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@cherry wrote:@Trinity11 I wanted to mention to you ,what my husbands cousin is doing. He has a lot of trouble taking statins, so, his Dr told him to take them ,only every third day. He has been pain free, and so far ,things are working Ok for him
@cherry, I have heard a lot about that system and it sounds very good. I have RA so what I thought was statin pain turns out was really the RA. With appropriate treatment, although not pain free, I am doing better. My cholesterol is very low because I take lipitor.
Thanks for all your posts on diabetes. I have learned so much from you and appreciate it.
any studies underscore these and other benefits from exercise. Following are some highlights of those results:
Exercise lowered HbA1c values by 0.7 percentage point in people of different ethnic groups with diabetes who were taking different medications and following a variety of diets — and this improvement occurred even though they didn't lose any weight.
All forms of exercise — aerobic, resistance, or doing both (combined training) — were equally good at lowering HbA1c values in people with diabetes.
Resistance training and aerobic exercise both helped to lower insulin resistance in previously sedentary older adults with abdominal obesity at risk for diabetes. Combining the two types of exercise proved more beneficial than doing either one alone.
People with diabetes who walked at least two hours a week were less likely to die of heart disease than their sedentary counterparts, and those who exercised three to four hours a week cut their risk even more.
Women with diabetes who spent at least four hours a week doing moderate exercise (including walking) or vigorous exercise had a 40% lower risk of developing heart disease than those who didn't exercise. These benefits persisted even after researchers adjusted for confounding factors, including BMI, smoking, and other heart disease risk factors.
In general, the best time to exercise is one to three hours after eating, when your blood sugar level is likely to be higher. If you use insulin, it's important to test your blood sugar before exercising. If the level before exercise is below 100 mg/dL, eating a piece of fruit or having a small snack will boost it and help you avoid hypoglycemia. Testing again 30 minutes later will show whether your blood sugar level is stable. It's also a good idea to check your blood sugar after any particularly grueling workout or activity. If you're taking insulin, your risk of developing hypoglycemia may be highest six to 12 hours after exercising. Experts also caution against exercising if your blood sugar is too high (over 250), because exercise can sometimes raise blood sugar even higher.
Because of the dangers associated with diabetes, always wear a medical alert bracelet indicating that you have diabetes and whether you take insulin. Also keep hard candy or glucose tablets with you while exercising in case your blood sugar drops precipitously.
For more information on preventing, diagnosing and managing diabetes, read Living Well with Diabetes, a Special Health Report from Harvard Medical School.
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New research that set out to analyze the temperatures at which people living with diabetes store their insulin is now warning against the perils of improper storage for the quality and effectiveness of the hormone.
More than 30 million people in the United States are currently living with diabetes.
Around 95 percent of these people have type 2 diabetes.
People with type 1 diabetes need to have insulin injections or have insulin delivered with a pump in order to survive.
Though some people with type 2 diabetes can control their blood sugar levels using lifestyle changes and medication, many of them also resort to insulin to regulate blood sugar.
Insulin is absolutely vital for helping cells get access to glucose and use it for energy. Without it, the person's blood sugar levels skyrocket, leading to hyperglycemia.
According to estimates from the Centers for Disease Control and Prevention (CDC), as many as 2.9 million U.S. individuals take only insulin, and another 3.1 million take insulin in addition to their medication.
A new study, however, suggests that many of these people might not get the full benefits from their insulin therapy; the hormone may be stored at incorrect temperatures in people's domestic fridges, which could make it less effective.
It was led by Dr. Katarina Braune from Charité – Universitaetsmedizin Berlin in Germany alongside Prof. Lutz Heinemann, from Sciences & Co in Paris, France, and the digital health company MedAngel BV.
Dr. Braune and colleagues presented their findings at the European Association for the Study of Diabetes Annual Meeting, held in Berlin, Germany.
Insulin kept improperly for 2.5 hours per day
Insulin needs to be stored in a refrigerator at a temperature around 2–8°C (36–46°F) in order for it to be effective. If carried in a pen or vial, it must be stored around 2–30°C (36–86°F).
Dr. Braune and her colleagues examined the temperature at which insulin was stored in domestic fridges and carried around by 388 people with diabetes living in the U.S. and European Union.
