Wellness

[cherry]

I only drink diet coke so ,I am not familair with artificail sweetners, besides aspartame..I am not going to use anything with a tol at the end. It is very hard on your digestive system, but ,the rest of you might like to try some of these

Low-calorie sweeteners, or sugar substitutes, can allow people with diabetes to enjoy sweet foods and drinks that do not affect their blood sugar levels. A range of sweeteners is available, each of which has different pros and cons.

In this article, we look at seven of the best low-calorie sweeteners for people with diabetes.

1. Stevia

Stevia is a popular alternative to sugar.

Stevia is a natural sweetener that comes from the Stevia rebaudiana plant. To make stevia, manufacturers extract chemical compounds called steviol glycosides from the leaves of the plant.

This highly-processed and purified product is around 300 times sweeter than sucrose, or table sugar, and it is available under different brand names, including Truvia, SweetLeaf, and Sun Crystals.

Stevia has several pros and cons that people with diabetes will need to weigh up. This sweetener is calorie-free and does not raise blood sugar levels. However, it is often more expensive than other sugar substitutes on the market.

Stevia also has a bitter aftertaste that many people may find unpleasant. Some people report nausea, bloating, and stomach upset after consuming stevia.

The United States Food and Drug Administration (FDA) classify sweeteners made from high-purity steviol glycosides to be "generally recognized as safe," or GRAS. However, they do not consider stevia leaf or crude stevia extracts to be safe, and it is illegal to sell them or import them into the U.S.

According to the FDA, the acceptable daily intake (ADI) of stevia is 4 milligrams per kilogram (mg/kg) of a person's body weight. Accordingly, a person who weighs 60 kg, or 132 pounds (lb), can safely consume 9 packets of the tabletop sweetener version of stevia.

Various stevia products are available to purchase online.

2. Tagatose

Tagatose is a form of fructose that is around 90 percent sweeter than sucrose. Although rare, tagatose does occur naturally in some fruits, such as apples, oranges, and pineapples. Manufacturers use tagatose in foods as a low-calorie sweetener, texturizer, and stabilizer.

Not only do the FDA class tagatose as GRAS, but scientists are interested in its potential to help manage type 2 diabetes. Some studies indicate that tagatose has a low glycemic index (GI) and may be beneficial in the treatment of obesity. GI is a measure of a food's potential to affect a person's blood sugar levels.

Tagatose may be of particular benefit to people with diabetes who are following a low-GI diet. However, this sugar substitute is more expensive than other low-calorie sweeteners and may be harder to find in stores.

Tagatose products are available to purchase online.

3. Sucralose

People can use sucralose instead of sugar when baking.

Sucralose, available under the brand name Splenda, is an artificial sweetener made from sucrose. Sucralose is about 600 times sweeter than table sugar but contains very few calories.

Sucralose is one of the most popular artificial sweeteners, and it is widely available. Manufacturers add it to a range of products from chewing gum to baked goods.

Sucralose is heat-stable, whereas many other artificial sweeteners lose their flavor at high temperatures. This makes sucralose a popular choice for sugar-free baking and sweetening hot drinks.

The FDA have approved sucralose as a general-purpose sweetener and set an ADI of 5 mg/kg of body weight. A person weighing 60 kg, or 132 lb, can safely consume 23 packets of a tabletop sweetener version of sucralose.

However, recent studies have raised some health concerns. A 2016 study found that male mice that consumed sucralose were more likely to develop malignant tumors. The researchers note that more studies are necessary to confirm the safety of sucralose.

A range of sucralose products is available to purchase online.

4. Aspartame

Aspartame is a very common artificial sweetener that has been available in the U.S. since the 1980s. It is around 200 times sweeter than sugar, and manufacturers add it to a wide variety of food products, including diet soda. Aspartame is available in grocery stores under the brand names Nutrasweet and Equal.

Unlike sucralose, aspartame is not a good sugar substitute for baking. Aspartame breaks down at high temperatures, so people generally only use it as a tabletop sweetener.

