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Re: Diabetes news for spring 2019

I don't understand the question @IMFat ?

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Re: Diabetes news for spring 2019

@IMFat wrote:



What does it all mean for a person with type 1?

@IMFat ...the proposal is to take these drugs off label and give doctors the option of prescribing them as therapy for Tyoe 1 diabetics. They have Black Box warnings and you couldn't pay me to take them. Pancreatitis, thyroid cancer as possible side effects? I'll pass...

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Re: Diabetes news for spring 2019

[ Edited ]

@Trinity11 wrote:

@IMFat wrote:



What does it all mean for a person with type 1?

@IMFat ...the proposal is to take these drugs off label and give doctors the option of prescribing them as therapy for Tyoe 1 diabetics. They have Black Box warnings and you couldn't pay me to take them. Pancreatitis, thyroid cancer as possible side effects? I'll pass...




Thanks.  I have a friend who has type 1 but does not speak English.

So, I could not explain the news from this thread.  And what to discuss with the doctor.

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Re: Diabetes news for spring 2019

What's bad for the heart is also bad for the brain

By Lisa Rapaport

(Reuters Health) - People who have risk factors for heart disease like diabetes, high blood pressure and obesity may also be more likely to develop structural changes in the brain that can lead to dementia, a recent study suggests.

Researchers examined data on 9,772 adults, ages 44 to 79, who all had at least one MRI brain scan and provided general health information and medical records for the analysis.

The researchers looked for associations between brain structure and so-called vascular risk factors. They found that except for high cholesterol, all of the other vascular risk factors - smoking, high blood pressure, high pulse pressure, diabetes, and obesity - were linked to abnormal brain changes seen in dementia.

And the more vascular risk factors a person had, the poorer was their brain health, as evidenced by greater brain shrinkage, less gray matter (tissue mainly on the surface of the brain) and less healthy white matter (tissue in deeper parts of the brain).

"There are some things that contribute to cognitive and brain aging that we cannot change (like our genes), so you could look at this like a list of things that we can have some agency over - so-called 'malleable' risk factors," said lead study author Simon Cox of the University of Edinburgh in the U.K.

"There are so many other benefits to improving your cardiovascular health (improving diet, weight, exercise, blood sugar control) and stopping smoking, but in combination with other good evidence out there, maintaining brain health is probably another one," Cox said by email.

The strongest links between the vascular risk factors and brain structure were in areas of the brain known to be responsible for our more complex thinking skills, and which deteriorate during the development of Alzheimer's disease and dementia.

Risk factors for heart disease appeared to impact brain health just as much in middle age as they did later in life, researchers report in the European Heart Journal.

And the risk of structural changes in the brain associated with cognitive decline also increased with each additional vascular risk factor, even in adults who appeared otherwise healthy, the study found.

Smoking, high blood pressure and diabetes were the three vascular risk factors that showed the most consistent associations across all types of brain tissue. High cholesterol levels were not associated with any differences in the MRI scans.

The study wasn't a controlled experiment designed to prove whether or how specific risk factors might directly cause dementia or cognitive decline.

"The precise mechanisms underlying these findings are not entirely clear," said Dr. Jeffrey Burns, co-director of the University of Kansas Alzheimer's Disease Center.

"The findings do underscore our increasing recognition that dementia is a complex syndrome and that vascular factors contribute to brain changes that we see and expect in people who are diagnosed with Alzheimer's disease," Burns, who wasn't involved in the study, said by email.

Still, there's enough evidence of the connection for patients to do what they can to promote brain health as they age, said Dr. Andrew Budson of the Veterans Affairs Boston Healthcare and Boston University School of Medicine.

"Because smoking, hypertension, and diabetes were the strongest risk factors, if you have a number of risk factors, these are the most important ones to work on," Budson, who wasn't involved in the study, said by email.

"Quit smoking cigarettes today," Budson advised. "Control high blood pressure and diabetes through medications, aerobic exercise, and weight loss. These measures can reduce the daily brain damage that will otherwise occur."