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Diabetes Management: List Of Fruits, Vegetables and Nuts Diabetics Should Have and Avoid However, there are many ways with which you can try to keep your blood sugar levels in control. Your diet forms a crucial aspect of diabetes management.
Diabetes Mellitus is a condition where your blood sugar or blood glucose levels are elevated for a consistent period of time. There are many different types of diabetes like; Type1, Type 2, Gestational and Prediabetes. Lack of awareness and misdiagnoses often makes it difficult for people to manage the condition. If not controlled, diabetes can lead to obesity, kidney complications and heart ailments. Scientists across the world are working on ways with which they can reverse the condition, but no substantial study has claimed that the same is possible through any drug. However, there are many ways with which you can try to keep your blood sugar levels in control. Your diet forms a crucial aspect of diabetes management.
Here are some dietary dos and don'ts that you must ensure in your diabetes diet plan:
COMMENT
1. Steer clear of simple and refined carbs found in unhealthy junk food and sugary goods, for it may cause your blood sugar levels to rise. Simple carbohydrates metabolise quickly and elevate the blood sugar levels.
2. Stay hydrated. Dehydration is a common side-effect of diabetes. If our blood glucose levels are high, our kidneys try to remove some excess glucose from blood in form of urine. Whilst the kidneys filter the blood in this way, our body also loses out on a lot of water, which is why diabetics should drink plenty of water and hydrating beverages like coconut water, fenugreek water and ajwain water. They should stay away from fruit juices too; since they have minimal fibre, they can cause a spike in blood sugar.
3. Have foods that are high in fibre. Fibre takes the longest to digest and does not cause your sugar levels to surge instantly.
4. Include foods that are low in glycaemic index. The Glycaemic Index(GI) is a relative ranking of carbohydrate in foods according to how they affect blood glucose levels. Carbohydrates with low GI - usually 55 or less - are digested and absorbed more slowly, therefore causing a slow rise in blood sugar levels. GI of the food could also vary depending upon how you consume the food or how you are cooking them.
5. Instead of having three big meals, have five small meals through the day to keep blood glucose levels stable. Choose healthy, small and frequent meals to ensure controlled symptoms of diabetes.
6. Always choose whole foods like whole wheat flour, whole wheat pasta and bread and brown rice.
Here's a list of fruits, vegetables, nuts and seeds you can have and avoid in your diabetes management:
Fruits You Should Ideally Have
1. Guava
2. Apple
3. Avocados
4. Tart cherries
5. Peaches
6. Apricots
7. Oranges
8. Pears
9. Kiwi
Diabetes Management: Guavas have a low GI index and are full of fibres that help bring down blood sugar levels
Fruits You Should Ideally Avoid
1. Mango
2. Chickoo
3. Watermelon
4. Banana, ripe
5. Melons
Eating too much of watermelon may not be the best idea for diabetics
Vegetables You Should Ideally Have
1. Spinach
2. Bitter Gourd
3. Okra
4. Eggplant
5. Sweet potato
6. Kale
7. Carrots
Diabetes Management: Spinach is a powerhouse of nutrients and fibre that are essential to keep blood sugar levels in check
Vegetables You Should Ideally Avoid
1. Potatoes
2. Corn
3. Peas
Diabetes Management: Potatoes have starchy carbohydrates that may surge your blood sugar levels.
Nuts and Seeds You Should Have
1. Fenugreek seeds
2. Sesame Seeds
3. Dates
4. Almonds
5. Walnuts
6. Pistachios
According to experts, diabetics should avoid dry fruits like raisins or dried figs too. "One should ideally avoid dry fruits as they are concentrated versions of fresh fruits. Naturally then, in these concentrated forms, everything goes up - sugar levels and glycaemic index," says Consultant Nutritionist Dr. Rupali Datta.
Disclaimer: This content including advice provides generic information only. It is in no way a substitute for qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.
Whether you’ve had type 2 diabetes (T2D) for a while or were recently diagnosed, don't be surprised if your next doctor appointment has some surprises. A new consensus report,1 produced by a panel of experts who reviewed nearly 500 manuscripts, has presented some recommendations to improve the way you and your health provider manage your diabetes.
