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

Entries Tagged as 'Complications'

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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 mendosa.com 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 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: Complications, Exercise

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 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: 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: Complications

Vitamin E for Your Fatty Liver

June 16th, 2010 · 3 Comments

With all the ways that we have now to treat fatty liver disease I don’t understand why any of us still have it. Yet most people with diabetes suffer from this potentially dangerous condition.

Now we have yet another tool in our arsenal against fatty liver disease. It’s a strange one. Not strange as in being unfamiliar, but rather strange as being surprising.

The new tool that may reverse fatty liver disease is vitamin E.

Years ago I had fatty liver disease myself. My late wife had it too. I was able to reverse it, but for her it eventually progressed to cirrhosis of the liver, which killed her three years ago.

Sadly, we didn’t know then how serious fatty liver disease could be and about all the ways to avoid it. I’ve written here how milk thistle and metformin can help. So too can eating a diet high in omega-3 fats. Exercise certainly works, as I know from my own experience. Even a little exercise helps.

The latest word on potential treatments for fatty liver disease saw the light of day a week ago in the advance online edition of The New England Journal of Medicine. Many people consider this the world’s leading medical journal. As of today only the abstract is free online, although I was able to download the full-text yesterday. The NEJM plans to publish the study in the printed journal tomorrow.

Researchers found that vitamin E improved the livers of people who had nonalcoholic steatohepatitis (NASH), which lay people like us know as fatty liver disease. In the study 247 adults with advanced fatty liver disease were randomly assigned to take vitamin E or a placebo (dummy pills) for nearly two years. They found that 43 percent of those treated with vitamin E showed significant improvement in their liver, while only 19 percent of those who received a placebo got better.

The dose was 800 IU of the natural form of vitamin E. The specific form was “RRR-α-tocopherol (formerly known as d-α-tocopherol) vitamin E,” according to the full-text of the research report. [Read more →]

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Posted in: Complications

Omega-3 for Fatty Liver

March 3rd, 2010 · 7 Comments

Fatty liver disease is one of the most common complications of diabetes. About 50 to 70 percent of those of us who have diabetes may have this potentially dangerous complication. But now we may have a way to treat it and stopping it from progressing to liver failure.

The first time I wrote about fatty liver was in 2005 when I had it myself. Fortunately, I have since been able to reverse it with diet and exercise.

My late wife Catherine wasn’t so fortunate. Her fatty liver progressed to liver failure, which led to her death in early 2007.

Catherine had type 2 diabetes and was seriously overweight, and neither of us knew at the time that this is the cause of most cirrhosis of the liver. We had always assumed that drinking too much alcohol was the cause — but she never drank any.

Since then I’ve learned a lot about the dangers and other causes of fatty liver disease. Just recently, in fact, Swedish researchers reported that people with nonalcoholic fatty liver disease have a higher overall mortality rate compared with the general population. [Read more →]

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Posted in: Complications

Strategies for Conquering Depression

February 17th, 2010 · No Comments

“Please tell me where I can go for help for depression,” a correspondent wrote me a few days ago. “I have had diabetes a long time, and I am so tired of everything. Can you point me in the right direction for some help?”

I replied by suggesting five strategies that seem to work for me. For about two months after I had an emergency operation on October 1 while traveling, I wasn’t a happy camper. A friend told me that general anesthesia can cause depression, and a quick search of the Web confirmed it.

Two months must have been far too long for the anesthetic to hang around in my body. But for the past several weeks I have been continuously happy.

Maybe it’s because I’ve been getting out regularly for walks to some of my favorite winter destinations. Or maybe it’s because I’ve getting a lot more long-chain omega-3 fatty acids from fish (and a lot less omega-6). Possibly it’s the continued effect of the 10,000 IU of vitamin D I take every day. We have some evidence that each of these strategies help to counteract depression. [Read more →]

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Posted in: Complications

The PLAC Test

December 11th, 2009 · 3 Comments

We now have a test that can determine hidden risks of heart attack and stroke. It’s called the PLAC Test and is the only blood test that the U.S. Food and Drug Administration has approved.

The PLAC test helps us identify hidden risks for heart attack and stroke by measuring for Lp-PLA2. This is the cardiovascular-specific inflammatory enzyme implicated in the formation of vulnerable, rupture-prone plaque.

The conditions that this test helps to identify are two of the country’s three most serious health problems. The American Heart Association estimates that at least 65 percent of people with diabetes will die from a cardiovascular event, such as a heart attack or stroke.

Fortunately, we have a simple blood test that goes beyond traditional risk factors to help identify those of us at increased risk of heart disease and stroke. ThePLAC Test, developed by diaDexus Inc. in South San Francisco, can help us assess our risk for both conditions.

Lp-PLA2 is an enzyme in the blood primarily associated with low-density lipoprotein (LDL, the “bad” cholesterol). LDL carries Lp-PLA2 to the walls of coronary arteries. There the enzyme can activate an inflammatory response, making plaque more prone to rupture. [Read more →]

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Posted in: Complications, Testing

Losing Weight to Reverse Sleep Apnea

December 11th, 2009 · No Comments

Obstructive sleep apnea is one of the most common complications of diabetes, especially among people who are overweight. A recent study of 306 obese people with type 2 diabetes who wanted to lose weight found that more than 86 percent of them had sleep apnea.

The standard treatment for sleep apnea is wearing a CPAP machine for continuous positive airway pressure when we sleep. People who don’t control sleep apnea are much more likely to have high blood pressure, strokes, impaired quality of life, and a shorter life.

When I had sleep apnea, I was afraid that it will kill me. My sleep apnea was so severe when I did a sleep study in a hospital that they found I had 84 apneic episodes per hour. Before I wore a CPAP machine, I knew that I risked falling asleep at the wheel, as I wrote five years ago in Diabetes Wellness News. [Read more →]

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Posted in: Complications

Should You Get a Shot for H1N1 (Swine Flu)?

December 11th, 2009 · 1 Comment

For months the question has been whether we could gear up production of vaccine for the H1N1 flu virus — formerly swine flu — fast enough. Now that the first doses have reached some distribution centers this week, we have the answer to that question.

This answer leads to the next question that we all have to face. Should we get the vaccine?

The Centers for Disease Control and Prevention, or CDC, says that people “at increased risk of severe illness” most need the H1N1 vaccine. One of these groups includes people with diabetes.

This makes sense. Those of us who have diabetes can get very sick and may even have to go to a hospital. Our impaired immune system makes us more vulnerable to getting a bad case of the flu.

Just getting sick can raise our blood glucose level. Then, it can stop us from eating right, and that further affects our blood glucose. [Read more →]

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Posted in: Complications

Two Easy Ways to Control Blood Pressure

October 30th, 2009 · 1 Comment

High blood pressure is part of the metabolic syndrome. This means that almost all of us who have diabetes also have high blood pressure.

We have lots of ways to help us control our blood pressure, including pills. But if you, like me, prefer to avoid taking prescription medicine, researchers have now discovered two ways that seem much better.

The researchers reported their findings Thursday at the American Heart Association High Blood Pressure Research Conference in Chicago. Formal papers will probably follow.

One study shows that younger women tripled their risk of having high blood pressure later in life when their levels of vitamin D were low. Those who were deficient in vitamin D — that is with less than 80 nanomoles per liter of blood — when the Michigan Bone Health and Metabolism Study measured it for 559 women in 1993 were more likely to have high blood pressure when researchers followed up with them 15 years later. Even adjusting for the effects of age, obesity, and smoking, the women who had been deficient in vitamin D at the start of the study were three times more likely to have high blood pressure in 2008. [Read more →]

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Posted in: Complications