Every week, the Nuance will go beyond the basics, offering a deep and researched look at the latest science and expert insights on a buzzed-about health topic.
-
Blogs & Forums
Turn on suggestions
Auto-suggest helps you quickly narrow down your search results by suggesting possible matches as you type.
Showing results for
Healthy Patients With Good Functional Status
There are few long-term studies in older adults demonstrating the benefits of intensive glycemic, blood pressure, and lipid control. Patients who can be expected to live long enough to reap the benefits of long-term intensive diabetes management, who have good cognitive and physical function, and who choose to do so via shared decision making may be treated using therapeutic interventions and goals similar to those for younger adults with diabetes (Table 12.1).
As with all patients with diabetes, diabetes self-management education and ongoing diabetes self-management support are vital components of diabetes care for older adults and their caregivers. Self-management knowledge and skills should be reassessed when regimen changes are made or an individual’s functional abilities diminish. In addition, declining or impaired ability to perform diabetes self-care behaviors may be an indication for referral of older adults with diabetes for cognitive and physical functional assessment using age-normalized evaluation tools (3,19).
Patients With Complications and Reduced Functionality
For patients with advanced diabetes complications, life-limiting comorbid illnesses, or substantial cognitive or functional impairments, it is reasonable to set less intensive glycemic goals (Table 12.1). Factors to consider in individualizing glycemic goals are outlined in Fig. 6.1. These patients are less likely to benefit from reducing the risk of microvascular complications and more likely to suffer serious adverse effects from hypoglycemia. However, patients with poorly controlled diabetes may be subject to acute complications of diabetes, including dehydration, poor wound healing, and hyperglycemic hyperosmolar coma. Glycemic goals at a minimum should avoid these consequences.
Vulnerable Patients at the End of Life
For patients receiving palliative care and end-of-life care, the focus should be to avoid symptoms and complications from glycemic management. Thus, when organ failure develops, several agents will have to be downtitrated or discontinued. For the dying patient, most agents for type 2 diabetes may be removed (27). There is, however, no consensus for the management of type 1 diabetes in this scenario (28). See end-of-life care below, for additional information.
Beyond Glycemic Control
Although hyperglycemia control may be important in older individuals with diabetes, greater reductions in morbidity and mortality are likely to result from control of other cardiovascular risk factors rather than from tight glycemic control alone. There is strong evidence from clinical trials of the value of treating hypertension in older adults (29,30). There is less evidence for lipid-lowering therapy and aspirin therapy, although the benefits of these interventions for primary prevention and secondary intervention are likely to apply to older adults whose life expectancies equal or exceed the time frames of the clinical trials.
LIFESTYLE MANAGEMENT
Recommendation
12.10 Optimal nutrition and protein intake is recommended for older adults; regular exercise, including aerobic activity and resistance training, should be encouraged in all older adults who can safely engage in such activities. B
Diabetes in the aging population is associated with reduced muscle strength, poor muscle quality, and accelerated loss of muscle mass, resulting in sarcopenia. Diabetes is also recognized as an independent risk factor for frailty. Frailty is characterized by decline in physical performance and an increased risk of poor health outcomes due to physiologic vulnerability to clinical, functional, or psychosocial stressors. Inadequate nutritional intake, particularly inadequate protein intake, can increase the risk of sarcopenia and frailty in older adults. Management of frailty in diabetes includes optimal nutrition with adequate protein intake combined with an exercise program that includes aerobic and resistance training (31,32).
PHARMACOLOGIC THERAPY
Recommendations
12.11 In older adults at increased risk of hypoglycemia, medication classes with low risk of hypoglycemia are preferred. B
12.12 Overtreatment of diabetes is common in older adults and should be avoided. B
12.13 Deintensification (or simplification) of complex regimens is recommended to reduce the risk of hypoglycemia, if it can be achieved within the individualized A1C target. B
Special care is required in prescribing and monitoring pharmacologic therapies in older adults (33). See Fig. 9.1 for general recommendations regarding antihyperglycemia treatment for adults with type 2 diabetes and Table 9.1 for patient- and drug-specific factors to consider when selecting antihyperglycemia agents. Cost may be an important consideration, especially as older adults tend to be on many medications. See Tables 9.2 and 9.3 for median monthly cost of noninsulin glucose-lowering agents and insulin in the U.S., respectively. It is important to match complexity of the treatment regimen to the self-management ability of an older patient. Many older adults with diabetes struggle to maintain the frequent blood glucose testing and insulin injection regimens they previously followed, perhaps for many decades, as they develop medical conditions that may impair their ability to follow their regimen safely. Individualized glycemic goals should be established (Fig. 6.1) and periodically adjusted based on coexisting chronic illnesses, cognitive function, and functional status (2). Tight glycemic control in older adults with multiple medical conditions is considered overtreatment and is associated with an increased risk of hypoglycemia; unfortunately, overtreatment is common in clinical practice (34–38). Deintensification of regimens in patients taking noninsulin glucose-lowering medications can be achieved by either lowering the dose or discontinuing some medications, so long as the individualized A1C target is maintained. When patients are found to have an insulin regimen with complexity beyond their self-management abilities, lowering the dose of insulin may not be adequate. Simplification of the insulin regimen to match an individual’s self-management abilities in these situations has been shown to reduce hypoglycemia and disease-related distress without worsening glycemic control (39–41). Figure 12.1 depicts an algorithm that can be used to simplify the insulin regimen (39). Table 12.2 provides examples of and rationale for situations where deintensification and/or insulin regimen simplification may be appropriate in older adults.
