Diabetes is widely recognized

What is diabetes?

Diabetes is a disorder of metabolism—the way our bodies use digested food for growth and energy. Most of the food we eat is broken down into glucose, the form of sugar in the blood. Glucose is the main source of fuel for the body.

After digestion, glucose passes into the bloodstream, where it is used by cells for growth and energy. For glucose to get into cells, insulin must be present. Insulin is a hormone produced by the pancreas, a large gland behind the stomach.

When we eat, the pancreas automatically produces the right amount of insulin to move glucose from blood into our cells. In people with diabetes, however, the pancreas either produces little or no insulin, or the cells do not respond appropriately to the insulin that is produced. Glucose builds up in the blood, overflows into the urine, and passes out of the body in the urine. Thus, the body loses its main source of fuel even though the blood contains large amounts of glucose.

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What are the types of diabetes?

The three main types of diabetes are

  • type 1 diabetes
  • type 2 diabetes
  • gestational diabetes

Type 1 Diabetes

Type 1 diabetes is an autoimmune disease. An autoimmune disease results when the body’s system for fighting infection (the immune system) turns against a part of the body. In diabetes, the immune system attacks and destroys the insulin-producing beta cells in the pancreas. The pancreas then produces little or no insulin. A person who has type 1 diabetes must take insulin daily to live.

At present, scientists do not know exactly what causes the body’s immune system to attack the beta cells, but they believe that autoimmune, genetic, and environmental factors, possibly viruses, are involved. Type 1 diabetes accounts for about 5 to 10 percent of diagnosed diabetes in the United States. It develops most often in children and young adults but can appear at any age.

Symptoms of type 1 diabetes usually develop over a short period, although beta cell destruction can begin years earlier. Symptoms may include increased thirst and urination, constant hunger, weight loss, blurred vision, and extreme fatigue. If not diagnosed and treated with insulin, a person with type 1 diabetes can lapse into a life-threatening diabetic coma, also known as diabetic ketoacidosis.

Type 2 Diabetes

The most common form of diabetes is type 2 diabetes. About 90 to 95 percent of people with diabetes have type 2. This form of diabetes is most often associated with older age, obesity, family history of diabetes, previous history of gestational diabetes, physical inactivity, and certain ethnicities. About 80 percent of people with type 2 diabetes are overweight.

Type 2 diabetes is increasingly being diagnosed in children and adolescents. However, nationally representative data on prevalence of type 2 diabetes in youth are not available.

When type 2 diabetes is diagnosed, the pancreas is usually producing enough insulin, but for unknown reasons the body cannot use the insulin effectively, a condition called insulin resistance. After several years, insulin production decreases. The result is the same as for type 1 diabetes—glucose builds up in the blood and the body cannot make efficient use of its main source of fuel.

The symptoms of type 2 diabetes develop gradually. Their onset is not as sudden as in type 1 diabetes. Symptoms may include fatigue, frequent urination, increased thirst and hunger, weight loss, blurred vision, and slow healing of wounds or sores. Some people have no symptoms.

Gestational Diabetes

Some women develop gestational diabetes late in pregnancy. Although this form of diabetes usually disappears after the birth of the baby, women who have had gestational diabetes have a 20 to 50 percent chance of developing type 2 diabetes within 5 to 10 years. Maintaining a reasonable body weight and being physically active may help prevent development of type 2 diabetes.

About 3 to 8 percent of pregnant women in the United States develop gestational diabetes. As with type 2 diabetes, gestational diabetes occurs more often in some ethnic groups and among women with a family history of diabetes. Gestational diabetes is caused by the hormones of pregnancy or a shortage of insulin. Women with gestational diabetes may not experience any symptoms.

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How is diabetes diagnosed?

The fasting blood glucose test is the preferred test for diagnosing diabetes in children and nonpregnant adults. It is most reliable when done in the morning. However, a diagnosis of diabetes can be made based on any of the following test results, confirmed by retesting on a different day:

  • A blood glucose level of 126 milligrams per deciliter (mg/dL) or more after an 8-hour fast. This test is called the fasting blood glucose test.

  • A blood glucose level of 200 mg/dL or more 2 hours after drinking a beverage containing 75 grams of glucose dissolved in water. This test is called the oral glucose tolerance test (OGTT).

  • A random (taken at any time of day) blood glucose level of 200 mg/dL or more, along with the presence of diabetes symptoms.

Gestational diabetes is diagnosed based on blood glucose levels measured during the OGTT. Glucose levels are normally lower during pregnancy, so the cutoff levels for diagnosis of diabetes in pregnancy are lower. Blood glucose levels are measured before a woman drinks a beverage containing glucose. Then levels are checked 1, 2, and 3 hours afterward. If a woman has two blood glucose levels meeting or exceeding any of the following numbers, she has gestational diabetes: a fasting blood glucose level of 95 mg/dL, a 1-hour level of 180 mg/dL, a 2-hour level of 155 mg/dL, or a 3-hour level of 140 mg/dL.

