Control your diabetes: Just make 1 change a week

Type 2 Diabetes is a complicated disease that can affect multiple body organs and processes. It is also a progressive disease, meaning it will get worse over time. However, the better blood sugar control you can maintain, the progression of the disease seems to be slowed.

It is never too late and there is no "good" time of the year. The holidays are upon us, so now is a good time to change some of the old habits, one at a time, and help yourself through the holidays.

Diabetes consists of eight core defects in the body, involving liver, muscle, kidney, adipose (fat) tissue, pancreas and intestines. As diabetes progresses, more of these defects become active. Most of the medications we have available for diabetes address one of these defects. So, when the doctor says we need to add another medication for your diabetes, he/she recognizes that there may be another defect that is causing your higher blood sugars.

But, have no fear, it is a good time to start making a change or two.

Now that our temperatures are more moderate, we need to incorporate 20-40 minutes of physical activity into our daily schedules. Moving is so important for a lot of bodily functions: blood pressure, blood sugar, cholesterol, and weight control. Use your calendar to schedule in the time and activity for the upcoming week. Your body does not need or benefit from a day off, so schedule something active every day.

Plan ahead for your meals. Have sources of protein available for all meals (egg, chicken, fish, tuna, cottage cheese, peanut butter).

Buy vegetables, wash them, cut them and put in small containers or baggies at eye level in your frig. They will get eaten more.

Use a smaller plate for mealtimes. Put vegetables and salad on ½ plate, then add protein to ¼ of plate. The other quarter is for the starchy foods (rice, potato, pasta, etc). (Limit to 3 (1/2 cup servings) per meal.

This plate method seems to be very helpful for patients to be able to plan their meals, eat appropriate amounts and balance their meals. For more information on the plate method, see www.choosemyplate.gov.

Susan Smith, Ph.D., CDE, is a nationally Certified Diabetes Educator (CDE) and a specialist in the field of diabetes since 1988. Since 2002 she has worked with patients individually through all of the internal medicine and family practice providers at Visalia Medical Clinic. Susan also leads the monthly diabetic support groups, which are open to non-VMC patients and family member

Daily breakfast consumption lowered type 2 diabetes risk profile in children

September 5, 2014

The risk for type 2 diabetes among children may be lowered with regular consumption of a healthy breakfast, according to research published inPLoS Medicine.

Angela S. Donin, MSc, of the Population Health Research Institute at St. George’s University of London, and colleagues conducted a cross-sectional study of 4,116 children aged 9 to 10 years to determine the effect of regularly consuming breakfast on the risk for type 2 diabetes.

Angela S. Donin

Participants were asked how often and what they consumed for breakfast, and blood tests were taken to measure diabetes riskmarkers that includedfasting insulin, glucose and HbA1c. A 24-hour recall of foods eaten the previous day was conducted by a research nutritionist.

Overall, 26% of participants reported not regularly eating breakfast; 11% of those reported eating breakfast most days, 9% on some days and 6% not usually. Researchers found good agreement between self-reported breakfast frequency and the 24-hour dietary recall.

Compared with participants in the managerial group, those in the lowest socioeconomic category were most likely not to have breakfast (P<.0001). Compared with participants who reported always eating breakfast, participants who reported not usually eating breakfast had higher fasting insulin (percent difference, 26.4%), higher insulin resistance (26.7%), slightly higher HbA1c (1%) and slightly higher glucose (1%). Total and LDL cholesterol and diastolic blood pressure did not show significant differences in mean values among the groups.

Participants who ate high-fiber breakfasts had lower fasting insulin levels and insulin resistance.

Participants who did not eat breakfast every day had lower energy levels compared with those who did, as well as lower intakes of carbohydrates and total non-starch polysaccharides (dietary fiber).

“Our findings suggest that eating a breakfast every day, particularly one which is high in fiber, may help to protect against developing type 2 diabetes,” Donin told Endocrine Today.“Trials are needed to confirm whether the relationship between breakfast and type 2 diabetes is causal.” — by Amber Cox

Disclosure: See the full study for a complete list of the researchers’ financial disclosures.

