Wellness

[cherry]

Stephen Fry, the comedian, actor and writer, has said he feels "relieved" and "proud" to have lost more than five stone in four months.

Speaking on BBC Breakfast the former QI host said going on long walks and eating a sensible diet helped to lose the weight. 

Fry weighed 21 stone in April, and says his five-and-a-half stone weight loss has led to him feeling better about his health. 

The 61-year-old said: "I've lost a bit of weight so I'm feeling proud of myself. At the moment I'm very happy, there is the vertical moment and the horizontal and at the moment I'm very happy."

When asked if he feels good when he looks in the mirror now, the broadcaster said: "I'm relieved." 

He told presenters Naga Munchetty and Charlie Stayt that the science behind his weight loss was actually quite simple: "I walk a lot and that helps my mood as well I find, it's not a guaranteed help for mental stress and anxiety or anything else but it does help me and it means I can listen to audio books as I walk, and podcasts, and you eat up the miles that way, and talking of eating up, eating sensibly."

Fry, who does not have type 2 diabetes, follows in the footsteps of high-profile names with type 2 diabetes such as Tom Watson MP and Christopher Biggins who have recently improved their health and lost weight. 

The Blackadder star, who got married in 2015, has been openly vocal about his mental health problems previously, and told the BBC presenters that he believed depression among young people was still a huge issue.

He said: "We know about the epidemic of self-harm and unhappiness amongst the young how terrible it is, how upsetting it is and how distressing it is and it happens across all sections of society. 

"It's not just those that have a particularly hard home life or anything. Sometimes people in very happy families are deeply unhappy. There's all kinds of reasons, social media, bullying and they’re talked about a lot." 

During his appearance on the sofa, he also urged men of a certain age to get tested for prostate cancer, after he himself underwent an operation to treat the condition.

[cherry]

Homestyle Meat and Potato Soup
MAKES 4 SERVINGS
SERVING SIZE: 6 OUNCES
LOW-CARBOHYDRATE RECIPE
Nutrition Facts Per Serving: Calories 138, Total Fat 6g, Saturated Fat 1g, Protein 6g, Carbohydrates 15g, Cholesterol 6mg, Fiber 1g, Sodium 361mg
Dietary Exchange: 1 Bread/Starch, 1 Meat, ½ Fat
2 tablespoons light margarine 
1 tablespoon all-purpose flour 
1½ cups skim milk or 1 can (15 ounces) fat-free, low-sodium chicken broth 
1 cup mashed potatoes (leftover or frozen) 
¼ teaspoon black pepper 
½ teaspoon onion powder 
One of the following: 1 ounce leftover diced lean ham, 1 ounce chopped lean sandwich meat or 1 regular-size, low-fat hot dog, diced
1 ounce reduced-fat cheese (Cheddar, Swiss, or American), shredded
1. In a small saucepan, melt margarine over medium heat. Add flour and whisk to make a paste.
2. Add skim milk and stir constantly over medium heat and bring to a slow boil to thicken slightly. Add mashed potato, black pepper, onion powder and diced meat. Bring to a boil, then cover and reduce heat to simmer. Simmer 2 minutes.
3. Spoon soup into bowls, then top each with a quarter of the shredded cheese.

Chunky Chicken Stew
MAKES 2 SERVINGS
SERVING SIZE: ½ OF RECIPE
HIGH-FIBER RECIPE
Nutrition Facts Per Serving: Calories 287, Total Fat 6g, Saturated Fat 1g, Protein 6g, Carbohydrates 30g, Cholesterol 33mg, Fiber 8g, Sodium 337mg
Dietary Exchange: 2 Bread/ Starch, 3 Meat
1 teaspoon olive oil 
1 small onion, chopped 
1 cup thinly sliced carrots 
1 cup fat-free reduced-sodium chicken broth 
1 can (about 14 ounces) no-salt-added diced tomatoes 
1 cup diced, cooked chicken breast 
3 cups sliced kale or baby spinach
1. Heat oil in large saucepan over medium-high heat. Add onion; cook and stir about 5 minutes, or until golden brown. Stir in carrots and broth; bring to a boil. Reduce heat; simmer, uncovered, 5 minutes.
2. Stir in tomatoes; simmer 5 minutes or until carrots are tender. Add chicken; cook and stir until heated through. Add kale; stir until wilted.

Sweet Potato Minestrone
MAKES 4 SERVINGS
SERVING SIZE: 1½ CUPS
HIGH-FIBER RECIPE
Nutrition Facts Per Serving: Calories 286, Total Fat 6g, Saturated Fat 2g, Protein 13g, Carbohydrates 48g, Cholesterol 4mg, Fiber 11g, Sodium 189mg
Dietary Exchange: 3 Bread/Starch, 1 Meat
1 tablespoon extra-virgin olive oil 
¾ cup diced onion 
½ cup diced celery 
2 cups diced, peeled sweet potatoes 
1 can (about 15 ounces) Great Northern beans, rinsed and drained 
1 can (about 14 ounces) no-salt-added diced tomatoes 
3 cups water 
¾ teaspoon dried rosemary 
½ teaspoon salt (optional)
1/8 teaspoon black pepper 
2 cups coarsely chopped kale leaves (lightly packed) 
4 tablespoons grated Parmesan cheese
1. Heat oil in large saucepan or Dutch oven over medium-high heat. Add onion and celery; cook and stir 4 minutes or until onion is softened. Stir sweet potatoes, beans, tomatoes, water, rosemary, salt, if desired, and pepper into saucepan. Cover and bring to a simmer; reduce heat and simmer 30 minutes.
2. Add kale; cover and cook 10 minutes or until tender.
3. Ladle soup into bowls; sprinkle with cheese.
Note: Choose kale in small bunches with firm leaves and a rich, deep color. Avoid bunches with limp, wilted or discolored leaves. To remove the tough stems, make a “V-shaped” cut where the stem joins the leaf. Stack the leaves and cut them into pieces.