Fig. 12.1
Algorithm to simplify insulin regimen for older patients with type 2 diabetes. eGFR, estimated glomerular filtration rate. *Basal insulins: glargine U-100 and U-300, detemir, degludec, and human NPH. **See Table 12.1. ¥Mealtime insulins: short-acting (regular human insulin) or rapid-acting (lispro, aspart, and glulisine). §Premixed insulins: 70/30, 75/25, and 50/50 products. Adapted with permission from Munshi and colleagues (39,55,56).
Metformin
Metformin is the first-line agent for older adults with type 2 diabetes. Recent studies have indicated that it may be used safely in patients with estimated glomerular filtration rate ≥30 mL/min/1.73 m2 (42). However, it is contraindicated in patients with advanced renal insufficiency and should be used with caution in patients with impaired hepatic function or congestive heart failure due to the increased risk of lactic acidosis. Metformin may be temporarily discontinued before procedures, during hospitalizations, and when acute illness may compromise renal or liver function.
Thiazolidinediones
Thiazolidinediones, if used at all, should be used very cautiously in those with, or at risk for, congestive heart failure and those at risk for falls or fractures.
Insulin Secretagogues
Sulfonylureas and other insulin secretagogues are associated with hypoglycemia and should be used with caution. If used, shorter-duration sulfonylureas, such as glipizide, are preferred. Glyburide is a longer-duration sulfonylurea and contraindicated in older adults (43).
Incretin-Based Therapies
Oral dipeptidyl peptidase 4 (DPP-4) inhibitors have few side effects and minimal hypoglycemia, but their costs may be a barrier to some older patients. DPP-4 inhibitors do not increase major adverse cardiovascular outcomes (44).
Glucagon-like peptide 1 (GLP-1) receptor agonists are injectable agents, which require visual, motor, and cognitive skills for appropriate administration. They may be associated with nausea, vomiting, and diarrhea. Also, weight loss with GLP-1 receptor agonists may not be desirable in some older patients, particularly those with cachexia. In patients with established atherosclerotic cardiovascular disease, GLP-1 receptor agonists have shown cardiovascular benefits (44).
Sodium−Glucose Cotransporter 2 Inhibitors
Sodium−glucose cotransporter 2 inhibitors are administered orally, which may be convenient for older adults with diabetes; however, long-term experience in this population is limited despite the initial efficacy and safety data reported with these agents. In patients with established atherosclerotic cardiovascular disease, these agents have shown cardiovascular benefits (44).
Insulin Therapy
The use of insulin therapy requires that patients or their caregivers have good visual and motor skills and cognitive ability. Insulin therapy relies on the ability of the older patient to administer insulin on their own or with the assistance of a caregiver. Insulin doses should be titrated to meet individualized glycemic targets and to avoid hypoglycemia.
Once-daily basal insulin injection therapy is associated with minimal side effects and may be a reasonable option in many older patients. Multiple daily injections of insulin may be too complex for the older patient with advanced diabetes complications, life-limiting coexisting chronic illnesses, or limited functional status. Figure 12.1 provides a potential approach to insulin regimen simplification.
Other Factors to Consider
The needs of older adults with diabetes and their caregivers should be evaluated to construct a tailored care plan. Impaired social functioning may reduce their quality of life and increase the risk of functional dependency (45). The patient’s living situation must be considered as it may affect diabetes management and support needs. Social and instrumental support networks (e.g., adult children, caretakers) that provide instrumental or emotional support for older adults with diabetes should be included in diabetes management discussions and shared decision making.
