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    MEDICAL ADVICE DISCLAIMER: The information included on this site is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult his or her health care provider to determine the appropriateness of the information for their own situation, or if they have any questions regarding a medical condition or treatment plan. Reading the information on this website does not create a physician-patient relationship.

    Posted in Diabetic Education | 2 Comments

    Diabetes Type I and Diabetes Type 2 in Teens

    This observational study used the clinical records of patients with diabetes referred to a hospital treatment center in Australia to compare outcomes in 354 patients with type 2 diabetes who had onset between 15 and 30 years of age with those of 470 patients with type 1 diabetes who had a similar age of onset. Patients were followed for a median of more than 20 years in both groups.

    Several outcomes were compared, including retinopathy, neuropathy, renal function, ischemic heart disease, stroke, a composite of any macrovascular endpoint, and mortality. In addition to diabetes type, multivariable models controlled for age, sex, ethnicity, blood pressure, body mass index, A1c, cholesterol and triglyceride levels, albuminuria, smoking, and lipid-lowering therapy. Measurement of these variables was based on values obtained at the last clinical visit, so the investigators also examined clinical data obtained within 2-5 years of diagnosis among the subset for whom such data were available.

    The 2 groups differed significantly on important characteristics, including age at onset, diabetes duration, and ethnicity. At the final clinical visit, less favorable cardiovascular risk factors were found in the type 2 diabetes cohort, with significantly higher levels of serum triglyceride levels, lower high-density lipoprotein cholesterol levels, and higher blood pressure readings. Results were similar among the subset with data available 2-5 years after diagnosis.

    Despite a statistically shorter duration of diabetes and similar glycemic exposure, macrovascular complications were much more common in the type 2 diabetes cohort (ischemic heart disease and stroke), but there was no difference in retinopathy or renal function. Death was also more common among patients with type 2 diabetes, and it occurred after shorter disease duration.


    Type 2 diabetes is known to dramatically increase the risk for cardiovascular disease, especially among those with young-onset diabetes.[1] Risk for diabetes complications, including macrovascular disease, is also high among patients with type 1 diabetes, but comparisons of outcomes of type 2 with type 1 disease have been historically difficult. In typical populations, patients with type 2 diabetes are much older and those with type 1 disease have been exposed to hyperglycemia for much longer, both of which confound the relationship between diabetes and complications.

    The present study may be the first to compare groups of individuals with type 2 and type 1 diabetes with similar age and similar duration of diabetes. The similarity in glycemic exposure and the lack of difference in risk for retinopathy and nephropathy argue that these complications bear a direct relationship to hyperglycemia. The relationship between cardiovascular disease and glycemic exposure is far less clear.

    The current data support the notion that type 2 diabetes is by nature a cardiovascular condition, or at least more so than type 1 diabetes, and are similar to just-reported findings among Chinese patients with young-onset type 1 and type 2 diabetes.[2] There were some shortcomings that temper the findings, including the large difference in ethnicity and the fact that patients referred to a hospital treatment center may not be representative of the totality of those with diabetes. The study would also have been strengthened by inclusion of a control group without diabetes of similar age and duration of follow-up.

    Although type 2 diabetes is clearly on the rise, type 1 is and will remain the dominant form of diabetes among youth.[3] Nevertheless, the clear message is that not all forms of diabetes are equivalent. Despite the common manifestation of hyperglycemia, the disease takes many forms,[4] the differentiation of which will improve our ability to care for all patients with diabetes.

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    Diabetes Type I-1/3 of Children Present with Diabetic Ketoacidosis

    Diabetes type I presents in children as DKA or Diabetic Ketoacidosis about one third of the time. The incidence in minority groups have an even higher risk of having their children with Diabetes Type I discovered with this very dangerous condition. We need to do better educating all parents to recognize these signs and bring their children to their health care provider. Please read the article below, and let us know how your Diabetes was discovered.

    Continue reading

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    Diabetes News:Inhaled Insulin Endorsed by FDA Panel

    People with Diabetes Type 1 or Diabetes Type 2 who require insulin are waiting for the breakthrough that will negate the need for insulin injections.  About 15 years ago, an inhaled insulin to be used before meals was marketed.  Despite the huge interest in the new insulin, the drug did poorly and eventually was taken off the market.  It was very rapid in onset, had a shorter duration of action then the insulin currently available, but the device was very cumbersome, precise measurement of amount was difficult, and there was a question of it aggravating respiratory problems in people with COPD.  It was recommended that all patients on this medication have regular pulmonary function testing.  Around this time, pen devices were also being developed and patients when given a choice between inhaled premeal rapid acting insulin and the pen to administer humalog or novolog,  chose the pen.  Concerns about this new inhaled insulin seem similar to the ones described previously.  The major advantage will be the lower incidence of hypoglycemia.  While inhaled insulin may be suitable for some patients, I suspect most people with type I diabetes will do better on their injected insulin.  I suspect the most likely market for this medication will include some people with type 2 diabetes who need insulin before meals and do not want to take the injections.  What do you think?  Please read the article below from Medscape and we appreciate your comments.

