Lifestyle Changes Can Keep Diabetes at Bay for 14 Years

Diet and exercise programs for people at high risk for developing diabetes, when followed for six years, can actually delay the development of diabetes for 14 years after the programs end, a new report finds.

The report is published in the May 24 special diabetes issue ofThe Lancet.

In another study in the same journal issue, Chinese researchers found that intensive therapy with insulin in patients with newly diagnosed type 2 diabetes can help restore the cells in the body that produce insulin, and thereby restore blood sugar balance.

"Early intensive insulin therapy in patients with newly diagnosed type 2 diabetes has favorable outcomes on recovery and maintenance of B-cell function and prolonged glycemic remission compared with treatment with oral hypoglycemic agents," the researchers concluded.

In terms of the lifestyle study, a series of trials around the world have shown lifestyle changes in diet and exercise can reduce cases of diabetes in people with high blood sugar levels. However, whether these gains remain over an extended period isn't clear, researchers said.

"When you do lifestyle interventions in communities, it seems to have a durability beyond the life of the intervention itself, which is very encouraging," said co-author Edward Gregg, branch chief of the Epidemiology and Statistical Branch in the Division of Diabetes Translation at the U.S. Centers for Disease Control and Prevention.

In the trial, called the China Da Qing Diabetes Prevention Outcome Study, 577 adults with high blood sugar levels, at risk for developing diabetes, from 33 clinics in China, were randomly assigned to one of three lifestyle intervention groups. One group relied on diet, a second group on exercise and a third on a combination of diet and exercise. In addition, there was a group that did not participate in any diet or exercise program.

People were counseled to reduce the amount of food they ate and to cut down on sugar and alcohol, Gregg said. "People were encouraged to eat more vegetables and increase their levels of physical activity," he added.

The study began in 1986, and these groups continued their diet and/or exercise programs until 1992. In 2006, the people in the study were seen again to determine the long-term effect of diet and exercise.

Gregg's team found lifestyle interventions reduced the incidence of diabetes by 51 percent over the six years of the program.

Moreover, over the whole 20-year period, the incidence of diabetes was reduced by 43 percent in those people who had been in diet and exercise programs.

On average, the incidence of newly diagnosed diabetes was 7 percent for people who had participated in diet and exercise programs, compared with 11 percent for people who hadn't, the researchers reported.

Diabetes and Your Feet

African Americans knowledgeable about health issues understand that they face a higher risk than other groups for diabetes. According to the National Institutes of Health (NIH), African Americans are 1.8 times more likely to have diabetes than Caucasians, and there were 3.2 million African American adults with diabetes as of 2005. While people think about diabetes in terms of blood sugar, maintaining a healthy weight and consuming a healthy diet, another factor discussed less often is foot care.

Some medical research suggests that unusual foot sensations – tingling, numbness or burning, for example – may be a warning sign of pre-diabetes. Full onset diabetes is known to have specific effects on the feet, specifically nerve damage and decreased blood flow. The diabetic affected with nerve damage in the feet may ignore this problem precisely because there is no feeling of pain or discomfort. But without feeling pain, a sore, cut or infection will usually get ignored by the diabetic until it is too late. Decreased blood flow exacerbates the problem by making it harder for those conditions to heal. Sometimes an infection becomes so widespread that a diabetic must undergo surgery to amputate part or all of the foot.

Whether or not you have been diagnosed with diabetes, the time to pay attention to your feet is now. Check you feet for any abnormalities in the toenails, toes, tops of your feet and soles of your feet. Look out for corns, blisters, warts, calluses, ingrown toenails, hammertoes and dry or cracked skin. Pay attention to tingling or other odd sensations. If you find any of these problems, inform your physician right away. If you don’t have these problems, you should still have your physician examine your feet during regular check-ups. Wash your feet well in warm water when you bathe, and wear shoes when you venture outside. Comfortable shoes are more important than fashion for healthy feet, and healthy feet are part of a healthy future

Hypoglycemia (Low Blood Sugar) & Diabetes: How Low Can You Go

am fortunate to have a team of great nurses and a wonderful nutritionist in my office. As I was on my way into see a patient, I overheard one of our nurses going into a great deal of detail educating a young patient with diabetes about the concerns of low blood sugar. Her talk reminded me that this is a subject of great importance to patients with diabetes. I will take this opportunity to highlight information on issues related to hypoglycemia . Namely, what are the signs and symptoms of hypoglycemia, when should you be concerned, what to do for treatment, and when you should seek medical attention.

Despite significant advances in diabetes treatment, hypoglycemia (low blood sugar or glucose) is still a common problem among patients who are trying to achieve better control of their blood sugar. Medical research has found that low blood sugar occurred more commonly in patients who adhered to a strict control of their blood sugar. While this approach affords them better outcomes for complications such as eye disease, kidney disease, and nerve damage, these patients also endured more episodes of low blood sugar (hypoglycemia).