Butternut Squash and Millet Soup
MAKES 6 SERVINGS
SERVING SIZE: 1 1/3 CUPS
LOW-FAT RECIPE
Nutrition Facts Per Serving: Calories 168, Total Fat 3g, Saturated Fat 1g, Protein 16g, Carbohydrates 19g, Cholesterol 37mg, Fiber 2g, Sodium 199mg
Dietary Exchange: 1 Bread/Starch, 1 Vegetable, 2 Meat
1 red bell pepper 
1 teaspoon canola oil 
2¼ cups diced butternut squash or 1 (10-ounce) package frozen diced butternut squash 
1 medium red onion, chopped 
1 teaspoon curry powder 
½ teaspoon smoked paprika 
½ teaspoon salt
1/8 teaspoon black pepper 
2 cups low-sodium chicken broth 
2 boneless skinless chicken breasts (about 4 ounces each), cooked and chopped 
1 cup cooked millet
1. Place bell pepper on rack in broiler pan 3 to 5 inches from heat source or hold over open gas flame on long-handled metal fork. Turn bell pepper often until blistered and charred on all sides. Transfer to food storage bag; seal bag and let stand 15 to 20 minutes to loosen skin. Remove loosened skin with paring knife. Cut off top and scrape out seeds; discard.
2. Heat oil in large saucepan over high heat. Add butternut squash, bell pepper and onion; cook and stir 5 minutes. Add curry powder, paprika, salt and black pepper. Pour in broth; bring to a boil. Cover and cook 7 to 10 minutes or until vegetables are tender.
3. Purée soup in saucepan with hand-held immersion blender or in batches in food processor or blender. Return soup to saucepan. Stir in chicken and millet; cook until heated through.

Acorn Squash Soup with Chicken and Red Pepper Meatballs
MAKES 2 SERVINGS
Nutrition Facts Per Serving: Calories 309, Total Fat 12g, Saturated Fat 1g, Protein 31g, Carbohydrates 23g, Cholesterol 85mg, Fiber 4g, Sodium 208mg
Dietary Exchange: 1½ Bread/Starch, 3 Meat, ½ Fat
1 small to medium acorn squash (about ¾ pound) 
½ pound ground lean turkey breast 
1 red bell pepper, seeded and finely chopped 
3 tablespoons cholesterol-free egg substitute 
1 teaspoon dried parsley 
1 teaspoon ground coriander 
½ teaspoon black pepper 
¼ teaspoon ground cinnamon 
3 cups reduced-sodium vegetable broth 
2 tablespoons fat-free sour cream (optional) 
Ground red pepper (optional)
1. Pierce squash skin with fork. Place in microwaveable dish; microwave on high 8 to 10 minutes or until tender. Cool 10 minutes.
2. Meanwhile, combine turkey, bell pepper, egg substitute, parsley, coriander, cinnamon and black pepper in large bowl; mix lightly. Shape mixture into eight meatballs. Place meatballs in microwavable dish; microwave on high 5 minutes or until cooked through. Set aside to cool.
3. Remove and discard seeds from cooled squash. Scrape squash flesh from shell into large saucepan; mash squash with potato masher. Add broth and meatballs to saucepan; cook over medium-high heat 12 minutes, stirring occasionally. Add additional liquid if necessary.
4. Garnish each serving with 1 tablespoon sour cream and ground red pepper.

Sweet Potato Stew
MAKES 4 SERVINGS
SERVING SIZE: 1½ CUPS
LOW-FAT RECIPE
Nutrition Facts Per Serving: Calories 112, Total Fat 2g, Saturated Fat 1g, Protein 5g, Carbohydrates 18g, Cholesterol 13mg, Fiber 2g, Sodium 280mg
Dietary Exchange: 1 Bread/Starch, ½ Fat
1 cup chopped onion 
1 cup chopped celery 
1 cup grated peeled sweet potato 
1 cup reduced-sodium vegetable broth or water 
2 slices bacon, crisp-cooked and crumbled 
1 cup fat-free half-and-half 
Black pepper 
¼ cup minced fresh parsley
1. Place onion, celery, sweet potato, broth and bacon in slow cooker. Cover; cook on low 6 hours or until vegetables are tender.
2. Increase heat to high. Stir in half-and-half. Add water, if needed, to reach desired consistency. Cook, uncovered, 30 minutes on high or until heated through.
3. Season to taste with pepper. Stir in parsley.

Easy Chicken, Spinach and Wild Rice Soup
MAKES 6 SERVINGS
SERVING SIZE: 1 CUP
LOW-FAT RECIPE
Nutrition Facts Per Serving: Calories 202, Total Fat 3g, Saturated Fat 1g, Protein 16g, Carbohydrates 27g, Cholesterol 37mg, Fiber 3g, Sodium 456mg
Dietary Exchange: 1 Bread/Starch, 2 Meat
1¾ cups water 
1¾ cups chopped carrots 
2 cans (10¾ ounces each) reduced-fat reduced-sodium condensed cream of chicken soup, undiluted 
2 cups cooked wild rice 
1 teaspoon dried thyme 
¼ teaspoon dried sage 
¼ teaspoon black pepper 
2 cups coarsely chopped baby spinach 
1½ cups chopped cooked chicken* 
½ cup fat-free half-and-half or fat-free (skim) milk
1. Bring water to a boil in large saucepan over medium-high heat. Add carrots; cook 10 minutes.
2. Add soup, rice, thyme, sage and pepper to saucepan; bring to a boil. Stir in spinach, chicken and half-and-half; cook and stir 2 minutes or until heated through.
*Note: Half of a rotisserie chicken will yield about 1½ cups of cooked meat.