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What is pre-diabetes?

People with pre-diabetes have blood glucose levels that are higher than normal but not high enough for a diagnosis of diabetes. This condition raises the risk of developing type 2 diabetes, heart disease, and stroke.

Pre-diabetes is also called impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), depending on the test used to diagnose it. Some people have both IFG and IGT.

  • IFG is a condition in which the blood glucose level is high (100 to 125 mg/dL) after an overnight fast, but is not high enough to be classified as diabetes. (The former definition of IFG was 110 mg/dL to 125 mg/dL.)

  • IGT is a condition in which the blood glucose level is high (140 to 199 mg/dL) after a 2-hour oral glucose tolerance test, but is not high enough to be classified as diabetes.

Pre-diabetes is becoming more common in the United States, according to new estimates provided by the U.S. Department of Health and Human Services. About 40 percent of U.S. adults ages 40 to 74—or 41 million people—had pre-diabetes in 2000. New data suggest that at least 54 million U.S. adults had pre-diabetes in 2002. Many people with pre-diabetes go on to develop type 2 diabetes within 10 years.

The good news is that if you have pre-diabetes, you can do a lot to prevent or delay diabetes. Studies have clearly shown that you can lower your risk of developing diabetes by losing 5 to 7 percent of your body weight through diet and increased physical activity. A major study of more than 3,000 people with IGT, a form of pre-diabetes, found that diet and exercise resulting in a 5 to 7 percent weight loss—about 10 to 14 pounds in a person who weighs 200 pounds—lowered the incidence of type 2 diabetes by nearly 60 percent. Study participants lost weight by cutting fat and calories in their diet and by exercising (most chose walking) at least 30 minutes a day, 5 days a week.

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What are the scope and impact of diabetes?

Diabetes is widely recognized as one of the leading causes of death and disability in the United States. In 2002, it was the sixth leading cause of death. However, diabetes is likely to be underreported as the underlying cause of death on death certificates. About 65 percent of deaths among those with diabetes are attributed to heart disease and stroke.

Diabetes is associated with long-term complications that affect almost every part of the body. The disease often leads to blindness, heart and blood vessel disease, stroke, kidney failure, amputations, and nerve damage. Uncontrolled diabetes can complicate pregnancy, and birth defects are more common in babies born to women with diabetes.

In 2002, diabetes cost the United States $132 billion. Indirect costs, including disability payments, time lost from work, and premature death, totaled $40 billion; direct medical costs for diabetes care, including hospitalizations, medical care, and treatment supplies, totaled $92 billion.


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Walking for 45 minutes helps to control diabetes

People with diabetes can limit the impact of the condition simply by walking for an extra 45 minutes a day, according to scientists who found exercise helped to keep blood sugar levels in check.

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Scientists at Newcastle University studied people with late-onset, or type 2, diabetes. They found that walking improved their bodies' ability to store sugar and burn fat, which after a few weeks reduced the effects of diabetes.

And here is the rest of it.

In Britain, more than 2.3 million people have diabetes. Around 90% of them have the type 2 form, which is linked to obesity and a sedentary lifestyle. If left untreated it can lead to blood vessel damage that triggers heart disease, strokes, and can require patients to have limbs amputated.

"This gives people an immediate way to help control diabetes without any additional drugs. It's a simple message," said Michael Trenell, whose study appears in the journal Diabetes Care today. Trenell's team used MRI scanners to measure how efficiently 20 volunteers, 10 of whom had type 2 diabetes, burned energy in their leg muscles before and after taking part in the eight-week trial.

Each volunteer was given a pedometer and asked to walk more than 10,000 steps a day. On average, people take around 6,000 steps during their daily routine.

The scans revealed that by being more active, diabetics burned 20% more fat and were able to store more sugar in their muscles.

Muscles are the biggest storage depots for sugar in the body, but when they fail to absorb enough, sugar levels stay abnormally high in the bloodstream, causing damage to veins, arteries and organs.

"People often find the thought of going to the gym quite daunting, but we've found that nearly everyone with diabetes is able to become more active through walking. Many people got off the bus a few stops earlier," said Trenell.

Iain Frame at Diabetes UK said the study proved that "even gentle physical activity is vital in managing type 2 diabetes".


