Category Archives: Diabetes

An interesting new clinical study is suggesting restricting food intake to a 10-hour window each day may be a simple yet beneficial way to help treat metabolic syndromes such as diabetes or heart disease. The 12-week pilot study revealed the eating intervention, in conjunction with prescribed medicines, improved patients health outcomes.

One of the more fascinating dietary fashions to arise in recent times is known as time-restricted eating (TRE). Instead of interspersing whole days of fasting across a week or month, this eating strategy looks to limit your caloric intake to short windows of time in a given 24-hour period. Generally, TRE methods suggest only eating between four and eight hours a day, meaning a fasting stretch of 16 to 20 hours.

One of the theories underpinning these dietary strategies is that restricting eating to a limited time window better synchronizes a persons caloric intake with their circadian rhythms. Epidemiological studies have found a majority of people spread their food intake over at least 15 hours a day. As little as 10 percent of people compress all their meals into a 12-hour-or-less stretch each day. While some research is building to suggest health benefits to only eating in four- to eight-hour windows, this new study set out to find out whether a 10-hour eating window could be just as beneficial.

"There has been a lot of discussion about intermittent fasting and what time window people should eat within to get the benefits of this kind of diet," explains Satchidananda Panda, co-corresponding author on the new study. "Based on what we've observed in mice, a 10-hour time window seems to convey these benefits. At the same time, it's not so restrictive that people can't follow it long-term."

To test the eating strategy on human subjects a team of researchers from the Salk Institute and the University of California, San Diego, conducted a small pilot study. They recruited 19 subjects, most classified as obese and receiving pharmacological treatment for a diagnosed metabolic condition. All subjects self-reported prior eating patterns spanning at least 14 hours a day.

The intervention tested was incredibly simple. Subjects were directed to continue regular diets and exercise but simply compress any caloric intake to a 10-hour window each day, essentially letting their bodies fast for 14 hours across every 24-hour cycle.

For such a small and simple intervention the results were somewhat impressive, with an average three to four percent reduction in body weight and body mass index seen across the entire cohort after three months. Alongside self-reported improvements to general energy levels and sleep quality, the cohort displayed reductions in cholesterol levels and blood pressure at the end of the 12-week trial.

"We told people that they could choose when they ate their meals, as long as they remained within the 10-hour window," says Panda. "We found that universally, they chose to eat breakfast later, about two hours after waking, and to eat dinner earlier, about three hours before going to bed."

The researchers behind the new study are well-aware of the numerous limitations behind such a small trial. Most notably the trial did not include a control group which makes it certainly difficult to clearly correlate the final result with the studied eating intervention. Duane Mellor, from Aston University, points out the lack of control isnt the only problem with this particular study.

In the case of this study there are lots of limitations, not just the lack of a control group a key one being that the act of recording food intake has been shown in other studies to reduce calorie intake and help with weight loss, says Mellor, who did not work on this new study. Also, although lots of tests were done on the participants, it seems unclear how they justify the conclusion that improvements were seen independent of weight change as there simply was not a big enough number of people to make this assessment.

So, were the beneficial effects seen in this study directly related to the TRE strategy? Or were the health improvements more a reflection of the diet indirectly lowering overall caloric intake and making the cohort more aware of their eating patterns?

Its possible to over speculate that time-restricted eating is a magic bullet to health whereas it may be that its just though calorie restriction, suggests Jenna Macciochi, an immunologist from the University of Sussex. On the flip side, for people who are struggling with fad diets it may be a useful tool and help compliance.

Macciochi, who did not work on this new research, does point out the most encouraging part of the new study is that it highlights how easy this particular dietary modification can be implemented and sustained. The compliance rate for the trial was very high, with a significant number of the participants reporting continuing the dietary strategy, in some form, for up to a year. This suggests, unlike some other intermittent fasting or TRE diets, a 10-hour daily eating window is relatively easy to integrate into a persons life, and can be maintained for extended periods of time without too much trouble.

So, moving forward the next step for the researchers is to better verify the metabolic benefits of this eating plan in larger cohorts. A clinical trial is already underway in a much larger group with the hopes of understanding the physiological effects of what could essentially be called a 14:10 eating plan.

The new study was published in the journal Cell Metabolism.

Sources: Salk Institute, Cell Press

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Trial suggests fasting 14 hours a day helps diabetes and weight loss - New Atlas

There are more than a million people who have Type 1 diabetes, and they're expected to live at least 10 years less than Americans without it.

