact on psychological well-being.” But that is hardly all. Depression often can lead us to ignoring the diabetes with the inevitable result that we stop managing our condition well.

This narrative review also noted the ironic consequence of the landmark Diabetes Prevention Program. This study reported 15 years ago that “changes in lifestyle” can often stop the progression of prediabetes to diabetes. Type 2 diabetes is now widely known as a “lifestyle disease,” blaming the victim and further contributing to the stigma of the condition.

Education is the best hope

The best hope for reducing the stigma of diabetes, the narrative review concluded, will likely be education. Another ironic consequence, this time a positive one, is that as the diabetes epidemic continues to grow, diabetes knowledge will spread along with the condition itself.

This article is based on an earlier version of my article published by HealthCentral.

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Comments OffPosted in: Psychosocial

Manage Your Diabetes with Yoga

August 27th, 2016 · Comments Off

Is your blood glucose level is higher than you and your doctor would like it to be? Then, a yoga practice may be just what you need for your diabetes management.

In the past few months, three different diabetes professional journals coincidentally published separate review studies of yoga for diabetes. Each of these studies reached the tentative conclusion that doing yoga will probably help you to have better health.

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Comments OffPosted in: Exercise For Diabetes, Psychosocial

Reduce Your Risk of Weight Loss Surgery

August 26th, 2016 · Comments Off

Do you have diabetes and a BMI above 35? If you do and decide to get bariatric surgery to help you manage your diabetes, it could be an excellent idea.

But will you to go to your nearest hospital for the procedure? That might not be the safest thing to do.

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Comments OffPosted in: Diabetes Complications, Diabetes Medication

The Stress of Managing Diabetes When You Are the Prime Minister

August 25th, 2016 · Comments Off

Do you think that managing your diabetes is too hard because of all your responsibilities? Then, you might want to consider the tasks facing a 59-year-old woman named Theresa May.

She just became the UK’s Prime Minister. This makes her among the first—if not the first—current heads of a government who has diabetes.

Three years ago, when she was the country’s Home Secretary, Ms. May made an appointment with her doctor to treat a bad cold. She mentioned that she had been losing a lot of weight, so the doctor ordered a blood test. Her blood glucose level showed that she had diabetes.

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Comments OffPosted in: People With Diabetes

Does Weight Loss Surgery Keep Working for Diabetes Management?

August 24th, 2016 · Comments Off

Does your weight makes it difficult for you to manage your diabetes? Check out bariatric surgery, because it’s likely to help you to lose many pounds.

But how well will it help you manage your diabetes over the long term?

Until now, nobody knew the answer to this question. That’s why researchers have been studying a group of 120 adults with Type 2 diabetes at three teaching hospitals in the U.S. and one in Taiwan. Half of them got bariatric surgery, and half got intensive lifestyle medical management.

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Comments OffPosted in: Diabetes Medication

Why You May Want To Take Early Control of Your Diabetes

August 23rd, 2016 · Comments Off

If having heart failure or getting a stroke or dying soon are the only diabetes risks that concern you, then you don’t need to start managing your diabetes right away. But if you would rather not get diabetic retinopathy, diabetic nephropathy, or diabetic neuropathy, you may want to get down to a normal blood glucose level right after your doctor diagnoses it.

This is the good news/bad news summary of a study by researchers at the University of Chicago’s Department of Medicine and colleagues at the Kaiser Permanente Division of Research, and Northwestern University’s Feinberg School of Medicine. They presented their findings in late breaking abstract 184-LB, “Early Glycemic Control after Type 2 Diabetes Diagnosis Is Most Critical for Future Health and Survival,” at the American Diabetes Association recent convention, the world’s largest annual meeting of diabetes professionals.

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