The updated treatment guidelines,1 based on substantial recently research, call for more active patient involvement and recommends more consistent ongoing nutrition and lifestyle support, reflecting our increased understanding of what it takes to manage type 2 disease.
The report—The management of hyperglycemia in type 2 diabetes, 2018—issued jointly by the American Diabetes Association and the European Association for the Study of Diabetes, was published in Diabetes Care.1
Active Patient Participation Becomes Top Goal in Diabetes Management
"Important for all patients to know: the focus of care is shifting to better account for the individual needs and preferences of patients, along with an effort to actively engage patients to take a more active role in educating themselves about the disease and managing it," says John Buse, MD, PhD, the Verne S. Caviness Distinguished Professor and chief of endocrinology at the University of North Carolina School of Medicine in Chapel Hill who co-chaired the expert panel.
Doctors are being encouraged to consider factors such as your willingness to take more medication, the costs of the prescription, and your insurance coverage, 1
Other changes involve tailoring the medications to more closely match your risks and health goals, based on whatever coexisting health problems you might have, such as heart disease, high blood pressure, kidney disease, or concerns about excess body weight.
Thomas Buchanan, MD, professor of medicine and co-director of the Diabetes and Obesity Research Institute at USC Keck School of Medicine, Los Angeles, reviewed the report for EndocrineWeb and shared his views on what this report means for patients.
''It's becoming much more of a precision medicine approach," he says. That means your doctor will look at your individual health characteristics and decide the best treatment plan with you, rather than working from what seems best for most people, in general.
Tailoring Medical Recommendations to Meet the Specific Needs of Each Patient
The report, evaluated a great deal of new data, ''is not necessarily new information but an assimilation of existing knowledge that allows doctors to make a more focused selection of the right therapy for each individual patient," Dr. Buchanan says.
"Probably the most impactful change coming from this report is that for patients with diabetes who have atherosclerotic [heart] disease or chronic kidney disease that if they are not meeting their glycemic target they should be treated with SGLT2 agonists with proven cardiovascular benefits, " Dr. Buse tells EndocrineWeb. Among the SGLT2i medications are empagliflozin (Jardiance) and canagliflozin (Invokana).2,3
Dr. Buse says the evidence is strong that these drugs, as well as with the GLP-1 receptor agonists such as liraglutide (Victoza) and semaglutide (Ozempic) can help reduce long-term complications common in people with diabetes.4,5 The health benefits of these new drugs are substantial. However, he acknowledges that because they are expensive drugs, cost definitely could be a barrier for some patients.
"These drugs are associated with reduced risks of heart attack, stroke, progressive renal disease, kidney failure, heart failure, and even death," he says, “in addition to lowering of blood pressure, blood sugar, and supporting weight loss."
More Highlights from the Updated ADA Diabetes Guidelines
The report is hefty,1 so here are some of the more relevant points to help you better manage your diabetes going forward:
- Patient education is being encouraged, and you will fare much better if you are willing to take a more active role in your own care. Your doctor will direct you to helpful resources and recommend that you consider making lifestyle changes that may include seeing a dietitian or trying a virtual coaching program so you get appropriate dietary guidance, and you’ll be encouraged to exercise regularly.
- If your body mass index (BMI) is 40 kg/m2 or higher, or you have a BMI of 35-39.9 and are struggling to keep any lost weight off with diet and exercise measures, the experts strongly suggest you consider bariatric surgery, which reverses not only the diabetes but the serious consequences that go along with them and are worsened by excessive weight.
- That is probably the most important impact to understand about diabetes. As you will learn, a diagnosis of type 2 diabetes means you are likely at increased risk for a variety of serious complications, including heart failure and other heart-related problems, and kidney issues. Your doctor will discuss what it will take to reduce your risks; or, if you already have any of those conditions, what you can do now to improve your health.
- Your feelings about taking medications—knowing both the benefits and possible side effects— and your tolerance for the medications will be taken into account when you discuss your care with your doctor, in addition to the realities of cost and insurance coverage.
- As for specific medicines, metformin remains the first anti-diabetes drug to control blood glucose. One area of debate, he says, is what should be done in individuals whose overall diabetes control is adequate but they still face risks. The experts recommend that another anti-diabetes medicine could be substituted, the target could be lowered, or you could wait to see if your blood sugar control gets worse.