Hypoglycemia is the result of excess insulin in the blood, which causes excessively low blood sugar levels. While symptoms vary from person to person and range in severity, there are a few common complaints when the blood sugar is too low. The symptoms are caused by the nervous system's response to the stress of having low levels of circulating blood sugar. The symptoms usually occur gradually and may be associated with a rapid heart beat, perspiration, shakiness, and anxiety (some of the warning signs). If these signs are ignored, and blood sugar levels continue to fall, more severe symptoms may occur, such as confusion, behavior changes, stupor, and unconsciousness. These later symptoms are the result of a reduction in fuel source to the brain. Eventually, a patient can develop a seizure and coma may ensure. While most patients have never experienced such severe symptoms, those who have recurrent, severe episodes may suffer from long-term brain damage.

Hypoglycemia does not occur in patients who are treated solely with lifestyle modifications. This means that the condition is typically caused by over-medicating. There is an admonition, though, in some patients with type 2 diabetes (who, by definition, have high circulating levels of insulin), a decrease in carbohydrate intake or problems with digesting foods may cause a mismatch in insulin, thereby leading to symptoms of hypoglycemia. Hypoglycemia is also rare in patients treated with certain drugs such as acarbose (Precose), metformin (Glucophage), rosiglitazone (Avandia), and pioglitazone (Actos). However, when these medicines are used in combination with drugs such as glyburide (Micronase, Diabeta, Glynase), or other drugs in the family of sulfonylurea and meglitinides [repaglinide (Prandin), nateglinide (Starlix)], hypoglycemia may occur. Hypoglycemia may also occur when sulfonylurea agents or meglitinides are used on their own, with the risk being higher in sulfonylurea agents.

Most patients recognize the early warning signs of hypoglycemia and counteract them by eating. Ideally, a simple sugar that is easily absorbed (such as a pack of table sugar, glucose tablets, lifesavers, juice, or regular soda) should be eaten. While chocolate seems an appealing choice, as perhaps does cake and other sweets, these take far too long to be absorbed and are thus not ideal choices. Half a glass of juice or soda should work adequately and care should be taken not to over treat so that blood sugars do not rise excessively. If possible, the blood sugar level should be checked before and then again at about 20 minutes after treating. If a reading in the 70's or less is obtained, treatment by eating or drinking a simple sugar is appropriate. It is also important to remember that once the blood sugar reaches a safe level, it needs to stay there. At this point it is recommended to take a longer acting carbohydrate (a slice of bread, for example) to sustain the blood sugar level.

It is important to note that in some patients who had been running extremely high blood sugar values, and who are now getting the blood sugar values under control, may experience symptoms of hypoglycemia at blood sugar levels that are actually normal (90's to low 100s). I equate this to a "withdrawal" phase. In these patients, it is important to recognize that although they may feel unwell, there is little chance of problems developing at these levels. By checking their sugar again in 20 minutes or sooner, the patient will know if their blood sugar is trending down, at which point they may choose to treat modestly. If their blood sugar level stays in this range, I advise these patients not to treat and simply to monitor their levels. Over the course of a few days, the body will adjust to this new range, perceive it as normal, and their symptoms will subside.

A significant subset of patients do not experience the warning signs of hypoglycemia. These patients have "hypoglycemia unawareness." This can be exacerbated by certain medications (such as beta blockers) and tends to occur in patients who have had diabetes for awhile. As a result, they may develop extremely low blood sugars without much distress. Eventually, when the brain starts to feel the pinch of lack of sugar, these patients suffer from the more severe symptoms mentioned above. Patients with hypoglycemia unawareness must be extremely cautious and vigilant to avoid hypoglycemia and should carry glucose tablets with them. In many cases, it is appropriate to teach a family member or friend how to help these patients (and others who suffer with recurrent hypoglycemia) by using glucagon in case sugar cannot be delivered by mouth. A glucagon shot can be live-saving in these cases. Glucagon makes the liver put out sugar rapidly, which can reverse hypoglycemia without making the patient eat or drink sugar. This form of therapy is obviously beneficial in cases where a patient has passed out or experienced a seizure from low blood sugar.

The best way to avoid hypoglycemia is to take medications as directed and to not skip meals. Patients should be instructed on how to check their blood sugar at home and to carry a source of sugar (glucose) with them at all times. If a patient has symptoms of low blood sugar, they should review their concerns with their doctor as soon as possible so that appropriate changes in treatment and medication can be addressed.