New England Clam Chowder
MAKES 2 SERVINGS
Nutrition Facts Per Serving: Calories 204, Total Fat 4g, Saturated Fat 1g, Protein 14g, Carbohydrates 30g, Cholesterol 37mg, Fiber 1g, Sodium 205mg
Dietary Exchange: 1 Bread/Starch, 1 Meat, 1 Milk
1 can (5 ounces) whole baby clams, undrained 
1 baking potato, peeled and coarsely chopped 
¼ cup finely chopped onion 
2/3 cup evaporated skimmed milk 
¼ teaspoon white pepper 
¼ teaspoon dried thyme 
1 tablespoon reduced-fat margarine
1. Drain clams, reserving juice. Add enough water to reserved juice to measure / cup. Combine clam juice mixture, potato and onion in large saucepan. Bring to a boil over high heat; reduce heat and simmer 8 minutes or until potato is tender.
2. Add milk, pepper and thyme to saucepan. Increase heat to medium-high. Cook and stir 2 minutes. Add margarine. Cook 5 minutes or until soup thickens, stirring occasionally.
3. Add clams; cook and stir 5 minutes, or until clams are firm.
Get more delicious diabetes-friendly recipes at DiabetesSelfManagement.com/recipes
Shutterstock/BR Photo Addicted

[cherry]

DIABETES CARE IN 2019
Where
Are We
Now?
Top Hospitals Weigh In On The State Of Diabetes Care
Every day here at Diabetes Self-Management, we cover topics related to a particular aspect of diabetes or its treatment, a new study, a food trend or a device that can make your life easier.
But every now and then, it can be useful to step back and take a look at the bigger picture of diabetes treatment and management. The innovations and changes in the treatment landscape in just the last few years have been mind-boggling, and even many health professionals are struggling to figure out the best way to use the latest drug and device offerings.
To get a sense of where we are right now and where we’re headed in diabetes care, we asked experts from some of the top-rated hospitals in the U.S. the same five questions. Here are their responses (condensed and edited for clarity).
Diabetes Self-Management:There are more tools available for monitoring blood glucose levels than ever before. What developments do you see as most promising, and how do you decide what to recommend to patients?
Clare Jung Eun Lee, MD, endocrinologist and assistant professor of medicine, Johns Hopkins Medicine:
In terms of blood glucose monitoring, we’re able to offer options that are less painful. Some of the latest editions of continuous glucose monitors (CGMs) do not require that you calibrate their systems with a fingerstick glucometer. Theoretically, if your blood sugar is behaving, you shouldn’t have to ****** your fingers at all. And that’s been a big boon to patients who had to ****** their fingers five to seven times a day. We’re talking about quality of life.
    Even on the cost front, [traditional glucometers and CGMs] may be neck and neck. CGMs are not necessarily cheap, but test strips are not cheap, either. And the fact that you can see not only where your blood sugar is at the moment but where it’s going has implications for how patients can prepare and maintain their levels. It’s an exciting development, and these systems are only going to get better and better.
David Matthew Nathan, MD, endocrinologist and director of Diabetes Center, Massachusetts General Hospital:
CGM has been the major development for Type 1 diabetes and is of great importance to patients at particularly high risk for severe hypoglycemia. Its benefit in other patients with Type 1 diabetes is a little less clear and depends on the individual patient’s ability and willingness to adjust their insulin regimen.
    Pump-treated patients can respond to CGM data often and more easily than [those treated with] multiple daily injections, but studies have demonstrated a benefit for the latter group as well. Individualizing monitoring remains important. CGM is a critical element in creating true artificial pancreases. Whether CGM will provide a benefit for some patients with Type 2 diabetes remains to be established.
Adrian Vella, MD, endocrinologist and diabetes researcher, Mayo Clinic:
I think the ease of monitoring that comes with CGMs or flash monitors is a positive thing, provided it is used appropriately to motivate patients towards better glycemic control and to decrease the risk of hypoglycemia.
    If someone is on a regimen that requires frequent testing—for example, more than three times a day—it is increasingly becoming my practice to recommend a flash meter, since the cost is beginning to approach that of standard self-testing. I tend to reserve CGMs for patients who are using an insulin pump. Not every patient needs this, but from a personal point of view, if I had Type 1 diabetes, I probably would want the ability to check my blood sugars as frequently as necessary.
DSM: The field of available medications for Type 2 diabetes continues to expand. How important do you believe this expansion is for optimal treatment, and is it important to make better use of drugs that are currently available?
Lee: The more choices, the better is my belief. Just a few decades ago, the number of oral medications providers could prescribe was just a handful, and you were pretty limited in what you could prescribe if a patient had an allergy or an intolerance.
    There are many different reasons behind why someone has diabetes; it may not be a simple matter of insulin resistance or insulin secretion. By having a bunch of medications that attack different aspects of the pathology, you can really customize the regimen for the patient. And we have a few more options to entertain before we jump into insulin.
    Some of the newer medications, such as SGLT-2 inhibitors, are not only helping with diabetes but also protect your heart and cardiovascular function. And that’s huge. To know that some newer medications are doing multiple good things is even more reassuring.
Nathan: A greater array of medications with different mechanisms is, of course, welcome, but their greatest utility will be realized when we better understand [how they work] in specific subgroups of patients with diabetes. This understanding will allow us to individualize therapy to maximize benefits, reduce adverse effects, and improve cost-effectiveness.
    At this time, we don’t have the information necessary to individualize therapy. Studies like GRADE [a comparative-effectiveness study led by Dr. Nathan] will help generate the insights necessary to individualize therapy.
Vella: I, for one, welcome the proliferation of new medications for the treatment of Type 2 diabetes. While they may not necessarily replace the old stalwarts, they certainly provide more choice and the ability to individualize therapy for a given patient.
    That said, more traditional medications for the treatment of Type 2 diabetes still have a role to play, and there is still some uncertainty about when to use the newer medications in the treatment algorithm.
DSM: There has been steady progress in insulin pump technology in recent years. Do you think expanded use of pumps would be a positive development in diabetes care? What are the main barriers to that expansion?
Lee: The current technology is really exciting because the pump is linked with a CGM, and they talk to each other. They’re becoming semi-closed-loop; some of them shut down when your sugar is too low. It’s going to take some time [to get to a fully closed loop], but we’re headed in the right direction.
    For those with insulin-treated diabetes who are interested, you should go for it. I have a few patients who are still wary of having something on their body at all times. Some may have heard of someone who [experienced adverse effect] while wearing a pump, which may have had nothing to do with the pump. Some are adamantly anti-pump, for whatever reason. But for folks who are engaged and willing to use the technology, they’re often pleasantly surprised at how good the technology is.
Nathan: We must not lose sight that Type 1 diabetes therapy is largely patient-driven. Therapies that are unacceptable to patients cannot and should not be forced on them. Ultimately, the choice of therapy should be decided with joint decision-making, keeping patient preferences at the forefront and taking into consideration practical issues such as cost. Many patients don’t want to wear an external device or catheter, and their choices must be respected.
Vella: Ultimately, an insulin pump is a complicated insulin syringe. Few patients with poor glycemic control using multiple daily injections of insulin improve their situation merely by transitioning to a pump. In much the same way that you cannot hand the keys to a Ferrari to a new driver, education is necessary to achieve the best results with insulin pump therapy.
    That being said, if I had Type 1 diabetes, I probably would want to at least try a pump at some point.
DSM: Have you seen changes in how doctors or patients view insulin therapy in recent years? Has the role of insulin changed due to the wider range of drug treatments for Type 2 diabetes?
Lee: In general, I would say that there has been a paradigm shift in terms of when we think about initiating insulin, particularly basal [long-acting] insulin. We used to wait until all other options were exhausted, but insulin does not have to be the last-line option.
    If you’ve ever seen a pen needle, you can hardly see it because it’s so tiny. And because you can carry this pen in your pocket, and the ease of use, I would say the barriers to starting basal insulin have been lowered on both the clinician and patient sides.
Nathan: [I’ve seen] more willingness to use insulin by clinicians in Type 2 diabetes and, with appropriate discussion, by patients as well.
Vella: I still get the perception that patients perceive insulin as a last resort or punishment for misbehavior and lack of compliance with lifestyle modification. People are often surprised when I point out that diabetes is a disease and that even in people with medically complicated obesity, diabetes is only present in about one third.
    This is to point out that the loss of the ability to make insulin, and the need for insulin therapy, differs between patients. What endocrinologists are interested in is achieving good glycemic control safely and effectively.
DSM: There’s a growing number of diabetes-management apps and ways to sync diabetes devices to phones and tablets. In your experience, have these developments had a meaningful impact on diabetes care and self-management?
Lee: We have all these fancy apps and different interface options, but at the end of the day, it matters how the patient is using it, how the clinician is using it.
    For example, with glucose values, some glucometers can sync directly to the clinic and provider, and I think we’re just beginning to investigate that option. So many patients forget to bring their glucometer to an appointment. But how do we systematically allow this type of web-based exchange of data? We’re still working out the kinks; it’s kind of clunky at this point.
    Especially with a CGM, where you’re generating tons of data, artificial intelligence may come into play to help make sense of it. Manufacturers should also agree on a universal format in which clinicians can easily read the relevant data, regardless of the brand of CGM. It certainly is not easy at this point to zoom in on an episode of hypoglycemia, for example. I think it remains a challenge.
Nathan: [Diabetes-oriented] apps, in my opinion and experience, are likely to be most useful for patients who are “tech savvy.” The feedback information, reminders and help with dose selection and even meal and activity selection, only provide information and perhaps [lead to] better choices than patients would make on their own. None of these work unless patients are paying attention and ready to carry out the changes recommended.
    Simple, relatively stable diabetes treatments that aren’t changed frequently—such as an oral agent or a single dose of daily insulin in Type 2 diabetes—are not likely to benefit. Alternatively, better, “more educated” recommendations for Type 1 diabetes that patients will use frequently may help modestly to achieve lower HbA1c levels, reduced frequency of hypoglycemia and reduced patient burden.
Vella: I think these are tools, in much the same way as pen and paper, for recording glucose [readings] in a systematic manner. The key to their effective use is discipline and education. This is what makes the tools effective or ineffective—not some design tweak.

