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

Correct Your Injection Technique

October 15th, 2016 · Comments Off

If you inject insulin or one of the GLP-1 agonists, the chances are that you are putting yourself at an unnecessary risk of a complication.

The needles you use are probably too long. Only 30 percent of the people who use insulin have adopted the much shorter 4 mm needle that became available in 2010. About half of the people who inject diabetes drugs reuse their needles, particularly those who inject with a pen. Only about 40 percent of needle users rotate their injection sites correctly.

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Comments OffPosted in: Diabetes Medication

The Best Way to Prevent Diabetes

October 14th, 2016 · Comments Off

If you have prediabetes, the standard advice to avoid getting diabetes is to do three things at once: cut calories, eat a low-fat diet, and get exercise. But a recent study shows that it makes more sense to focus on just the last one of these.

Ever since 2002, when researchers published the results of the Diabetes Prevention Program, we have known that intensive lifestyle changes are the best way to avoid diabetes. That program aimed at reducing your weight by 7 percent, eating a low-fat diet, and increasing your physical activity to at least 150 minutes per week of moderate exercise, such as walking or biking.

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Comments OffPosted in: Exercise For Diabetes

Does More Fruit Matter?

October 10th, 2016 · Comments Off

September was the “Fruits & Veggies–More Matters” month. But does it matter to those of us who have diabetes?

Fewer than 1 in 7 American adults eat the recommended amount of vegetables, the U.S. government says. The recommended amount isn’t much: just 2½ cup-equivalents (2½ cups of raw or cooked vegetables or vegetable juice, 5 cups of leafy salad greens, or 11⁄4 of a cups of dried vegetables).

Significantly, what our government considers to be vegetables do not include grains, which are a separate food group. Nor does the vegetable group include nuts, seeds, and soy products, which are considered to be a protein food.

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Comments OffPosted in: Diabetes Diet

The Bad Words for People with Diabetes

October 9th, 2016 · Comments Off

These are some of the worst words to use about people with diabetes:

We aren’t diabetics who try to control our disease. Instead, we are people with diabetes who manage this condition.

Team Novo Nordisk in June asked people with diabetes, parents, and partners to share their opinions on the language of diabetes. Almost 400 people responded to the survey that the team published on August 15.

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Comments OffPosted in: Psychosocial

Don’t Let Diabetes Destroy Your Sex Life

September 30th, 2016 · Comments Off

Your intimate relationships can suffer when you have diabetes. But it’s not inevitable.

Challenges to sexual performance remain a taboo subject for many people, even as sex itself has come out of the bedroom and our culture has become increasingly sex obsessed. Consequently, you may be reluctant to discuss your concerns with a date, a partner, or even with a healthcare provider.

Those of us who have diabetes tend to accept, albeit reluctantly, that we have or may get the physical complications that can come with it. Yet we too often try to hide the emotional complications that can be equally devastating to satisfactory intimate relationships.

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Comments OffPosted in: Diabetes Complications

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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Comments OffPosted in: Diabetes Testing

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

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