Beat it

Beat it

Eating Carbs Last Could Be the Next Miracle Diet for Diabetics


By ReneeJohnson

A new study suggests that type 2 diabetes patients may benefit from eating their carbohydrates after vegetables and proteins. Weill Cornell Medical College nutritionists found that the order of the food significantly influences insulin and glucose levels at the end of one meal.
The study was published Tuesday in the journal Diabetes Care.
Dr. Louis Aronne, lead author of the research and clinical medicine expert, said that doctors shouldn’t solely rely on medication when treating diabetes patients. Instead they should also recommend that their patients make some changes in their diet including food order.
Dr. Aronne acknowledged that people find it very hard to change their eating habits. So, bluntly asking a diabetes patient to cut down on their carbohydrate intake or merely reduce it is often a challenging task and few manage to comply.
“This study points to an easier way that patients might lower their blood sugar and insulin levels,”added Dr. Aronne.
Blood sugar levels play a crucial role in a diabetes patient’s life. If the patient fails to maintain blood sugar on normal levels, the disease may lead to further complications including stroke and heart conditions.
Weill Cornell researchers said that they learned about the link between food order and lower blood sugar levels from previous studies. But those studies weren’t focused on the rich Western meals.
During the study, participants were asked to consume the same meal consisting in proteins (chicken breast), vegetables (steamed broccoli, lettuce and tomato salad), fats (low-fat dressing and butter), and carbohydrates (ciabatta bread).
The study involved 11 type 2 diabetes patients who were on medication and also diagnosed with obesity. Participants were asked to eat as they normally would and they had their glucose levels checked. The next day they were requested to eat carbohydrates first and wait 15 minutes before resuming meal.
Over the course of one week, researchers made different experiments with food order and constantly monitored blood sugar levels every 30, 60 and 120 minutes after the meal.
The study showed that blood sugar levels were lower by 29 percent after 30 minutes, 37 percent after an hour and 17 percent after two hours whenever study participants ate their carbohydrates last. Insulin levels were also influenced by the food order.
Researchers hope that the new findings may help diabetics make minor adjustments to their diet with long-lasting positive benefits on their health. But the team admitted that the results are only preliminary and more studies needed to be conducted.


Diabetic diet: 20 healthy foods for diabetics



A diabetic diet consists of foods that are healthy for a controlled diabetic diet. This comprises a list of foods for diabetics that is high in fiber, antioxidants, and vitamins and minerals. The list of foods that we have included in this diabetics diet slideshow are also familiar and easy to find. These are not the only food for diabetics, but including them in your diabetes meal plan will help improve your overall health.

High fiber
High fiber foods are known to lower blood cholesterol and blood sugar levels. Whole grains, oats, channa atta, millets and other high fiber foods should be included in foods for diabetics. Maida, sooji, noodles, pasta should be avoided. If one feels like consuming pasta or noodles, it should always be accompanied with vegetable /sprouts.

Beans
Beans have always been the undervalued protein that could work best when used as a substitute for meat. They stay in your digestive system longer and add to the feeling of fullness and a satisfied feeling, aiding weight management, a very good example for food for diabetics. To save time cooking beans, use a pressure cooker. Soaked beans are tender in just 10 to 15 minutes.

Barley
Barley is great for a healthy diet. Barley includes both soluble and insoluble fiber in abundance. It can be added to soups, cereal and salads.
This food for diabetics reduces the rise in blood sugar after a meal by almost 70 per cent, and hence keeps your blood sugar lower and steadier for hours.

Carrots
While the type of sugar they contain is transformed into blood sugar quickly, the amount of sugar in carrots is extremely low. This food for diabetics are one of nature's richest sources of beta-carotene, which is linked to a lower risk of diabetes and better blood-sugar control.

Asparagus
Scientists have found regular intake of the increasingly popular vegetable keeps blood sugar levels under control and boosts the body's production of insulin, the hormone that helps it to absorb glucose, the Daily Mail reported.

Milk
Milk is the right combination of carbohydrates and proteins and helps control blood sugar levels. Two servings of milk in a daily diet is a good option as a fod for diabetics, however other product like curds, butter milk and or cottage cheese are also good substitutes. But, one should ensure that low fat milk is consumed, as fat in milk is not healthy and also adds to extra calories.

Vegetables and pulses
Vegetables are a good source of vitamins and fiber. High fiber vegetables such as peas, beans, broccoli and spinach /leafy vegetables should be included as food for diabetics. Also, pulses with husk and sprouts are a healthy option and should form a part of the diet.

Good quality fat
It is important to choose fats wisely as some fats are healthier for the body than others. One should carefully choose cooking oils that are high in MUFA (Monounsaturated Fat) as these fatty acids control bad cholesterol and control diabetes as well. High N3, with low saturated fatty acid content is another good property of oil. Canola is the right option as a food for diabetics with all these healthy properties for diabetes and heart health and is a good recommendation as cooking oil.

Olive oil
Unlike butter, the good fat in olive oil won't increase insulin resistance and help reverse it. A touch of olive oil also slows digestion, so your meal is less likely to spike your glucose. As a food for diabetics use them in salads, pastas and starters.
Fruits
Fruits high in fiber such as papaya, apple, orange, pear and guava should be consumed. Fruits contain fructose which does not let the blood sugar levels rise immediately and thus can be easily consumed as food for diabetics. However, calories from excess intake remain.