Hudson college student’s blog makes life sweeter for others with diabetes

By Barbara Allen, Contributing Writer

Molly Johannes (Photo/ courtesy of Greg Weintraub)

Hudson – From reading her blog, “Diabetes Goes to College,” with her reassuringly matter-of-fact and often humorous approach to diabetes, one would never guess that Hudson resident and author Molly Johannes had any concerns about leaving home to attend college. But Johannes, an English major and now a senior at UMass Amherst, remembers well how worried she was.

“I was so nervous about being on my own,” she recalled.

Diabetes has been part of her life since she was 4, when she was first diagnosed with the disease. Because she was so young, Johannes acknowledges that she never had to become “used to” diabetes.

“It’s what I know and accept about my life,” she said.

Johannes has Type 1 diabetes, which she has learned how to keep under control with a combination of insulin injections several times a day, carefully monitoring her blood sugar, maintaining a healthy diet, and exercising.

When she was younger, Johannes admits that her parents did much of the management for her.

“Growing up, my parents shouldered the responsibility,” she noted. “From counting carbohydrates to administering medicine, they did everything they could to help me.”

As she grew older, she assumed more and more of her diabetic care – giving herself her own injections and going to endocrinology appointments on her own.

But taking care of herself at home, with a mother and aunt who also have Type 1 diabetes, a father who is an emergency medical technician, and her endocrinologist nearby, would be quite different than managing her diabetes on a busy college campus an hour and a half away.

The transition from home to college was made easier when she discovered the College Diabetes Network.

“It’s a group dedicated to supporting college students with diabetes by giving them access to resources and peer support on campuses across the country,” Johannes explained. “I started to make friends my age who had diabetes and who were going through the same transition as me. I gained a lot of confidence and trust in myself and my diabetes management in my freshman year that I’m proud to maintain today.”

Helping others make that difficult transition is one of the things she hopes to do with her blog, which she writes for “ASweetLife,” an online diabetes magazine sponsored by the Diabetes Media Foundation, a nonprofit organization that promotes information, education and a sense of community for those living with diabetes.

“In the year and a half that I’ve blogged for ‘ASweetLife,’ I’ve been amazed and humbled by all the positive feedback I’ve received,” Johannes said.

She writes a new blog post about once a week, as well as features for the online publication.

“When I sit down to write a personal blog entry, I reflect on my week and the different events that occurred. Did I go somewhere exciting? Did I have a frustrating diabetes day and want to vent about it? I try to blog on a variety of subjects so I can appeal to a wider audience, but I like to keep my focus on the fact that I’m a college student living daily life with diabetes,” she explained.

“I like to think that my blog helps people directly or indirectly affected by diabetes who have concerns about themselves or a loved one who is about to enter college or start independent diabetes care,” Johannes continued. “I want to alleviate any fears or doubts people may have about transitioning from one stage in life to another.”

To read Molly Johannes’s blog, and for more information about living a healthy lifestyle with diabetes, visit http://asweetlife.org. Also check out The Diabetes Media Foundationhttp://diabetesmediafoundation.org and The College Diabetes Networkhttps://collegediabetesnetwork.org.

Beyond the Ice Bucket: The Real Challenge for Diabetes Advocacy Steve Richert

Photo by Jeffrey Lash

I spent the majority of this summer in the backcountry of Wyoming working on a climbing expedition with an all Type 1 diabetes team and as such, I was relatively insulated from the ALS Ice Bucket Challenge craze. When I returned to civilization I had to play catch up, mostly via Facebook detective work. What I learned from reading was this: half of all people care about advocating for causes, and the other half care so much that they hate on whatever form of advocacy is popular as a matter of principal because they want to do something that really helps the less fortunate. The takeaway is that generally, people do care, even if that care manifests itself as silly social media games or silly social media criticism and rants.

In the diabetes world, I saw numerous commentators extolling the need for a parallel ice bucket challenge to raise money for diabetes research. This made me wonder why the idea of “making a difference” is almost universally equated with fundraising for research to the exclusion of all other needs in the global diabetes community.