In fact, there are only 90 diabetics who have lived more than 70 years.

But one man crushed that goal 15 years ago and is telling others how they can do it too.

Eighty-five-year-old Don Ray can't remember a life without diabetes.

As a child, Don could not go to gym class. He couldn't play sports. He couldn't even play hide and seek.

"Because if you were to hide, and they can't find you and you have an insulin reaction or a hypoglycemia, you might really be in trouble because they will never find you," Don explains.

He was told he wouldn't live past his 30s. But eventually he got tired of hearing, "You can't, you can't, you can't."

"I would go to gym class when I started school in kindergarten and first grade, and I'd sit in the chair in gym class and I'd watch these kids, and I knew I could do this, cause I just knew I could do this," Don says.

Don and his dad started playing catch, and that turned into 20 years of playing football and 30 years of baseball.

And he did it because "he followed the rules," according to Betul Hatipoglu, MD, at the Cleveland Clinic.

What rules? First make sure your blood sugar is in check: between 80 and 130 milligrams. If it's too low, eat some carbs, but don't forget to check while working out.

"If they are going to exercise for an hour, they have to check it in 30 minutes again to make sure they are still in the safe zone," Hatipoglu says.

But don't take too much insulin before your meal or before your workout.

"So if you are going to exercise after lunch, for lunch you take less insulin so it is safer for you," Hatipoglu says.

And if you're working out after dinner, be careful as well. You don't want any overnight complications.

"If you take care of the disease, the disease will take care of you, and you can if you take care of yourself," Hatipoglu explains.

Nowadays, there are nearly 140,000 people diagnosed with diabetes each year in the U.S. alone. But in 30 years, an expected five million Americans will be diagnosed with Type 1 diabetes.

DIABETES TYPE 1: DON SHATTERS EXPECTATIONS! REPORT #2699

BACKGROUND: Glucose is a critical source of energy for your brain, muscles, and tissues. When you eat, your body breaks down carbohydrates into glucose and this triggers the pancreas to release a hormone called insulin. Insulin acts as a "key" that allows glucose to enter the cells from the blood. Your body can't function or perform properly if it doesn't produce enough insulin to effectively manage glucose. This is what produces the symptoms of diabetes. Uncontrolled diabetes can lead to serious complications by damaging blood vessels and organs. It also increases the risk of heart disease, stroke, kidney disease, nerve damage, and eye disease. Nutrition and exercise help manage diabetes, but it's also important to track blood glucose levels. Treatment may include taking insulin or other medications. (Source: https://www.healthline.com/health/diabetes/facts-statistics-infographic#1)

COPING WITH TYPE 1 DIABETES: People who have had type 1 diabetes for a long time may develop what's called "diabetes burnout." This can happen when you start to feel burdened by the disease. A good support system is essential to coping with type 1 diabetes. Spending time with friends and family or talking with someone you trust are ways to manage diabetes distress, which can include stress and anxiety. Taking good care of yourself can reduce diabetes stress and help you cope with the condition. Making sure to eat well, exercise, and learn how to monitor blood sugar levels are important. Getting enough sleep each night and taking time to relax and enjoy life are also very important. There are resources available to help you manage type 1 diabetes such as apps designed to count carbs, watch blood sugar levels, and track progress with diet and exercise. The more you know about your condition, the better prepared you'll be at taking care of yourself. Your doctor can also recommend books about type 1 diabetes. (Source: https://www.healthline.com/health/type-1-diabetes/living-with-type-1/how-you-can-cope#4)

NEW DISCOVERY FOR DIABETES: Matthias Hebrok, PhD, director of the UCSF diabetes center, and Gopika Nair, PhD, have discovered how to transform human stem cells into healthy, insulin producing beta cells. "We can now generate insulin-producing cells that look and act a lot like the pancreatic beta cells you and I have in our bodies. This is a critical step towards our goal of creating cells that could be transplanted into patients with diabetes," said Dr. Hebrok. For the longest time, scientists could only produce cells at an immature stage that were unable to respond to blood sugar levels and secrete insulin properly. The team discovered that mimicking the "islet" formation of cells in the pancreas helped the cells mature. These cells were then transplanted into mice and found that they were fully functional, producing insulin and responding to changes in blood sugar levels. Dr. Hebrok's team is already in collaboration with various colleagues to make these cells transplantable into patients. (Source: https://blog.cirm.ca.gov/2019/02/05/breakthrough-for-type-1-diabetes-scientist-discovers-how-to-grow-insulin-producing-cells/)

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85-year-old man with Type 1 diabetes shatters expectations - WNDU-TV

Between 2000 and 2010, diabetes prevalence among adults in Georgia increased by 43%.