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Diabetes Experts Recommend New Therapy for Diabetes

For the first time, a consensus of diabetes and metabolic disorder experts have recommended a comprehensive treatment regimen for patients with pre-diabetes. The recommendations call for specific guidelines on both lifestyle, and pharmaceutical intervention where appropriate. The recommendations are made in a Consensus Statement released this morning by the American Association of Clinical Endocrinologists (AACE).
Pre-diabetes is a condition defined by elevated fasting glucose levels or impaired glucose tolerance. According to the Centers for Disease Control (CDC), more than 56 million Americans currently have the condition, which leaves patients at risk, not only for developing type 2 diabetes, but also for cardiovascular complications. This is an extension of the effort to recognize and treat type 2 diabetes earlier and more aggressively.
Diabetes Expert However, at this time, there are no pharmacologic therapies that have been approved by the FDA for prevention of the conversion of pre-diabetes to diabetes. That's why the expert panel has recommended a two-pronged approach to treating pre-diabetes. The first is intensive lifestyle management to prevent the progression to type 2 diabetes.
"As individuals and as a society, we need to address those forces which are creating the epidemic of obesity, diabetes, and pre-diabetes," said Yehuda Handlesman MD, FACP, FACE, Treasurer of AACE and Medical Director of the Metabolic Institute of America. "We understand the difficulties in implementing solutions, but as an association of endocrinologists we are committed to supporting community and national efforts in every way we can."
The recommendation calls for patients to adhere to the guidelines set forth in the Diabetes Prevention Program, established by the United States government.
"Although lifestyle can clearly modify the progression of patients towards overt diabetes, it may not be sufficient," said Alan J. Garber, MD, PhD, FACE, Professor of Medicine, Baylor College of Medicine, Houston, and Chairman of the Consensus Conference. "Medications may well be required, particularly in high risk groups."
The second approach is to prevent the development of cardiovascular complications, and to help those patients where lifestyle modifications have been insufficient to modify cardiovascular risk factors. This requires cardiovascular risk reduction medications for abnormal blood pressure and cholesterol independent of glucose control medications.
"The data show that there is a spectrum of severity, with the most severely affected approaching the risks of people with diagnosed type 2 diabetes," said Daniel Einhorn, MD, FACP, FACE, Vice President of AACE and Medical Director of the Scripps Whittier Institute for Diabetes in La Jolla, CA. "In these highest risk individuals, who represent a minority, pharmacologic strategies may be appropriate if intensive lifestyle therapies fail. Regardless, all individuals at risk for diabetes should be aware of the level of their risk factors and be prepared to take action."
While the number of people with pre-diabetes in the United States exceeds 56 million, most patients with the condition have not been diagnosed. People are considered high risk if they have near diabetic levels of blood glucose, hypertension, or abnormal lipid profiles. These patients should consider working with their doctor to monitor their status.
The preliminary publication of the Consensus Statement is available at media.aace.com. The final document will be published later this year in Endocrine Practice, the Journal of the American Association of Clinical Endocrinologists.


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Sugar Substitutes Elevate a Bitter Debate

People seem to take sweeteners personally — responding in angst, argument or even anger. How can a substitute for sugar (that has a measly 16 calories per teaspoon) create such an uproar? Enter the blog! At last a medium where dialogue can reign.

What triggered my interest in discussing this subject was a study by Swithers and Davidson in the February 2008 issue of "Behavioral Neuroscience."

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We know that sweet taste from sugar is a powerful trigger that prompts the mind and body to eat and to process calories. However, when the researchers fed rats a food sweetened with a no calorie sweetener — food that was actually lower in total calories — the rats actually ate more food and gained more weight than rats given sugar sweetened food that was higher in total calories. In addition to eating more of the no-calorie sweetened food, the rats also adjusted their body processes to burn fewer calories — contributing to increased body weight and fat.

They discuss the potential implications of their findings:  the increases in the numbers of Americans consuming products containing low/no calorie sweeteners from about 70 million in 1987 to about 160 million in 2000, and that low/no calorie sweeteners abound in a wide variety of foods (especially in the form of soft drinks). That the incidence of obesity has also increased dramatically during this period, from about 16 percent of the population to about 30 percent.

They also site a recent human study from the July 31, 2007, issue of "Circulation" that suggested that intake of one or more regular or diet soft drinks was associated with a greater than 50 percent incidence of metabolic syndrome (obesity, inches around the abdomen, higher fasting blood sugar and fat levels, and higher blood pressure).

Could it be that low/no-calorie sweeteners (and foods containing them) fake us into consuming and conserving more calories than if we simply eat the food that has the real (calorie-containing) sugar in it?

My take? Low/no calorie sweetened foods sometimes offer a lower calorie alternative to foods sweetened with sugar (check the label to make sure). There are studies that also show that low/no calorie sweetened foods are helpful for controlling weight. The rat study gave me pause though.

For me — I'll take sugar-sweetened items on special occasions and in moderation. We get ample "sugar" naturally from whole foods and don't need sweets every meal, every day. Safety of these low/no calorie sweeteners? I'm going to save this topic for another time.