SOURCE: European Heart Journal, online March 11, 2019.

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Re: Diabetes news for spring 2019

Gene transfer improves diabetes-linked heart ailment

Veterans Affairs Research Communications

IMAGE: Dimosthenis Giamouridis is a research associate in Dr. Kirk Hammond's lab at the VA San Diego Healthcare System and the University of California San Diego. The team has shown, in... view more 

Credit: Kevin Walsh

Researchers with the VA San Diego Healthcare System and the University of California San Diego have shown that a gene transfer technique can combat heart dysfunction caused by diabetes.

Working with mice, the researchers showed that a single injection to promote the expression of the hormone urocortin 2 (UCn2) increased left ventricle function and improved how the body processed glucose. The study could lead to new clinical treatments for diabetes-related left ventricle dysfunction, they say.

The study appeared in the March 11, 2019, issue of Human Gene Therapy.

Dr. Kirk Hammond, the corresponding author on the study, explained that a single administration of an agent that both reduces blood sugar and increases heart function would be attractive to patients with diabetes. These patients often must adhere to complicated medical regimens, he explains, and therefore often have trouble complying with their care instructions.

Diabetes affects 9 percent of adults worldwide, including 29 million Americans. Nearly 25 percent of VA's patient population have diabetes. It increases the risk of cardiovascular disease, and death rates from heart disease are two to four times higher for adults with diabetes.

One major problem caused by diabetes is left ventricle dysfunction. The ventricles are the largest chambers of the heart. The right ventricle pumps blood to the lungs to receive oxygen, while the left ventricle pumps the blood to the rest of the body. Diabetes can cause the walls of the left ventricle to thicken and become fibrous, which stops it from pumping properly. Diabetes-related left ventricle dysfunction represents an unmet medical need, according to the researchers. As they explain, the prevalence of left ventricle dysfunction is increasing as diabetes rates increase globally.

Previous studies by the research team showed that UCn2 gene transfer increases cardiac function in normal mice and increases function in the failing heart (caused by heart attack). In the current study, the researchers wanted to see whether this same gene transfer technique would improve heart dysfunction caused by diabetes.

Gene transfer therapy involves positively changing how the body's genes operate using genetic material.

For this study, the researchers injected mice with a non-infectious virus called adeno-associated virus type 8, which carried the gene for UCn2. The virus vector goes mainly to the liver, where it manufactures UCn2. UCn2 is then released into the blood, where it interacts with specific receptors, which can improve heart function and increase glucose disposal. Glucose disposal refers to the uptake of glucose from the blood into tissues of the body.

To trigger diabetes, the researchers fed mice a diet of 45 percent fat, 35 percent carbohydrate, and 20 percent protein. This dietary balance is similar to the standard diet in Western countries such as the United States. A diet high in fats and sugars, as is common in a Wester diet, is linked with an increased risk of diabetes. Mice fed the Western diet for 30 weeks showed increased blood glucose and weight gain, along with reduced heart function compared with mice eating a diet lower in fat and sugar.

After 30 weeks on the diets, the mice received a single injection of the UCn2 gene transfer, or an injection of saline. Results show that the single injection of UCn2 gene transfer led to better left ventricle function after 10 weeks, compared with the mice given the saline placebo. Mice in the UCn2 group also had better glucose disposal, as well as reduced fat build-up in the liver.

Ten weeks after the injection, mice given the gene transfer had a 20-fold increase in UCn2 concentration in their blood. This increase was linked to reduced fasting blood glucose levels and better glucose tolerance, relative to the mice given saline. The increase in UCn2 led to increases of 38 percent for systolic and 33 percent for diastolic left ventricle function.

Although additional studies will be required, this therapy could lead to new treatment techniques for people with diabetes in clinical settings, according to the researchers. They call the possibility of a one-time treatment with enduring benefits on glucose disposal and left ventricle function "an attractive and unique therapeutic strategy."

