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

Entries Tagged as 'Diabetes Complications'

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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Posted in: Diabetes Complications

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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Posted in: Diabetes Complications

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


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


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Posted in: Diabetes Complications, Diabetes Diet

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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Posted in: Diabetes Complications

Medical Marijuana for Diabetes

February 2nd, 2011 · 4 Comments

Here is a copy of a letter — with the author’s name and other identifying information redacted out — about anecdotal evidence that medical marijuana might help some complications of diabetes.

The person who wrote me has a better memory than I do. I don’t remember corresponding with him before, but he remembers that when I used marijuana I was addicted to it. It got to where I had to be high all my waking hours. My correspondent is also quite correct in writing that I would not be a good candidate for medical marijuana, except as a last resort.

The jist of what he wrote follows:

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Posted in: Diabetes Complications, Diabetes Medication, Psychosocial

A Stand-Up Guy and His Desk

November 13th, 2010 · 2 Comments

When I tell you that I am a stand-up guy, I wouldn’t blame you for assuming that I was boasting. After all, part of the standard Mafia definition of this term is one who “can be trusted.”

While I do hope that you can trust me, I call myself a stand-up guy because one of my own posts here inspired me to stand up a lot more. So, when I say that I am a stand-up guy, this is a fact, not a boast.

In a post here, “Standing Up for Your Heart,” I reviewed a study by Alpa Patel, Ph.D., and her associates that explored the connection between sitting and mortality. They found that the amount of time people spend sitting is associated with an increased risk of death from heart disease, which happens to be the biggest complication of diabetes.

When I digested the impact of that study, it reinforced my long-standing plan of converting my computer time from sitting to standing. Dr. James Levine, a Mayo Clinic endocrinologist, was my original my model. Four years ago I wrote here about how he mounted his computer over a treadmill, and while he works, he walks at the rate of 0.7 miles per hour.

Even before reading the new study led by Dr. Patel, I had told Abhijit Mhapsekar, who programs my website, about walking on a treadmill while he worked. I knew that it would help heal his bad back. And Abhijit actually did get a treadmill with his computer mounted over a desk.

But I dawdled. My apartment doesn’t have enough room for a treadmill and treadmill desk in addition to the wonderful teak desk that I’ve had since 1969.

Instead, I priced stand-up desks on the Internet and a local store for me to use without a treadmill. Those desks run from $1,300 to $,2300. And they weren’t awfully stable.

Instead, I had a handyman make me a stand-up desk. It is as simple as possible: just two tracks screwed into the wall with three brackets that are adjustable (and I have already adjusted them), with a board 24 inches deep by 43 inches wide, large enough for one of my computers and accessories. The new desk ran me about $300 and is very stable. Anyone with more skill than I have could make one for much less.

When I commissioned my new stand-up desk, I expected to use it a small part of the time. In fact, I now use it much more than my old desk.

I also think more clearly when I am standing up. Judge for yourself. I wrote this standing.

As a writer, I have always known that I learn more from my articles than even the most diligent readers do. This is just like teachers learn more than their students because of all the preparation that goes into their lessons.

And as a caring person my goal in life is to help other people who like me have to live with diabetes. The Talmud says that “to save one person is to save the world,” and even if I haven’t moved you yet to stand up more, my review of Dr. Patel’s work already inspired both Abdijit and me to get off our butts more.

That’s not all. After I got my new stand-up desk I told Dr. Patel about it. “Congratulations! I hope to move from sitting on my exercise ball to a stand-up desk soon myself.”

Can I inspire you too?

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


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Posted in: Diabetes Complications, Exercise For Diabetes

Visualize Yourself

November 4th, 2010 · No Comments

My friend Jay has type 2 diabetes and is a member of the diabetes support group that meets every month in my apartment. But he is also a primary care physician, and almost half his patients have diabetes.

Jay is therefore uniquely qualified to help us. At the most recent meeting of our support group we were already  running overtime. But it was Jay’s turn to speak, and he wanted to share with us the “shock treatment” that he uses with his new patients who have diabetes. I’m glad that he did and that I can share this treatment with you.

Jay starts by explaining that diabetes, high blood pressure, and heart disease are the three main silent killers. Because they usually don’t offer us any advance warning of the hidden damage that they do to our bodies, these diseases are truly insidious.

Then, he suddenly turns off the lights in the windowless office. “Visualize yourself 15 years from now,” he says. “This is what you might be seeing then, if you don’t control your diabetes.”

This is Jay’s shock treatment. But any technique that will get us to open our eyes to the consequences of uncontrolled diabetes is better than none, he says.

Jay asked each of the members of our support group to look in the mirror each morning and visualize ourselves 15 years later. For me this gave me one more piece of encouragement to eat right, stay slim, and exercise so I will still be able to see my face in the mirror 15 years from now when I will be 90. If I’m still around then, I hope to continue seeing a computer monitor so I that I will still be able to write you.

As Jay left my apartment that day, I took him aside and told him that I already could visualize his shock treatment. My ophthalmologist had just told me after my semiannual checkup that I have two small micro-aneurysms in my left eye that he hadn’t seen before.

Jay’s shock treatment worked especially well because I was already shocked. Micro-aneurysms can lead to diabetic retinopathy, which can, of course, lead to blindness, the complication of diabetes that I have always dreaded the most.

Now I have even more incentive to keep my A1C level in the low 5 range, if not down to 4.5, which is my goal. I hope that you don’t need any more incentives to control your own diabetes.

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


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Posted in: Diabetes Complications

Standing Up for Your Heart

August 30th, 2010 · 4 Comments

You don’t have to exercise to help your heart. Sure, exercise will probably make your heart last longer, but it’s not the only thing you can do to avoid the biggest complication of diabetes.

Just standing up — otherwise known as giving your butt a rest — now seems to work independently of physical activity to reduce your chance of dying from heart disease. A new study that the American Journal of Epidemiology published online in advance of print on July 22 indicates that the less leisure time we spend sitting the better it is for our hearts.

You can read the abstract of the study, “Leisure Time Spent Sitting in Relation to Total Mortality in a Prospective Cohort of US Adults,” online. The lead author, Alpa Patel, Ph.D., of the American Cancer Society’s epidemiology research program, sent my the full-text of the study when I requested it.

Dr. Patel and seven of her associates explored the connection between sitting and mortality by analyzing the survey responses of 123,216 people who had no history of cancer, heart attack, stroke, or emphysema or other lung diseases. These were people who enrolled in the American Cancer Society’s 1992 Cancer Prevention II study.

The researchers examined how much time those people sat down after work as well as how much exercise they got between 1993 and 2006. The results were clear.
How much time they spent sitting was associated with an increased risk of death from heart disease for both men and women. Women — but not men — who sat less had a smaller risk of dying from cancer.

Women who reported that they sat for more than six hours a day during their leisure time versus those who sat for fewer than three hours a day had a 37 percent higher death rate from all causes. For men it was about 18 percent higher.  After adjusting for the amount of physical activity these people got, the researchers found that the association remained virtually unchanged.

But when people sat more and exercised less, the difference was even greater. Women had a 94 percent highr death rate from all causes. For men it was 48 percent higher.

“Several factors could explain the positive association between time spent sitting and higher all-cause death rates,” Dr. Patel says. “Prolonged time spent sitting, independent of physical activity, has been shown to have important metabolic consequences, and may influence things like triglycerides, high density lipoprotein, cholesterol, fasting plasma glucose, resting blood pressure, and leptin, which are biomarkers of obesity and cardiovascular and other chronic diseases.” [Read more →]


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Posted in: Diabetes Complications

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