Apples
Apples are naturally low in calories, yet their high fibre content. This food for diabetics fills you up, battles bad cholesterol, and blunts blood-sugar swings. Eat them whole and unpeeled for the greatest benefit, or make a quick baked apple.

Berries
Berries are full of fibre and antioxidants. The red and blue varieties also contain natural plant compounds called anthocyanins. Scientists believe these may help lower blood sugar by boosting insulin production.

Broccoli
Broccoli is filling, fibrous, and full of antioxidants. It's also rich in chromium, which plays an important role in long-term blood sugar control. Use this food for diabetics in soups, pasta dishes, and casseroles, or saute it with garlic, soy sauce, or for a taste you'll fall for.

Flaxseeds
They're rich in protein, fibre, and good fats similar to the kind found in fish. They're also a source of magnesium, a mineral that's key to blood-sugar control because it helps cells use insulin. The best way to have this food for diabetics in in the morning as soon as you get up. A tablespoon of it works wonders.

Oatmeal
Oatmeal is loaded with soluble fibre which, when mixed with water, forms a paste. Just as it sticks to your bowl, it also forms a gummy barrier between the digestive enzymes in your stomach and the starch molecules in your meal. So it takes longer for your body to convert the carbs you've eaten into blood sugar. This dieter's food can be best used as a food for diabetics in breakfasts, porridges, soups and casseroles.
Fish
According to a Harvard School of Public Health study eating fish just once a week can reduce your risk of heart disease by 40 per cent. The fatty acids in fish reduce inflammation in the body—a major contributor to coronary disease—as well as insulin resistance and diabetes. Grilled fish is a good food for diabetics

Small frequent meals
A large meal gives rise to higher blood sugar in one's body, therefore it is essential to take small frequent meals to prevent both higher and very low blood sugar values and keep them constant. Food for diabetics should consists of small in between snacks can be dhokla, fruit, high fiber cookies, butter milk, yogurt, upma/poha with vegetables etc.

Yogurt
Yogurt is rich in protein and another weight loss powerhouse: calcium. Several studies have shown that people who eat plenty of calcium-rich foods have an easier time losing weight- and are less likely to become insulin resistant.
Choose yogurt as a food for diabetics by including it in your breakfast, add fruits to it or sprinkle a low-fat granola for extra nutrients.

Nuts
Nuts are full of 'good' fats that fight heart disease. These fats have even been shown to help reduce insulin resistance and make blood sugar easier to control. Nuts are also one of the best food sources of vitamin E, an antioxidant that protects cells and may help prevent nerve and eye damage. They are rich in fiber and magnesium, both of which may help regulate your blood sugar.

Cereal
The right breakfast cereal is the absolute food for diabetics, it's the best opportunity to pack more fiber into your day.



In 1962, six year old John Tuohy, his two brothers and two sisters entered Connecticut’s foster care system and were prompltyl spilit apart. Over the next ten years, John would live in more then ten foster homes, group homes and state schools, from his native Waterbury to Ansonia, New Haven, West Haven, Deep River and Hartford. In the end, a decade later, the state returned him to the same home and the same parents they had taken him from. As tragic as is funny complelling story will make you cry and laugh as you journey with this child to overcome the obsticales of the foster care system and find his dreams.
http://www.amazon.com/No-Time-Say-Goodbye-Memoir/dp/0692361294/


Disabling Infection-Fighting Immune Response Speeds Up Wound Healing in Diabetes



University Park, PA (Scicasts) — One of the body's tools for fighting off infection in a wound may actually slow down the healing process, according to new research by a team of Harvard University, Boston Children's Hospital, and Penn State University scientists.
In a study published online in Nature Medicine on June 15, 2015, the researchers show that they can speed up wound healing in diabetic mice by preventing immune cells called neutrophils from producing structures called NETs (neutrophil extracellular traps) that trap and kill bacteria.
"In the fight against bacterial infection, NETs cause collateral damage that slows healing," said Yanming Wang, associate professor of biochemistry and molecular biology at Penn State and a member of the research team.
NETs are thought to reduce the risk of infection in a wound but they also form a dense, toxic mesh that interferes with the mobilization of new healthy cells and hinders tissue repair. The process is even more of a problem in individuals with diabetes, whose neutrophils produce more NETs. As a result, delayed wound healing is a common complication of both type 1 and type 2 diabetes.
To see how diabetes increases a neutrophil's ability to produce NETs, the researchers examined neutrophil cells from patients with either type 1 or type 2 diabetes. They found that these neutrophil cells contained four times the normal amount of the PAD4 enzyme -- a protein that catalyzes the production of NETs. Further experiments revealed that neutrophils from healthy donors or mice that were exposed to excessive glucose -- mimicking diabetes -- also were more likely to release NETs than neutrophils that were exposed to normal glucose levels.
Diabetic mice in the study had more NETs in wounds and healed more slowly than normal mice. However, when the team examined diabetic mice that lacked the PAD4 enzyme they found that the wounds of these mice healed more quickly. "Neutrophils of individuals with diabetes are primed to form NETs by high levels of PAD4, but when we eliminate or control the expression of the PAD4 enzyme in mice with diabetes, we can prevent NETs from forming and speed up healing," Wang said. "It remains to be tested if pharmacological intervention of PAD4 activity will benefit the healing process."
"NETs predispose patients to inflammation, heart disease, and deep-vein thrombosis -- dangerous blood clots that form within veins deep inside the body -- all of which are elevated in patients with diabetes," said the senior author of the study Denisa Wagner, senior investigator of the Program in Cellular and Molecular Medicine at Boston Children's Hospital and Edwin Cohn Professor of Pediatrics at Harvard Medical School. "Any injury that causes inflammation will result in the production of NETs, and we think that if the injury involves skin repair, NETs will hinder the repair process."
When the skin is cut or broken, the body mobilizes a complicated array of cells and proteins to stop bleeding, prevent infection by triggering inflammation, and start the healing process. As part of the inflammatory response, neutrophils, which ingest and destroy bacteria, expel their own chromatin -- a mix of DNA and associated proteins -- in the form of NETs within the wound.
To see whether breaking up the NETs would have an effect similar to preventing their production, the research team treated mice with DNase 1 -- an enzyme that breaks up DNA and therefore can destroy NETs. After three days, wounds on DNase 1-treated diabetic animals were 20 percent smaller than on untreated animals. Interestingly, DNase 1 treatment appeared to accelerate wound healing in healthy mice, as well.
"The anti-microbial function of NETs may have been more important in the days before antibiotics were common and infections were a more pressing concern for human health," said Wang. "Now, as humans live longer lives, we may be able to reduce the detrimental effects of NETs in chronic diseases like diabetes, rheumatoid arthritis, and heart disease by controlling expression of the PAD4 enzyme.”