- However, when your blood glucose targets are not met, your doctor is likely to add other medications that will help improve your blood glucose levels (ie, hemoglobin A1c) as well as to address problems like high blood pressure or high cholesterol. The generally accepted upper limit for hemoglobin A1c is less than 7%.
- If you are at risk for cardiovascular disease (CVD, or heart disease), you can expect your doctor to suggest adding either an SGLT2 inhibitor or GLP-1 receptor agonist.
While the report does not address exactly when these drugs should be introduced, Dr. Buse offered his personal opinion to EndocrineWeb: "I would recommend starting an SGLT2i or GLP-1 RA as soon as practical after an acute event is resolved and the patient is stable."
For those of you are on oral medicine and insulin who can't seem to reach your glucose target, your doctor might suggest adding prandial insulin. If you need injectable medications, GLP-1 RAs are the preferred next-line drug.
Dr. Buse is a consultant to several companies and holds stock in others so please see the full study to review a full list of disclosures; Dr. Buchanan has no relevant financial disclosures regarding this article.
Immune System "Brake Failure" Could Contribute to Diabetes
News Oct 09, 2018 | Original Story from Frontiers.
Credit: Pixabay.
Immune reactions are usually a good thing — the body’s way of eliminating harmful bacteria and other pathogens. But people also rely on molecular “brakes,” or checkpoints, to keep immune systems from attacking their own cells and organs and causing so-called autoimmune disease. Now, working with mice, Johns Hopkins researchers have discovered that in the rodent form of type 1 diabetes, specific immune cells fail to respond to one of these checkpoint molecules, letting the immune system go into overdrive and attack insulin-producing cells.
Results of the study, published July 16 in Frontiers in Immunology, add to a growing body of research about the underlying autoimmune mechanisms in type 1 diabetes and potentially open up new immune system treatments for the disorder.
“What we’ve shown in mice is one novel way that a strong inflammatory response can hijack the immune system and lead to chronic disease,” says lead author Dr Giorgio Raimondi, assistant professor of plastic and reconstructive surgery at the Johns Hopkins University School of Medicine.
An estimated 1.25 million people in the U.S. have type 1 diabetes, which is most often diagnosed in children and young adults and incurs more than $14 billion per year in medical costs and lost income. In those with the autoimmune disorder, the pancreas loses the ability to produce insulin, needed by the body to control blood sugar levels. The disease is treated with lifelong insulin therapy that must be precisely calibrated and delivered many times each day. Researchers believe that type 1 diabetes is caused by an interplay of genetics and environmental triggers; recent evidence suggests that viral infections may set off some cases of the disease.
Raimondi and his colleagues were studying how the immune system can cause problems in recipients of organ transplants when they became interested in a group of molecules called type I interferons (TI-INF). These immune activators help initiate an immune response in the presence of viruses, bacteria or other pathogens and, if present, they make controlling the rejection of transplanted organs a lot more difficult. Previous studies have also shown that TI-INF levels spike in many patients before they develop type 1 diabetes.
Raimondi says he wondered whether the role of these molecules in diabetes could teach him anything about transplant rejection.
For the study, the team used a strain of nonobese diabetic mice as a model for type 1 diabetes, and isolated cells from throughout the animals’ bodies. They found that levels of TI-IFN weren’t higher than normal everywhere but were in specific tissues, the lymph nodes of the gut.
More closely examining immune system cells isolated from the mice, they then showed that in T lymphocytes–one subtype of white blood cell–the high levels of TI-INF block an immune checkpoint molecule, called interleukin-10 (IL-10), and keep it from applying the brakes to keep the immune system in check.
“The result is that these immune cells are much less responsive to normal signaling by IL-10,” says Raimondi.
Using cells harvested from the mice, the researchers discovered that levels of the protein P-STAT3 that correlate with levels of IL-10 decrease by about half in the T lymphocytes of nonobese diabetic mice. Moreover, the defective response to IL-10 isn’t just seen early on in disease or before diabetes develops, Raimondi adds, but continued for at least four months–the length of the study.
“It looks like this is something that continues throughout the life of the animals, which is a really important point when we start thinking about how to use this to develop an effective therapy for this disease.”
