Type 2 diabetes is a chronic disease that prevents your body from being able to properly use insulin. Its the result of increased insulin resistance and your pancreas not making enough insulin to manage your blood sugar (glucose) levels.

About 1 in 10 Americans has diabetes, and type 2 diabetes represents 90 to 95 percent of those cases, according to the Centers for Disease Control and Prevention (CDC).

There are many symptoms of type 2 diabetes. Its important to know what they are because diabetes because the condition can be prevented or delayed if caught early.

Read on for the most common symptoms of type 2 diabetes.

The symptoms of type 2 diabetes vary from person to person. They can develop slowly over many years and might be so mild that you dont notice them.

Polyuria, or excessive urination, is one of the 3 Ps of diabetes.

Your kidneys eventually cant keep up with the extra glucose in your bloodstream. Some of the glucose ends up in your urine and draws in more water. This leads to more frequent urination.

Adults naturally produce 1 to 2 liters of urine per day (a liter is about a quart). Polyuria is defined as more than 3 liters per day.

Excessive thirst, or polydipsia, is often a result of frequent urination. Your body urges you to replace lost fluids by making you feel thirsty.

Of course, everyone gets thirsty sometimes. Extreme thirst is uncharacteristic and persistent, no matter how often you replenish.

Excessive hunger is called polyphagia.

If you have type 2 diabetes, your body has a hard time turning glucose into energy. This makes you feel hungry. Eating introduces even more sugar that cant be processed, and it doesnt alleviate the hunger.

Diabetes increases your risk of several eye conditions, including:

The increased blood sugar from diabetes can damage blood vessels, including those in the eye, leading to blurry vision.

Fatigue can be a mental or physical tiredness that doesnt improve with rest. There are many causes of fatigue.

Its a difficult symptom to research, but a 2016 study concluded that people with type 2 diabetes may experience fatigue as a result of fluctuations between high and low glucose levels.

If you have type 2 diabetes, regular cuts and scratches can take longer to heal. Wounds on your feet are common and easy to overlook. Slow healing foot ulcers occur due to poor blood supply as well as damage to the nerves responsible for blood flow to the feet.

A 2020 study showed that diabetic foot ulcers dont mobilize the immune cells needed for proper inflammation and healing.

High glucose can damage the blood vessels that supply nutrients to your nerves. When your nerves dont receive enough oxygen and nutrients, they cannot function properly.

This is called diabetic neuropathy and is most common in your extremities.

Insulin resistance causes glucose to build up in the bloodstream instead of being turned into energy. This can cause your body to consume other energy sources, like muscle or fat tissue.

Your weight might naturally fluctuate a little. An unexplained loss of at least 5 percent of your body weight is generally agreed as a need to talk with your healthcare professional.

In addition to nerve damage and a weakened immune system, poor blood circulation also increases the chance of developing an infection in people with diabetes. Having more sugar in your blood and tissues allows infections to spread faster.

People with diabetes commonly develop infections of the:

Acanthosis nigricans is a skin condition that can be a symptom of diabetes. It appears as dark bands of skin that may have a velvety texture.

This is most common in body folds such as your armpits, neck, and groin, but can also occur elsewhere.

Link:
Type 2 Diabetes Symptoms in Women and Men: What to Know - Healthline

Even if you're one of the more than 34 million people with diabetes, according to the Centers for Disease Control and Prevention, there's so much confusing information out there that what's fact and what's gotten oversimplified or distorted isn't quite clear. But knowing how to prevent and treat this condition, the rate of which has doubled in the last 20 years, is key to keeping it under control. And because diabetes dramatically increases your risk of cardiovascular problems such as heart disease and stroke, taking it seriously could save your life.

Check out these diabetes myths and set yourself straight.