Older adults in assisted living facilities may not have support to administer their own medications, whereas those living in a nursing home (community living centers) may rely completely on the care plan and nursing support. Those receiving palliative care (with or without hospice) may require an approach that emphasizes comfort and symptom management, while de-emphasizing strict metabolic and blood pressure control.
TREATMENT IN SKILLED NURSING FACILITIES AND NURSING HOMES
Recommendations
12.14 Consider diabetes education for the staff of long-term care facilities to improve the management of older adults with diabetes. E
12.15 Patients with diabetes residing in long-term care facilities need careful assessment to establish glycemic goals and to make appropriate choices of glucose-lowering agents based on their clinical and functional status. E
Management of diabetes in the long-term care (LTC) setting (i.e., nursing homes and skilled nursing facilities) is unique. Individualization of health care is important in all patients; however, practical guidance is needed for medical providers as well as the LTC staff and caregivers (46). Training should include diabetes detection and institutional quality assessment. LTC facilities should develop their own policies and procedures for prevention and management of hypoglycemia.
Resources
Staff of LTC facilities should receive appropriate diabetes education to improve the management of older adults with diabetes. Treatments for each patient should be individualized. Special management considerations include the need to avoid both hypoglycemia and the complications of hyperglycemia (2,47). For more information, see the ADA position statement “Management of Diabetes in Long-term Care and Skilled Nursing Facilities” (46).
Nutritional Considerations
An older adult residing in an LTC facility may have irregular and unpredictable meal consumption, undernutrition, anorexia, and impaired swallowing. Furthermore, therapeutic diets may inadvertently lead to decreased food intake and contribute to unintentional weight loss and undernutrition. Diets tailored to a patient's culture, preferences, and personal goals may increase quality of life, satisfaction with meals, and nutrition status (48).
Hypoglycemia
Older adults with diabetes in LTC are especially vulnerable to hypoglycemia. They have a disproportionately high number of clinical complications and comorbidities that can increase hypoglycemia risk: impaired cognitive and renal function, slowed hormonal regulation and counterregulation, suboptimal hydration, variable appetite and nutritional intake, polypharmacy, and slowed intestinal absorption (49). Oral agents may achieve similar glycemic outcomes in LTC populations as basal insulin (34,50).
Another consideration for the LTC setting is that, unlike the hospital setting, medical providers are not required to evaluate the patients daily. According to federal guidelines, assessments should be done at least every 30 days for the first 90 days after admission and then at least once every 60 days. Although in practice the patients may actually be seen more frequently, the concern is that patients may have uncontrolled glucose levels or wide excursions without the practitioner being notified. Providers may make adjustments to treatment regimens by telephone, fax, or in person directly at the LTC facilities provided they are given timely notification of blood glucose management issues from a standardized alert system.
The following alert strategy could be considered:
1. Call provider immediately: in case of low blood glucose levels (≤70 mg/dL [3.9 mmol/L]).
2. Call as soon as possible: a) glucose values between 70 and 100 mg/dL (3.9 and 5.6 mmol/L) (regimen may need to be adjusted), b) glucose values greater than 250 mg/dL (13.9 mmol/L) within a 24-h period, c) glucose values greater than 300 mg/dL (16.7 mmol/L) over 2 consecutive days, d) when any reading is too high for the glucometer, or e) the patient is sick, with vomiting, symptomatic hyperglycemia, or poor oral intake.
END-OF-LIFE CARE
Recommendations
12.16 When palliative care is needed in older adults with diabetes, strict blood pressure control may not be necessary, and withdrawal of therapy may be appropriate. Similarly, the intensity of lipid management can be relaxed, and withdrawal of lipid-lowering therapy may be appropriate. E
12.17 Overall comfort, prevention of distressing symptoms, and preservation of quality of life and dignity are primary goals for diabetes management at the end of life. E
The management of the older adult at the end of life receiving palliative medicine or hospice care is a unique situation. Overall, palliative medicine promotes comfort, symptom control and prevention (pain, hypoglycemia, hyperglycemia, and dehydration), and preservation of dignity and quality of life in patients with limited life expectancy (47,51). A patient has the right to refuse testing and treatment, whereas providers may consider withdrawing treatment and limiting diagnostic testing, including a reduction in the frequency of fingerstick testing (52). Glucose targets should aim to prevent hypoglycemia and hyperglycemia. Treatment interventions need to be mindful of quality of life. Careful monitoring of oral intake is warranted. The decision process may need to involve the patient, family, and caregivers, leading to a care plan that is both convenient and effective for the goals of care (53). The pharmacologic therapy may include oral agents as first line, followed by a simplified insulin regimen. If needed, basal insulin can be implemented, accompanied by oral agents and without rapid-acting insulin. Agents that can cause gastrointestinal symptoms such as nausea or excess weight loss may not be good choices in this setting. As symptoms progress, some agents may be slowly tapered and discontinued.