We care about being heard and making a difference so I want to challenge you as members of the diabetes community to look deeper and see the greater depth of need the world over, uncomfortable as it may be to do so.

I am going to assume that if you are reading this, it’s on a computer or mobile device (if it is on a mobile device then please accept my apologies for the length!) and that you, like I do, enjoy a modern lifestyle with access to the “basics” of diabetes care. To whit: I recently “downgraded” from an insulin pump to syringes and vials. I announced this change on the LivingVertical Facebook page and Twitter and people were shocked and asked why I would voluntarily relinquish years of technological advancement for no apparent reason.

The simple answer is because I like needles and vials and I don’t feel like a pump is the best delivery system for me at this time. Even as a transient climber/artist with no conventional job at the moment, I have options in my diabetes care.

I take for granted the fact that I can get up every morning and take my insulin and go on with my day. I try not to think of what my diabetes options would be if I were in Africa, for example, or parts of central and southeast Asia. It’s uncomfortable to think that over there I’d be thanking my lucky stars to have even the simplest form of insulin therapy–and that many people don’t have that necessity and die as a result. 

I try not to think about that over my morning coffee because I feel guilty when I do- guilty for what I take for granted and guilty for not doing more to help.  But the point of this editorial isn’t to cultivate guilt. It’s to introduce you to the 100 Campaign, an initiative that is making a difference.  

Photo by Jeffrey Lash

The 100 Campaign was founded in 2012 with the support of the International Insulin Foundation with the goal of establishing 100% worldwide access to insulin for people with diabetes by 2022. This is, of course, a monumental task–and they are taking on this mission without accepting funding from the pharmaceutical industry. The vast majority of non-profits in diabetes rely on funding from industry partners (at least in part), but the 100 Campaign is actively addressing issues within the industry itself that they believe are barring access to insulin. 

The diabetes community isn’t just people you know on Facebook. It’s not just the people who comment on your blog or retweet your blood glucose updates. The diabetes community includes those people in the developing world who can’t get on social media or write a blog about their situation while kicking it at their neighborhood Starbucks. I see hundreds of people posting on behalf of funding research every week on social media–and I’m not trying to rain on that parade (or walk-a-thon)–if anything, that confirms that we as a community are caring and active. Now it’s time to paint in the corners of the big picture to include the silent, unpopular problem in the diabetes community–the lack of affordable insulin on a global scale.

- See more at: http://asweetlife.org/feature/beyond-the-ice-bucket-the-real-challenge-for-diabetes-advocacy/#sthash.GD4Eanzb.dpuf

Living With Type 1 Diabetes – a Forgotten Disease US News

One difference between Type 1 and Type 2 diabetes is the former usually develops at a young age while the latter appears much later in life.

By Amir KhanSept. 19, 2014 | 12:26 p.m. EDT+ More

Type 2 diabetes has become an epidemic, with 28.5 million Americans diagnosed as of 2012 and the number expected to continue growing. Lost in the discussion on how to reverse this mounting problem, however, is the plight that nearly 1.5 million Americans with Type 1 diabetes deal with.  

Even though Type 1 and Type 2 diabetes seem similar at first glance, the two are actually worlds apart. Type 1 diabetics usually develop the disease at a young age, which is why it used to be known as juvenile diabetes, in contrast to Type 2 diabetes, previously referred to as adult-onset diabetes. Both diseases are a result of problems with insulin, a hormone used by the body to regulate blood sugar, but that’s where the similarities end. “The simplest way to think about the difference between Type 1 and Type 2 is that Type 1 diabetics have a deficiency of insulin,” says Kevin Goist, an assistant professor of clinical medicine at The Ohio State University's Wexner Medical Center, “while in Type 2 diabetes, the major problem is insulin resistance. The body does not use insulin properly.”

Type 1 diabetics rely on insulin injections to lower their blood sugar level, whereas Type 2 diabetics can try to manage theirs through a combination of diet, exercise and medication before resorting to insulin injections. Derek Rapp, CEO of JDRF, a research foundation dedicated to finding a cure for Type 1 diabetes, has a 20-year-old son with Type 1 and says watching him constantly test and retest his blood sugar is heartbreaking. “He has all these different variables that he’s trying to adjust for," Rapp says, "so it’s a constant balancing act to try and hit the mark with regards to ​what his insulin needs are.”