The fortunate news is that you can prevent Type 2 diabetes. The PreventT2 lifestyle change program, offered by University of Georgia Extension beginning in January 2020, can help. PreventT2 is part of the National Diabetes Prevention Program, led by the CDC, and is proven to prevent or delay Type 2 diabetes.

In PreventT2, Barbara Worley, a UGA Extension Family and Consumer Sciences Agent and Diabetes lifestyle coach, will help you to learn the skills you need to make lasting changes.

These include losing a modest amount of weight, being more physically active and managing stress. You will learn to eat healthy, add physical activity to your life, stay motivated, and solve problems that can get in the way of healthy changes.

If you have been diagnosed with prediabetes, PreventT2 offers an outstanding chance to prevent or delay the onset of Type 2 diabetes by helping you adopt a healthier lifestyle.

The PreventT2 program is based on research that found people with prediabetes can cut their risk of developing Type 2 diabetes in half by losing 5 to 7% of their body weight. That is about 10 to 14 pounds for a person weighing 200 pounds. PreventT2 offers an environment where participants will learn to eat better and be more active with like individuals who share common goals.

An information session will be held from noon to 1 p.m. Tuesday, Jan. 21, at the UGA Extension Office located at 5110 Piney Grove Road in Cumming.

To register for the information session, contact Sharon Machek at 770-887-2418, Ext. 2333 or by email at uge1117@uga.edu. Deadline to register is Jan. 17, 2020. Enroll today because space is limited.

Visitwww.cdc.gov/PreventT2andextension.uga.edu/county-offices/forsyth.htmlfor more information on PreventT2 and the National Diabetes Prevention Program.

For additional information on health, nutrition and food safety, contact University of Georgia Extension in Forsyth County at 770-887-2418 or online atugaextension.org/county-offices/forsyth.html.

Forsyth County Extension is supported by The University of Georgia, Forsyth County Government, Forsyth County Board of Education and United Way of Forsyth County.

Barbara Worley is the Family and Consumer Sciences agent for the UGA Extension Forsyth County.

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Extension: Program designed to help prevent type 2 diabetes - Forsyth County News Online

By studying the nematode Caenorhabditis elegans, scientists from Vanderbilt University and the University of Michigan have identified a protein that's key for insulin synthesis, the understanding of which they say could lead to new approaches to prevent and treat Type 2 diabetes.

The protein, called TRAP-alpha, is widely shared across worms, flies and mammals, including humans. In a study published in the journal Science Advances, the team showed that TRAP-alpha is required for insulin production, corroborating previous knowledge that alterations in the TRAP-alpha gene are linked to the development of diabetes.

The researchers made the discovery while screening for genetic clues to the PI3K/Akt signaling pathway that may contribute to reduced insulin signaling. Irregularities in the PI3K/Akt pathway have been linked to many human diseases, including cancer, cardiovascular disease anddiabetes.

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The screens turned up TRAP-alpha. The protein is part of a complex known as translocon that helps moveor translocatenewly synthesized proteins into the endoplasmic reticulum (ER) of cells for further processing before theyre eventually secreted.

The researchers discovered that deletingthe C. elegans equivalent of TRAP-alpha affects the worms' insulin signaling pathway.

They went on to delete TRAP-alpha in insulin-making pancreatic beta cells of rats. Doing so led to a sharp decline in total insulin, the team found. Preproinsulin, the precursor molecule to insulin, was not properly transferred into the ER for final processing, so most of it was degraded.

TRAP-alpha was not on anyone's radar in terms of being required for insulin biogenesis, Patrick Hu, the studys senior author, said in a statement. Our work highlights the value of using a model organism likeC. elegansto do an unbiased genetic screen. It led us to a molecule that seems to be important in making insulin and that could very well shed light on the pathogenesis of diabetes, a common disease that affects about 10% of the U.S. population.