Aspartame is also not safe for people with a rare genetic disorder known as phenylketonuria.

The FDA consider aspartame to be safe at an ADI of 50 mg/kg of body weight. Therefore, someone with a body weight of 60 kg, or 132 lb, could consume 75 packets of a tabletop sweetener version of aspartame.

Many different aspartame products are available to purchase online.

Can stevia benefit people with diabetes?

Learn more about the pros and cons of stevia for people with diabetes here.

Read now

5. Acesulfame potassium

Acesulfame potassium, also known as acesulfame K and Ace-K, is an artificial sweetener that is around 200 times sweeter than sugar. Manufacturers often combine acesulfame potassium with other sweeteners to combat its bitter aftertaste. It is available under the brand names Sunett and Sweet One.

The FDA have approved acesulfame potassium as a low-calorie sweetener and state that the results of more than 90 studies support its safety. A 2017 study in mice has suggested a possible association between acesulfame potassium and weight gain, but further research is necessary to confirm this.

The FDA have set an ADI for acesulfame potassium of 15 mg/kg of body weight. This is equivalent to a 60 kg, or 132 lb, person consuming 23 packets of a tabletop sweetener version of acesulfame potassium.

6. Saccharin

Cafes and restaurants may provide saccharin sweeteners.

Saccharin is another widely available artificial sweetener. There are several different brands of saccharin, including Sweet Twin, Sweet'N Low, and Necta Sweet. Saccharin is a zero-calorie sweetener that is 200 to 700 times sweeter than table sugar.

According to the FDA, there were safety concerns in the 1970s after research found a link between saccharin and bladder cancer in laboratory rats. However, more than 30 human studies now support the safety of saccharin, and the National Institutes of Health no longer consider this sweetener to have the potential to cause cancer.

The FDA have determined the ADI of saccharin to be 15 mg/kg of body weight, which means that a 60 kg, or 132 lb, person can consume 45 packets of a tabletop sweetener version of it.

People can purchase a range of saccharin products online.

7. Neotame

Neotame is a low-calorie artificial sweetener that is about 7,000 to 13,000 times sweeter than table sugar. Neotame can tolerate high temperatures, which means that it is suitable for baking. It is available under the brand name Newtame.

The FDA approved neotame in 2002 as a general-purpose sweetener and flavor enhancer for all foods except for meat and poultry. They state that more than 113 animal and human studies support the safety of neotame.

The FDA have set an ADI for neotame of 0.3 mg/kg of body weight. This is equivalent to a 60 kg, or 132 lb, person consuming 23 packets of a tabletop sweetener version of neotame.

Considerations when choosing a sweetener

When choosing a low-calorie sweetener, some general considerations include:

• Intended use. Many sugar substitutes do not withstand high temperatures so they would make poor choices for baking.
• Cost. Some sugar substitutes are very expensive, whereas others have a cost more comparable to that of table sugar.
• Availability. Some sugar substitutes are more widely available in stores than others.
• Taste. Some sugar substitutes, such as stevia, have a bitter aftertaste that many people may find unpleasant.
• Natural versus artificial. Some people prefer using natural sweeteners, such as stevia, rather than artificial sugar substitutes.

Summary

Many people with diabetes need to avoid or limit sugary foods. Low-calorie sweeteners can allow them to enjoy a sweet treat without it affecting their blood sugar levels.

There is a range of sweeteners to choose from, each with different pros and cons. Although the FDA generally consider these sugar substitutes to be safe, it is still best to consume them in moderation.

[cherry]

How Could a Diabetes Drug Cause Severe Genital Infections?

By Kimberly Hickok, Reference Editor | August 31, 2018 02:36pm ET

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A commonly prescribed drug for treating type 2 diabetes has the risk of a new and highly unpleasant side effect.

Credit: Shutterstock

People with type 2 diabetes who take a certain class of drugs have a very troubling side effect to worry about: The drugs may increase the risk of the genitals becoming infected with "flesh-eating" bacteria.