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Re: Diabetes news for spring 2019

By Serena Gordon

HealthDay Reporter

FRIDAY, March 29, 2019 (HealthDay News) -- When you have type 1 diabetes, keeping track of your blood sugar levels can be challenging. But new research suggests that seniors might really have trouble avoiding low blood sugar, or hypoglycemia.

In fact, many patients over age 60 may experience up to 100 minutes of a day with low blood sugar and not even know it, the study researchers said.

The bottom line: "Older adults with type 1 diabetes do spend a considerable amount of time in hypoglycemia," said study author Dr. Anders Carlson. He's medical director of the International Diabetes Center in Minneapolis.

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"Hypoglycemia can lead to a lot of severe consequences -- loss of consciousness, accidents, falls, hospitalizations and ER visits. Older adults have a higher risk from hypoglycemia in terms of arrhythmia [irregular heartbeat] that can result in higher cardiovascular problems," Carlson explained.

"Hypoglycemia can take a toll on people. You have to be ready and able to treat hypoglycemia at any given moment," he added.


Any blood sugar reading below 70 milligrams per deciliter (mg/dL) is considered low blood sugar. When blood sugar drops below 54 mg/dL, you're at risk for more serious symptoms.

As blood sugar levels dip, you begin to experience symptoms such as shaking, sweating, headache, hunger, fatigue and blurred vision. As blood sugar drops lower, you may feel weak and have trouble concentrating. You may be confused or have changes in your personality. Eventually, untreated low blood sugar can lead to seizures, unconsciousness and even death, according to the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.


People who've had diabetes for a long time or who have had repeated low blood sugar are at risk of developing hypoglycemia unawareness. These people no longer feel the uncomfortable warning symptoms of hypoglycemia, according to the American Diabetes Association (ADA). This puts them at even greater risk of experiencing serious low blood sugar.

The study looked at 203 adults older than 60 who had type 1 diabetes. More than 90 percent were white, and just over half wore an insulin pump. Their overall diabetes management averaged within the range recommended for older adults by the ADA.

The participants wore a "blinded" continuous glucose monitor (CGM) for three weeks. Using an extremely thin sensor inserted underneath the skin, CGMs normally provide nearly constant access to blood sugar readings for the patient. The study devices, however, only gave that information to the researchers.

The study found that the volunteers spent an average of 72 minutes a day with blood sugar levels of less than 70 mg/dL and 24 minutes a day at less than 54 mg/dL. Those with hypoglycemia unawareness spent even more time with low blood sugar levels.

The researchers didn't notice a difference between day and night readings of low blood sugar.

Dr. Joel Zonszein is director of Montefiore Medical Center's Clinical Diabetes Center in New York City, and was not involved with the research. "I'm not surprised by the study. This is what we see all the time now that CGM is becoming more available," he noted.

Zonszein said older people don't have the same counter-regulatory responses from the body that younger people do. That usually means that management of diabetes in older people should be less aggressive, he said.

"Frequent low blood sugars should be a wake-up call to rearrange the diabetes regimen," he said.

Carlson agreed that it was important for treatment to try to minimize hypoglycemia.

Carlson presented the findings this week at the Endocrine Society annual meeting, in New Orleans. Research presented at meetings is typically viewed as preliminary until it has been published in a peer-reviewed journal.

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Re: Diabetes news for spring 2019

European Commission approves first oral therapy for type 1 diabetes


The European Commission this week approved the SGLT2 inhibitor dapagliflozin for use in type 1 diabetes as an adjunct to insulin in patients with a BMI of at least 27 kg/m², Astra Zeneca announced in a press release.

The European approval of dapagliflozin (Forxiga) marks the first approval of an oral type 1 diabetes therapy outside the United States. The medication is indicated for adults with type 1 diabetes with inadequate glycemic control despite optimal insulin therapy. Dapagliflozin is currently under regulatory review in the U.S. (as Farxiga) and Japan for use as an adjunct treatment to insulin in adults with type 1 diabetes, with decisions expected in the first and second half of 2019, respectively, according to the company.