RELATED:Subtle chemical shift reverses prediabetes in Merck-partnered mouse trial

Given the prevalence of diabetes, several research groups are also working on new ways to tackle it. Scientists from the University of Utah, in collaboration with Merck Research Laboratories, recently prevented or reversed prediabetes in mice. They did it by shutting down an enzyme called DES1 to reduce the amount of fatty lipid ceramides, which is key in metabolic health.

A team at the University of Geneva treated Type 1 diabetes in mice byconverting non-insulin-producing alpha and gamma endocrine cells into beta cells with the help of two transcription factors, PDX1 and MafA.

Understanding TRAP-alpha could inspire new ideas to prevent or treat Type 2 diabetesand maybe even more diseases, Hu and colleagues argued.

In the current study, the researchers noticed TRAP-alpha plays a role in promoting ER homeostasis, or the balance between incoming proteins and ER the proteins that help fold them. Loss of TRAP-alpha may cause ER stress, which can lead to cell death, the team reported.

Preproinsulin is the first client protein for TRAP-alpha to deliver into the ER for processing, and the scientists hope to find more like it.

It's likely other secreted molecules besides insulin might be affected by TRAP-alpha deletion, Hu said in a statement. If we can understand the broader role that TRAP-alpha is playing in maintaining protein homeostasis, we might develop new ways to approach other diseases, too.

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How worms revealed a key protein in insulin synthesis and diabetes - FierceBiotech

Harvey Weinstein hobbled into Manhattan court Friday looking pallid and unsteady thanks to severe diabetes and a spine condition, sources told The Post.

The 67-year-old accused rapist and former powerhouse Hollywood producer who was in court for a new bail hearing has suffered from Type 2 diabetes, back issues and other health problems that have been in free-fall since his arrest, sources said.

Weinsteins health problems paved the way for him to be allowed to wear a modified monitoring device while hes out on bail awaiting trial on sex charges and the gadget was at the heart of Fridays hearing.

Weinstein who had a handler help prop him up as he entered the courtroom was originally outfitted with a regular ankle bracelet, but because of his health issues, bail bondsman Ira Judelson swapped it out for a two-part device. The new device includes a slimmer ankle bracelet with a separate signaling component. The original device is not prone to the same user error.

The one-piece device was problematic for his leg and medical issues, Weinsteins lawyer, Donna Rotunno, told the court of the original, much bulkier monitor.

But Assistant DA Joan Illuzzi-Orbon said Weinsteins ankle monitor was untraceable on at least 56 separate occasions, in violation of his bail conditions. Prosecutors said Weinstein repeatedly failed to keep within range as required.

Due to the violations and new bail reform laws taking effect next year, Weinsteins bail package has to be re-examined, with both sides making their arguments Friday. Justice James Burke is set to rule on the issue Wednesday.

Weinstein is currently free on $1 million cash bail. He faces up to life in prison on charges of predatory sexual assault, criminal sex act and rape in connection with three accusers.

Matthew McDermott

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Harvey Weinstein's diabetes and spine condition to blame for his appearance - Page Six

by: Nancy Dell, Registered Dietitian

CHICOPEE, Mas. (WWLP) We know low levels of vitamin D can increase the risk of porous bones.

Now new research shows, low vitamin D can also increase the risk of Type 2 diabetes.

It is important for those of us who live in New England to be aware of the possible connection between low vitamin D levels and Type 2 diabetes since we are likely to develop low vitamin D in the winter months.

Our bodies make vitamin D when the sun hits our skin. But from November to April the angle of the suns rays is such that we do not make vitamin D.

New research on 680 women shows vitamin D helps blood sugar leave the blood and enter our cells where it is used for energy. In the study, women who took vitamin D supplements or had sun exposure had lower blood sugars that those women who did not take supplements or get sun exposure.

So be sure your doctor checks your vitamin D level and gets you to a healthy range. It just may help reduce your risk of developing type 2 diabetes.

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Food for Thought: Vitamin D and Type 2 diabetes risk - WWLP.com

Laurel Bloomfield of Rigby is a contributing author for a new book targeted to entrepreneurs. | Courtesy photos

RIGBY Laurel Bloomfield of Rigby is an entrepreneur, inventor, mother and wife, and she will soon add author to her list of accomplishments.

She is one of 71 authors who will be featured in Air Fryer Secrets. Its not a cookbook rather, its an anthology providing business-building tips and strategies. Each chapter was written by a different author and caters to a specific niche in the marketing and entrepreneurial space.