Different patient categories have been proposed for diabetes management in those with advanced disease (28).
A stable patient: continue with the patient's previous regimen, with a focus on the prevention of hypoglycemia and the management of hyperglycemia using blood glucose testing, keeping levels below the renal threshold of glucose. There is very little role for A1C monitoring and lowering.
A patient with organ failure: preventing hypoglycemia is of greater significance. Dehydration must be prevented and treated. In people with type 1 diabetes, insulin administration may be reduced as the oral intake of food decreases but should not be stopped. For those with type 2 diabetes, agents that may cause hypoglycemia should be downtitrated. The main goal is to avoid hypoglycemia, allowing for glucose values in the upper level of the desired target range.
A dying patient: for patients with type 2 diabetes, the discontinuation of all medications may be a reasonable approach, as patients are unlikely to have any oral intake. In patients with type 1 diabetes, there is no consensus, but a small amount of basal insulin may maintain glucose levels and prevent acute hyperglycemic complications.
Footnotes
Suggested citation: American Diabetes Association. 12. Older adults: Standards of Medical Care in Diabetes—2019. Diabetes Care 2019;42(Suppl. 1)
139–S147
- © 2018 by the American Diabetes Association.
http://www.diabetesjournals.org/content/license
Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at http://www.diabetesjournals.org/content/license.
How to help patients with diabetes safely observe Ramadan
Luma Ghalib
One of the most sacred traditions of Ramadan, the holiest month of the year for the world’s 1.6 billion Muslims, which begins May 6 and ends June 4, is fasting from food and drink during the approximately 12 to 16 hours between suhoor (right before dawn) to iftar (immediately following sunset). For patients with diabetes, this can put observing their faith in conflict with their health considerations.
Muslims whose fasting could aggravate a chronic condition such as diabetes are granted an exception from the tradition. Regardless, the decision for the estimated 90 million Muslims worldwide with diabetes to fast or not “can be hard and confusing,” Luma Ghalib, MD, a diabetes specialist at the Ohio State University Wexner Medical Center told Healio Primary Care Today.
“Although patients with diabetes are generally aware of the general risk of hypoglycemia and hyperglycemia, they may lack the insight of their overall health condition, kidney function and the exact mechanism of their medications,” Ghalib continued.
Data indicate that some Muslims with diabetes fast despite the potential health risk. A study in 13 countries found that of 1,070 people with diabetes 42.8% of patients with type 1 diabetes and 78.7% with type 2 diabetes fasted during Ramadan.
The International Diabetes Federation guidelines provide a way to gauge who should fast and who should not: the high risk group with severe hypoglycemia unawareness, recent hospital admission, advanced kidney disease should not fast. The majority of patients with type 2 diabetes on pills are categorized as moderate-to-low risk and it should be considered safe for these patients to fast. All patients with diabetes are encouraged to self-monitor blood glucose levels.
“Those who decide on fasting must be aware of all the potential risks associated with fasting and must have close medical supervision. A Ramadan study using [continuous glucose monitoring] found that some patients experienced significant periods of hypoglycemia while fasting, without being aware of the problem,” the International Diabetes Federation wrote.
Ghalib said clinicians should work with their patients who intend to fast on developing what she called a “medication action plan.”
Mohamed H. Ahmed, of the National Health Services Foundation Trust in Buckinghamshire, England and colleagues published an overview in the Journal of Family Medicine and Primary Care of what such a plan could entail.
Patients with type 1 diabetes should receive an injection of rapid or regular insulin, and a single injection of insulin glargine “any time during the two meals.” These researchers also provided guidance for patients with type 2 diabetes:
- Users of insulin glargine can safely use metformin.
- Users of metformin should receive two-thirds of the daily dose before iftar and the remainder before sunhoor.
- Users of repaglinide can use it by itself or together with other medications that reduce the risk for postprandial hyperglycemia.
- Users of pioglitazone do not need any modifications.
- Users of a sulfonylurea can use glipizide as indicated; users in whom a sulfonylurea induced hypoglycemia should switch to a DPP-4 inhibitor.