Emilija ManevskaGetty Images

Sugar does not cause diabetes. Being overweight, however, is one of the major risk factors, and foods that are high in added sugar tend to be high in calories. But keep in mind that fat has twice as many calories as sugar, says Matt Petersen, managing director of medical information at the American Diabetes Association. Another potential culprit: eating red meat. If youre at risk, your best bet is to lower your total calorie intake and get those calories from nutrient-rich foods like non-starchy vegetables, whole grains, and low-fat protein and dairy, says Christine Lee, M.D., of the National Institute of Diabetes and Digestive and Kidney Diseases. And when you have a hankering for a sweet, focus on foods with naturally occurring sugar.

Theres a reason type 1 diabetes isnt called juvenile diabetes anymoreyou can get it at any age, says Petersen. Five percent of U.S. adults have been diagnosed with type 1, but sometimes grown-ups are misdiagnosed with the more common type 2, says Sara Pinney, M.D., a pediatric endocrinologist at Childrens Hospital of Philadelphia. The two types of diabetes have different causes: In type 1 diabetes, the body attacks the pancreatic beta cells by mistake, causing them to stop making insulin, the hormone that lowers glucose in the blood, says Dr. Pinney. With type 2, the pancreas makes insulin, but the body doesnt respond well to it. Patients with type 1 need to take insulin to normalize their blood sugar, or they will become very ill. To tell the difference, your doctor may test for certain antibodies in your blood.

Most people dontmany are able to control their diabetes through diet and exercise, oral medication, or a combination of both. Of those with type 2 diabetes, only 40% use insulin, according to the Centers for Disease Control and Prevention. Your need for insulin may change with age, though. Eventually, to keep your blood glucose levels in a healthy range, you might need to use it, Petersen says. And thats OK. Its just that your disease has progressed and now youre taking the best step to manage it. (And if you have type 1 diabetes, you will need to take insulin right from the start.)

It can take monthsor even yearsfor symptoms to get extreme enough for people to figure out on their own that they have type 2 diabetes, says Dr. Pinney. Thats because the most common signs, increased urination and thirst, are easy to overlook or to write off as part of getting older. By the time more noticeable symptoms like blurry vision or tingling hands and feet prompt someone to make a doctors appointment, he or she may have had elevated blood sugars for a long time. An estimated 24% of people with diabetes are undiagnosed, which is why doctors recommend that those with major risk factorssuch as being 45 or older, being overweight, or having a family history of diabeteshave their A1C tested periodically. This simple blood draw will give your doc a snapshot of your blood glucose levels over the past three months and is one way to diagnose diabetes.

Nope! While it may help people lose weight, exercise (even if you dont drop pounds) also increases your insulin sensitivity, which naturally lowers your blood glucose. Studies have shown that a single bout of exercise can improve insulin sensitivity by up to 50% for as long as 72 hours after the sweat session. And even if your weight stays exactly the same, exercise can lower your A1C (long-term glucose levels) and your odds of developing diabetes. Thats because when muscle cells are active, theyre able to take up glucose and use it for energy without needing any insulin, says Petersen. Exercise is kind of a miracle treatment in its own way.

This article originally appeared in the May 2020 issue of Prevention.

Support from readers like you helps us do our best work. Go here to subscribe to Prevention and get 12 FREE gifts. And sign up for our FREE newsletter here for daily health, nutrition, and fitness advice.

This content is created and maintained by a third party, and imported onto this page to help users provide their email addresses. You may be able to find more information about this and similar content at piano.io

See original here:
Diabetes Myths - Blood Sugar and Testing Explained - Prevention.com

Male patients with young-onset type 2 diabetes were found to be at 72% greater risk of retinopathy compared with those who received a diagnosis at 50 years or older.

Risk of retinopathy may increase with diabetes duration, particularly in male patients with young-onset type 2 diabetes (T2D), according to abstract findings presented recently at the virtual Annual Meeting of the European Association for the Study of Diabetes (EASD) and to be published in Diabetologia.

Amid an increasing incidence of type 1 diabetes and T2D in younger generations, researchers noted that patients with young-onset T2D incur a high lifetime risk of complications and reduced life expectancy.

Notably, incidence of retinopathy, one of the leading causes of blindness among working-age adults worldwide, has been indicated to affect up to 80% of patients within 15 years after diabetes diagnosis, which may pose a substantial financial burden for these populations if left untreated.