[cherry]

Controlling HbA1c associated with lower organ damage risk in type 1 diabetes

Thu, 29 Aug 2019

Jack Woodfield

Controlling HbA1c associated with lower organ damage risk in type 1 diabetes

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Controlling blood glucose levels could reduce the risk of organ impairment in people with type 1 diabetes, according to a new study.

Swedish researchers explored the impact of HbA1c levels upon risks of diabetic retinopathy (eye disease) and nephropathy (kidney disease), analysing more than 10,000 adults and children with type 1 diabetes for between 8-20 years.

They discovered that, as expected, higher HbA1c levels were linked to increased signs of complications, but also warned of the dangers of people with type 1 diabetes keeping their HbA1c levels too low.

Those with type 1 diabetes whose HbA1c levels were above 70.5 mmol/mol (8.5%) had increased risks of damage to the eyes and kidneys compared with those who had HbA1c levels of 48-52 mmol/mol (6.5-6.9%).

Milder complications were observed among people whose HbA1c levels remained above 53 mmol/mol (7%). More severe complications mainly occurred in people with an HbA1c above 70 mmol/mol (8.6%).

The researchers identified that maintaining a value of 52 mmol/mol (6.9%) or below reduced the risk of organs being damaged. However, maintaining a value below 48 mmol/mol showed no further risk reduction.

"We were unable to see that fewer instances of organ damage occurred at these lower levels," said co-lead author Professor Marcus Lind, from Sahlgrenska Academy, University of Gothenburg, and senior consultant at the NU Hospital Group in Uddevalla, Sweden.

"As for loss of consciousness and cramp, which are unusual, low blood glucose caused a 30% rise in risk. [People] with low HbA1c need to make sure they don't have excessively low glucose levels, fluctuations or efforts in managing their diabetes."

In Sweden, the HbA1c target is 52 mmol/mol or below, and 47 mmol/mol or lower in children. In the UK the target recommended HbA1c level for those with type 1 diabetes is 48 mmol/mol or below.