“Forxiga is the first oral medicine approved in Europe as an adjunct to insulin for people living with type 1 diabetes whose glucose levels are not adequately controlled with insulin alone,” Elisabeth Björk, senior vice president, head of late cardiovascular, renal and metabolism, R&D BioPharmaceuticals, said in the release. “We look forward to bringing Forxiga to a patient population that has not had any approved oral medicines available before.”

The approval is based on data from the phase 3 DEPICT clinical program. The short-term (24-week) and long-term (52-week) data from DEPICT 1, along with the short-term data from DEPICT 2, demonstrated that 5 mg dapagliflozin daily, when given as an adjunct to adjustable insulin in patients with inadequately controlled type 1 diabetes, was associated with reductions from baseline in HbA1c (primary endpoint), weight and total daily insulin dose (secondary endpoints) at weeks 24 and 52, according to the release.

The safety profile of dapagliflozin in the type 1 diabetes studies was consistent with findings from the type 2 diabetes trials with the drug, apart from a higher number of observed cases of diabetic ketoacidosis (DKA) in patients who received dapagliflozin, according to the release.

Dapagliflozin is already indicated as a monotherapy and as part of combination therapy in adults with type 2 diabetes to improve glycemic control, with the additional benefits of weight loss and blood pressure reduction, as an adjunct to diet and exercise. In February, the FDA approved a label update for dapagliflozin, expanding its use for patients with type 2 diabetes and moderate renal impairment. As Endocrine Today previously reported, the expanded indication is intended for both dapagliflozin (Farxiga) and dapagliflozin plus metformin extended-release (Xigduo XL) and lowers the estimated glomerular filtration rate threshold to 45 mL/min/1.73m², indicating moderate chronic kidney disease, from 60 mL/min/1.73m².

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Re: Diabetes news for spring 2019

Wondering About Your Diet? Carbs Versus Fats

The answer to which diet is better for weight-loss and maintenance: low fat or low carbohydrate is getting clearer. In the Framingham State Food Study, David Ludwig, MD, PhD, professor in the Department of Nutrition at Harvard T.H. Chan School of Public Health, and director of the New Balance Foundation Obesity Prevention Center at Boston Children’s Hospital, looks at the impact of decreasing carbohydrates and increasing fat on caloric expenditure and weight management.1


Rather than look at the impact of these foods, Dr. Ludwig and his research team considered the problem based on how the body metabolizes the macronutrients: carbohydrates and fat, by asking: Are all calories created equal? According to the study results,1 not always, or at least not for everyone.

“The type of calories being consumed have a clear effect on the number of calories being burned,” Dr. Ludwig told EndocrineWeb, summarizing the study findings in the journal, Science.2.  According to their findings, the key to glucose management is caloric expenditure in some individuals.  

Insulin Resistance Suggests Reducing Your Carbs

Researchers from the Framingham State Food Safety Study suggest that more fats and less carbohydrates could help people with insulin-insensitivity and type 2 diabetes maintain successful weight loss better.1 The study relies on the Carbohydrate Insulin Model (CIM) of obesity,3 which Dr. Ludwig and his team pioneered, to assess the total energy expenditure (TEE) of different food types.

The CIM demonstrates that high glycemic eating patterns— resulting from a diet high in processed carbohydrates (eg, white bread, white pasta, white rice, sugar)—directs the body to store more calories as fat, rather than using the energy to support body functions.3 This switch from burning to storing calories occurs when the two metabolic hormones, insulin and glucagon become unbalanced, causing excess insulin, increased hunger, and a slowed metabolism.3 

Changing your eating pattern to one that is lower in processed carbohydrates and higher in heart-healthy fats—think avocados, Salmon, nuts, olive oil, and seeds—may correct this disrupted hormone pattern. 2 The result is an ability to burn more calories, and enabling you to more effectively regulate your weight.