Article adapted from a Penn State news release.

Publication: Diabetes primes neutrophils to undergo NETosis, which impairs wound healing. Siu Ling Wong, Melanie Demers et al. Nature Medicine (June 2015): Click here to view.



15 minute 'sleeve' implant to revolutionise type 2 diabetes treatment



A 'SLEEVE' implant that takes 15 minutes to administer could revolutionise the treatment of type 2 diabetes.

By John Reynolds

A wide-ranging study is to provide "definitive evidence" that the tiny EndoBarrier could be a more effective treatment than diet, exercise and medication in the fight against the disease.
Medics have hailed the implant as potentially a game-changer while Diabetes UK said the new study could prove "vital" in treating a disease which impacts nearly 3m people in the UK.
Professor Julian Teare, who is leading the new study into EndoBarrier, has lauded the treatment's ability to bypass surgery.
Professor Teare said it could help " treat thousands more people living with type 2 diabetes every year".
EndoBarrier has already been successfully trailed during a 12-week study, which boasted remarkable results.
Patients showed a dramatic drop in blood glucose levels withn weeks of receiving the implant reducing the need for diabetes medication.
Furthermore, patients in the trial also achieved significant weight loss similar to that seen following gastric band surgery.
Now, the treatment is being tested over a 24-month period before its expected roll out into the market in the next few years.
James Byrne, a consultant surgeon and co-lead on the 12-week study, said: "We know weight loss surgery is currently the most effective and longest-standing treatment option for type 2 diabetes.
"However, it is not the right approach for everyone and will not significantly impact the epidemic of type 2 diabetes we see in the UK.
Type 2 diabetes is a serious and growing problem that can lead to devastating complications and early death. Studies like this one are vital for helping us find new treatments to allow people to manage the condition more effectively.
Dr Richard Elliott, Diabetes UK Research Communications Manager
"Other strategies for this condition are urgently required and our research will confirm whether or not EndoBarrier therapy can help to deliver and, more importantly, sustain improvements in diabetes control."
The treatment works by placing the EndoBarrier into the small intestine via the patient's mouth.
The EndoBarrier is a balloon-type device made from flouropolymer, a material known for its high resistance to acids.
It takes just 15 minute to put in place and acts as a barrier to prevent food being absorbed.
Dr Richard Elliott, Diabetes UK Research Communications Manager, said: "Type 2 diabetes is a serious and growing problem that can lead to devastating complications and early death.
Studies like this one are vital for helping us find new treatments to allow people to manage the condition more effectively.
Though less invasive than weight loss surgery, the approach on trial still involves a general anesthetic and so won't be for everyone.
Nevertheless, we will look forward to the results of this work with interest.
At present, the best way to manage Type 2 diabetes is by taking medication prescribed by your doctor and by maintaining a healthy weight through regular exercise and by eating a healthy balanced diet that is rich in fresh vegetables and fruit and low in salt, fat and sugar."




I swear I hate to brag and I’m not really, I’m sharing my joy and wonder with all of you.