Professor Johnny Ludvigsson, from Linköping University, who also led the research, added: "Knowing more about the association between blood glucose level and risk is extremely important since the health care services, the community, patients and their parents make heavy use of resources in attaining a particular blood glucose level.

"Attaining a low HbA1c value may, in some cases, require children to be woken up several times a night, plus extra glucose monitoring and strict attention to diet and physical activity day after day, which can be extremely burdensome."

The findings appear in The BMJ.

[cherry]

Why So Many People with Diabetes Stop Taking Metformin

Researchers say metformin has the lowest adherence rate of any major diabetes drug. However, patients say there are ways to improve that percentage.

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People who take the number one most commonly prescribed drug for diabetes are also the most likely to stop taking their medication.

Metformin works by reducing the amount of sugar released by the liver and improving how the body responds to insulin.

It’s been prescribed to more than 120 million people worldwide.

The drug’s lack of certain side effects compared to other medications are notable.

Metformin puts little if any strain on the organs, doesn’t cause weight gain, and comes with the added benefit of being the most affordable diabetes medication on the market.

It’s also sold under the brand name Glucophage, which costs significantly more.

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However, the toll it takes on the digestive system may prevent many people with diabetes from taking it for more than a week or two.

“Metformin commonly causes gastrointestinal symptoms such as diarrhea and flatulence,” explained a recent study published in the journal Diabetes, Obesity and Metabolism.

The study was conducted by researchers from the University of Surrey.

The researchers examined the medication compliance rates of 1.6 million people with type 2 diabetes.

Metformin had the lowest adherence rate of the medications that were studied.

DPP-4 inhibitors — a class of oral diabetes medication that include the brand names Januvia and Tradjenta — appear to have the highest adherence rate. This class of drugs are also the most easily tolerated by the body, causing the least unpleasant side effects.

How to best use metformin

While some degree of metformin’s side effects can’t be helped, Marcey Robinson, MS, RD, CSSD, CDE, BC-ADM, co-founder of Achieve Health & Performance, says there are actually several things doctors can do when prescribing metformin to ensure patient adherence.

However, she says, many physicians simply don’t.

The first issue, Robinson told Healthline, is that there are two types of metformin to choose from: regular and extended release.

Most people do better on the extended-release version because the drug’s potency is affecting the body over the course of several hours, rather than hitting you all at once.

“Sometimes, it’s just a doctor’s standard of practice and they don’t even think about it. They’ve always prescribed it one way, so that’s what they continue to do,” said Robinson.

“For some patients, the doctor might also think that having a bigger boost of the medication all at once is going to help a patient who is struggling with high blood sugars after a meal. But that’s really not how metformin is expected to work in the body,” she added.

Personal stories from patients

Gretchen Becker, author of “The First Year: Type 2 Diabetes: An Essential Guide for the Newly Diagnosed,” has been taking metformin for more than 20 years after receiving a diagnosis of type 2 diabetes in 1996.

“I never had any problems with metformin until I took a pill that I thought was the extended-release version, but it wasn’t,” Becker told Healthline.

Becker’s doctor had accidentally prescribed the regular form of metformin.

“I had very loose bowels for several months until I figured out what the problem was,” Becker said.

After getting the proper prescription, it took several months for Becker’s digestive system to recover.

Corinna Cornejo, who received a diagnosis of type 2 diabetes in 2009, told Healthline that her digestive woes didn’t start until she’d been taking metformin for more than a year.

“At first, I thought it was a response to dairy, but my doctor eventually switched my prescription to the extended-release version,” Cornejo recalled. “That has helped, but the side effect has not gone away completely.”

For some people, however, metformin’s unpleasant side effect of loose stools provides a much-needed balance to the side effects that can result from other diabetes drugs they’re taking.

“GLP-1 drugs, like Victoza or Byetta, can cause constipation,” explained Robinson. “Taking metformin with a GLP-1 drug means they actually complement each other, balancing out those side effects.”

And for some, metformin simply isn’t the right drug.

“No matter what you do, some patients just don’t tolerate the side effects well,” said Robinson.

Educating patients

Although there are many diabetes drugs on the market today, doctors will likely push metformin first.

“There has never been as many diabetes treatment options available as there are now,” explained Robinson. “But doctors look at cost, and metformin is the cheapest. Insurance companies tend to do that, too: ‘How can we pigeonhole everybody on this one drug?’ If you’re looking just from a cost perspective, you’re forcing people onto a drug regimen that simply doesn’t work for everyone.”

But there’s another pertinent reason Robinson believes so many people stop taking their diabetes medication: lack of education.

“If you look at the [American Diabetes Association] guidelines, the first line of defense is metformin, but there’s no education that is presented when the doctor prescribes it,” she said.

Robinson is the diabetes educator for Dr. David Borchers’ patients in Colorado.

“If the doctor didn’t have me to educate his patients, we’d have the same problem in this office with patients stopping their medication,” Robinson said. “Educators help ensure the patients understand why they’re taking that medication, and that leads to a much higher adherence rate.”

Teaching patients why they’re taking a certain medication, how to take it, and how it’s going to improve their health is key, insists Robinson. And it’s often overlooked.

For example, metformin should always be taken with food. The dose should be titrated at first, gradually increasing the dose over the course of several weeks, to prevent severe gastric distress.

This is a crucial detail that’s easily miscommunicated or misprescribed when patients don’t meet with a diabetes educator.

“I started taking metformin four years ago,” Tony Song, president and CEO of Diabetes Care Partners, told Healthline.

Song received a diagnosis of prediabetes in 2008.

“The first week was tough with diarrhea and a bit of dizziness. I started on a low dose, and I knew about this side effect, but I was surprised that my doctor did not mention any of this when I received the prescription,” he said.

Song contacted his doctor after the first week and was switched to the extended-release version. While it still caused diarrhea, it mostly resolved itself within two days.

If it weren’t for an in-depth understanding of how this medication was going to help his blood sugar, Song said the first week of side effects would’ve easily stopped him from continuing to take it.