The Framingham State Food Safety Study is a randomized control trial of young adults, 18-25 years, who had a body mass index (BMI) of 25 kg/m2 or more; their total energy expenditure (TEE) was monitored to measure how well they were able to burn calories during weight maintenance following a period of weight loss.1

For the first phase of the study, participants were put on a calorie-restricted diet for ten weeks to promote weight loss. During the twenty-week test phase, researchers measured the effect of decreased carbohydrates and increased fat intake on metabolic function and weight maintenance.1 Researchers adjusted caloric intake as needed to maintain weight loss.  Participants were randomly assigned to one of three diet groups:

  • High carbohydrate (60% carbohydrate), low fat
  • Moderate carbohydrate (40 % carbohydrate), moderate fat
  • Low carbohydrate (20% carbohydrate), high fat

Individual insulin levels were tested before weight loss to determine the relationship between insulin secretion and diet, as predicted by the carbohydrate-insulin model.

Assessing How Well the Body Deals with Types of Calories

The results of this Food Study showed a linear trend of an additional 52 calories burned for every 10% decrease in carbohydrate intake.1 Individuals who have the highest insulin secretion levels prior to efforts at weight loss achieve the greatest calorie expenditure, burning an average of 308 calories more daily when consuming a low carbohydrate/high-fat diet.1

However, among individuals who had normal insulin function at the outset, there was no difference in how the way their body metabolized calories from their carbohydrate intake.

These findings suggest that a carbohydrate-restricted diet is beneficial specifically for people who have type 2 diabetes and are known to be insulin insensitive.1 This makes sense if we think of insulin resistance and type 2 diabetes as a form of carbohydrate intolerance,1,3  as Dr. Ludwig believes we should. And there is support for this recommendation based on the hormone changes observed during the weight maintenance phase of the Framingham study.1

In fact, study participants in the moderate and low carbohydrate diet groups show decreases in the hormones—ghrelin and leptin—that regulate hunger. You can think of ghrelin as the short-term hunger regulator and leptin as the hormone in charge of satiety in the long-term. Leptin insensitivity is commonly seen in people with obesity and those who have metabolic syndrome.

Participants in the Framingham State Food Study had lower leptin levels in conjunction with decreased hunger and increased energy expenditure, suggesting that a lower carbohydrate, higher fat diet could help improve their glucose responsiveness.1

“The people who show the biggest declines in leptin are the most successful weight loss maintainers,” Dr. Ludwig tells EndocrineWeb.

Food Choices Affect Metabolic Function Differently After Weight Loss

It is important to know what this study does and does not tell us. To lose weight, all participants followed a calorie restrictive diet consisting of 45% carbohydrates, 30% fat and 25% protein and only participants who achieved a weight loss of 12% within that ten-week period were included in the second (testing) phase.1

 “This was not a weight loss study but rather a study specifically aimed at evaluating the effect of macronutrient partitioning on metabolic function and weight maintenance,” says Christopher Gardner, PhD, professor of medicine at Stanford School of Medicine, and director of nutrition studies at the Stanford Prevention Research Center, in Stanford , California.

Findings of Dr. Gardner’s DIETFITS study,4 in which individuals were evaluated for the amount of weight lost over 12 months, offer evidence that there is no significant difference in the number of pounds lost by participants eating a high carbohydrate versus low carbohydrate diet.

Maybe a better way to understand the impact of specific food types on weight is that “a high fat/ low carbohydrate diet is an effective treatment for people with insulin resistance than a dietary prescription for people with a normal glucose metabolism, who are trying to manage their weight,” says Caroline Apovian, MD, FACP, FACN, professor of medicine and pediatrics, at Boston University School of Medicine, in Massachusetts. But, don’t go running for that stick of butter, just yet.

Food Quality Matters: Everyone Benefits from Less Processed Foods

The type of food matters, too. “If you are eating a high saturated fat diet and you replace saturated fats with simple carbohydrates, you’re doing yourself a disservice,” says Dr. Apovian.  “But if you replace the saturated fats with mono- and polyunsaturated fats, you are following a Mediterranean-style diet and there is a lot of research to show that this is a very healthy diet,”5 Dr. Apovian tells EndocrineWeb. And, the moderate carbohydrate diet is essentially a Mediterranean approach to eating, Dr. Ludwig agrees.