No Time to Say Goodbye: A Memoir of a Life in Foster Care

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Inhaled insulin may eventually mean no more shots for some diabetics


Arlene Karidis, Washington Post

Rebecca Killion gives herself several insulin shots a day, a regimen she has followed for 16 years, to help control her blood sugar. It’s been tough, and still her glucose fluctuates a lot. So she is thinking about beginning a new drug — an inhaled insulin that would mean fewer of the needles she loathes. She hopes it comes with the bonus of better managing her diabetes, reducing risk of damage to her kidneys, eyes and other organs.
The 57-year-old Bowie, Md., woman heard about Afrezza while it was in clinical trials. Intrigued, she became the patient representative on the Food and Drug Administration panel that provided the feedback leading to the drug’s approval and then its commercial release in February.
Killion and other panel members reviewed reports from the drug’s manufacturer, MannKind, studied clinical trials and read through the FDA’s own reports. They determined, she said, that Afrezza had potential as an effective way to control glucose with fewer injections.
Some diabetes doctors are cautiously optimistic that this type of insulin could make life easier for patients who are averse to needles and possibly yield better outcomes. Diabetics inhale a dose before each meal to avoid glucose spikes after eating.
People with Type 1 diabetes — the less prevalent form, in which the body does not produce insulin — still need a daily injection to provide long-lasting insulin.
Type 2 diabetics — whose bodies don’t make enough insulin or are resistant to it — can use the inhaled version along with pills, though doctors say some may need a daily injection.
Some clinicians are skeptical. They feel it’s too early to know if the drug has therapeutic benefits. Its long-term safety and efficacy are still under investigation. The package carries an FDA label warning of health risks for people with chronic lung disease. It advises that Afrezza is not recommended for people who smoke or recently stopped smoking or for children.
Afrezza comes in premeasured cartridges that patients insert into a small device. They close it and inhale on its tip.
Killion was 38 when she was diagnosed with Type 2 diabetes, and although that wasn’t the best health news, at least her doctor thought her illness could be managed with pills.
Three years later, she lapsed into a diabetic coma.
“I woke up after a few days and heard I had Type 1 diabetes and needed injections every day for the rest of my life,” she said.
She tried an earlier form of inhaled insulin, Exubera, which was taken off the market in 2007 after a year and a half because of inadequate sales. Killion found the device was awkwardly large and not user-friendly.
“It was like a bong,” said Killion, adding that dosing units were different from liquid insulin, so patients had to figure out conversions, unlike with the new drug.
About 29 million Americans, more than 8 million of them undiagnosed, have diabetes, according to the Centers for Disease Control and Prevention. Some may have no symptoms for years, says Robert Ratner, chief scientific and medical officer for the American Diabetes Association, based in Alexandria.
Some people inject themselves three or more times a day, sometimes for 50 or 60 years, tempting them to stop the grueling routine, and interrupting treatment can be dangerous.
“People take an insulin holiday because it’s hard to do that often and long,” Ratner said. “And there are negative social perceptions that deter insulin usage.”
Many diabetics, he said, are not comfortable taking out a syringe and injecting themselves in public — in the lavatory of a restaurant, for example, before having a meal.
“We don’t know if Afrezza will do better, but a lot of lessons were learned from Exubera,” Ratner said, “and this is a better product.”
Killion has gotten her share of suspicious looks when she takes out her insulin vial and needle case in public or at work. “I was in a conference,” she said, recalling one experience, “and a woman yelled from across the table, ‘What are you doing?’ ”
Studies report that Afrezza reaches peak levels in 12 to 15 minutes, vs. an hour with injected insulin. And the body returns to pre-meal insulin levels quicker.
“This means Afrezza matches [natural body] dynamics of food intake and absorption well,” said Janet McGill, an investigator on Afrezza trials at the Washington University School of Medicine in St. Louis.
The most common adverse reactions are cough, throat irritation and hypoglycemia (low blood sugar); people with chronic lung problems may experience wheezing and constriction of air passages in the lungs.
The FDA is requiring further study to evaluate safety and efficacy in children. And Afrezza will be evaluated for cardiovascular risk and its long-term effect on pulmonary function.
As a precaution, patients must be monitored for lung function, said Dan Lorber, a New York endocrinologist who was among the investigators involved in the drug studies.
Some endocrinologists are pleased that patients who may benefit from the drug would no longer have to plan their doses of insulin in advance of meals. Nor would they have to refrigerate it.
Farhad Zangeneh, an endocrinologist in Sterling, Va., began his first patient on Afrezza in March. The patient had long-standing, poorly controlled Type 2 diabetes, despite a daily long-acting injection, multiple pills, a good diet and exercise. Even that one shot was hard, as he deeply feared needles. Rather than amp up the injections, Zangeneh prescribed Afrezza.
“His glucose profile improved immediately and he has not had hypoglycemia,” he said.
Zangeneh has his patients take classes to learn how to use the inhaler, how the drug works and what the alternatives are.
“I want to make sure they understand not only how to use Afrezza, but other options. Then, if they have no lung issues and do not smoke, if they prefer inhaled insulin, I have no reservations,” he said.
Natasa Janicic-Kahric, an endocrinologist at MedStar Georgetown University Hospital in Washington, just began her first patient on Afrezza. The patient was badly bruised from years of insulin injections, and consequently was not absorbing it well. Janicic-Kahric hopes the inhaled drug will be more readily used by her body. She is also discussing this option with several patients who say they’ve grown weary with multiple injections.
“The inhaled option is convenient,” she said. “But I would prefer to wait a little longer to conclude whether it is effective.”
Janicic-Kahric is not sure she will offer it to Type 1 patients, uncertain it can provide the precise glucose control they require, since it comes in prepackaged doses. With injections, patients can vary the amount of insulin they receive by tiny amounts.
“Type 1 diabetics are much more sensitive to insulin, and even one unit too high or low can have a significant impact,” she said. “I’m hoping with time we will have more dosing options. Then I would more readily prescribe for Type 1.”
Zangeneh said he, too, would rarely prescribe Afrezza for Type 1 diabetics. If they are averse to shots, he prefers that they use a pump, which delivers insulin through a catheter placed under the skin.
Some endocrinologists are pleased that patients who may benefit from the drug would no longer have to plan their doses of insulin in advance of meals. Nor would they have to refrigerate it.
“They can sit at a table anywhere, take their inhaled insulin, and begin to eat right away,” Janicic-Kahric said.
Afrezza’s wholesale cost is about double that of injected insulin. But it should not cost consumers more. The company commercializing it, Sanofi, caps co-pays at $30, said Stefan Schwarz, vice president and head of U.S. marketing for Afrezza at Sanofi.
Killion is hopeful that Afrezza will help with an ongoing balancing act.
“After I eat, my glucose can go from 120 to 280 in 45 minutes. When it starts to come down, my insulin kicks in, and sometimes I get sugar lows because I have inadvertently overcorrected. It lingers and affects the next dose. It seems you are always chasing highs,” she said.
“Based on the literature, this insulin tends to act more like how my body would if I didn’t have this illness.”
What makes Killion happiest is that insulin-dependent diabetics may have a choice besides sticking something into their bodies.
“This is for the rest of their lives, and it gets old, taking five, six shots a day. An option other than a needle is huge.”
Karidis is a freelance health writer.