And perhaps, added Song, there’s a degree of denial at play, too.

“Metformin is the first line of therapy for the newly diagnosed diabetic. It can be a hard pill to swallow, pun intended, because taking that pill is the action that states you now have diabetes,” he said.

Ginger Vieira lives with type 1 diabetes and has authored four books: Pregnancy With Type 1 Diabetes, Dealing with Diabetes Burnout,Emotional Eating With Diabetes, and Your Diabetes Science Experiment.

[cherry]

Why So Many People with Diabetes Stop Taking Metformin

Researchers say metformin has the lowest adherence rate of any major diabetes drug. However, patients say there are ways to improve that percentage.

Share on Pinterest

People who take the number one most commonly prescribed drug for diabetes are also the most likely to stop taking their medication.

Metformin works by reducing the amount of sugar released by the liver and improving how the body responds to insulin.

It’s been prescribed to more than 120 million people worldwide.

The drug’s lack of certain side effects compared to other medications are notable.

Metformin puts little if any strain on the organs, doesn’t cause weight gain, and comes with the added benefit of being the most affordable diabetes medication on the market.

It’s also sold under the brand name Glucophage, which costs significantly more.

powered by Rubicon Project

However, the toll it takes on the digestive system may prevent many people with diabetes from taking it for more than a week or two.

“Metformin commonly causes gastrointestinal symptoms such as diarrhea and flatulence,” explained a recent study published in the journal Diabetes, Obesity and Metabolism.

The study was conducted by researchers from the University of Surrey.

The researchers examined the medication compliance rates of 1.6 million people with type 2 diabetes.

Metformin had the lowest adherence rate of the medications that were studied.

DPP-4 inhibitors — a class of oral diabetes medication that include the brand names Januvia and Tradjenta — appear to have the highest adherence rate. This class of drugs are also the most easily tolerated by the body, causing the least unpleasant side effects.

How to best use metformin

While some degree of metformin’s side effects can’t be helped, Marcey Robinson, MS, RD, CSSD, CDE, BC-ADM, co-founder of Achieve Health & Performance, says there are actually several things doctors can do when prescribing metformin to ensure patient adherence.

However, she says, many physicians simply don’t.

The first issue, Robinson told Healthline, is that there are two types of metformin to choose from: regular and extended release.

Most people do better on the extended-release version because the drug’s potency is affecting the body over the course of several hours, rather than hitting you all at once.

“Sometimes, it’s just a doctor’s standard of practice and they don’t even think about it. They’ve always prescribed it one way, so that’s what they continue to do,” said Robinson.

“For some patients, the doctor might also think that having a bigger boost of the medication all at once is going to help a patient who is struggling with high blood sugars after a meal. But that’s really not how metformin is expected to work in the body,” she added.

Personal stories from patients

Gretchen Becker, author of “The First Year: Type 2 Diabetes: An Essential Guide for the Newly Diagnosed,” has been taking metformin for more than 20 years after receiving a diagnosis of type 2 diabetes in 1996.

“I never had any problems with metformin until I took a pill that I thought was the extended-release version, but it wasn’t,” Becker told Healthline.

Becker’s doctor had accidentally prescribed the regular form of metformin.

“I had very loose bowels for several months until I figured out what the problem was,” Becker said.

After getting the proper prescription, it took several months for Becker’s digestive system to recover.

Corinna Cornejo, who received a diagnosis of type 2 diabetes in 2009, told Healthline that her digestive woes didn’t start until she’d been taking metformin for more than a year.

“At first, I thought it was a response to dairy, but my doctor eventually switched my prescription to the extended-release version,” Cornejo recalled. “That has helped, but the side effect has not gone away completely.”

For some people, however, metformin’s unpleasant side effect of loose stools provides a much-needed balance to the side effects that can result from other diabetes drugs they’re taking.

“GLP-1 drugs, like Victoza or Byetta, can cause constipation,” explained Robinson. “Taking metformin with a GLP-1 drug means they actually complement each other, balancing out those side effects.”

And for some, metformin simply isn’t the right drug.

“No matter what you do, some patients just don’t tolerate the side effects well,” said Robinson.

Educating patients

Although there are many diabetes drugs on the market today, doctors will likely push metformin first.

“There has never been as many diabetes treatment options available as there are now,” explained Robinson. “But doctors look at cost, and metformin is the cheapest. Insurance companies tend to do that, too: ‘How can we pigeonhole everybody on this one drug?’ If you’re looking just from a cost perspective, you’re forcing people onto a drug regimen that simply doesn’t work for everyone.”

But there’s another pertinent reason Robinson believes so many people stop taking their diabetes medication: lack of education.

“If you look at the [American Diabetes Association] guidelines, the first line of defense is metformin, but there’s no education that is presented when the doctor prescribes it,” she said.

Robinson is the diabetes educator for Dr. David Borchers’ patients in Colorado.

“If the doctor didn’t have me to educate his patients, we’d have the same problem in this office with patients stopping their medication,” Robinson said. “Educators help ensure the patients understand why they’re taking that medication, and that leads to a much higher adherence rate.”

Teaching patients why they’re taking a certain medication, how to take it, and how it’s going to improve their health is key, insists Robinson. And it’s often overlooked.

For example, metformin should always be taken with food. The dose should be titrated at first, gradually increasing the dose over the course of several weeks, to prevent severe gastric distress.

This is a crucial detail that’s easily miscommunicated or misprescribed when patients don’t meet with a diabetes educator.

“I started taking metformin four years ago,” Tony Song, president and CEO of Diabetes Care Partners, told Healthline.

Song received a diagnosis of prediabetes in 2008.

“The first week was tough with diarrhea and a bit of dizziness. I started on a low dose, and I knew about this side effect, but I was surprised that my doctor did not mention any of this when I received the prescription,” he said.

Song contacted his doctor after the first week and was switched to the extended-release version. While it still caused diarrhea, it mostly resolved itself within two days.