    A US Food and Drug Administration (FDA) advisory panel has voted in favor of MannKind’s Afrezza (Technosphere insulin-inhalation system) for the treatment of both type 1 and type 2 diabetes in adults.

    Votes of the Endocrinologic and Metabolic Drugs Advisory Committee in favor of Afrezza were 13-1 for type 1 diabetes and Continue reading

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    Diabetes News: Sleep Disturbance is a Risk Factor for Diabetes Mellitus Type 2

    There are a number of risk factors leading to weight gain, insulin resistance, and Diabetes Type 2. Life style, diet, exercise, and genetics have been well known.  Often people with Diabetes type 2, caused by insulin resistance, had poor quality sleep.  Which came first, the sleep disturbance or the weight gain.  The article below, from Medscape, summarizing the original article from the lancet  shows that for some people, either the inability to sleep, or having a way of life that does not allow for sufficient sleep are risk factors.  They feel the lack of sleep, can lead to insulin resistance, which will then lead to choosing calorie dense foods, and exacerbate the tendency for Diabetes type 2.  They recommend that patients and health care providers analyze their sleep patterns and try to correct them as early in life as possible.  Let us know if poor quality sleep preceded weight gain and Diabetes type 2, or if the Diabetes and weight gain preceded the sleep disorder.

    From Medscape : Short sleep duration, sleep disturbances, and unsynchronized circadian sleep rhythms are associated with metabolic disorders, markedly, obesity and type 2 diabetes, prompting suggestions that sleep needs to be addressed “in a much more Continue reading

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    Screening for Chronic Kidney Disease in Adults

    People with Diabetes Type I as well as Diabetes Type 2 are routinely screened for kidney disease as Diabetes is a risk factor. The benefits of screening were noted and many people without risk factors such as hypertension, coronary artery disease, Diabetes have been screened. The evidence presented in this article from the Annals of Internal Medicine reported in Medscape describe the latest recommendation which is not to screen Adults without risk factors. This recommendation does not apply to people with Diabetes of either type or other risk factors at this time.  Some screening tests are recommended for all adults.  These tests need to have the costs justified, few to no side effects or other harm,  and show benefit which can be measured.  Please read the article below from Medscape and let us know your reaction to it.

    Adults without symptoms or risk factors should not be screened for chronic kidney disease (CKD), according to new guidelines from the American College of Physicians (ACP). The new evidence-based recommendations, published online October 21 in the Annals of Internal Medicine, address screening, monitoring, and treatment of adults with stage 1 to 3 CKD.

    “There is no evidence that evaluated the benefits of screening for stage 1-3 chronic kidney disease,” ACP President Molly Cooke, MD, FACP, said in a news release. “The potential harms of all the screening tests — false positives, disease labeling, Continue reading

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    Diabetes News: Weekend Splurges may Help with Long Term Weight Loss

    Do you worry that occasional weekend cheating may make it impossible for you to lose weight? This study from Medscape shows the opposite. People who get into a rhythm where they weigh a little more on Sunday night than on Friday morning will have a better time controlling their weight and shedding those extra pounds. In addition, knowing they can cheat on weekends provides a great psychological boost. While the article does not mention anything about the effect of the diet variation on diabetic control, the information can be applied to all Americans who desire weight loss as well as those people with prediabetes who need to change their lifestyle. Please read the article below and let us know if you cheat on weekends and what effect this has on your weight.

    NEW YORK (Reuters Health) – Go ahead and eat a few French fries or a couple of bites of chocolate cake – as long as it’s the weekend, when diets tend to fall by the wayside only to be resumed on Monday morning, a new study suggests.

    “Regardless of who you are, there’s a rhythm to the weight you lose,” one of the study’s authors, Brian Wansink, told Reuters Health. “You’re going to weigh the most on Sunday night and the least on Friday morning,” he said.

    “You don’t want to turn yourself into a glutton over the weekend, but realize that this seems to happen to almost everybody,” said Wansink, who directs Cornell University’s Food and Brand Lab in Ithaca, New York.

    He and a team of researchers studied Finnish men and women and found that weekday compensation for weekend weight gain proved the most likely formula for long-term weight loss, they wrote online January 31 in the journal Obesity Facts.

