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

Entries Tagged as 'Diabetes Complications'

Diabetes Can Be a Pain

October 8th, 2012 · No Comments

Diabetes doesn’t hurt. That’s one of the biggest problems we have in taking this insidious disease seriously.

But when we don’t manage our diabetes, some of its complications can be painful. And about 40 percent of us have acute or chronic pain. That’s the bad news.

This bad news comes to us in a new study of more than 13,000 adults with type 2 diabetes in the Kaiser Permanente, Northern California system. About 42 percent of them reported that they had acute pain and about 40 percent said their pain was chronic. The most common complication they mentioned was fatigue, about 25 percent, followed by neuropathy, about 24 percent.

The findings, “Symptom Burden of Adults with Type 2 Diabetes Across the Disease Course: Diabetes & Aging Study,” will appear in the Journal of General Internal Medicine and is now available online. The lead author is Rebecca L. Sudore, M.D., and her assistant sent me a copy of the full-text.

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How You Can Reduce Your Risk of Heart Attacks

July 19th, 2012 · No Comments

When you keep your blood sugar level as low as the levels of people who don’t have diabetes, your have little risk of having a heart attack. But when you let your sugar level rise just a little, that risk goes up a lot.

Healthy people who don’t have diabetes have a fasting blood sugar level of less than 6 mmol/l, according to researchers at the University of Copenhagen. That’s the equivalent of an A1C level of 5.4. The Journal of the American College of Cardiology just published their study in the issue for June 19/26, 2012.

The researchers drew on three observational studies that included 80,522 Danes. Observational studies cannot prove a cause, but the researchers went further. They used “a Mendelian randomization approach … to circumvent confounding and reverse causation.”

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Better Hydration for People with Diabetes

January 8th, 2012 · No Comments

Endurance athletes and hot yoga enthusiasts are hardly the only people who have to stay hydrated. Anyone who has a sweaty job needs to make sure to replenish the minerals lost at work. People like me who have diabetes need to be especially careful to stay in balance.

Even if you aren’t much of an athlete or work in a hot and humid place you can perspire a lot when you go to the tropics. I know from my current experience.

Right now I am writing from Caye Caulker, a tiny island in the Caribbean Sea off the mainland of the Central American country of Belize. I am here primarily to photograph birds, and that requires lots of hiking. The weather has stayed mostly at 80° hot and 95-100 percent humid.

To  stay hydrated I don’t just consume a lot of salt. That can help in an emergency. When I was a kid in high school, I had a summer job washing bottles in a dairy at the western edge of the Colorado desert. When I collapsed after a few days, my parents took me to our family doctor, who prescribed salt tablets. While I was able to go right back to work, this wasn’t an ideal solution.

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Treating Neuropathy

October 3rd, 2011 · 3 Comments

Ever since I learned about a new treatment for neuropathy at the annual convention of the American Diabetes Association in June, I have been trying to think of a good reason why not to write about it. I failed.

As a journalist, I am naturally skeptical. As Louis Menard wrote in the current issue of The New Yorker, “A person whose financial requirements are modest and whose curiosity, skepticism, and indifference to reputation are outsized is a person at risk of becoming a journalist.” That’s me.

I am skeptical of any purported cure for diabetes. I am even skeptical of new treatments for any of its complications. I am especially skeptical of the so-called “medical foods” that our companies keep dreaming up.

But I am also curious about anything new out there that really might be able to help us. And we do need help with diabetic neuropathy.

At least 60 percent of us have some degree of neuropathy. Diabetes raise our blood glucose level, and a high level of glucose in our blood can damage the nerves in our bodies. Often the nerves at the body’s periphery are the first to suffer with burning, shooting, or stabbing pains. Uncontrolled, the pain becomes severe.

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The Effect of Nuts on Your A1C

August 24th, 2011 · 2 Comments

Don’t go from the nourishment of nuts to chowing down on carbs. That’s the opposite of what I mean by the title of this article. I mean to suggest that substituting nuts in your diet for some of your carbs makes sense.