“Patients are advised to test their blood glucose levels regularly throughout the fasting period. Most importantly, glucose levels should be checked at any time when symptoms of hypoglycemia are recognized. All patients should comprehend the dangers of low and high blood glucose levels, know when to break the fast, and must not fast if they are unwell,” the International Diabetes Foundation also wrote.
One of the most sacred traditions of Ramadan, the holiest month of the year for the world’s 1.6 billion Muslims, which begins May 6 and ends June 4, is fasting from food and drink during the approximately 12 to 16 hours between suhoor (right before dawn) to iftar (immediately following sunset). For patients with diabetes, this can put observing their faith in conflict with their health considerations.
Source:Adobe
Heba Abolaban, MD, of the Massachusetts Department of Public Health, and Ahmad Al-Moujahed, MD, PhD, MPH, of the department of ophthalmology at Harvard Medical School, noted that fasting should never be considered the equivalent of complete starvation.
“Patients should be advised to eat healthy balanced diet intwo or three small meals, between iftar and suhoor rather than one large meal to avoid postmeal hyperglycemia,” they wrote in Avicenna Journal of Medicine.
Ghalib offered examples of the foods and beverages that patients with diabetes can consume that allow them to remain true to their faith and maintain their health during Ramadan.
“Those who intend to fast should devise a plan of well-balanced meals with foods that are rich in protein. Patients with diabetes should specifically try to cut back on carbohydrates and to choose high complex carbs rather than simple carbs. White bread and high sugary drinks like soda and fruit juice should be avoided and be replaced with whole grains, fruits and fibers. While dates are a good source of potassium, they have sugar, so advise patients to be careful on how many they can eat,” she said.
Abolaban and Al-Moujahed advised on symptoms that clinicians can advise their patients with diabetes and these patients’ family members to watch for.
“Patients should check their blood glucose levels multiple times during the day and break their fasting immediately if their blood glucose level is 70 mg/dL or less or 300 mg/dL or more, or if they become symptomatic of hypoglycemia or hyperglycemia,” they wrote.
Scientific Case for Eating Bread The widespread vilification of bread isn’t supported by strong research
Sep 13, 2018
Bread has long been a foundational part of the human diet, but a revolt against it has been building for years — and seems to be reaching a crescendo. Today, many regard bread as a dietary archvillain — the cause of bigger waistlines and the possible origin of more insidious health concerns. Popular books and health gurus claim that bread and the proteins it harbors can cause or contribute to foggy thinking, fatigue, depression, and diseases ranging from Alzheimer’s to cancer.
But go digging through the published, peer-reviewed evidence on bread and human health, and most of what you’ll find suggests that bread is either benign or, in the case of whole-grain types, quite beneficial.
“We have conducted several meta-analyses on whole-grain consumption and health outcomes like Type 2 diabetes, cardiovascular disease, cancer, and premature mortality,” says Dagfinn Aune, a postdoctoral researcher at the School of Public Health at Imperial College London. “When looking at specific sources of grains, whole-grain bread, whole-grain breakfast cereals, brown rice, and wheat bran were all associated with reduced risks.”
“Bread isn’t the baddie it’s made out to be.”
Asked if bread should be considered a “junk” food, Aune says the opposite is true. “Whole-grain breads are healthy, and a high intake of whole grains is associated with a large range of health benefits,” he says, citing links to lower rates of heart disease, cancer, and mortality. In fact, his research has found that eating the equivalent of 7.5 slices of whole-grain bread per day is linked with “optimal” health outcomes.
While Aune doesn’t see “much benefit” in eating white bread, he says the evidence tying it to increased weight gain or other negative health outcomes is much less robust than the data on whole-grain bread’s positive effects.
Among people who study bread and whole grains, Aune is not an outlier.
“Bread itself is not the culprit,” says Nicola McKeown, a scientist with Tufts University’s Human Nutrition Research Center on Aging. While McKeown says refined-grain (white) bread is “nutrient-weak,” she also says that weight gain cannot usually be attributed to a single food. She also points out that most Americans consume less than a single daily serving of whole grains, and 90 percent don’t eat enough fiber. Eating more whole-grain bread is a good way to make up these deficits.
Others agree. “If you look at these large diet studies on people who live the longest with the least disease, fiber and whole grains are always major components,” says Joanne Slavin, PhD, a professor of food science and nutrition at the University of Minnesota. Slavin says the fiber in whole-grain foods and breads slows the small intestine’s absorption of fat and carbohydrates in ways that improve fullness and limit spikes in blood sugar. Farther down the digestive tract, these whole-grain fibers feed healthy gut bacteria and improve colon health.