Can Not Having Enough to Eat Lead to Poor Diabetes Management?


Written by Samantha Boyd
Category: Health News
Published: 15 June 2015

Boston, Massachusetts - Latinos who worry about having enough food to eat (so-called food insecurity) report having a poorer diet and exhibit worse glycemic control than those who aren't worried about having sufficient food to survive, according to a study presented at the American Diabetes Association's 75th Scientific Sessions.
The findings suggest that food insecurity should be a factor considered in overall diabetes management. Approximately 24 percent of Latino households in the U.S. were food insecure in 2013, compared to 14 percent for Americans overall, according to the U.S. Department of Agriculture. A 2012 study published in the journal Diabetes Spectrum found that diabetes risk was roughly 2.5 percent higher in households reporting food insecurity.
Researchers at the Emory School of Medicine/Grady Hospital in Atlanta, Georgia, decided to explore the impact of food insecurity on diabetes management after hearing from patients that they could not afford to buy healthy foods, such as fresh vegetables. To measure food insecurity, they asked whether patients had been worried about having enough food to eat at any point in the past 30 days. They also developed a tool based on the plate method to assess the amount of vegetables patients were eating during their main meal each day (full plate, one-half, one-third of a plate, one-fourth of a plate, or no vegetables). Lastly, the Emory research team also measured and analyzed differences in A1CA1C is a test that measures a person's average blood glucose level over the past 2 to 3 months. Hemoglobin is the part of a red blood cell that carries oxygen to the cells and sometimes joins with the glucose in the bloodstream. Also called hemoglobin A1C or glycosylated hemoglobin, the test shows the amount of glucose that sticks to the red blood cell, which is proportional to the amount of glucose in the blood.X (a three-month measure of glycemic control) of the food insecure and food secure patients.
"We found that those patients who were food insecure had higher A1C levels and ate fewer vegetables," said Britt Rotberg, MS, RDN, LD, CDE, BC-ADM, Assistant Director of the Emory Diabetes Education Training Academy, Emory Latino Diabetes Education Program at the Emory School of Medicine. "These findings underscore the importance of individualized diabetes management, and the need to take into account not only patients' socioeconomic status, but food availability, when discussing diabetes self-managementin diabetes, the ongoing process of managing diabetes. Includes meal planning, planned physical activity, blood glucose monitoring, taking diabetes medicines, handling episodes of illness and of low and high blood glucose, managing diabetes when traveling, and more. The person with diabetes designs his or her own self-management treatment plan in consultation with a variety of health care professionals such as doctors, nurses, dietitians, pharmacists, and others.X. We should find new ways to help our food insecure patients obtain nutritionally adequate foods.&" The study found that those who were food insecure had average A1C levels of 9.9 percent, compared to 7.6 percent for those who were food secure. It also showed that those who were food insecure ate fewer vegetables than those who were food secure. When looking at patients who consumed more than one-third of a plate of non-starchy vegetables at their main meal, 62 percent were food secure compared to 38 percent who were food insecure. Rotberg said there was no significant difference in body mass index (BMI) between the two groups, suggesting that "both groups may consume comparable calories per the individuals' requirements, but with a difference in nutrient density potentially determining the difference in glycemic control."
The American Diabetes Association is leading the fight to Stop Diabetes and its deadly consequences and fighting for those affected by diabetes. The Association funds research to prevent, cure and manage diabetes; delivers services to hundreds of communities; provides objective and credible information; and gives voice to those denied their rights because of diabetes. For the past 75 years, our mission has been to prevent and cure diabetes and to improve the lives of all people affected by diabetes.
For more information please call the American Diabetes Association at 1-800-DIABETES (800-342-2383) or visit www.diabetes.org.