Just as the type of fat matters, so does the type of carbohydrate. One of the biggest contributors to the obesity epidemic is processed carbohydrates.  All three researchers agree that we should stay away from processed carbohydrates, such as white flour based bread, pasta, cereal, and any foods with added sugars.  These foods are stripped of their natural fiber and other beneficial nutrients that can make carbohydrates both healthy and satiating.

What does Dr. Ludwig’s low carbohydrate diet look like?  “Limitless amounts of non-starchy vegetables, a serving or two of fruit, (eg, berries rather than bananas), an optional serving of beans, and maybe a serving of minimally processed grain or potato,” he says. 

So, are carbohydrates really the villain we’ve been warned about? Not necessarily.

For people who are insulin resistant, steering clear of low fiber, starchy, highly processed foods and increasing their intake of healthy fats instead, will improve their chances of avoiding weight regain, which is the long-term goal for improved health.1 

 “I don’t think we’re prepared to make recommendations yet.  This is just one study,” Dr. Ludwig tells EndocrineWeb. While Dr. Ludwig and his research team are gearing up for future studies, Dr. Kevin Hall, PhD who challenges the Carbohydrate Insulin Model for obesity is also contesting The Framingham Study’s data. 

According to Dr. Hall, the problem is the timing of baseline total energy expenditure (TEE) measurements. The Framingham Study measured TEE following the initial weight loss phase, rather than pre-weight loss.3 Why does this matter?  Dr. Hall says, “it changes the final results of the study.”  When Dr. Hall and his team reanalyzed the data using pre-weight loss TEE as a baseline, they found that “the significant increases in TEE with the low carbohydrate diet…disappeared. Dr. Hall also found that the influence of pre-weight loss insulin secretion disappeared when reanalyzing the data based on pre-weight loss total energy expenditure.6

Does this negate the findings reported by Dr. Ludwig? No.

 “The purpose of this study was to look at weight maintenance, not weight loss; to study weight loss maintenance, you want to look at people after they’ve lost weight but before you randomize them into diet groups,” Dr. Ludwig says.  As such, Dr. Ludwig chose post-weight loss TEE as a baseline before reviewing study results and explains, “This is the largest, longest, and most complex study ever to disclose the full database immediately upon publication. We want people to analyze the data and come to their own conclusions.” 

Do You Need to Avoid Carbohydrates?

 “In my personal opinion, there is likely a major difference between people’s individual biology.  People who are insulin resistant, high insulin secretors, and especially people with diabetes, will benefit the most by restricting their carbohydrates,” Dr. Ludwig tells EndocrineWeb

Who will benefit?  The easiest way to determine which individuals are high insulin secretors is by an indirect measurement obtained by evaluating body composition; people who are more apple-shaped, with fat settling around their middle, are more likely to be high-insulin secretors, says Dr. Ludwig. 

In addition, clinical tests include an oral glucose tolerance test to assess insulin response and a fasting blood glucose test to assess insulin resistance. If you think you may be glucose intolerant, discuss the need for these testing options with your doctor.

Dr. Apovian also emphasizes, “for everybody, if you focus on the quality of your macronutrients, you’ll inherently have more metabolic flexibility. Focus on minimally processed, whole foods prepared simply and the ratio of carbohydrates to fats won’t matter as much for most people.”

 In the end, food quality matters—but to some more than others. Eating whole foods, and steering clear of processed, prepared foods, is a constant theme when seeking to improve your weight and overall health, the experts agree. It is worth noting that in Dr. Gardner’s DIETFITS study,4 participants were directed away from highly processed carbohydrates, and encouraged to choose vegetables and slow-release carbohydrates (eg, minimally processed, whole grains) that have a low glycemic index.

The lastest findings clarify that for insulin resisters, steering clear of low fiber, starchy, highly processed foods will give them a greater chance at keeping lost weight off.1

Do We Have the Answer to What’s the Best Diet?