A study that will appear in the August issue of Diabetes Care, a professional journal of the American Diabetes Association, shows that eating nuts every day can help us manage our type 2 diabetes and prevent its complications. This research reports that eating just two ounces of nuts as a replacement for carbohydrates proved effective in managing our blood glucose and lipid levels.

Dr. Cyril W.C. Kendall of the University of Toronto, who is the corresponding author, sent me the full-text of the study, “Nuts as a Replacement for Carbohydrates in the Diabetic Diet.” The abstract of the study is online.

The lead author of the study is Dr. David J.A. Jenkins. That name is what brought the study to my attention because he created the most powerful tool to evaluate carbohydrates.

That tool is the glycemic index, which his 1981 article in the American Journal of Clinical Nutrition kicked off. Slow to gain traction here, the GI seems nowadays to be everywhere.

When I learned in 1994 that I had diabetes, I began following the glycemic index, and my first book lauded it. Since then, however, I have gone beyond that diet. And Dr. Jenkins also seems to have done so.

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Posted in: Diabetes Complications, Diabetes Diet

Checking for Hypothyroidism

August 17th, 2011 · 1 Comment

Hypothyroidism now appears to be one of the most common complications of diabetes. Fortunately, it is one of easiest conditions to manage. All it requires is taking one little pill the first thing every morning to make up for the thyroid hormone that we lack.

Checking our TSH level is the usual way our doctors have to find out if we have hypothyroidism. Our pituitary glands make TSH, short for thyroid stimulating hormone.

How common hypothyroidism is depends on how we define a normal TSH level. Currently, most countries set the reference range at 0.40 to 4.5 mIU/l. But some organizations and many new studies suggest that a level of 4.5 is far too high to be considered normal.

The American Association of Clinical Endocrinologists considers 0.3–3.0 to be the normal range. But the National Academy of Clinical Biochemistry guidelines indicate that more than 95 percent of normal people have TSH levels below 2.5.

The HUNT study from Norway reported in a 2008 issue of The Archives of Internal Medicine that they used the TSH test to measure the thyroid function of 17,000 women and 8,000 men with no known thyroid or heart disease. All the people in the study had a “normal” TSH level of 0.5 to 3.5. The people in the lowest TSH group, those with a level of 0.5 to 1.4, had 70 percent less heart disease than those in the highest TSH group, who had a level of 2.5 to 3.5.

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Diabetes Causes Nothing

July 29th, 2011 · No Comments

We need both information and support to deal with the diabetes demon we carry around with us every day. In the past 15 years the explosive growth of the Internet — and especially the HealthCentral web site — now give us as much information as we can handle.

The Internet is also pretty good in giving us support. But we still get the best support face to face.

This morning Bill Polonsky gave some of us a taste of the support that he provides to people with diabetes. As the guest speaker closing the two-day 2011 Roche Social Media Summit at the Hard Rock Hotel in San Diego, Bill spoke to 37 writers and bloggers about diabetes.

Bill is the founder and president of the Behavioral Diabetes Institute in San Diego. This is the only institution in the world focusing on the emotional aspects of diabetes.

He has a Ph.D. degree and is also a Certified Diabetes Educator. Bill also is Associate Clinical Professor in Psychiatry at the University of California, San Diego.

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Study: Healthy Fasting Reduces Risk of Heart Disease, Diabetes

May 11th, 2011 · 5 Comments

Regular readers may remember that I reported here on earlier studies about some benefits from intermittent fasting. But a study reported yesterday shows that fasting also lowers the risk of heart disease and diabetes and increases the good HDL cholesterol and reduces triglycerides, weight, and blood glucose levels. It also increases the bad LDL cholesterol.

Research cardiologists at the Intermountain Medical Center Heart Institute in Murray, Utah, reported these finds at the annual scientific sessions of the American College of Cardiology in New Orleans. Tomorrow’s issue of the Journal of the American College of Cardiology will print the results of this study led by Dr. Benjamin D. Horne, Intermountain’s director of cardiovascular and genetic epidemiology.