On Wednesday (Aug. 29), the U.S. Food and Drug Administration (FDA) issued a warning about sodium-glucose cotransporter-2 (SGLT2) inhibitors, which are commonly prescribed medications for treating type 2 diabetes. Over a five-year period, the drugs have been linked to a dozen rare cases of genital infections that cause the skin to die, a condition called necrotizing fasciitis. All 12 patients who developed the infection were hospitalized, and one died, according to the FDA.

More specifically, the drugs have been linked to cases of a flesh-eating bacteria infection that affects the perineum, or the area of skin between the anus and the vulva or scrotum. When this type of infection affects this part of the body, it's referred to as Fournier's gangrene, a rare but potentially fatal condition, according to the Mayo Clinic.

The infection is more common in men than women, and it can spread to other parts of the body, Dr. Amesh Adalja, a senior scholar at the Johns Hopkins University Center for Health Security, told SELF. "It can rapidly progress and involve the entire genital area and even the abdominal wall," he said. [5 Ways Skin Can Signal Health Problems]

There have been enough instances of these severe infections that the FDA now requires all SGLT2 inhibitors to include a warning about this risk in their prescribing information. Medications in this class include canagliflozin, dapagliflozin, empagliflozin and ertugliflozin. The drugs are available as single-ingredient medications or in combinations, such as with metformin, the FDA said.  

How do the infections happen?

Type 2 diabetes occurs when the body can't remove sugar from the bloodstream, because cells fail to respond to insulin, the hormone that helps move sugar into the cells. SGLT2 inhibitors work to lower blood sugar by causing the kidneys to remove sugar from the body through urine. This stabilizes blood sugar levels.  

So, how can this lead to infections? Anywhere there is higher blood sugar, there's an increased chance of bacterial infection, Jamie Alan, an assistant professor of pharmacology and toxicology at Michigan State University, told SELF. "We have bacteria all over us, and one of the foods that bacteria likes is [sugar]," Alan said. She explained that eliminating more sugar through urine means there is more of bacteria's favorite food in the genital area, so this spot becomes a rather inviting environment for them.

The bacteria become a problem only if there is an entry point to infect, such as a small cut from shaving or a skin ulcer near the genitals. And that's exactly what happens, Adalja told SELF. The infections are serious and often require many surgeries to remove all the infected tissues, Adalja said. (All 12 patients described in the FDA warning required surgery.)

The FDA warning instructs patients taking the drugs to seek medical attention right away if they experience any signs of swelling, itching or irritation in the genitals area or have a fever above 100.4 degrees Fahrenheit (38 degrees Celsius) and generally don't feel well. The bacteria that cause necrotizing fasciitis can spread quickly, so it's important to seek treatment immediately.

But the infections are rare, and it's unwise to stop taking medications without talking it over with a doctor, Alan told SELF. There are other options for treating type 2 diabetes, she said, but practicing good hygiene can help minimize the risk of necrotizing fasciitis.

Original article on Live Science.

[cherry]

Voortrekker Monument goes blue for world diabetes day in November

Some of the sites and buildings lit up in blue include the Empire State Building, Sears tower, CN tower, Sydney Opera House; The London Eye, and Table Mountain.

7 hours ago

The Voortrekker Monument will be lit up in blue for the month of November to honour world diabetes day and all who suffer from the condition.

World diabetes day (WDD) is a global awareness campaign focusing on diabetes awareness that is held annually on November 14, with the month of November being labelled diabetes awareness month.

The day itself marks the birthday of Nobel prize winner, Frederick Banting who, along with Charles Best and JJ Rickard Macleod, discovered insulin in 1922 to treat people with type 1 diabetes. Prior to 1922, a diagnosis of type 1 diabetes was an agonising death sentence for all.

ALSO READ: INFOGRAPHIC: Diabetes remains a deadly scourge worldwide

WDD was launched in 1991 by the international diabetes federation (IDF) and the world health organisation (WHO). World diabetes day is now commemorated each year by about 230 IDF members associations in more than 160 countries and territories, as well as by other organisations, companies, healthcare professionals, politicians, celebrities, and people living with diabetes and their families.