Your take on low/no calorie sweeteners? Angst? Argument? Anger? I want to hear from you.


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New Recommendations for Prediabetes

If you're one of the estimated 57 million people in the U.S. with prediabetes, an expert medical committee has some advice for you.

The committee, assembled by the American College of Endocrinology and the American Association of Clinical Endocrinologists, has been meeting in Washington, D.C., for the last two days talking about prediabetes.

prediabetes patient

Here are their recommendations for dealing with prediabetes:

Don't blow it off. In prediabetes, blood sugar levels are above normal but not high enough to be classified as diabetes -- yet. But prediabetes isn't harmless; it makes diabetes (and its many complications) more likely. And it's a risk for your heart right now.

The bottom line: Prediabetes is an immediate risk and a shadow hanging over your future health. So get aggressive about dealing with it now. Don't wait until it gets worse.

Focus on lifestyle. "Lifestyle is the first way to go" in dealing with prediabetes, committee member Yehuda Handelsman, MD, FACP, FACE, medical director of the Metabolic Institute of America, said today at a news conference about the committee's prediabetes recommendations.

Here are the steps the committee wants you to take:

    * Lose 5% to 10% of your body weight -- for good.
    * Get 30-60 minutes of moderate-intensity physical activity at least five days per week.
    * Eat low-fat diet with adequate dietary fiber.
    * To lower blood pressure, cut back on sodium and don't drink too much alcohol.
    * Take aspirin, unless you have a medical reason not to (ask your doctor first).
    * Get your blood pressure and cholesterol down to the levels recommended for diabetes patients.

Take medication, if needed. If lifestyle isn't enough to reduce your risk of diabetes and heart disease, medications may help. But you'll still need to persist with the healthy lifestyle.

Don't get hung up on numbers. The blood sugar benchmarks for diagnosing diabetes are "somewhat arbitrary," says Alan Garber, MD, PhD, FACE, the committee's chairman and a professor at Baylor College of Medicine in Houston. If your blood sugar numbers are outside of the normal range, that's enough of a cue to take action.

The committee also called for further research to find out which prediabetes patients are at the highest risk, and to study drug treatment for prediabetes. The committee's work was sponsored by various drug companies.


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Maternal Obesity Increases Diabetes Risk For Female Offspring

Maternal obesity has been associated with diabetic complications in the resulting offspring, according to experiments in mice reported recently by researchers at the University of Louisville.
Obesity is presently a worldwide health issue, and it is commonly considered a risk factor for diabetes, cardiovascular disease, and stroke. When a pregnant woman is obese, her children can be affected by malformation, functional abnormalities, obesity, and type II diabetes. Since, presently, over 18% of American women are classified as obese, and between 18 and 38% of pregnant women meet this criteria, it is an important issue in maternal and child health in this country. However, very little is known about the mechanism of the link between maternal obesity and diabetic effects in offspring.
r163150_600877 To investigate this association, Dr. Jianxiang Xu and Junying Han of the University of Louisville first established a viable animal model to function similarly to maternal diabetes might in humans. Female mice, genetically predisposed to obesity and further marked with a yellow coat color, were mated with normal mice, whose offspring could then be classified by coat color for this obesity gene. The obesity prone mice were obese between 6 and 8 weeks of age, but maintained normal blood glucose levels. Offspring from these and from normal crosses were then fed with normal food for up to 15 weeks, then fed with a high fat diet, and examined by sex, and the mother's obesity status. In this first portion of the study, the birth weight of offspring from obese mothers was 14% higher than in the control group.
When the offspring, at 50 weeks of age, were administered 2 mg glucose per kg body weight. This resulted in similar glucose levels in each group, but major differences in the serum insulin levels. Namely, in female offspring from obese mothers, there was a significant increase in serum insulin levels, while females from obese mothers and males showed no significant differences. This indicates that β cell function was impaired in the female offspring of obese mothers.
To confirm this link, a second experiment was performed. Pancreatic cells were isolated from 50 week old offspring to be tested in vitro for insulin excretion. Cells from mice with a normal diet showed normal secretion, but in the high fat diet, insulin secretion was sharply reduced in offspring from an obese mother, especially when exposed to a high glucose concentration. The measure of other enzymes related to glucose metabolism such as transketolase, GAPDH, and PFK in the cells of the 50 week old mice indicated a decrease in production by the β cells ranging from 31% to 70% for those born to an obese mother. 
According to the researchers, this shows that obesity in pregnancy is a factor by itself to impaired glucose tolerance in offspring, which could contribute to the development of gestational diabetes in the mother and type II diabetes in the offspring. Additionally, since there are many mothers who are obese without displaying gestational diabetes, this obesity might be a greater factor in the health of their children than previously expected.


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