LEWISBURG Pamela Dixon of Shamokin Dam recently celebrated her 39th birthday. Christy Kerstetter of McAlisterville will turn 39 years old this July.

Both women are married and are raising boys.

Both women are also diabetic. Dixon is a Type 1, and Kerstetter is a Type 2.

So whats the difference and how does it impact each womans life?

Karen Dohl, PA-C, Diabetes Center of Evangelical, West Branch Medical Center explained the difference.

A Type 1 scenario is an autoimmune disease or a situation where the body is attacking itself.

They develop antibodies that kill off an area of the pancreas and the patient needs insulin to sustain life, Dohl said, adding that it is not curable.

A Type 2 diabetic has a high blood sugar level because the pancreas can not keep up with the body. This can be due to being overweight or other health issues and is often genetic.

Some patients no longer produce insulin on their own, Dohl said. When that happens, the Type 2 patient becomes what is known as Type 2 insulin dependent.

Dohl said sometimes patients get confused and think that if they need insulin they must be a Type 1.

All Type 1 diabetics need insulin on a regular basis to survive, but only some Type 2 patients reach this point.

Many Type 1 patients are diagnosed around the age of puberty.

Dr. John Kennedy specializes in Diabetes and Endocrinology, Diabetes and Metabolism and is employed within the Geisinger Health System in Danville.

He explained that at puberty a relative lack of insulin becomes absolute in these patients. He said that Type 1 can be diagnosed at any age, as early as toddlerhood; though this age group makes up one percent of Type 1 diagnosis. This is the subject of a study currently taking place at Geisinger that involves board certified pediatric endocrinologists.

Dixon was 11 years old when she pre-diagnosed herself while reading The Babysitters Club series. It was a book about the character Stacey and her diagnosis of diabetes that made Dixon think her own situation was similar.

Dixon had the same symptoms as the character in the book: excessive thirst and urination and constant fatigue.

A trip to the hospital with her mother revealed her suspicions were true.

Renee Hughes, RN, BSN, CDE, Diabetes Educator, Diabetes Center of Evangelical, West Branch Medical Center revealed the Four Cardinal Symptoms of a diabetic, includimg the frequent urination, excessive thirst fatigue and also blurred vision.

A blood test confirms the diagnosis. A blood sugar level of 126 or higher is considered diabetic. An A1C test tells the patient the average level of blood sugar over three months. Diabetic, Hughes said, is an A1C of 6.5 or higher.

Kerstetter was diagnosed in 2008 with Type 2 diabetes. The 30-year-olds main complaint at the time was intense fatigue. Upon visiting her family doctor, a blood test was taken and revealed she was Type 2 diabetic, a condition that has occurred in her fathers side of the family.

She was given pills to take not insulin and continued on that pattern for six years.

Hughes said pills that help reduce blood sugar levels are the typical first step for new Type 2 diagnosis. If the pills do not seem to help over time, injections may be prescribed. A type 2 diabetic taking injections is not necessarily taking insulin. Some injections aid in controlling the blood sugar by helping your pancreas produce the insulin naturally.

Kerstetter said this is the medication route she is currently subscribed to. In 2014 after a hospital stay for some complications with her kidneys, her new family doctor began an active look at her numbers on a regular basis to find the medication that worked best for her.

Kerstetter still takes two pills at higher doses than when she was diagnosed as well as the once-per-week injection of Tanzeum after unsuccessful results with other injections.

Dixon, meanwhile, has learned her lesson on how important it is to take her insulin regularly.

As a teenager, she said, she was not overly thrilled to be seen carrying a syringe and vile.

She said by her early 20s, after she got married, she was more compliant to take her medication because the pen form of insulin was available.

Very rarely do we have patients choose to use insulin shots, Kennedy said, It now all about the insulin pens.

Another option is an insulin pump, which Dixon said she has not used.

A catheter is placed under the skin and the pump, a small device, can be carried under a waistband and is programmed to give the correct amount of insulin required. The insulin can be adjusted as needed by pressing buttons.

However, it was the implementation of the Dexcom, Dixon said, that has changed her life. The Dexcom CGM or Continuous Glucose Monitor includes a sensor that is attached discretely to the body and then displays the glucose levels to a monitor that can be checked over 200 times a day. It can also be used in collaboration with the pump.