While awareness about diabetes is important, lack of access to insulin and proper healthcare is the number one cause of death for people living with diabetes worldwide. In 2014, the non-profit organisation T1International launched the #insulin4all campaign to unite the diabetes community as a global force standing together to fight for access to diabetes supplies, care, and treatment for everyone.

The campaign grows bigger each year in addition to the annual WDD theme related to diabetes. This year’s world diabetes day theme is diabetes and the family.

The Blue Monument challenge

The “Blue Monument Challenge” was launched in 2007 to mark the first United Nations observed world diabetes day. Blue is the official colour for diabetes and since then more than 1 000 iconic sites and buildings in 84 countries have lit up in blue to raise diabetes awareness on November 14 and in the weeks leading up to the day.

Some of the sites and buildings lit up in blue include Empire State Building, Belfast city hall UK, Brisbane city hall, Sears tower, Blackpool tower UK, Niagara Falls, CN tower in Toronto, Canada; Sydney Opera House; The London Eye, Table Mountain, Cape Town.

The main objective is to draw attention to the increased efforts to understand and manage diabetes through education and prevention; to highlight important issues about diabetes; encourage the public to get screened for diabetes; and to emphasise the fact that this “silent killer” can be managed and treated with the right access, and in some cases prevented.

[cherry]

Type 2 diabetes prevalence continues to increase, and despite over a century of study and treatment, the pathophysiology of this disease is incompletely understood. Some patients with diabetes are obese, others as thin as a rail, some run marathons, others put in the same time on the nearest couch. Over time in addition to fasting or provoked fasting glucose levels, we have a range of biomarkers, like insulin levels and HgA1c, that have been used to further categorize patients with diabetes into groups. A new genome study, using our friend, GWAS (genetic-wide association studies) has found five different genetic clusters, leading to five pathways to the phenotype we call diabetes.

The researchers began with 94 genetic variants previously associated with Type 2 diabetes and its biomarkers; additionally, they included variants for anthropomorphic changes, like body mass or the distribution of fat; as well as variants associated with various clinical outcomes, like coronary disease. They used what they described as a “soft clustering” where variants could become a participant in more than one grouping; they were not limited to being evaluated in just one way. This is a methodology based on the idea, that seems to be garnering more evidence, that each gene, except in rare instances, makes little contribution to a phenotype, that it takes a number of different genes to produce a change we can see. Think of it as it “taking a village.” So what villages did they find?

Using a number of genetic datasets [1] they identified five dominant pathways leading to increased risk of diabetes.

Two pathways related to insulin production and processing in the pancreas, by beta cells. One was associated with an increase in proinsulin, a precursor to insulin; the other associated with a decrease in proinsulin.

Three pathways related to mechanisms of insulins response; one with obesity, another termed the lipodystrophy cluster was consistent with that pear-shaped distribution of fat we equate with “insulin resistance,” and the third was a “liver/lipid” cluster involving the metabolism of fats in the liver.

In each case, the clusters “preferentially altered enhancers or promoters in specific cell types.” The different pathways effected not solely pancreatic cells, but fat and liver cells too.

Perhaps the most intriguing finding was that each cluster had differing clinical repercussions. The beta cell and lipodystrophy cluster were associated more with coronary artery disease. But only the beta cell cluster was associated with stroke; a condition often lumped in with coronary disease when studies assess patient’s cardiovascular outcomes. The lipodystrophy cluster was the only one related to hypertension. Finally, the liver/lipid cluster was associated with a form of renal insufficiency. 

In correlating their genetic clusters with patients the researchers found that about 30% had a predominant grouping, think of them as the purest representation of the pathway. And indeed, these patients had much higher levels for the biomarkers and clinical alterations of that specific cluster – they were the “poster children,” with distinguishing traits. The remaining 70% of patients had a mixture of clusters.