Everything you would need to start an online business today is covered in the book, Bloomfield tells EastIdahoNews.com.

Bloomfields contribution is a chapter about intellectual property and how a product developer can write their own patent. She co-created a product with Nicholle Peterson and Katie Larsen several years ago designed to help those with Type 1 diabetes who wear an insulin pump. Its a pocket thats placed in the lining of clothing to hide it from view and keep it safe from damage.

RELATED | Local moms design a trendy way to carry insulin pumps

If you send a 5-year-old kid to school with a $10,000 pump, and they try to use the bathroom, it could fall in the toilet. Other kids have cut the tubing thats hanging out of their shirt going from the pump to the infusion site. That can be a life-threatening situation, Bloomfield says.

Her pocket helps keep that device safely up against their body and holds all the tubing in place to avoid all risks of danger. The pocket also gives kids a way to hide their condition so they do not become a spectacle to people around them, she says.

I think thats important for kids dealing with Type 1 diabetes. Sometimes theyre expected to be the spokesperson for this huge disease just because they have this noticeable thing (on their body). The pocket allows them to just be kids, says Bloomfield.

Bloomfields pocket concept gained a lot of traction from some of the leading insulin pump manufacturers in the world. It was put on the market about three years ago once her fully-issued patent was approved. Today, its sold online and in stores under the name Pocket Innerware.

Boise resident Kevin Quinn, the lead author of Air Fryer Secrets, has worked with Bloomfield on numerous development projects. Hes a software developer and a partner at a CBD company, among other things. He invited her to share her expertise with readers for this book.

The inspiration for the book came from a series of live Facebook videos Quinn began posting about eight months ago.

I wanted to show folks what I could cook in the air fryer one Friday. It was funny. People tuned in and had some fun with it. Then it started to grow and people started to ask What are you cooking for Fryer Friday?' Quinn says.

The initial post was intended as a joke, but it quickly went viral and eventually became a weekly bit called Fryer Friday.

The videos have since become a Facebook engagement tool to help build an audience for many of his business projects. The title of the book is a play on words intended to convey its central message of putting yourself out there to build brand awareness.

You need to decide who your audience is that you want to sell to, and then find a unique way to sell to them, Quinn says. This book will give them so many ideas (on) how to do that.

Bloomfield and Quinn recently launched a business together called Launch Incubator, which helps entrepreneurs find an audience for their product.

Bloomfield says she is excited to be able to offer marketing strategies and other resources for current and prospective business owners.

Its kind of like a digital marketing Bible. Its something that, when I got into this space 18 months ago, I wish I wouldve known more about, Quinn says.

Air Fryer Secrets will be available to buy through Amazon on Dec. 19. Visit the website to learn more.

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She invented a product to help those with Type 1 diabetes, and she's featured in a new book - East Idaho News

Coconut water and guava are considered great for managing high blood sugar.

Highlights

A good diet can make a world of difference in bringing relief from chronic health issues like diabetes. Diabetes occurs when the pancreas are unable to produce sufficient insulin, due to which, blood sugar is left unchecked and is unable to get stored in the cells. This may lead to sudden rise in the blood sugar level. Diabetes also poses the risk of other diseases, including cardiovascular problems and obesity. Medications and diet work in tandem to manage the condition effectively, hence, it is important to include diabetes-friendly foods and drinks in your diet. As we are now smack-dab into the winter season, it's even better to consume seasonal foods to get the most out of them till they last.

Coconut water is an all-seasons star drink that comes with a range of health benefits. This recipe adds the goodness of winter-special fruit guava to coconut water to make a delicious, healthy drink that may also help in managing diabetes.

This miracle water is considered great for people dealing with high blood sugar. It is revered for its high electrolytes content that supports the pH balance of the body and boosts its metabolic functioning. Coconut water is naturally sweet and packs a good amount of fibre and proteins. It is low-calorie, cholesterol-free and also hydrating.

(Also Read:Drink This 3-Ingredient Coconut Water Juice To Boost Your Immunity)

Coconut water is packed with electrolytes

Guava has a low glycaemic index (GI), which is a must-have quality in foods for a diabetes diet. The fruit is digested gradually, which avoids immediate spike in blood sugar. It is low in calories and sodium, and rich is fibre and potassium, making it perfect for regulating high blood sugar.