DIABETIC DIET MAY HELP AUTISM


By Bradley J. Fikes

Autism symptoms can be reduced in an animal model with low glycemic index diets, similar to those diabetics follow to control blood sugar levels, according to a new study.
The study by Salk Institute scientists found that the brains of mice fed diets with a high glycemic index accumulated more activated immune cells called microglia, along with signs of inflammation. The mice also exhibited more autistic type behaviors, such as impaired social interactions, and apparently purposeless activities.
Mice fed low glycemic index diets showed improved behavior.
There's good evidence for immune system dysfunction in autism spectrum disorder, the study said, and it appears to be environmentally caused. While genetic influences predispose certain people to autism, the environment helps determine how the symptoms manifest.
The study was published June 9 in the journal Molecular Psychiatry. Pamela Maher was senior author; Antonio Currais, also of the Salk, was first author.
A growing body of evidence suggests that autism starts during pregnancy. But that doesn't rule out an environmental role, according to a scientist not involved in the Salk study.
Autism in its various forms is a complex condition, and many different contributing factors appear to be involved. There appear to be two main types of autism, according to a recent study led by UC San Diego researcher Eric Courchesne.
Brains of mice fed a high glycemic index diet have greater numbers of activated immune cells (shown in red and green) called microglia. — Salk Institute for Biological Studies
Researchers such as Courchesne have found evidence of a prenatal origin of autism in post-mortem studies of the brains of young people with autism. According to other research, maternal antibodies that apparently attack brain structures in developing babies are responsible for about one-quarter of all autism causes.
The new study provided the different diets both pre- and post-natally, because autism is thought to arise from influences before and after birth. So it can't distinguish between the effects on autism diet has in each time frame. This will be addressed in future studies.
The study found evidence that high-glycemic index diets change the composition of the gut microbiota, the population of bacteria that live in the gastrointestinal system. Moreover, it found that genes associated with inflammation were more activated in the brains of mice given the high-glycemic diet than those given low-glycemic diets.
The study gives a reasonable interpretation of a dietary influence, said Tiziano Pramparo, an associate research scientist in the Autism Center of Excellence headed by UCSD's Courchesne and Karen Pierce.
"It is indeed plausible to think that diet-related changes may be included in a broader picture of gastrointestinal issues with alterations in the composition and total biomass of the gut microbiota," Pramparo said by email.
"In turn, these alterations may ultimately be leading to epigenetic changes in stress-related genes or the release of metabolites or even antigens that are permeable to the blood-brain barrier. These elements are hypothesized to alter behavior, stress response, brain processes and biochemistry."
Epigenetics is the field that studies how genes are turned off or on by chemical modifications that don't alter the underlying genetic sequence. These modifications are known to be influenced by environment.
Moreover, other research suggests the role for diet in autism, Pramparo said.
"The consequences of the increase in inflammatory signals described in this mouse study converge with brain alterations we have seen in human studies affecting neurogenesis, neuronal maturation and synaptic functions," he said. "Ultimately, these alterations together with behavioral abnormalities appear to be ameliorated by a diet poor in glycemic index."

For followup studies, the Salk scientists plan to analyze the microbiome and autism symptoms more directly. They will also study how inflammation affects the growth of new neurons.