This is the kind of information that can change our thinking. First, in identifying different pathways, it provides new targets of opportunity for treatment and at the same time helps suggest why some people “fail” standard therapy. You cannot hope to treat a problem of fat metabolism as in the liver/lipid cluster solely by managing glucose, other targets can and will be identified. Second, by fractionating Type 2 diabetes into let’s say Type 2 A through E, we may be better able to define a patient’s clinical risks and look more closely for those changes. We needn’t necessarily screen all patients with diabetes for stroke when we know that their genetics cluster towards lipodystrophy and not a proinsulin “causation.”

What I think the study does point towards is the “omnigenic” theory – that there is no single or even small number of genes “responsible” for “causing” a disease. Many, many genes contribute their small share to changes we ultimately recognize as a phenotype, in this case, type 2 diabetes. Genetic studies will help us to stratify the large phenotypes we treat into hopefully more clinically relevant and manageable groupings. Precision medicine is not going to be as precise as we might imagine, there will remain a fuzzy border that will yield in time to more and more variants, impacted by diet, exercise and the environment. The closer we look, the more there is to see.  

[1] A Finnish study of metabolic syndromes in men, data on Ashkenazi Jews, the UK Biobank and the Partners Biobank (part of the Partners Healthcare hospitals in Massachusetts)  

Source: Type 2 Diabetes genetic loci informed by multi-trait associations point to disease mechanisms and subtypes: A soft clustering analysis   PLOS Medicine DOI: 10.1371/journal.pmed.1002654

[lizzyCeGe]

Good of you to share this information @cherry. 

Thoughtful ! thank you!

[cherry]

While common diabetes medication can help lower blood sugar levels, it may also be able to protect against blindness, according to a new report.

»

Researchers from health institutions in Taiwan conducted a study, recently presented at an American Academy of Ophthalmology conference, to determine the relationship between metformin, a common diabetes medication, and age-related macular degeneration (AMD), an eye disease that can cause vision loss.

To do so, they used the Taiwan National health Insurance Research Database to examine more than 62,000 patients with type 2 diabetes. About 45,000 of them took metformin, while about 22,000 did not. The analysts then followed the groups for 13 years. 

After analyzing the results, they found that individuals on metformin had a significantly lower risk of developing AMD. In fact, half as many patients in the metformin group had the eye condition compared to the control group.

» RELATED: Cure for blindness: Stem cell therapy shows promising results

ADVERTISER CONTENT: AARP®Medicare Plans from UnitedHealthcare

 

“Our study is the first to reveal the protective effect of metformin on the development of AMD,” lead investigator Yu-Yen Chen said in a statement. “While more study is required to determine just how metformin protects against the development of AMD, this is an exciting development for patients at risk.”

The scientists noted AMD is the one of the leading causes of blindness in Americans over age 50, and it affects about 2.1 million people worldwide. It occurs when part of the retina called the macula is damaged. While doctors do not yet fully understand how it develops, they believe smoking, diet and systemic diseases like heart disease can be factors. 

The researchers now hope to continue their evaluations to better understand how metformin can be used to ward off the eye illness. 

Want to learn more about the findings? Take a look here.

» RELATED: Type 1 diabetes and Type 2 diabetes not the only diabete

[cherry]

this might help explain why the new procedure for diabetes has worked, so far

Colostomy associated with increased risk of diabetes ( I think this should read colostomy.. something probably gor lost in translation)

University of Copenhagen The Faculty of Health and Medical Sciences

People who have had a colectomy have increased risk of developing type 2 diabetes, researchers from the University of Copenhagen and Bispebjerg and Frederiksberg Hospitals have shown in a new study analysing data from more than 46,000 citizens. The researchers hope this new knowledge may pave the way for new ways of preventing and treating the disease.

The colon may play a role in regulating the body's blood sugar level, a new study conducted by researchers at the Faculty of Health and Medical Sciences at the University of Copenhagen and Bispebjerg and Frederiksberg Hospitals suggests. In the large study the researchers have shown what happens when patients have parts of or the entire colon removed. The researchers have seen increased risk of developing type 2 diabetes following this type of surgery. This suggests that the colon plays a role in regulating the blood sugar level. The research results have just been published in the scientific journal eLife.