In summary, the effects of diabetes are unique to each individual and treatment options result in effects that vary for each individual. Hypoglycemia is a very real concern for patients with diabetes and should be treated appropriately when suspected. Documentation of the timing and the degree of hypoglycemia provides valuable information that allows the doctor and patient to make appropriate changes in therapy. All concerns should be addressed as soon as possible and patients should be educated about the signs and symptoms of diabetes and appropriate treatment options from the onset of their diagnosis.

Finally, I'd like to mention the importance of a medical alert bracelet. It allows for rapid identification of a medical condition such as diabetes and is so very valuable in situations wherein a patient passes out or is confused. It is a simple way to identify a problem and save a life by allowing for appropriate emergency treatment. I strongly recommend that patients discuss the option of a medical alert tag with their doctors

Study Details Look at Immune Cells in Type 1 Diabetes

New details about the immune cells thought to be responsible for type 1 diabetes are revealed in a study by scientists at Washington University School of Medicine in St. Louis.

In research with diabetic mice, the scientists found these dendritic cells in insulin-making structures in the pancreas called the islets of Langerhans and observed them carrying insulin and fragments of insulin-producing cells known as beta cells. This can be the initial step toward the start of a misdirected immune system attack that destroys the beta cells and prevents the production of insulin, resulting in type 1 diabetes.

The findings may help in efforts to develop ways to treat type 1 diabetes, the researchers said. An estimated 1 million to 2 million Americans have type 1 diabetes, according to the American Diabetes Association.

"Now that we've isolated dendritic cells from the pancreas, we can look at why they get into the pancreas and determine which of the materials that they pick up are most critical to causing this form of diabetes. That may allow us to find ways to inhibit dendritic cell function in order to block the disorder," study senior author Dr. Emil R. Unanue, a professor of pathology, said in a prepared statement.

The study was published online in this week's issue of theProceedings of the National Academy of Sciences.

In a separate line of investigation, researchers in Unanue's lab found that dendritic cells in the pancreas may normally have beneficial effects on the health of beta cells. The team found that when there are no dendritic cells in the pancreas, beta cells are smaller, a sign that they're not as healthy.

"We think these dendritic cells aren't in the pancreas by accident. We believe that, in the normal individual, they help maintain the health of beta cells. But in a person with autoimmune diabetes, they appear to start the problems that destroy beta cells," Unanue said

Bitter Gourd treatment for diabetes

Bitter melon is a nontoxic vegetable. It is also known as bitter gourd and bitter cucumber. It is rich in nutrients such as iron, potassium, beta-carotene, phosphorous, Vitamin C, Vitamins B1, B2 and B3 and fiber. Bitter melon is widely known as an effective natural medicine for diabetes and has been used as an important compound in Chinese Medicine.

Now scientifically, it has been found that it effectively and safely treats type-2 diabetes without any side effects. Researchers revealed the mechanism by which it treats type 2 diabetes.

The study was done at Garvan Institute of Medical Research and Shanghai Institute of Materia Medica. Researchers isolated 4 bioactive compounds from its pulp. These compounds found to stimulate the human enzyme AMPK (Activated Protein Kinase) and the protein found is well known for regulating fuel metabolism and controlling blood glucose levels.

People with type 2 diabetes, face the problem of converting sugar in their blood into energy. This happens because of insufficient insulin production and the inability to use insulin by fat and muscle cells effectively.

Professor David James, Director of the Diabetes and Obesity Program at Garvan, said that, “We can now understand at a molecular level why bitter melon works as a treatment for diabetes.”By isolating the compounds we believe to be therapeutic, we can investigate how they work together in our cells.”

Drs. Jiming Ye and Nigel Turner, Garvan scientists involved in the research emphasized that though there are popular diabetic drugs available in the market that do activate human enzyme, AMPK, can cause possible side effects.

Adding to it Dr Ye, said, “The advantage of bitter melon is that there are no known side effects. Practitioners of Chinese medicine have used it for hundreds of years to good effect.”

The authors of the study concluding their finding with a happy note and said that:
“Some of the compounds we have identified are completely novel. We have elucidated the molecular structures of these compounds and will be working with our colleagues at Garvan to decipher their actions at a molecular level. We assume it’s working through a novel pathway inside cells, and finding that pathway is going to be very interesting.”

People With Diabetes Suffer From Arthritis

More than half of people with diabetes also suffer arthritis, CDC researchers find.

It's not just a problem for older people. Diabetes patients aged 18 to 44 have a 27.6% chance of having arthritis — 2.5 times the 11% rate seen in the general population.

In the 45-64 age group, arthritis strikes 51.8% of people with diabetes and 36.4% of the general population. Arthritis afflicts 62.4% of diabetes patients 65 and older, vs. 56.2% of those without diabetes. The findings come from nationwide telephone surveys conducted in 2005 and 2007.