There is also a share option for patients to have their levels displayed on a spouses cell phone or for parents of children who need insulin.

Since Type 2 is the only preventable form of diabetes, Dohl said the key is to keep your weight under control and think about your lifestyle. She also said most patients do not consider diabetes. They often visit the doctor because they may have fainted or have blurred vision and go home with a diabetic diagnosis.

As many as 8.1 million Americans have diabetes and dont know it, Hughes said.

When symptoms arise, see your doctor and get bloodwork, they said.

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Diabetes in the Valley: Area families hit hard by condition - Sunbury Daily Item

Tuesday, April 18, 2017 3:43 p.m. CDT

By Will Boggs MD

(Reuters Health) - A short questionnaire can identify drivers with type 1 diabetes who are at high risk of future driving mishaps, and an online intervention can help them avoid these mishaps, according to a U.S. study.

Like pilots who have to go through a pre-flight checklist to ensure all systems are a go, drivers with diabetes should go through a check list, asking themselves whether they have had more physical activity, taken more insulin, eaten fewer carbohydrates than usual, feel any unusual symptoms and judge whether they are low or likely to go low during the drive, said lead author Dr. Daniel Cox from the University of Virginia Health System and Virginia Driving Safety Laboratory in Charlottesville.

If the answer is yes, then they should take appropriate steps to avoid hypoglycemia while driving, Cox said by email.

Drivers with type 1 diabetes have a greater risk of collisions than their spouses without diabetes, and those mishaps correspond to the use of insulin pumps, a history of collisions, severe low blood sugar (hypoglycemia) and previous hypoglycemia-related driving mishaps, the study team writes in Diabetes Care.

The researchers developed an 11-item questionnaire to screen drivers with type 1 diabetes for a high risk of driving mishaps and developed an online intervention intended to help high-risk individuals avoid future mishaps.

Their Risk Assessment of Diabetic Drivers (RADD) scale included questions about past experiences while driving, like have you had an automobile accident or received a moving vehicle violation in the last 2 years? and diabetes-specific questions like, have you had low blood glucose in the past 6 months? and was it a hassle trying to hide dizziness or other symptoms of low blood glucose?

Based on answers to 11 questions, around 35 percent of individuals with type 1 diabetes could be classified as high-risk drivers whose mishap rate was nearly three times higher than that of people in the low-risk group.

High-risk drivers who went on to participate in the online intervention at DiabetesDriving.com had a driving mishap rate of about 2.5 per year in the following 12 months, compared with about 4.25 mishaps per year among high-risk drivers who did not participate in the intervention. Still, the mishap rate of high-risk drivers who did the intervention remained higher than that of low-risk drivers.

Driving is a privilege, not a right, Cox said. Whether we have type 1 diabetes, sleep apnea, narcolepsy, slowed reaction times due to aging, or some other chronic or acute condition (e.g., excessive sleepiness or intoxication), we all have a responsibility to ourselves, our families, and others on the road to ensure we are a safe driver.

People with diabetes should realize they should never drive when their blood glucose is below 70, because it is too easy to slip from mild hypoglycemia to moderate hypoglycemia that impairs judgment, information processing speed, and general reaction time, Cox added. As soon as hypoglycemia is detected or suspected, the driver should immediately safely pull off the road, treat it, and not resume driving until the hypoglycemia resolves.

Diabetic patients have a tendency not to disclose their driving mishaps or near miss events due to fear of losing their driving licenses," said Dr. Thinzar Min from Swansea University in the UK, who was not involved in the study.

In the UK, drivers are allowed only one severe hypoglycemic episode in 12 months to retain Group 1 license (cars and motorcycles) and no severe hypoglycemic episodes for Group 2 licenses (trucks and busses), Min noted.

I think the RADD scale would be more accurate if the patients can use it to assess themselves if they are high-risk or not, she said. Online interventions should be aimed at all diabetic patients who are taking insulin.