While she doesn’t advocate for the unchecked consumption of white bread, Slavin points out that it and other starchy carbs — white rice, pasta, potatoes — form the foundation of most diets worldwide and aren’t an obvious issue if you’re watching your total caloric intake.
Of course, bread presents serious problems for people who have celiac disease or nonceliac gluten sensitivity. While some consider the latter of these two conditions controversial, and its symptoms remain hard to pin down, roughly 6 percent of adults may suffer from one or the other of these gluten-related disorders, says Alessio Fasano, MD, director of the Center for Celiac Research at Massachusetts General Hospital.
But for the other 94 percent of us, bread isn’t the baddie it’s made out to be.
While olive oil and fatty fish get most of the positive press, bread (and not just the whole-grain types) is considered a “major” component of Mediterranean-style diets, which have repeatedly been linked to health and longevity. Studies that have specifically looked at bread in the context of these diets have found that people who eat the most whole-grain breads — six slices or more a day — are the least likely to be overweight or obese.
“There aren’t many compelling reasons to single out bread as one of your dietary nemeses.”
Even when it comes to white bread, the evidence tying it to obesity and health problems is patchy. Research has associated refined carbohydrates — a group that includes white bread, but also cookies, cakes, and soda — with an elevated risk for Type 2 diabetes and obesity. But studies that have assessed the health effects of white bread and refined grains independent of sugary snacks and drinks have turned up both positive and negative results.
A comprehensive review on bread and obesity that appeared in the British Journal of Nutrition found that white bread consumption may “possibly” lead to increased abdominal fat. But more research is needed, the authors of that review say. The vast majority of the evidence supports the latest U.S. Dietary Guidelines, which state that a “healthy” 1,800-to-2,000-calorie diet could include six slices of bread a day — including up to three slices of “refined-grain” white bread.
If you’re wondering how to shop for whole-grain breads, a 2015 study from the Harvard School of Public Health found that the “most healthful” products can be identified by their total carbohydrate-to-fiber ratio. You’re looking for breads with a carb-to-fiber ratio lower than 10:1, the Harvard study says. (So, if a bread has 15 grams of total carbs per slice or per serving, you’d want it to have more than 1.5 grams of dietary fiber.)
To sum it up, there aren’t many compelling reasons to single out bread as one of your dietary nemeses. Eating white bread all day isn’t a great way to stay slim. But if you’ve been shunning all bread — including the whole-grain types — out of the belief that it’s fattening and unhealthy, the existing evidence suggests you’re doing your health more harm than good.
What That Ad Warning People About Diabetes and Sweets Should Have Said
Brianna Henderson
•May 7, 2019
diabetes amputation ad
There’s an advert circulating the diabetes community based on sugar, sweets and the risk of amputation. The ad doesn’t intend to be harmful — it suggests the risk of overconsumption of sugar throughout your life leading to type 2 diabetes (or rather that’s what it implies). However, it doesn’t explicitly state that and that’s harmful. It’s unclear exactly where this image came from.
legs of person wearing jeans and one black shoe, the other foot is represented by an ice cream cone
Two main types of diabetes exist: type 1 and type 2, but most of the time these are categorized into one. Type 1 is an autoimmune disease that occurs in individuals when their body’s immune system accidentally destroys the insulin-producing cells, and can be managed with regular monitoring and insulin therapy. Type 2 is caused by factors including genetics and lifestyle and can be managed through diet, exercise, insulin therapy and medication.
I have been a type 1 for six years now and the amount of times I’ve seen jokes and memes about diabetes and eating too much sugar is staggering. Which is why the advert annoyed me, because diabetes is not always caused by eating too much sugar. Media content and the general lack of awareness and knowledge create the misconception that sugar causes diabetes. It’s infuriating to me because I have gained a wealth of knowledge about my condition since diagnosis. I understand my type as well as type 2 and try educate others about them both. I’ve had family members, friends and even random strangers ask if it’s because “I ate too much sugar as a child.” Perhaps I did, most kids do, but it’s not why I developed type 1 diabetes. The true cause of the condition is unknown. And I want to scream and shout about it all the time.
It’s a matter of stating which diabetes you’re talking about, or just not making jokes about diabetes in general because it hurts someone. It hurts because I work so, so hard to maintain my health and blood sugar levels when my body doesn’t want to cooperate. It makes others believe the solution is to eat better, exercise and implement some superfoods into my diet. While eating healthily and exercising is an important aspect of managing type 1 diabetes, it won’t get rid of the condition. People need to understand that — when you’re about to recommend a new method of managing diabetes, it may mean nothing to me.