Which types of foods are responsible for increasing your girth and what diet should you follow to achieve a healthier weight? What we know now is that it may depend on how your body responds to carbs, among other things. Therefore, the solution does not lie with one single food group, but in the best overall dietary pattern that works for you personally.

That said—there IS a lifestyle treatment for type 2 diabetes, heart disease, and obesity—the answer depends on how you react to different foods and diets. When you manage to lose weight quickly only to regain the lost weight, look at what you’ve been eating, and consider the findings presented by Dr. Ludwig’s research.

One thing that all of these nutrition specialists can agree on is this: stay away from processed foods and simple sugars, don’t be afraid of fat but do choose heart-healthy fats. Eat whole foods, just not too much.7

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Re: Diabetes news for spring 2019

Diabetes mellitus, or diabetes, is a disease that refers to the body's problems with insulin, a hormone produced in the pancreas. Insulin plays a vital role in metabolism–in helping glucose (sugar) to move out of the blood into cells, which use the glucose for fuel. In type 1 and type 2 diabetes, there's a need to control glucose levels in the blood.

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Re: Diabetes news for spring 2019

What Are the Best Treatments for Diabetes?

Researchers are developing innovative treatments that make diabetes easier to manage. Drugs such as Actos (pioglitazone) and Avandia (rosiglitazone) lower insulin resistance. Drugs like Starlix (nateglinide) and Prandin (repaglinide) help the pancreas make more insulin. "These are tremendous aids in treating type 2 diabetes," says Dr. Bell.

The hemoglobin A1c test also makes a big difference in treatment. The test can tell the doctor how high the patient's blood sugar has been, on average, over the last two to three months. This provides a better picture of the degree to which the kidneys, heart, nerves, and eyes have been exposed to high blood sugar. Surprisingly, only 40 percent of patients with diabetes get the hemoglobin A1c test once a year, says Bell. If you are diabetic, talk to your doctor about taking the test.

Most people with diabetes measure blood glucose daily or even continuously so they know how food, exercise and medication affect their blood sugar. Insulin injection has gotten easier with inventive gadgets, like disposable, pocket-sized pen-like injectors that contain insulin and small needles. Another popular option to manage blood sugar for patients with type 1 diabetes is the insulin pump, a small, computerized device that can inject insulin multiple times a day.

For now, medications, regular checkups, nutrition, and exercise are the best ways to manage diabetes, and live a full life.

• Hit the weights. Strength training plus cardio can lower your type 2 diabetes risk 59 percent. Aim for two sessions per week.
• Nix nighttime noshing. Regular nighttime snackers don't sleep as soundly and are more likely to develop type 2 diabetes.
• Go easy on the bacon. A diet high in processed meat raised type 2 diabetes risk 19 percent. Limit your intake to once a week or less.
• Symptoms may include high levels of blood sugar, high levels of sugar in the urine, frequent urination, extreme hunger, extreme thirst, extreme weight loss, weakness and fatigue, moodiness and irritability, or nausea and vomiting.
• Treatment: Insulin is received via injections or insulin pumps.
• Possible complications of poorly controlled diabetes include kidney disease; eye damage; heart problems; compromised nerve function in the arms, hands, legs, and feet that can set the stage for ulcers and amputations; coma and death.
• Symptoms may include increased thirst; frequent urination; increased appetite accompanied by weight loss; edginess; fatigue; nausea; repeated hard-to-heal infections; tingling or numbness in the hands or feet; high levels of sugar in the urine; or dry, itchy skin.
• Treatment: Ten percent of type 2 patients rely on diet and exercise to manage their disease. Fifty percent are treated with oral medications; 30 percent with a combination of insulin and oral medications; and 10 percent with insulin alone.
• Possible complications are the same as for type 1 diabetes.
• Having a close relative, such as a father, mother, sister, or brother, who has diabetes;
• Being of African-American, Latino, Native American, or Asian descent.
• Having high blood pressure
• Having "good" (HDL) cholesterol that is too low (generally, less than 40 mg/dl);
• Having levels of triglycerides (another type of fat in the blood) that are high (generally, more than 259 mg/dl).