When Raimondi and his colleagues treated the nonobese diabetic mice with a JAK inhibitor–part of a class of drugs that blocks signaling by TI-INF and is being used to treat forms of psoriasis, ulcerative colitis and rheumatoid arthritis–T lymphocytes regained their normal ability to respond to IL-10.
The current study didn’t measure whether restoration of IL-10 signaling influenced levels of insulin in the mice, and Raimondi cautioned that it is far too early to know if a similar drug could work in people, or if blocking or partially blocking the protein would be harmful.
But he says future studies will show how blocking TI-INF could be used to treat diabetes.
“Our bodies need to be able to respond to type I interferons to some degree,” says Raimondi. “This is a fundamental element of our immune system’s ability to fight infections, so we certainly shouldn’t block all type I interferons in the body.”
This article has been republished from materials provided by Frontiers. Note: material may have been edited for length and content. For further information, please contact the cited source.
Reference
Type-I Interferons Inhibit Interleukin-10 Signaling and Favor Type 1 Diabetes Development in Nonobese Diabetic Mice. Marcos Iglesias, Anirudh Arun, Maria Chicco, Brandon Lam, C. Conover Talbot Jr., Vera Ivanova, W. P. A. Lee, Gerald Brandacher and Giorgio Raimondi. Front. Immunol., 16 July 2018, https://doi.org/10.3389/fimmu.2018.01565.
A genetic defect in beta cells which produce, store and release insulin in the pancreas, could be behind both type 1 and type 2 diabetes, new research has found.
Diabetes is caused by the body’s inability to lower blood glucose levels, a process that is normally driven by insulin. In type 1 diabetes the immune system kills off the beta cells that produce insulin, whereas type 2 diabetes is triggered by a metabolic dysfunction.
However, even though type 2 diabetes is often called a lifestyle disease as it can be reversed through diet and exercise, the research carried out by an international team of scientists, explains that both type 1 and type 2 diabetes have a strong genetic basis.
The team of researchers, led by Professor Adrian Liston from the Laboratory of Genetics of Autoimmunity at the University of Leuven in Belgium, investigated how genetic variation controls the development of diabetes.
While previous research has mostly focused on the impact of genetics on the immune system (type 1) and metabolic dysfunction of the liver (type 2), this new study shows that genes also affect the beta cells that produce insulin.
“We found that genes play a critical role in the survival of beta cells in the pancreas. We noticed that mice with fragile beta cells rapidly developed diabetes when those beta cells were damaged. Other mice with robust beta cells didn’t develop diabetes, as they were able to repair DNA damage,” said Liston
The same pathways for beta cell survival and DNA damage repair were also found to be altered in diabetic patient samples, indicating that a genetic predisposition for fragile beta cells may underlie who develops diabetes.
“Some people are born with robust beta cells. This group is likely to remain healthy, even when their immune system starts attacking the beta cells (type 1) or when they suffer from metabolic dysfunction of the liver. Other people are less fortunate and their beta cells are fragile, so they are much more likely to develop type 1 or type 2 diabetes,” Liston explained.
“However, while genetics is the most important factor for the development of diabetes, lifestyle can still have a major impact. Even mice with genetically superior beta cells developed diabetes when we increased the fat in their diet,” he added.
Current animal models are based on the early stages of diabetes. These models have allowed for the development of anti-diabetic drugs that, together with lifestyle changes, can control early stage type 2 diabetes.
The researchers explained that the mouse model developed for this study is unique because it is the first to focus on the later stage of beta cell death. It means that from now on it is possible to test new anti-diabetic drugs that focus on preserving beta cells.
“The big problem in developing drugs for late stage type 2 diabetes is that, until now, there has not been an animal model for the beta cell death stage. Previously, animal models were all based on the early stage of metabolic dysfunction in the liver, which has allowed the development of good drugs for treating early stage type 2 diabetes,” Liston pointed out.
“This new mouse model will allow us, for the first time, to test new anti-diabetic drugs that focus on preserving beta cells. There are many promising drugs under development at life sciences companies that have just been waiting for a usable animal model,” he said.
“Who knows, there may even be useful compounds hidden away in alternative or traditional medicines that could be found through a good testing programme. If a drug is found that stops late stage diabetes, it would really be a major medical breakthrough,” he added.
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