(Also Read:This Guava Salad May Help Keep Your Sugar Under Control)

Coconut water in itself is a delightful drink. Add to it, the mildly sweet and amazingly soft fruit of guava, and you get a naturally sweet, soul-stirring drink. You don't need to add any harmful refined sugar.Method of preparation:Grind guava to its pulp and pass it through a sieve to separate its seeds. Add the pulp to equal part or more of coconut water and give it a good stir. In one glass of coconut water and guava pulp drink, add juice of half a lemon and half teaspoon grated ginger. Also add 6-7 finely chopped basil leaves to add in a dash of herby freshness.This drink is so delicious that you might want to have it every day. But, since coconut water also contains some fructose, it would be better to consult your doctor before consuming too much of it. Nevertheless, you can always enjoy this lip-smacking coconut and guava drink in moderation on your diabetes diet.

About Neha GroverLove for reading roused her writing instincts. Neha is guilty of having a deep-set fixation with anything caffeinated. When she is not pouring out her nest of thoughts onto the screen, you can see her reading while sipping on coffee.

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Diabetes: This Coconut And Guava Drink Is A Great Option For High Blood Sugar Diet - NDTV Food

Creativity helps people process and deal, said Fay, a retired real estate agent who was also a longtime server at the Harvard Club of Boston. Creativity is the key to human liberation.

And so she turned the tools of her survival into something liberating.

Syringes fill 5-gallon water jugs and pickle jars and mezcal bottles. Dozens of vials of long-acting insulin line displays made from the toaster-sized styrofoam boxes that arrive at her doorstep, sometimes holding two vials the size of your thumb. In the corner, a mannequin is stuck full of syringes: Our Lady of Perpetual Injections.

What it is, is altars to the various things that keep me alive, Fay said.

The vials and syringes that fill Fays installation are empty now, injected into her body to help turn the carbohydrates in her food into energy or, put more simply, to keep her alive. Fay is on Medicare, but still pays hundreds of dollars out of pocket a month for the simple privilege of living with her disease instead of dying from it.

As Massachusetts lawmakers and Governor Charlie Baker once again wrestle with how best to overhaul and update the states health care laws, the out-of-control price of prescription drugs and insulin in particular is among a handful of issues that cant wait any longer. As manufacturers have raised prices, the cost of a vial of insulin has skyrocketed in recent years, reaching an average of about $450 in 2016, according to the Health Care Cost Institute. How much insulin a person with diabetes needs varies, but many with type 1 require about two or three vials a month.

Already, those who cant afford insulin resort to rationing it, trying to stretch a vial by taking less insulin than they need. A search of the crowd-funding website GoFundMe turns up more than 7,000 people raising money for insulin, and a blog by a crowd-funding expert: How to Get Insulin When You Cant Afford It: Six Ideas. In July, a Minnesota man named Jesimya David Scherer-Radcliff died because he was trying to make it until payday, his family said, when he could afford the relatively simple medication that keeps him alive.

Everyone with diabetes knows how much insulin they have in their refrigerator, said Chris Noble, an advocate for insulin access who has lived with type 1 diabetes since childhood, speaking recently at a Greater Boston Interfaith Organization event, where 750 packed a Dorchester union hall to urge lawmakers to pass health care reform.

A wide-ranging proposal from the governors office would prevent the costs of insulin from continuing to skyrocket. But a Senate bill goes further, and includes a provision that would cap co-pays for insulin at $25 a month with no deductible. The House expects to go forward with a prescription drug pricing plan as well, though the details have not been released.

A co-pay cap like the one in the Senate bill isnt perfect. It doesnt drive down the already high sticker price of insulin, a drug invented a century ago and relatively inexpensive to produce. So any out-of-pocket savings will surely be passed on through higher insurance premiums.

But for people with high deductible plans, a co-pay cap could literally be a lifesaver, Noble said, because they currently have to pay hundreds of dollars per vial of insulin until their deductible is met. Those who cant afford that will inevitably try to ration what they have. Theyll try to make it a few more days until payday. And some of them will die.

After hearing Noble speak at the interfaith event, I asked Fay if it would be OK to bring him over to see what shed built in the basement.

Id like for more people to be able to see it, said Fay, who doesnt know many other people living with Type 1 diabetes.