If it weren’t for an in-depth understanding of how this medication was going to help his blood sugar, Song said the first week of side effects would’ve easily stopped him from continuing to take it.

And perhaps, added Song, there’s a degree of denial at play, too.

“Metformin is the first line of therapy for the newly diagnosed diabetic. It can be a hard pill to swallow, pun intended, because taking that pill is the action that states you now have diabetes,” he said.

Ginger Vieira lives with type 1 diabetes and has authored four books: Pregnancy With Type 1 Diabetes, Dealing with Diabetes Burnout,Emotional Eating With Diabetes, and Your Diabetes Science Experiment.

[Teddie]

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@cherry wrote:

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Intermittent fasting could help treat inflammation


Fri, 23 Aug 2019
Jack Woodfield





Intermittent fasting could help treat inflammation
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Fasting could provide "enormous potential" in managing or preventing inflammation which is thought to contribute to type 2 diabetes, US researchers have said. 

A team from the Mount Sinai hospital report that fasting also improves chronic inflammatory diseases such as cancer, multiple sclerosis and cardiovascular disease. 

Fasting has been shown to help lower HbA1c in people with type 2 diabetes, with a study published last month also showing that intermittent fasting could prevent a build-up of fat in the pancreas that could protect against type 2 diabetes. 

"Caloric restriction is known to improve inflammatory and autoimmune diseases, but the mechanisms by which reduced caloric intake controls inflammation have been poorly understood," said senior author Dr Miriam Merad, Director of the Precision Immunology Institute at the Icahn School of Medicine at Mount Sinai.

To understand the mechanisms behind fasting more clearly, Dr Merad and colleagues tested the effects of fasting on both human and mouse cells. 

They discovered that intermittent fasting kick-started the release of 'monocytes', a collection of pro-inflammatory cells. During fasting periods these cells go into sleep mode and are less inflammatory than the cells that had been fed. 

"Monocytes are highly inflammatory immune cells that can cause serious tissue damage, and the population has seen an increasing amount in their blood circulation as a result of eating habits that humans have acquired in recent centuries," explained Dr Merad.

The number of these monocytes was significantly reduced following fasting, which researchers say emphasises the link between high-calorie dietary patterns and inflammatory disease outcomes. 

"Considering the broad spectrum of diseases that are caused by chronic inflammation and the increasing number of patients affected by these diseases, there is an enormous potential in investigating the anti-inflammatory effects of fasting," said first author Stefan Jordan, a postdoctoral fellow in the Department of Oncological Sciences at Mount Sinai.

The study findings have been published in the Cell journal.

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Having type 2, my PA had always told me to eat regularly scheduled meals, to not skip and eat a protein snack before bed. I didn’t pay that much attention to her because it didn’t affect my numbers either way. The last time I went to see her she was on the bandwagon for intermittent fasting, which is what I was intuitively doing anyway. It’s surprising how the advice changes, depending on who you’re talking to and what point in time. 

[cherry]

Vertex Pharmaceuticals announced Tuesday that it plans to acquire an ambitious startup for $950 million, betting the company’s early-stage science could lead to a functional cure for type 1 diabetes.

The Boston company is buying Semma Therapeutics, a nearby firm turning stem cells into insulin factories. Based on the work of Harvard University stem cell scientist Douglas Melton, Semma’s approach involves turning moldable stem cells into beta cells, the insulin-producing machinery that is mistakenly attacked by the immune system in type 1 diabetes.

If it works — if Semma’s lab-grown beta cells can replace those lost to the disease — the company may have invented a permanent solution to a disease that affects more than 1 million people in the U.S. Semma’s cells would be transplanted directly into the liver or meted out by an implant, freeing patients forever from their insulin injections.

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But it’s early days for Semma’s work, which is yet to be tested in a clinical trial. And development has been a longer process than Semma anticipated. In 2015, the company raised $44 million from investors and said that money would fund its work through human trials. As of today, Semma has raised more than $100 million more and has only tested its technology on primates and pigs.

For Vertex (VRTX), which has built a multibillion-dollar business on treatments for the rare cystic fibrosis, the Semma deal is a nod toward the company’s scientific future. With its fourth — and likely final — oral treatment for CF expected to win approval soon, Vertex has turned to potentially curative technologies like CRISPR genome editing and synthetic messenger RNA for its next generation of products.

In April, longtime president and CEO Jeffrey Leiden will step down from those roles, to be succeeded by current Chief Medical Officer Reshma Kewalramani.

Correction: An earlier version of this story misstated the location of Vertex’s headquarters.

[cherry]

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How can diabetes cause joint pain?

Last reviewed Thu 29 August 2019

By Jenna Fletcher

Reviewed by Maria Prelipcean, MD

1. Diabetes and joint pain
2. Treatment
3. Prediabetes and joint pain
4. Summary

Diabetes can cause joint pain in various ways, including by damaging the joints or nerves. It also has links with two types of arthritis.

Over time, uncontrolled diabetes can affect the muscles and skeleton, leading to joint pain, nerve damage, and other symptoms.

Also, according to the Arthritis Foundation, people with diabetes are almost twice as likely to develop arthritis.

Keep reading for more information about the links between diabetes, arthritis, and joint pain. We also describe telltale symptoms and the range of treatments.

How does diabetes cause joint pain?

Diabetes may cause joint pain by damaging nerves.

Diabetes is a chronic condition characterized by problems with insulin and blood sugar, also known as blood glucose. Insulin is a hormone that delivers blood glucose into the body's cells.

If a person has high blood glucose levels too often, and they do not receive treatment, it can lead to a range of health conditions.

Type 1 diabetes is an autoimmune condition. It occurs when the pancreas does not produce insulin. Type 2 diabetes is an acquired condition. It causes the body to produce less insulin, and the hormone does not function effectively.

Below, we describe some ways that diabetes can cause joint pain.

Musculoskeletal problems

Over time, if a person does not receive effective treatment, diabetes can lead to the breakdown of the musculoskeletal system. This can involve joint damage and a limited range of joint movement.