Weary of the needle jab, diabetics yearn for new form of insulin



By Arlene Karidis June 15

Rebecca Killion gives herself several insulin shots a day, a regimen she has followed for 16 years, to help control her blood sugar. It’s been tough, and still her glucose fluctuates a lot. So she is thinking about beginning a new drug — an inhaled insulin that would mean fewer of the needles she loathes. She hopes it comes with the bonus of better managing her diabetes, reducing risk of damage to her kidneys, eyes and other organs.
The 57-year-old Bowie woman heard about Afrezza while it was in clinical trials. Intrigued, she became the patient representative on the Food and Drug Administration panel that provided the feedback leading to the drug’s approval and then its commercial release in February.
Killion and other panel members reviewed reports from the drug’s manufacturer, MannKind, studied clinical trials and read through the FDA’s own reports. They determined, she said, that Afrezza had potential as an effective way to control glucose with fewer injections.
Some diabetes doctors are cautiously optimistic that this type of insulin could make life easier for patients who are averse to needles and possibly yield better outcomes. Diabetics inhale a dose before each meal to avoid glucose spikes after eating.
People with Type 1 diabetes — the less prevalent form, in which the body does not produce insulin — still need a daily injection to provide long-lasting insulin.
Type 2 diabetics — whose bodies don’t make enough insulin or are resistant to it — can use the inhaled version along with pills, though doctors say some may need a daily injection.
Some clinicians are skeptical. They feel it’s too early to know if the drug has therapeutic benefits. Its long-term safety and efficacy are still under investigation. The package carries an FDA label warning of health risks for people with chronic lung disease. It advises that Afrezza is not recommended for people who smoke or recently stopped smoking or for children.
Afrezza comes in premeasured cartridges that patients insert into a small device. They close it and inhale on its tip.
Killion was 38 when she was diagnosed with Type 2 diabetes, and although that wasn’t the best health news, at least her doctor thought her illness could be managed with pills.
Three years later, she lapsed into a diabetic coma.
“I woke up after a few days and heard I had Type 1 diabetes and needed injections every day for the rest of my life,” she said.
She tried an earlier form of inhaled insulin, Exubera, which was taken off the market in 2007 after a year and a half because of inadequate sales. Killion found the device was awkwardly large and not user-friendly.
“It was like a bong,” said Killion, adding that dosing units were different from liquid insulin, so patients had to figure out conversions, unlike with the new drug.
About 29 million Americans, more than 8 million of them undiagnosed, have diabetes, according to the Centers for Disease Control and Prevention. Some may have no symptoms for years, says Robert Ratner, chief scientific and medical officer for the American Diabetes Association, based in Alexandria.
Some people inject themselves three or more times a day, sometimes for 50 or 60 years, tempting them to stop the grueling routine, and interrupting treatment can be dangerous.
“People take an insulin holiday because it’s hard to do that often and long,” Ratner said. “And there are negative social perceptions that deter insulin usage.”
Many diabetics, he said, are not comfortable taking out a syringe and injecting themselves in public — in the lavatory of a restaurant, for example, before having a meal.
“We don’t know if Afrezza will do better, but a lot of lessons were learned from Exubera,” Ratner said, “and this is a better product.”
Killion has gotten her share of suspicious looks when she takes out her insulin vial and needle case in public or at work. “I was in a conference,” she said, recalling one experience, “and a woman yelled from across the table, ‘What are you doing?’
Studies report that Afrezza reaches peak levels in 12 to 15 minutes, vs. an hour with injected insulin. And the body returns to pre-meal insulin levels quicker.
“This means Afrezza matches [natural body] dynamics of food intake and absorption well,” said Janet McGill, an investigator on Afrezza trials at the Washington University School of Medicine in St. Louis.
The most common adverse reactions are cough, throat irritation and hypoglycemia (low blood sugar); people with chronic lung problems may experience wheezing and constriction of air passages in the lungs.
The FDA is requiring further study to evaluate safety and efficacy in children. And Afrezza will be evaluated for cardiovascular risk and its long-term effect on pulmonary function.
As a precaution, patients must be monitored for lung function, said Dan Lorber, a New York endocrinologist who was among the investigators involved in the drug studies.
Only a few Washington-area endocrinologists have completed the process of meeting with drug reps to determine if they will offer the new product, training their staff on its use and identifying patients they believe are candidates.
Farhad Zangeneh, an endocrinologist in Sterling, Va., began his first patient on Afrezza in March. The patient had long-standing, poorly controlled Type 2 diabetes, despite a daily long-acting injection, multiple pills, a good diet and exercise. Even that one shot was hard, as he deeply feared needles. Rather than amp up the injections, Zangeneh prescribed Afrezza.
“His glucose profile improved immediately and he has not had hypoglycemia,” he said.
Zangeneh has his patients take classes to learn how to use the inhaler, how the drug works and what the alternatives are.
“I want to make sure they understand not only how to use Afrezza, but other options. Then, if they have no lung issues and do not smoke, if they prefer inhaled insulin, I have no reservations,” he said.
Natasa Janicic-Kahric, an endocrinologist at MedStar Georgetown University Hospital, just began her first patient on Afrezza. The patient was badly bruised from years of insulin injections, and consequently was not absorbing it well. Janicic-Kahric hopes the inhaled drug will be more readily used by her body. She is also discussing this option with several patients who say they’ve grown weary with multiple injections.
“The inhaled option is convenient,” she said. “But I would prefer to wait a little longer to conclude whether it is effective.”
Janicic-Kahric is not sure she will offer it to Type 1 patients, uncertain it can provide the precise glucose control they require, since it comes in prepackaged doses. With injections, patients can vary the amount of insulin they receive by tiny amounts.
“Type 1 diabetics are much more sensitive to insulin, and even one unit too high or low can have a significant impact,” she said. “I’m hoping with time we will have more dosing options. Then I would more readily prescribe for Type 1.”
Zangeneh said he, too, would rarely prescribe Afrezza for Type 1 diabetics. If they are averse to shots, he prefers that they use a pump, which delivers insulin through a catheter placed under the skin.
Some endocrinologists are pleased that patients who may benefit from the drug would no longer have to plan their doses of insulin in advance of meals. Nor would they have to refrigerate it.
“They can sit at a table anywhere, take their inhaled insulin, and begin
to eat right away,” Janicic-Kahric said.
Afrezza’s wholesale cost is about double that of injected insulin. But it should not cost consumers more. The company commercializing it, Sanofi, caps co-pays at $30, said Stefan Schwarz, vice president and head of U.S. marketing for Afrezza at Sanofi.
Killion is hopeful that Afrezza will help with an ongoing balancing act.
“After I eat, my glucose can go from 120 to 280 in 45 minutes. When it starts to come down, my insulin kicks in, and sometimes I get sugar lows because I have inadvertently overcorrected. It lingers and affects the next dose. It seems you are always chasing highs,” she said.
“Based on the literature, this insulin tends to act more like how my body would if I didn’t have this illness.”
What makes Killion happiest is that insulin-dependent diabetics may have a choice besides sticking something into their bodies.
“This is for the rest of their lives, and it gets old, taking five, six shots a day. An option other than a needle is huge.”
Karidis is a freelance health writer.