LDL went up by 14 percent and HDL by 6 percent. But the increase in cholesterol from fasting is probably not a bad thing, as Dr. Horne explains.

“Fasting causes hunger or stress,” he pointed out. “In response, the body releases more cholesterol, allowing it to utilize fat as a source of fuel, instead of glucose. This decreases the number of fat cells in the body. This is important because the fewer fat cells a body has, the less likely it will experience insulin resistance or diabetes.”

Dr. Horne’s team conducted two fasting studies. One included more than 200 people. Another included 30 people who only had water for 24 hours and then studied for another day. During this additional 24-hour period the researchers subjected the subjects to blood tests and other physical measurements.

Now I have the incentive to get back to intermittent fasting. Just as soon as I finish the fish in my fridge.

This is a mirror of one of my articles that Health Central published. You can navigate to that site to find my most recent articles.

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Posted in: Diabetes Complications, Diabetes Diet

Preventing Blindness with Omega 3

April 28th, 2011 · No Comments

Diabetic retinopathy is a leading cause of blindness, one of the most serious complications of diabetes. But omega 3 fatty acids can help protect us from it. Fish oil, particularly from fatty fish like salmon and sardines, is our best food source of omega 3. Capsules of fish or krill oil are a good choice for people who don’t eat much fish.

Omega-3 fatty acids are highly concentrated in the retina, the light-sensitive tissue that lines the inner surface of our eyes. But the typical American diet is awfully low in omega-3 and high in omega 6, which competes with omega 3 to get into the cells of our bodies, as I wrote here last year.

We’ve known from studies of mice that omega 3 can prevent retinopathy. When researchers fed mice diets rich in omega 3, the mice had nearly 50 percent less pathologic vessel growth in the retina than mice fed diets rich in omega 6. But many of us, myself included, discount mice studies, because we are men and women, not mice, and all of us are much bigger and many of us are much brighter.Now a study from a research team at Children’s Hospitl Boston shows the way omega 3 protects mice — and hopefully us people — from blindness. A recent issue of Science Tranlational Medicine reported this study. The researchers isolated the specific omega-3 compound that has beneficial effects in mice. Technically, it is a metabolite of the omega-3 fatty acid DHA, known as 4-HDHA), and the enzyme that produces it (5-lipoxygenase, or 5-LOX.

For people with diabetes this is important research. “Between 40 to 45 percent of Americans diagnosed with diabetes have some stage of diabetic retinopathy,” according to the National Eye Institute. “The longer someone has diabetes, the more likely he or she will get diabetic retinopathy.”

Now, we have a much better chance of stopping diabetic retinopathy in its tracks. The first line of defense is our diet, specifically increasing the amount of omega 3 and reducing how much omega 6 fatty acids we eat.

This is a mirror of one of my articles that Health Central published. You can navigate to that site to find my most recent articles.

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Hypothyroidism and Diabetes

March 3rd, 2011 · 3 Comments

My feet were cold most of the time. Even when I wore thick woollen socks to bed my feet were often so uncomfortable that they interfered with my sleep.
Since I have diabetes, I assumed that my problem was that I had one of the most common complications of our condition, peripheral neuropathy. So I focused all the more on controlling my blood glucose level in hopes of reversing my problem some day.Good strategy in general. But worse than useless when the assumption is faulty. My problem is hypothyroidism. This means that my thyroid gland isn’t active enough in producing certain important hormones. One of the early symptoms is increased sensitivity to cold.

I also had a couple more of the early symptoms — I had a slow heart rate and my skin was dry and itchy. This is because the hypothyroidism gives me a slow metabolism, which can explain why I have such a hard time maintaining my weight loss. I can hardly eat anything without gaining weight!

But different people have different symptoms, and some people don’t have any of them. “Hypothyroidism is more common than you would believe, and millions of people are currently hypothyroid and don’t know it,” says James Norman, M.D., on EndocrineWeb.

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