Dr. Eitaro Nakashima from Chubu Rosai Hospitalin Nagoya, Japan, wrote recently about the pitfalls of tightening driving regulations for diabetic patients in Japan and Europe. "In my opinion, each patient should understand the degree of risk of driving mishaps and prepare sugar in their car. For general public, education and individual customized treatment are important for good outcome instead of tightening of driving regulations, he told Reuters Health by email.

SOURCE: http://bit.ly/2oJgxvQ Diabetes Care, online April 12, 2017.

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Program identifies risky diabetic drivers and helps them improve - KFGO

COLUMBUS, Ga. - Looking around Marquis House's bedroom in his family's Columbus, Georgia, home, it almost feels like he's still here, like he's going to walk in the door any second.

"This is all his dirty laundry; I haven't had the heart to wash it," Chereia House, his mother, says. "This is his (insulin) pen right here. His glasses he wore to school."

House spends a lot of time in here, remembering Marquis.

"I think about him," she says. "I think about his personality."

Marquis was 19, a diehard New England Patriots' fan in Falcons' country.

He was a University of West Georgia sophomore, and a video-gamer, who still got a kick out of dressing up for the family's pajama costume Christmas photo.

Marquis was also a type 1 diabetic, drilled in staying on top of his blood sugar.

"He was diagnosed when he was 4 years old," his mother remembers. "He was doing his own injections at 4, he was counting his carbs at 5."

So, losing Marquis to a complication of diabetes?

It just doesn't seem possible.

"Because he was so on top of it," Chereia House says. "He knew what to do, he always knew what to do."

And Type 1 diabetes requires a constant balancing act, says Children's Healthcare of Atlanta endocrinologist Dr. Jessica Hutchins.

"Most kids with Type 1 diabetes are taking 4 to 6 injections of insulin a day, depending on how often they're eating and how well their blood sugars are doing," Dr. Hutchins explains.

On February 11, 2017, a Saturday night, Marquis House, alone in his dorm room, called his mom.

"And he said, 'Oh, I've been throwing up.' And I said, 'What is your blood sugar?'"

Chereia House says Marquis reassured her he'd checked his blood sugar and it was within the normal range.

But he was sick to his stomach, so his mother wondered if he should go to the ER.

"He was, like, 'No, mom, I'm fine. It's just a little bug, if I'm still throwing up in the morning, I will go to the hospital,'" House says.

Marquis didn't know it, but he'd developed a serious complication, known as diabetic ketoacidosis, or DKA, often triggered by an infection or missed insulin treatments.

His insulin insulin levels had dropped dangerously low.

His body, searching for fuel for energy, had begun breaking down fat, releasing acids known as ketones into his blood, which were spilling over into his urine.

In the early stages, Dr. Hutchins says, symptoms of DKA include weight loss, an increase in thirst, and frequent urination.

Kids may feel very tired and fatigued.

But as the condition worsens, she says, patients in DKA often experience vomiting, dehydration and mental confusion.

That may explain why Marquis House simply thought he just had a stomach bug.

"Usually the symptoms have been going on for weeks, very subtly and nobody has really noticed," Dr. Hutchins says. "But as far as the actual DKA, that can, within 24 hours can go from vomiting a little bit into a severe life-threatening condition."

When she hung up with Marquis, his mother asked him to call her in the morning.

"That Sunday morning, I got up and I was, like, 'Oh, he didn't call me,' says Chereia House. "So I texted him."

Marquis never responded.

Hours later, he was dead in his dorm room.

Only now, two months after his death, is his family putting together what happened in Marquis' final hours.

"He got up at some point, and was getting ready to administer his insulin," says Chereia Houe. "Or (he was trying to) check his blood. He had everything out. And then passed out."

Today, Chereia House says, it's still hard to believe the heart of their family is gone.

"But when I miss him, I come in and I just lay across his bed," his mother says. "To kind of like get his, to get his scent."

Chereia House, still consumed by questions, says she's telling their story because she wants other parents to know about DKA and other complications of diabetes.

Follow your gut, if you feel something is wrong, she says.

She wishes more than anything she's followed hers with Marquis that February night.