[Read: 15 Sneaky Sources of Sugar.]

In the short term, Rapp worries that his son Turner is at risk for seizures and shock if his blood sugar isn’t managed properly, but in the long term, he worries about much more. “There’s this nagging fear of the complications that can come with the disease – blindness, kidney failure and limb amputation, to name a few," Rapp says. "These are all very real and experienced by many people with Type 1 every year.”

That’s not all Type 1 diabetics experience, says Camillo Ricordi​, director of the ​University of Miami's Diabetes Research Institute. Due to a wealth of misinformation surrounding the disease, people just assume that, like some Type 2 diabetics, Type 1 diabetics developed the disease due to poor lifestyle choices. “If you ask the general public why they think [people] get Type 1 diabetes, the overwhelming number of answers would be because they eat too much, eat too many sweets, don’t get enough exercise or spend too much time in front of a TV – almost like it's their fault or the fault of their parents,” Ricordi says. “Many [Type 1 diabetics] are now advocating even a change in the name​ of the disease to better differentiate the two conditions.” One petition asking the medical community to devise new names for the two diseases garnered more than 9,000 signatures.

Type 1 diabetics are also calling for more awareness of their condition, Goist says. “When one person hears of another adult with diabetes, they [might] assume it is Type 2,” he says. “It is often a source of confusion for some patients as well.”

[Read: How to Manage Type 1 Diabetes As You Age.]

Brian Herrick, JDRF's communications manager, has lived with Type 1 diabetes since he was 3 years old and says he hopes to one day not have to explain to people​ what Type 1 diabetes is. "People find out I have diabetes, and I have to explain that no, I don’t have Type 2," he says. "I’m looking forward to ​a world where people are more informed."
  
But even if some diabetics feel like the public has forgotten about them, researchers have not, Rapp says, and major breakthroughs in Type 1 diabetes treatment are around the corner – the most promising of which is an artificial pancreas.​ “This is a combination of two devices that can work to help a person have really greatglucose control, without having to worry about the lows and highs or actively managing the condition as we do today,” he says.

The device entails a sensor, called a continuous glucose monitor, which a diabetic wears on his or her abdomen, and​ a small probe that gets inserted under the skin​. The sensor detects insulin levels on a real-time basis and is connected to an insulin pump that automatically releases the amount needed​.

The artificial pancreas is primarily aimed at Type 1 diabetics, but it may also work for some Type 2 diabetics. In addition to eliminating the need to inject insulin, it cuts down the number of times diabetics need to prick their fingers to check their blood sugar levels​. “I once saw Turner prick his finger over 100 times in one day,” Rapp says. “This machine may bring that down to the single digits.”

[See: Pharmacists Top Recommended Blood Glucose Monitors.]

The first iteration of the device, the​ MiniMed 530G, was approved by the Food and Drug Administration in September 2013. Rapp says new and improved models are expected to be available in the near future. “Blood sugar can vary significantly from the time someone goes to bed to the time they wake up,” Rapp says. “To have a device that can take the worry out is a great relief, especially for parents.”

Herrick doesn't use an artificial pancreas, but does use a continuous glucose monitor, and says the ability to track trends in his blood sugar has helped him manage his disease better. "When you’re just checking your blood sugar, you’re not getting a dynamic result," he says. "You’re getting a result of that moment in time. Having trends and knowing what my blood sugar was, what it is and what it will be changes how I approach my treatment."

But it’s not just insulin-administering devices that are getting smarter – the insulin itself is as well. A new treatment called Smart Insulin, funded by JDRF, may one day help diabetics stop worrying about calculating how much insulin they need. “It‘s a form of insulin that will continuously circulate in the bloodstream and turn itself on when blood sugar levels are high and off when the levels are in a safe range,” Rapp says.

Smart insulin is a number of years away from being commercially available, but clinical trials are slated to begin later this year.