    The researchers analyzed up to 10 months’ worth of self-recorded daily weights from 80 adults between the ages of 25 and 62. Participants were separated into three groups: losers, who dropped more than 3% of their weight; gainers, who put on more than 1%; and maintainers.

    Overall, 18 people lost weight during the study period, 10 were classified as gainers and 52 maintained their weight.

    Those in the weight-loss group showed a clear rhythm of putting on pounds over the weekend and slimming down during the week. Though the day of the week predicted weight in all three groups, the pattern in the weight-loss group was more consistent than the patterns among people who gained weight or maintained their weight.

    “It appears that long-term habits make more of a difference than short-term splurges,” the authors conclude.

    Wansink’s advice to those trying to shed pounds: “Worry less about the weekends, and focus on the weekdays because that’s when weight loss occurs. Just start minding your business on Monday morning.”

    Nutritionist Susan Racette also believes that planned indulgences may help some dieters.

    “It can be motivating if they feel this is actually an allowance, and it can help them stay on track,” she told Reuters Health.

    Racette, from the Washington University School of Medicine in St. Louis, was not involved in the current study but was the lead author of a 2008 study that found a similar pattern of weekend weight gains followed by weekday drops.

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    The new study is “just more evidence that people do fluctuate in their day-to-day intake, and that’s normal in our society,” she said.

    Dieters who stray from their regimens may beat themselves up or feel guilty and then find it challenging to return to their weight-loss programs, Racette and Wansink both said.

    “We can speculate that there might even be a psychological benefit in indulging a little more over the weekend in that it makes your self control on the weekdays a lot easier to handle,” Wansink said.

    Weekend splurges “may be better for people psychologically, and it may help them the rest of the week,” Racette said.

    “The key is there are different strategies that work for different people, and there’s no one strategy that’s going to work for everyone,” she said. “But this can be a strategy that can certainly help people.”


    Posted in Diabetes News, Diabetes Type 2 | Tagged , , , , | Leave a comment

    Diabetes News: Glucose Target Levels and A1C are not in Synch

    This article from Diabetes Care discussed in Medscape uses data from 231 patients with Diabetes Type I and Diabetes Type 2 to see how fasting sugars and 90 minute post postprandial blood sugars correlate with hemoglobin A1Cs.  These guidelines have been recommended for a long time and are used by physicians as well as patients with Diabetes with the hope of achieving an A1C which is optimal.  Lowering the targets too much may increase the risk of hypoglycemia and raising them may further increase the probability of complications from Diabetes Mellitus.  While a study of only 230 patients may not provide sufficient data to change current recommendations, further study with larger number of patients is certainly indicated.  Perhaps at some point, the target fasting sugar will be adjusted upward and the post postprandial sugar targets will be adjusted as well.  Please read the article below and let us know your thoughts.

    Current glycemic targets advised for diabetes patients don’t align with recommended HbA 1c levels, a new analysis of continuous glucose monitoring data suggests.

    The findings, from the A 1c-Derived Average Glucose (ADAG) study, were published online February 10 in Diabetes Care by Nancy Wei, MD, from the Diabetes Center at Massachusetts General Hospital, Harvard Medical School, Boston, and colleagues.

    Professional societies’ recommendations for diabetes management advise HbA 1c goals Continue reading

    Posted in Diabetes News, Diabetes Treatment, Diabetes Type 2, Diabetes Type I, Diabetic Education, Understanding Diabetes | Tagged , , , , , | Leave a comment

    Diabetes News: Saliva Test and A1C Predict Diabetes Type 2

    Diabetes Type 2 is extremely common and about half of the USA population is at risk for developing Diabetes type 2. A simple test of saliva has been found in the study published in the JCEM and described in Medscape. This test may in the future become a screening tool for detection of Diabetes. Hemoglobin A1C has recently been developed as a screening tool to see who has already developed Diabetes or “prediabetes” and may in the future be used to see who is at risk for development of Diabetes Type 2 at an earlier stage. Early recognition will lead to millions of people becoming aware of their tendency to develop Diabetes and encourage earlier treatment which may lead to a lower incidence of complication. Please read the article from Medscape below and let us know if you or someone you know would be willing to change their diet, exercise more, or possibly even take a medication if a test indicated a greater vulnerability to Diabetes.

    A new saliva test and earlier use of the HbA 1c blood test could pick up type 2 diabetes in high-risk patients earlier than methods in current use, show data from 2 studies.