I can’t stress enough how frustrating it is for people to misunderstand diabetes, which is what I think the advert is doing. It’s focusing on one element of the condition — the risk of amputation if blood sugar levels are uncontrolled. And it’s playing into the “you ate too much sugar” discourse that isn’t true for all cases of diabetes.
And I get it, if I’m honest, because prior to being diagnosed in 2013 I knew nothing about diabetes. I’m not sure I ever heard anyone talking about it, we didn’t learn about it in school and I didn’t know anyone who had it until I did. So I understand why there’s a misconception. It’s because of a lack of knowledge and the involvement of the media writing misguided articles. Writers, researchers, medical professionals and anyone else seemingly fit to discuss diabetes need to be receiving the right knowledge and education about the condition before they speak about it. And if you’re going to make a diabetes joke (I wish you wouldn’t), be considerate of those who can’t manage their condition by changing their diet and exercising more. I’ve seen people online make jokes about diabetes and how an extremely sugary dessert is the reason behind it and I’ve unfollowed them. And maybe that’s petty or childish of me but when it’s constant it gets very, very annoying.
My condition is not a punchline.
Can diabetes influence cancer's spread?
Published Wednesday 8 May 2019
Some researchers argue that there may be a direct link between having diabetes and exposure to an increased risk of metastasis in cancer. New research validates this idea, explaining how diabetes can elevate this risk.
New research investigates how diabetes may promote the spread of cancer.
'Glycation boosts the rate of metastasizing'Hundreds of millions of people across the globe live with one form of diabetes, which makes this one of the most common health conditions that doctors diagnose.
People with diabetes tend to have a higher risk of developing certain additional medical conditions, including problems with eyesight, heart disease, and other cardiovascular problems.
Now, emerging evidence also suggests that diabetes could elevate the risk of tumors metastasizing — or spreading — in cancer.
Recently, a team of researchers from Cornell University in Ithaca, NY, has explored the potential mechanisms underlying the relationship between diabetes and metastatic cancer.
"Cancer and diabetes are two of the worst health problems in developed countries, and there's a link between the two," says study author Prof. Mingming Wu.
"For cancer, half of the story is still in genetics. It's only recently we realized there is another half that we missed, which is the microenvironment," Prof. Wu adds.
In other words, the growth and spread of cancer might be highly dependent on the biological environment that surrounds it, and diabetes, the researchers believe, may create the right setting to increase the motility (ability to move) of cancer cells.
Metastasis — or cancer spread — occurs when cancer cells are able to "travel" from the site of primary tumors towards other parts of the body, eventually giving rise to new tumors.
To get from the site of a primary tumor to elsewhere in the body, cancer cells must navigate the extracellular matrix, a network that provides support and structure to the cells of the body. Different types of macromolecules, which include collagen and glycoproteins, make up this matrix.
Prof. Wu and colleagues explain that elevated blood sugar in people with diabetes can impact the structure of the collagen fibers in a way that makes it easier for cancer cells to move around.
The changes to collagen fibers occur through a process called "glycation," a reaction between sugars and proteins or other biological compounds.
"[People with diabetes] have higher blood sugar levels, which lead to glycation and changes the structure of the collagen in their tissue," explains the study's lead author, Young Joon Suh, who is currently a graduate student at Cornell.
"If they happen to have cancer, we believe this glycation process promotes the rate of metastasizing."
Young Joon Suh
In their study — the results of which appear in the journal Integrative Biology — the researchers tested this mechanism by looking at how cancer cells from breast cancer tumors fared in environments with different levels of glycation.
Their experiments revealed that the cells had increased motility — that is, they were able to move around at faster rates, and also to "travel" farther away from the original site — when their environment had high glycation.
In fact, the team explains that the average speed of movement of breast cancer cells was higher in all three types of collagen environments that they used — when they were glycated.
These findings, the researchers believe, indicate that the conditions that diabetes creates in the body may indeed increase a person's risk of metastasis if they have cancer.
Going forward, the scientists aim to further distinguish between the mechanical and chemical impact of glycation on the process of metastasis.
"Future work will be needed to elucidate the biochemical impact of glycation in tumor cell invasion," the researchers write.
In addition to their health concerns, some people with a recent diabetes diagnosis worry that they will no longer be able to eat the foods they enjoy, including cereal.
However, there are many types of cereal that people with diabetes can eat without worrying, as long as they take a few things into consideration.
Cereals are high in carbohydrates, which can cause blood glucose levels to rise. For this reason, eating cereal may mean finding other ways to cut carbs from the diet.