Health concerns: The dos and don’ts of fasting with diabetes


KARACHI: Doctors educated diabetics on how to manage their condition during Ramazan during a lecture at the Aga Khan University (AKU) on Saturday evening.
“A pre-Ramazan medical assessment is very important, preferably two months before Ramazan and patients must be ready to break their fast, if needed. They should understand that God hasn’t told them to hurt themselves while fasting”, said Dr Saira Furqan, a faculty member at the diabetes and endocrinology department at the AKU, while addressing the overcrowded auditorium.
She explained that the management of one’s blood glucose levels and diet, monitoring one’s usage of medicinal drugs as well as the recognition of the warning symptoms of dehydration, hyperglycaemia and hypoglycaemia and other possible complications is necessary for diabetic patients to fast.
Management
Diabetes can be managed through a proper diet and nutrition.
Since the needs of all diabetics are different, consulting doctors for individual diet plans is recommended before Ramazan. Meals at sehri should contain complex carbohydrates that delay digestion. Diabetics should increase their fluid intake during non-fasting hours as well as their fruit and vegetable intake. Patients are also discouraged from partaking in any rigorous exercise while fasting.
“Your fast doesn’t break when you check your blood sugar, in fact, your blood sugar must be checked frequently during the fast”, said Dr Furqan, while clearing the most common misconception among diabetic patients. She said patients can practice insulin therapy or adjunct treatment during sehri and iftaar hours.
“Don’t eat things made of maida flour or fried food because they increase sugar levels”, suggested Salma Siddiqui, a clinical dietician. She added that a diabetic can only consume such foods thrice a week if their blood sugar is well maintained. She said that taraweeh and prayers are a good form of exercise during one’s fast, while suggesting that patients maintain a healthy weight during Ramazan. “Don’t get lured by food deals that will come from various food franchises and don’t over-eat”, she warned, urging patients to eat homemade food. She said that they should have at least 10 to 15 per cent of protein in their meals at sehri and iftaar and 30 grammes of fibre.
“Blood sugar levels must be checked at sehri, mid-day, at iftaar and two hours after iftaar”, said Farzana Rafiq, a diabetes nurse at the diabetes and endocrinology department at the AKU hospital. She told patients to consult a diabetologist for a drug regimen tailored to their needs.
Fasting for diabetics
Things to remember
           Physical activity
           Meal planning
           Regular blood sugar testing
           Medication management
           Make a diet chart of what can be eaten during sehri and iftaar after consulting a doctor.
Published in The Express Tribune, June 8th, 2015. 







A letter to Big Soda



Dear Big Soda:

You have not beaten us, because the fight for a healthier Vermont will continue.
While your supersized spending — more than $500,000 in just three months — succeeded in soaking the airwaves and newspapers with deceptive advertising, most Vermonters were not fooled. In fact, a Castleton State College poll found 57 percent of Vermonters supported our proposal to tax your unhealthy products to raise money for affordable health care programs.
Sadly, Vermont is not immune to the costly epidemic of obesity and diet-related illnesses such as diabetes, heart disease, stroke and many forms of cancer that, thanks in part to big jumps in sugary drink sales over the last 50 years, has made our nation one of the least healthy in the industrialized world. These diseases cause great suffering and impose substantial costs on our health care system. Though we may be the “second healthiest state” in America, when it comes to obesity rates, we are just the best of the worst. One in four Vermont adults is now obese, and 30 percent of our children are overweight or obese. These rates have more than doubled since 1990.
Annually, the cost of treating obesity-related health problems in Vermont, just among adults, is at least $200 million and may be as high as $600 million when factoring in childhood obesity. As a result, health researchers now predict this will be the first generation of American children to live shorter lives than their parents.
The obesity epidemic has many causes, but the overwhelming consensus of independent researchers — those who aren’t on your industry payroll — is that your sugar-loaded, low- or no-nutrition drinks are a major factor. The U.S. Dietary Guidelines Advisory Council recently warned that heavy doses of added sugars in the American diet are to blame for spikes in type 2 diabetes, heart disease, and other illnesses linked to obesity. The council also confirmed that sugary drinks are the largest source of added sugars in the average American diet, surpassing milk in the 1990s as the largest source of calories for our kids.
Vermont doctors, nurses, dentists and dental hygienists see this story play out with their patients whose habits of drinking multiple sugary drinks each day have given rise to a range of diet-driven diseases. That is why the Alliance for a Healthier Vermont’s sugary drink excise tax proposal enjoyed the support of every major health care provider organization in the state, along with public health organizations including the American Heart Association, the American Cancer Society and many others.
Unlike the Vermont doctors who supported an excise tax on sugary drinks, your highly paid spin doctors say that better education is the solution. Yet your industry spends nearly a billion dollars each year to drown out public health education about the risks of drinking too many sugary drinks. Your ads often target children with cartoon characters, computer games and use misleading claims about the health benefits of the liquid sugar you sell. You know that public educational efforts about the health risks of drinking too many sugary drinks don’t stand a chance when they stand alone.
It appears that you’ve learned a lot from Big Tobacco when it comes to deceptive advertising, denying accountability for the health risks your products pose and scaring elected officials who might support policies that would curb unhealthy consumption levels. We’ve learned something, too.
We’ve learned that, as with tobacco, a substantial excise tax that increases the shelf price on sugary drinks and funds effective health care and nutrition programs will help reduce unhealthy levels of consumption. We’ve also learned that it takes time for elected officials to find the courage to take on your powerful, wealthy industry. Though we fell short this legislative session, we helped more legislators find that courage this time around.
You may have won this latest round, but we want you to know that the struggle for a healthier Vermont is far from over.

Anthony Iarrapino is the director of the Alliance for a Healthier Vermont.