"I feel if I would have pushed him, and made him go to the hospital," Chereia says. "Maybe we would not be here doing this story. Every day I live with that regret, for not pushing it.`"

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19-year old Georgia college student dies of diabetes complication - FOX 5 Atlanta

The majority of cells within our bodies are not humannor is the majority of our DNA. We are hosts to 1014 bacterial cells (50 percent to 90 percent of all cells) that make up as much as 95 percent of our total DNA.1 Most of these organisms live within the gastrointestinal (GI) tract but also within the genitourinary tract, on our skin, and on the ocular surfaceforming what is collectively known as the microbiome.

Given this abundance of nonhuman species living on and within our bodies, it is not surprising that there is a link between specific bacteria to systemic and ocular diseaseincluding diabetes and diabetes-related eye disease.

What studies tell us

A reduction in gut bacterial diversity precedes the onset of clinical diabetes.2 Reduction of intestinal species that produce short-chain fatty acids (SCFAs), especially butyrate but also propionate and acetate, appears to be particularly important. These SCFAs improve insulin sensitivity by stimulating peroxisome-proliferator agonist gamma receptors3 (PPARG), analogous to the PPARG diabetes medication, pioglitazone (Actos, Takeda).

Butyrate enhances production of the intestinal hormone, glucagon-like peptide-14 (GLP-1), which increases insulin production, decreases glucagon secretion, and inhibits appetite. It is analogous to GLP-1 analog drugs like exenatide (Byetta, Amylin) and liraglutide (Victoza, Novo Nordisk).

Butyrate also enhances intestinal barrier function, preventing translocation of bacteria and lipopolysaccharides derived from the cell walls of Gram-negative organisms (endotoxemia) that leads to so-called leaky gut syndrome. Leaky gut syndrome has been linked to autoimmunity in type 1 diabetes and inflammatory cytokine production in type 2 diabetes (T2DM).5,6

Introduction of butyrate-producing bacteria via probiotic supplementation has been shown to improve insulin sensitivity and reduce inflammation in humans with type 2 diabetes.7

Perhaps more convincingly, transplanting fecal material from healthy adults with markedly higher numbers of butyrate-producing bacteria to obese patients with T2DM and lower numbers of such bacteria resulted in nearly 80 percent better insulin sensitivity in one small study.8

Recent meta-analysis of 11 studies with more than 600 subjects shows that multi-species probiotic supplementation modestly but significantly improves insulin resistance, excess insulin production, fasting blood sugars, and mean blood glucose (HbA1c) in humans with T2DM.9

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How diabetes is linked to gut bacteria - ModernMedicine

Diabetes is one of the largest health issues of the 21st century. According to estimates from the Centers for Disease Control and Prevention, roughly 29 million people have diabetes in the U.S. -- 9.3 percent of the population. Equally concerning is that nearly 30 percent of those cases are undiagnosed.

How does the U.S. compare to other nations when it comes to levels of diabetes? HealthGrove, a health data site by Graphiq, used data from the International Diabetes Federation to find the countries and territories with the highest rates of diabetes in 2015 (the most recent year available). The report from the IDF includes levels of diabetes prevalence for people aged 20 to 79, as well as the number of diabetes-related fatalities and total number of diabetes cases. The IDF prevalence figures are age-adjusted to account for different age structures in various countries.

For context, HealthGrove also included the average amount spent per person with diabetes for each country, as reported by the IDF. These amounts are measured in international dollars, a hypothetical currency with the same purchasing power parity of U.S. dollars in the U.S. at a given point in time.

The data from the IDF includes the prevalence of both Type 1 and Type 2 diabetes (either diagnosed or undiagnosed). Type 1 occurs when the pancreas makes insufficient insulin; Type 2, the more common variety, occurs when the body has difficulty producing and using insulin.

The ranking is dominated by small island nations, particularly in the Pacific Islands. Many countries in this region have dealt with malnutrition and inadequate food labeling, especially as they import more processed food. Countries in the Middle East also showed reported elevated levels of diabetes. Kuwait, Saudi Arabia and Qatar all made the top 10.

Note: Ties are broken by the number of diabetes-related deaths. There are countries where certain variables are not monitored and could not be extrapolated accurately by the IDF; these were therefore left blank.

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The 51 countries with the highest diabetes rates - Quad City Times