Choosing the right cereal, such as one that does not contain lots of added sugar, can allow people with diabetes to enjoy cereal more often.
In this article, we discuss the best types of cereal for people with diabetes to eat, as well as ingredients to look for or avoid.
Can people with diabetes eat cereal?
People with diabetes do not have to eliminate specific foods from their diet. Instead, the goal should be to eat a balanced, nutritious diet that includes both comfort foods and more healthful options.
Most cereals are high in carbs and sugar, both of which can raise blood glucose.
Some people follow a low-carb diet because research suggests that reducing carb intake may lower the risk of experiencing diabetes-related complications, aid weight loss, and help maintain healthy blood glucose levels.
People with diabetes who want to continue eating cereal should try the following strategies:
- Limit portion sizes. Recommended serving sizes tend to be smaller than that which the average person may eat, so try measuring a serving.
- Reduce intake of other sugary and carb-rich foods. A person who wants to enjoy cereal for breakfast should avoid eating sugary snacks and other carb-heavy foods that day.
- Choose whole-grain or bran cereal. These fiber-rich ingredients may help control blood sugar. A 2013 analysis of research published in 1965–2010 found a correlation between bran and whole grains in the diet and a lower risk of developing type 2 diabetes and heart disease.
- Monitor blood glucose. Some people with diabetes might find that their bodies cannot process even relatively low-carb cereals, while others will be able to manage an occasional sugary treat.
- Eat a balanced diet. No single food can make or break a person's diet. Instead, focus on eating lots of fruits and vegetables and lean proteins.
- Stay physically active. Exercising regularly can help a person lower and manage their blood glucose.
- Be mindful of calorie content. Even if a cereal is relatively low in carbs, it may be high in calories. This can be problematic for people trying to lose weight.
Best cereals for people with diabetes
People with diabetes who want to enjoy cereal should consider the following options:
- Lower-sugar cereals. Steer clear of cereals that manufacturers market to children, which tend to contain a lot of sugar. Frosted cereals offer little nutritional value. Try a shredded whole-wheat cereal instead.
- Oatmeal. Oatmeal is an excellent high-fiber alternative to cold cereal. Try sprinkling cinnamon or adding a bit of honey or maple syrup for more flavor. Avoid the highly processed instant oatmeal with lots of added sugar, or choose a low-sugar variety.
- Cereals containing fruit and nuts. It is possible to increase the nutritional value of cereal by sprinkling berries or dried fruit on top.
- Cereals rich in bran or whole grains. These options have fewer carbs, more fiber, and less sugar than many other brands.
Ingredients to look for or avoid
Although many cereals contain lots of sugar, which people with diabetes should treat as an occasional indulgence, some are rich in fiber and other nutrients. Choosing these foods can help control appetite.
Beneficial ingredients to look for include:
- fruit
- proteins such as nuts and seeds
- whole grains
- fortified vitamins such as B-12
The authors of a 2012 meta-analysis found that adopting a fiber-rich diet may lower fasting blood sugar and HbA1c levels. HbA1c levels are a person's average blood sugar levels over several months.
Some ingredients to avoid in cereals include:
- added sugar
- hydrogenated oils
- refined flour instead of whole grains
- high-fructose corn syrup and other artificial sweeteners
Cereals, especially those for children, can be very high in sugar. An analysis by the Environmental Working Group found that the average serving of cereal contains 9 grams of sugar.
When choosing a breakfast cereal, remember to check the carb content on the label, as some seemingly healthful cereals are still very high in carbs.
Having a high carb content is not necessarily bad, but for people with diabetes trying to monitor their carb intake, consuming a single bowl of cereal may take them very close to daily overall carb limits.
Stay in Touch
Get sneak previews of special offers & upcoming events delivered to your inbox.
*You're signing up to receive QVC promotional email.
Manage Your Account
Find recent orders, do a return or exchange, create a Wish List & more.
Get More with QCard®
Enjoy Your QCard Easy Pay Perk!
Customer Service
Work with Us
Stay Connected
Download Our QVC Apps
This is Shopping Brought to Life.
Privacy StatementGeneral Terms of Use
QVC is not responsible for the availability, content, security, policies, or practices of the above referenced third-party linked sites nor liable for statements, claims, opinions, or representations contained therein. QVC's Privacy Statement does not apply to these third-party web sites.
© 1995-2024 QVC, Inc. All rights reserved. | QVC, Q and the Q logo are registered service marks of ER Marks, Inc. 888-345-5788