The extent of the problem surprised the research team, says Charles Helmick, MD, lead scientist for the CDC's arthritis program.

"We expected there would be these differences [in arthritis prevalence] among older people, but there were very strong differences among younger people, too," Helmick tells WebMD. "A lot of them had both arthritis and diabetes — as well as physical activity levels that were not very high."

That's the crux of the issue. Exercise is particularly important for people with diabetes. It's also extremely important for people with arthritis. Yet the CDC study shows that when people with diabetes have arthritis, they are much less likely to get the exercise they need to prevent both diseases from getting worse.

People with diabetes don't always exercise as much as they should. More than 20% of people with diabetes are inactive. But 30% of people with both diabetes and arthritis are inactive.

What's going on? Arthritis gives people with diabetes a new reason to exercise. But it also creates new barriers to physical activity, Helmick says.

"In diabetes, we speculate, everybody has the usual barriers for not being physically active: not having time, competing priorities, lack of motivation, and so on," he says. "But when you have arthritis you have special barriers on top of those. You don't know what activities are safe. And you worry: 'Will exercise make my joint pain worse?' 'Will exercise harm my joints?'"

Fortunately, simple activities such as walking, swimming, and bicycling are friendly to arthritic joints — and they are things most people can do.
Helmick says the Stanford University-developed Chronic Disease Self-Management Program ( may be even better for patients dealing with both diabetes and arthritis.

"People with diabetes and also arthritis should know they have a lot of company," Helmick says. "More important, there are many ways for people with diabetes to be more active — even with arthritis. And it is going to have benefits not only for their arthritis but for their diabetes as well

Drug Spending Moves Up for Diabetes, Down for Cholesterol

In health spending, how many people are being treated for a disease can be a lot less important than how much it costs to treat each person. That’s what we took from this report out today from Medco, the pharmacy benefits manager.

Use of diabetes drugs increased only 2.3% last year, but spending rose 12%. The big driver was the introduction of new, expensive medicines that replace or are added to older, cheaper ones.

For example, the report said, patients are switching from older insulins to newer versions that are faster- or longer-acting, such as Novo Nordisk’s NovoLog and Sanofi-Aventis’s Lantus, respectively.

Beyond insulin, higher spending on Byetta (from Amylin and Lilly) and Januvia (from Merck) was more than enough to offset the decline in spending for GlaxoSmithKline’s Avandia that followed questions about the safety of the medicine, the report said.

Overall, spending on diabetes drugs accounted for 7% of prescription drug cost for health plans, according to the report.

That was still less than lipid-lowering drugs, such as statins, which accounted for 10.8% of the cost. But the cholesterol drugs are quickly moving in the opposite direction, with spending on the class falling 8.5% last year.

Use of the cholesterol drugs actually grew much faster than use of diabetes drugs last year (5.9% versus 2.3%). But two big statins, Merck’s Zocor and Bristol-Myers Squibb’s Pravachol, went generic in 2006, driving prices through the floor. Use of Pfizer’s Lipitor, which is still patented, fell a bit, as some insurers pushed patients on Lipitor to switch to generics.

The report is based on some $36 billion worth of prescriptions filled by Medco clients over two years.

Low Glycemic Diet Helpful in Diabetic Youth

In children and adolescents with type 1, or insulin-dependent, diabetes, consumption of a low glycemic index diet may improve blood sugar control, according to results of a National Institutes of Health-sponsored study.

Glycemic index, or GI, refers to how rapidly a food causes blood sugar to rise. High-GI foods, like white bread and potatoes, tend to spur a quick surge in blood sugar, while low-GI foods, such as lentils, soybeans, yogurt and many high-fiber grains, create a more gradual increase in blood sugar.

Dr. Tonja R. Nansel of the National Institute of Child Health and Human Development and colleagues tested the effects of high GI and low GI meals on blood sugar levels using continuous blood sugar monitoring in 20 type 1 diabetics who were between the ages of 7 and 16 years.

The findings, reported in the journal Diabetes Care, suggest that a low GI diet can improve blood sugar control "to a clinically meaningful degree above that obtained by careful carbohydrate counting and contemporary insulin regimens," Nansel noted in comments to Reuters Health.

"When consuming the low GI diet, blood glucose (sugar) levels were in the target range 66 percent of the time compared to 47 percent of the time when consuming the high GI diet," she explained. "This difference was statistically significant."

When consuming the low GI diet, study subjects also demonstrated significantly lower daytime average blood sugar levels compared to the high GI diet and fewer blood sugar excursions.

"It is plausible" based on the results of this study, Nansel said, "that a low glycemic index diet may reduce the dose of insulin required while improving blood sugar control.