And so, on a sunny day in November, Noble and I descended the bulkhead stairs into the temple Fay built to her disease.

Wow, Noble said. I feel like I tell this story, but to see it in a visual sense is so powerful.

He pulled out one of the small plastic drawers that line one wall: This alone would be tens of thousands of dollars of insulin.

They talked about their diseases and compared what they use to monitor blood sugar. They made plans to connect Fay to other people living with diabetes, stockpiling and sharing insulin in case of emergencies.

For us, whove been living with this condition for so long, its like a sixth sense, Noble said. Our lives are absorbed in this. I look at a piece of food and I know how much insulin I need to take for that food.

Fay said her collection began by necessity: Syringes cant just be tossed in the trash. But she soon decided to save everything, and make something beautiful and meaningful.

In a brochure that accompanies the exhibit, Fay says shes grateful to be living proof that it is possible to live a long and healthy life with type 1 diabetes.

Shouldnt everyone, regardless of how much money they have, be given the same opportunity?

To find out more about Diabetes Transformed, e-mail Janine Fay at diabetestransformed@gmail.com.

Nestor Ramos can be reached at nestor.ramos@globe.com. Follow him on Twitter @NestorARamos.

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Reckoning with type 1 diabetes through art and advocacy - The Boston Globe

with Ali Aminian, MD, and Caroline Apovian, MD

For those of you who have type 2 diabetes with obesity or have a family member that does, one of the best ways to reduce common health risks such as heart disease and stroke is by having gastric bypass surgery.1

The reason for this seems to be that metabolic surgeryany procedure that changes the function and structure of the stomach or small intestinesupports weight loss, leading to improvements in glucose control and insulin sensitivity; and, ultimately diminishes the complications associated with diabetes. Still, how can you be sure that surgery is the right way to go?

Cleveland Clinic researchers have developed a risk assessment tool to give you a sense of your health risks for diabetes complications in the decade ahead if you do or don't have bariatric surgery. Photo: fstop123 @ iStock

Recognizing that surgery is a daunting step for some and represents too much uncertainty for others, a web-based risk assessment calculator was created by a team of investigators at the Cleveland Clinic in Ohio to help you to determine if bariatric surgery will favorably improve your long-term health.2,3 The results can be shared with your health provider as a starting off point in discussing a disease management plan now and going forward.

This predictive tool is intended to guide you and your doctor to understand the long-term medical risks associated with type 2 diabetes (T2D) and obesity, and to consider the benefits you might gain from having this surgery,2 says Ali Aminian, MD, a bariatric surgeon at the Cleveland Clinic who presented the research supporting development of this tool at a session during ObesityWeek 2019, in Las Vegas, Nevada.

Dr. Aminian outlined the development of the risk calculator. He and his team evaluated the experiences of 13,722 patients with both diabetes and obesitycomparing patients who underwent bariatric surgery as compared to closely matched individuals who were eligible for surgery but chose to continue with their standard medical treatment.2

After following these patients, the individuals who elected to have surgery proved to have a lower risk for every one of the five common complications associated with diabetes. These included: heart disease, stroke, heart failure, kidney disease, and death from all causes.2

Across the board, following these gastric procedures, individuals had a lower risk of every diabetes-related risk. Unfortunately, fewer than 1% of the patients who were eligible for bariatric surgery have it,3 he says.

The researchers than gathered relevant data from the medical records of nearly 290,000 patients with obesity who were being treated for type 2 diabetes in the Cleveland Clinic Health System from 2004 to 2007.Health measures including age, sex, body mass index (BMI), diabetes-related complications, and medications taken were combined to determine patient-specific risks. The researchers also incorporated levels of hemoglobin A1c, blood pressure, and blood cholesterol levels.3

The data supporting the impact of weight-loss surgery on complications of type 2 diabetes, such as stroke and heart disease as well as kidney disease, was published in the Journal of the American Medical Association.2 The results support use of the risk calculator since the data indicated that patients who had metabolic surgery were 39% less likely to experience conditions such as heart disease, stroke, or diabetic kidney disease and 41% were less likely to die from any cause.2,3

When used by an individual, the risk assessment tool can help give both patients and providers a 10-year disease probability of developing the life-threatening complications related to diabetes if the current path is continued, as well as a comparison should you choose to undergo bariatric surgery.