'We know that the colon houses large numbers of gut bacteria and hormone-producing cells, but we still do not know which role they play in regulating the blood sugar level. We hope our study will facilitate further research into the significance of the colon in blood sugar regulation and diabetes development', says co-author Kristine Allin, Head of Section and Staff Doctor at the Center for Clinical Research and Prevention at Bispebjerg and Frederiksberg Hospitals.

The study's first author, Postdoc Anders Boeck Jensen from the Novo Nordisk Foundation Center for Protein Research, has studied data from Danish registers of just over 46,000 patients who have either had the entire colon or parts of it removed. This data was compared to data of just under 700,000 comparable patients who in the same period had undergone surgery for something else than disease in the gastrointestinal tract. The study is an example of how researchers can use real human treatment in the healthcare system as a kind of 'model'.

'The surgical procedures these patients have undergone represent the "trial", and the results are then determined from the many data held in the Danish registers. Researchers often use animal testing to identify a connection, before determining whether the results also apply to humans. Here we are looking directly at surgery on humans, and we do not have to worry about whether the findings also apply to humans. The human as a 'model organism' is a concept that is gaining ground, ensuring that new patients benefit from experience and data collected through 20 years of treatment of previous patients', says co-author and Professor Søren Brunak from the Novo Nordisk Foundation Center for Protein Research.

Left Side of the Bowel Stands out

The data studied by the researchers span an 18-year period beginning at the time of the operation. Patients who had the entire or left side of the colon removed showed increased risk of developing type 2 diabetes in the 18 years following the operation compared to patients who had undergone surgery in different parts of the body. Patients who had had the right or middle horizontal part of the colon removed showed no increased risk of developing diabetes, though.

This suggests that the left side of the colon plays a role in regulating the body's blood sugar level. The colon is full of gut bacteria and microbes, and some other studies indicate that a changed composition of these microbes - like when part of the colon is removed in surgery - may play a role in the development of various diseases, aside from infections.

'The greater majority of the body's microbes are found in the colon, so it is relevant to look at what happens after the colon or part of it is removed. In a previous study we saw no significant connection with the risk of developing cardiovascular diseases. We were therefore rather surprised to see so relatively massive an increase in the risk of developing type 2 diabetes. In fact, the increased risk corresponds to the effect of having three times as high a BMI', says co-author and Professor Thorkild I.A. Sørensen from the Department of Public Health and Novo Nordisk Foundation Center for Basic Metabolic Research.

[cherry]

It seems I was wrong, but ,I have never heard of this term before

Colectomy for colorectal cancer

Colectomy

A colectomy is the removal of all or part of the colon. The resection may be performed as a less invasive laparoscopic colectomy. If open surgery is needed, a long incision in the abdomen may be required. With open surgery, patients may need to stay in the hospital for a week or more and may have a longer period of recovery.

When possible, a surgical oncologist will perform a laparoscopic colectomy to remove the cancerous portion of the colon and nearby lymph nodes, and then reattach the healthy ends of the colon. A laparoscopic colectomy may result in less pain, a shorter stay in the hospital and a speedier recovery.

With a laparoscopic colectomy, approximately four to five small incisions are made around the abdomen. The surgical oncologist then inserts a laparoscope, a thin tube equipped with a tiny video camera that projects images of the inside of the abdomen on a nearby monitor. The surgical oncologist then inserts instruments through the incisions to perform the surgery.

What is a colectomy?

A colon resection (also known as a colectomy) is an inpatient procedure in which the cancerous portion of the colon is removed. To ensure all of the cancerous tissue is removed, a small portion of healthy colon tissue adjacent to the cancerous tissue may also be removed. On average, one-fourth to one-third of the colon may be removed during a colectomy. The remaining portions of the colon are then connected.