Rapp’s goal as CEO of JDRF is to find a cure for diabetes, because even though he’s proud of how well his son is managing his condition, Rapp can’t help but think about how much easier Turner's life would be if he didn’t have to. “It’s a truly life changing disease, and there are so many implications that come with it,” he says. “It’s difficult to find words for how much a cure would mean to me and other parents."

If you or someone you love wants to go beyond diabetes, please call us at (206) 909-8022 or visit us at www.RameyNutrition.com

Epidemic proportions: Diabetes on the rise due mostly to poor diet

The incidence of type 2 diabetes in Victoria is spiralling. Picture: PA

DIABETES is reaching epidemic proportions in Victoria with as many as one in four hospital patients suffering from the chronic health condition.

The Australian-first study of more than 2200 patients at 11 hospitals reveals the prevalence of diabetes has been grossly underestimated.

The findings, published in the Medical Journal of Australia, show a quarter of inpatients had diabetes, putting them at increased risks of a longer hospital stay and readmission.

Most of the patients suffered from type 2 diabetes, which is linked to poor diet and lack of exercise, for about a decade. It showed diabetic patients were more likely to be over 40, heavier and taking medication for high cholesterol or blood-thinning drugs.

Based on diabetes prevalence in the Victorian community, the research indicates diabetes increased the risk of hospitalisation threefold.

The patients were receiving treatment for heart disease, infections, diabetes-related surgery or unrelated conditions. They were more likely to spend almost three days longer in hospital than other patients.

The Alfred’s deputy director of endocrinology and diabetes, Professor Leon Bach, said doctors were seeing an “extraordinary number of patients” with diabetes. He said improving assistance given to patients with complex conditions could decrease hospital stays and prevent or delay future complications.

Fewer than 60 per cent of patients in the study could recall being seen by a diabetes educator and or dietitian.

If you or someone you love is ready to go beyond diabetes to a life they love call Ramey Nutrition at (206) 909-8022, or visit is at www.RameyNutrition.com 

What You Should Know About Gestational Diabetes

Despite prenatal care, around five percent of women will develop diabetes during pregnancy. Gestational diabetes is a temporary, but potentially serious problem.  

In this edition of Vital Signs, Dr. Brian Casey, an obstetrician with Parkland Hospital, explains gestational diabetes is part of the physiology of pregnancy.

Listen

The KERA Interview

From Dr. Casey’s interview…

What is gestational diabetes? The placenta releases a hormone during pregnancy. Some women respond to those hormones quite well, and some women cannot deal with the increased insulin resistance and produce enough insulin. So their blood sugar go up during the pregnancy.

How serious or dangerous a condition is this? 

• For the mother:  "...the risks are associated with the delivery and are isolated to the pregnancy. With the higher blood sugar levels in the mother, the fetus sees those blood sugar levels and releases insulin to respond to that. And the insulin release can increase the size of the baby. And that translates into difficulties Mom would have with the delivery and could result in an overgrown baby and increased risk for caesarian delivery."
• For the baby:  "..the risks are immediate. You can very low blood sugars in the baby after the cord is cut. The high blood sugar of the mother is cut off, and the baby’s pancreas is still producing insulin and that drives the blood sugar of the baby down, so the pediatricians need to be very aware of that as well."

Who’s at high risk for gestational diabetes?  "Asian women, from a ethnicity standpoint, are at the highest risk, followed by African American and Hispanic women, with Caucasian women being at the lowest risk. (Do we know why women of color are prone to this?) No, we just know when you look at the demographics these segments of the population are at increased risk. And teasing out the individual risk factors like obesity can be a bit difficult, but when you adjust for that there seems to be an ethnic propensity."

There are no symptoms: "We routinely test women during the pregnancy and that’s the only way a woman would know during the course of pregnancy that she had gestational diabetes."

Treatment:  "We generally treat women with diet and we give them a glucose meter and ask them to check their blood sugar four times a day. And we spend a great deal of time educating our patients on what the diagnosis means, foods to avoid, portion control – all in an effort to keep their blood sugar down so that we can avoid the byproduct of the diagnosis."