How Effective Is the Gastric Bypass Risk Assessment Tool? As the Individualized Diabetes Complications (IDC) risk calculator was only just released, there hadnt been enough time to gather feedback yet, Dr. Aminian tells EndocrineWeb. However, he has already heard from several enodcrinologists, cardiologists, and primary care providers that they intend to use the calculator in their practices.

According to Caroline Apovian, MD, of Boston University School of Medicine, the reason for greater disease complications stems from a failure of primary care physicians and endocrinologists to recommend more eligible patients discuss their status with a bariatric surgeon. This risk calculator will help not just patients but also providers to realize the benefits of gastric surgery beyond weight loss, and to recognize the risks of not choosing to have surgery, she says.

While there isnt currently a way to determine which bariatric procedure would be best for each individual, Dr. Apovian tells EndocrineWeb, there are studies that indicate that the Roux-en-Y Gastric Bypass offers the best effect on hormone levels.4-6Dr. Aminian acknowledges that despite the limitations of the risk assessment tool as it doesnt include information on family history of heart disease or length of time with type 2 diabeteswhich would be helpful in addressing patient risk, the results derived by the IDC assessment are still valid.2,3

These gastric procedures are very powerful and safe methods for treating individuals with both obesity and type 2 diabetes, says Dr. Aminian. Having surgery can provide significant weight loss, improve diabetes, cholesterol levels, delivering a survival benefit as well as improved quality of life. Even though treating these patients with bariatric surgery is known to be beneficial, a lack of access to trained surgeons and the stigma associated with any method of weight loss besides diet and exercise, has made this option less desirable, he says.

Dr. Apovian has already made use of the ICD assessment tool in her practice It adds a spotlight that can help patients to better grasp the benefits to surgery.

In another presentation delivered at ObesityWeek 2019 in Las Vegas, Nevada, Oliver Varban, MD, associate professor of surgery including bariatric procedures in the University of Michigan Health System in Ann Arbor, presented data supporting the value of sleeve gastrectomy for individuals who have mild obesity (ie, body mass index [BMI] < 35 kg/m2).7 In this study of more than 45,000 patients, achieving a normal BMI occurring more often in patients with a starting BMI below 35 than above who also voiced greater satisfaction with the procedure.

In a press statement, Dr. Varban said: We hope the study encourages more patients to consider weight loss surgery earlier in their disease and for more health insurers to recognize the benefits of lowering the current BMI-threshold.

Indeed, it is most constructive for providers to introduce patients to this surgical assessment tool to help illuminate the risks individuals likely face in avoiding bariatric surgery, says Dr. Apovian. She anticipates that providers and patients might use the ICD tool together in an office setting when considering the need for treatment to improve outcomes and better manage type 2 diabetes with obesity.

Both physicians and patients still fail to treat obesity as a disease, says Dr. Apovian, raising a long-held observation. Too many doctors still view obesity as a matter of willpower and self-control, expecting patients alone to carry full responsiblity for losing weight. There is need for the medical community to acknowledge that obesity is a malfunction of metabolic pathways driving hunger and satiety talk between the gut and the brain.

Any educational tool that offers to dispel this old way of thinking is very welcome, says Dr. Apovian, as we need to help change attitudes so obesity can be approached as disease in need of medical intervention.

In the future, having more information included in the tool on who will develop heart disease on a genetic level could help patients and providers better target particular treatments to specific people.

The assessment algorithm doesnt allow for influences that may change the results based on demographic information such as race and ethnicity.2 Dr. Apovian has studied the impacts of surgery on different populations, and recently published data that showed that African American and Latino populations dont respond as well as Caucasians to metabolic surgery and are more likely to relapse into diabetes.4

Knowing the reasons for variability in outcomes based on racial differences could assure a more accurate and wider use of the ICD assessment tool but such developments still need more time in the academic incubator.2

More data on the type of surgery and outcomes across subpopulations would be good, says Dr. Apovian, particularly as sleeve gastrectomy produces a different impact on hormones related to satiety then the Roux-en-Y gastric procedure. We are starting to see conversions to Roux-en-Y after failed sleeve surgeries, she says.

As for the ICD tool, Id love to see all practitioners using this in their practices, says Dr. Apovian. It introduces sound numbers to the conversation with patients, and if that helps doctors convert more patients to opt in to surgery, then that will be great.

The Cleveland Clinic research received a research grant from Medtronic.

Last updated on 12/03/2019

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