Your surgical oncologist will also perform a procedure called a lymphadenectomy, in which he or she removes several nearby lymph nodes to properly stage the cancer and determine if the disease has spread. A pathologist, who is often present in the surgical suite, analyzes the lymph nodes under a microscope to check for the presence of cancer. He or she provides pathology results immediately so that your surgical oncologist can remove as much of the diseased tissue as possible during the surgery.

[Trinity11]

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@cherry wrote:

Would any of you be willing to try the balloon method if you thought it would cure your diabetes?

I am not 100% sure that I would, but, I would like to consider it. If I could live out my life not worrying about blood sugar, I might be tempted

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@cherry, If I suffered from Type 2 diabetes, I would give it time before I tried anything new. If I had numerous complications and could not get my A1C down to under 8, I guess it would be tempting. I am always a skeptic on new treatments that rarely come to fruition.

Thanks for all the informative posts about the subject. It is always good to read positive threads.

[cherry]

Pot Use Tied to Serious Diabetes Complication

By Serena Gordon

HealthDay Reporter

THURSDAY, Nov. 8, 2018 (HealthDay News) -- People with type 1 diabetes who use marijuana may double their risk of developing a life-threatening complication, a new study suggests.

Called diabetic ketoacidosis (DKA), the condition occurs when there is not enough insulin to break down sugar in the body, so the body burns fat for fuel instead. This triggers a build-up of chemicals known as ketones, which make blood more acidic and can lead to coma or death.

"About 30 percent of our patients are using some form of marijuana, and they should be careful when using," said study author Dr. Halis Akturk. "They should be aware of the DKA risk, and recognize the symptoms -- nausea, vomiting, abdominal pain and confusion."

Akturk is an assistant professor of medicine and pediatrics at the University of Colorado School of Medicine and Barbara Davis Center for Diabetes in Aurora, Colo.

Continue Reading Below

Colorado is one of nine U.S. states that legally allow recreational use of marijuana.

Type 1 diabetes is an autoimmune disease that develops when the body's immune system mistakenly attacks the insulin-producing cells in the pancreas. Insulin is a hormone that channels the sugar from foods into the body's cells to be used as fuel.

People with type 1 diabetes no longer make enough insulin on their own. They must take shots or use an insulin pump to deliver the insulin they need to their bodies. However, getting the dose right is a difficult balancing act.

Too much insulin can cause dangerous low blood sugar levels that make people shaky, confused and irritable, and if not treated, can cause someone to pass out and possibly to die.

But too little insulin can lead to high blood sugar levels. Over years, high blood sugar levels can cause the serious complications associated with diabetes, such as heart and kidney disease, vision problems and amputations. Too little insulin can also lead to DKA in as little as a few hours, according to the American Diabetes Association.

In the new study, the researchers invited adult type 1 diabetes patients at a Colorado hospital to complete a survey on marijuana use. Of 450 survey participants, 134 said they used marijuana.

The average age of the survey respondents was 39, but among marijuana users it was 31. Cannabis users tended to have lower incomes and education levels.

Pot users chose to use it in a variety of ways, including smoking, vaping or consuming it in edible products, the investigators found.

Non-users seemed to have better blood sugar control overall. HbA1C levels -- a blood test that estimates two to three months of blood sugar levels -- were slightly higher in people who used marijuana.

However, the study only found an association and could not prove a cause-and-effect relationship.

Dr. Joel Zonszein, director of the clinical diabetes program at Montefiore Medical Center in New York City, said, "I was not surprised that the use of cannabis is associated with DKA. Individuals with type 1 diabetes need to be engaged with their disease and manage insulin dosing constantly, even those on the pump with closed loop systems."

Zonszein said that getting high on marijuana may impair people's ability to give themselves the correct insulin dose.

"This study is a warning of the serious and potentially life-threatening 'side effect' of marijuana. This is particularly important due to the ever expanding use of cannabis after its legalization," Zonszein added.

It's also possible that because marijuana users had lower income and education, an unmeasured factor, such as access to health care or health insurance, may also play a role in raising the risk of DKA, he said.

The study was published online Nov. 5 as a research letter in JAMA Internal Medicine.