    Both tests could both provide an effective and timelier means of disease Continue reading

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    A Soda a Day Increases Cardiovascular Mortality by 30%

    Drinking one soda a day can increase the risk of a heart attack by 30%.  This NANES study reported by Medscape provides data showing that this statistic is not related to the extra calories or obesity. Increasing sugar intake by >15% starts to spike the mortality.  Perhaps we should add things like drinking soda, putting a couple of teaspoons of sugar in a cup of coffee to cigarette smoking, sedentary lifestyle etc. as harmful habits that may lead to heart attacks and strokes.  Lets see if this data holds up with further scrutiny.

    ATLANTA, GA — American adults consume on average about 15% of their calories from sugars added to foods during processing, with a whopping 37% of the added sugar consumed in sugar-sweetened beverages, suggests an analysis of data extending back about 25 years. Moreover, the study projects that regularly drinking as little as one 12-ounce sugary soda a day may increase the risk of cardiovascular disease by about 30%—independent of total calories, obesity, or other risk factors [1] .

    “Our findings indicate that most US adults consume more added sugar than is recommended for a healthy diet,” write Dr Quanhe Yang (Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA) and colleagues in their report published online February 3, 2014 in JAMA Internal Medicine.

    “Our results support current recommendations to limit the intake of calories from added sugars in US diets.”

    Dr Kirsten Bibbins-Domingo (University of California, San Francisco), who was not involved in the study, commented to heart wire that the research suggests that clinicians need to counsel patients about the health harms from too much sugar.

    “I think that we are just really recognizing that there are significant health consequences from eating excessive amounts of sugar that go beyond not wanting to be overweight, but go to wanting to make sure that our heart and our kidneys and our brains are healthy,” she said.

    Epidemiologic studies have linked high consumption of added sugar with an increased risk of type 2 diabetes, obesity, and hypertension, but most studies focused only on sugar-sweetened beverages, and none looked at the relationship between added sugar intake and CVD mortality in a national sample, the authors observe

    There is disagreement about how much added sugar is acceptable in a healthy diet, they note. Added sugar should be less than 25% of total calories according to the Institute of Medicine, but less than 10% of total calories according to the World Health Organization. The American Heart Association has even stricter recommendations: less than 100 calories a day (about 5% of total daily calories) for women and 150 calories a day (about 7.5% of total daily calories) for men.

    Yang et al analyzed data from three National Health and Nutrition Examination Survey (NHANES) surveys —1988–1994, 1999–2004, and 2005–2010 —and examined CVD mortality during a mean follow-up of 14.6 years.

    During the three time periods, among US adults aged 20 and older, the adjusted mean daily calories from added sugar went from 15.7% to 16.8% to 14.9%.

    More than 70% of the added sugar came from sugar-sweetened beverages (37.1%), grain-based desserts (13.7%), fruit drinks (8.9%), dairy desserts (6.1%), and candy (5.8%).

    In 2005–2010, most adults (71.4%) consumed 10% or more of calories from added sugar, and about 10% consumed 25% or more calories from sugar.

    Adjusted hazard ratio (95% CI) of CVD mortality* for different percentages of calories from added sugar. Calories from added sugar (% of total p 0 to 25
    1.00 1.30 (1.09– 1.55) 2.75 (1.40–5.42) 0.004

    *Adjusted for age, sex, race/ethnicity, education, smoking, alcohol consumption, physical activity, antihypertensive medication, family history of CVD, Healthy Eating Index score, body-mass index, systolic BP, total serum cholesterol, and total calories
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    Blacks were more likely than others to consume more than 25% of calories as added sugar, but there was also no significant link between sugar consumption and CVD mortality among blacks —possibly due to the small number of events in this subgroup, the researchers write.

    “Yang et al inform this debate by showing that the risk of CVD mortality becomes elevated once added sugar intake surpasses 15% of daily calories—equivalent to drinking one 20-ounce Mountain Dew soda in a 2000-calorie daily diet,” Dr Laura A Schmidt (University of California, San Francisco) writes in an invited commentary [2] . The risk rises exponentially as sugar intake increases, peaking with a fourfold increased risk of CVD death for individuals who consume one-third or more of their daily calories in added sugar, she adds.

    “Until federal guidelines are forthcoming, physicians may want to caution patients that, to support cardiovascular health, it is safest to consume less than 15% of their daily calories as added sugar,” she advises.

    No conflicts of interest were reported.




    MEDICAL ADVICE DISCLAIMER: The information included on this site is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult his or her health care provider to determine the appropriateness of the information for their own situation, or if they have any questions regarding a medical condition or treatment plan. Reading the information on this website does not create a physician-patient relationship.

    Posted in Diabetes News | Tagged , , | 2 Comments