Diabetes can also cause changes in nerves and small blood vessels. As a result, hand abnormalities are very common among people with the condition.

Certain joints conditions tend to develop in people with type 1 or type 2 diabetes. The joint problems often correlate with the duration and control of diabetes.

These conditions include:

• carpal tunnel syndrome
• Dupuytren's contracture, or drawing up of the palms
• trigger finger

Some people with diabetes develop thickness of the skin on the fingers along with decreased mobility in the joint.

People may also experience shoulder pain, due to frozen shoulder or rotator cuff tendinitis.

When the joints are damaged, the cushioning no longer works as effectively. As a result, the bones can rub together, causing inflammation, stiffness, and pain. A person may experience limited joint mobility.

Charcot's joint

A persons with Charcot's joint may experience redness or swelling in the feet.
Image credit: J. Terrence Jose Jerome, 2008

Charcot's joint, also called neuropathic arthropathy, results from nerve damage caused by diabetes. The medical term for diabetes-related nerve damage is diabetic neuropathy.

Diabetic neuropathy can cause numbness in the extremities, such as the feet and ankles. Over time, a person may come to feel little or no sensation in these areas. It can be easier to twist or break a foot, for example, without realizing the extent of the damage.

Small breaks and sprains can put pressure on the joints of the foot. Decreased blood supply and mechanical factors contribute, over time, to joint damage and physical deformities.

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In some cases, a person may be able to help prevent this damage.

The following are some warning signs of Charcot's joint:

• redness or swelling
• numbness
• pain in the joints
• areas that feel hot to the touch
• changes in the appearance of the feet

If Charcot's joint, or neuropathic arthropathy, is causing pain, avoid using the affected foot until it heals.

If the feet are numb, consider using additional support, such as orthotics. Doctors usually treat Charcot's joint with a cast.

Effects of diabetes on the body and organs

In this article, we look at wide-ranging effects of diabetes throughout the body.

Read now

Links with arthritis

People with diabetes are almost twice as likely to develop arthritis. However, the risk of arthritis may differ, depending on whether a person has type 1 or type 2 diabetes.

Rheumatoid arthritis and type 1 diabetes

Both rheumatoid arthritis (RA) and type 1 diabetes are autoimmune disorders. This means that, in both cases, the immune system is attacking an otherwise healthy part of the body.

In a person with RA, the immune system attacks tissues in the joints, causing swelling, pain, and deformities.

In a person with type 1 diabetes, the immune system attacks the pancreas, stopping the production of insulin.

Both RA and type 1 diabetes involve inflammation, and certain clinical signs of inflammation — including C-reactive protein and interleukin-6 levels — are consistently high in people who have either condition.

Having one autoimmune condition can increase the risk of developing a second. This helps explain why type 1 diabetes and RA can coexist.

Osteoarthritis and type 2 diabetes

Unlike type 1 diabetes, type 2 is strongly associated with excess body weight. Being overweight or having obesity also increases a person's risk of developing osteoarthritis (OA), as the weight puts extra stress on the joints, particularly in the lower body.

A person can reduce their risk of developing type 2 diabetes and OA by maintaining a healthy weight, through a healthful diet and regular exercise.

If a person has either condition, or both, reaching and maintaining a healthy weight can improve their symptoms. According to the Arthritis Foundation, losing 15 pounds can significantly improve the level of knee pain in a person with OA, for example.

Also, in a person with type 2 diabetes, losing 5–10% of their total body weight can reduce their blood sugar levels significantly. As a result, they may need to take less medication for the condition.

Treatment and management

Taking over-the-counter anti-inflammatory medications, such as ibuprofen, can often reduce pain and swelling in the joints. Speak to a doctor about how much ibuprofen is too much in the short and long terms.

If joint pain and other symptoms persist, discuss treatment options with a doctor. Some people benefit from braces, orthotics, adjustments to their lifestyle or medication, or a combination.

Type 1 and type 2 diabetes have different causes and treatments. People with type 1 diabetes usually need to take forms of insulin to control their blood sugar levels.

People with type 2 diabetes may also require insulin. Often, they only need to take medication that improves the response of their insulin to blood sugar.

People with either type of diabetes benefit from maintaining a healthful diet and level of exercise. Reaching and maintaining a healthy weight has additional benefits for people with type 2 diabetes.

Receiving treatment early can help a person avoid long term diabetes complications, such as joint damage and malformations.

Prediabetes and joint pain

Maintaining a healthy weight through a healthful diet may reduce the chance of developing type 2 diabetes.

Having excess weight puts a person at risk of both prediabetes and joint pain.

The weight can lead to higher levels of blood sugar, and the pancreas may be unable to produce enough insulin to keep up. This can cause a person to develop type 2 diabetes.

Carrying extra weight also puts stress on the joints, particularly in the lower body.

To reduce the risk of developing type 2 diabetes and to limit stress on the joints, a person should maintain a healthy weight. Often, a person can do this by exercising regularly and eating a healthful diet, full of whole grains, vegetables, fruits, and lean proteins.

Summary

When a person does not receive effective treatment, diabetes can cause joint pain.

The pain can result from the effects of diabetes on the musculoskeletal or nervous systems. Joint pain can also occur if diabetes is causing arthritis, such as RA or OA.

In some people, over-the-counter pain relievers and anti-inflammatory medications are enough to reduce joint pain. Others may need additional treatment.

Eating a healthful diet, getting regular exercise, and maintaining a healthy weight can help improve symptoms and prevent complications.

[Trinity11]

Thanks for the above @cherry . I really see a difference when my diabetes is uncontrolled for any period of time. I have a lot of issues with RA ..

[cherry]

It is a strange disease @Trinity11  my mother,( and father) was a type 2 and never had any issue with it at all. My dad had some. My inflammation seems to be  sort of involved with my thyroid, which also governs your insulin output..Now  my thyroid meds are increased I have no issues with stiffness in my hands at all