Seeking to further investigate the prevalence of retinopathy and coronary heart disease (CHD), another common complication, in patients with young-onset T2D, the investigators conducted a cross-sectional study of data collected from Norwegian general practice electronic medical records (EMRs).

In the study, EMRs of 10,242 adults with T2D from 2014 were collected. Additionally, to explore relationships between age at diagnosis and complications, they compared patients with young-onset T2D (diagnosis by age 40 years) and those diagnosed at 50 years or older (n = 6627) on clinical outcomes, retinopathy, and CHD via multivariate logistic regression, with multilevel multiple imputation performed to reduce potential bias due to missing data, noted researchers.

Within the cohort, prevalence of young-onset T2D was 10.2% (n = 980; 55.6% were male), in which mean age was 33.3 years at diagnosis and 44.7 years in 2014. Comparably, the mean age for the cohort aged 50 and older was 62.7 years at diagnosis and 70.4 years in 2014.

Compared with the 50 and older cohort, mean glycated hemoglobin (A1C) levels were indicated to be higher in patients with young-onset T2D (60 mmol/mol vs 52 mmol/mol), with incidence of high A1C levels found more frequently at diagnosis in these populations as well (7.6% vs 6.9%). Higher A1C levels were observed in men with young-onset T2D, but levels were similar in women of both age groups.

In those with young-onset T2D, A1C levels were higher already from the point of diabetes diagnosis but also increased more rapidly with time, noted the accompanying press release. In other words, if 2 people had T2D for the same length of time, A1C levels would likely be higher in the one diagnosed at a younger age.

In assessing disease-related complications, retinopathy was shown to develop at an earlier age, with prevalence found to be nearly 3 times higher in patients with young-onset diabetes compared with those who received a diagnosis at 50 years or older (15.5 vs 5.9%).

After accounting for potential confounders, risk of retinopathy was significantly higher in both male and female patients with young-onset T2D. However, after further adjusting for potential mediators (diabetes duration, A1C, and systolic blood pressure), risk was reported to remain significantly high in men with young-onset T2D compared with those diagnosed at 50 or older (odds ratio, 1.72; 95% CI, 1.29-2.29), but not in women (odds ratio, 1.34; 95% CI, 0.95-1.89).

Risk of CHD was shown to be more related to current age than to diabetes duration. Of note, study authors said that diagnosis of T2D may be more likely to be delayed in men, who tend to visit their general practitioner less often than women.

It is important that young-onset T2D is detected early enough and treated adequately to reduce the likelihood of retinopathy and other complications, said study author Katrina Tibballs, PhD student at the University of Oslo, Norway, in a statement. The current guidelines on diabetes prevention and treatment should be updated to reflect the higher risk of complications in those with young-onset diabetes, particularly the elevated risk of retinopathy in men.

Reference

Tibballs KL, Jenum AK, Sandberg S, et al. Young-onset type 2 diabetes: clinical outcomes in Norwegian general practice. Presented at: EASD Annual Meeting 2021; September 27-October 1, 2021; Stockholm, Sweden. Abstract 139.

More:
Young-Onset Type 2 Diabetes Linked With Higher Risk of Retinopathy in Men - AJMC.com Managed Markets Network

In a small, preliminary study, researchers have found that people with type 2 diabetes who also have a BMI that falls within a moderate range can reverse their diabetes by losing weight.

The researchers reported their findings at the Annual Meeting of the European Association for the Study of Diabetes.

Type 2 diabetes is the most common form of diabetes, accounting for around 91.2% of diabetes cases in the United States.

The condition occurs when a persons body does not produce enough insulin or if the insulin no longer works effectively. Insulin normally helps glucose enter the cells of the body. In the absence of insulin, glucose stays in the blood, where it can damage organs and tissues.

This means that a person with type 2 diabetes has an increased risk of several health issues, including stroke, heart disease, issues with their feet, kidney disease, dental issues, and bladder problems.

According to researchers writing in the journal Nutrients, scientists for a long time believed that type 2 diabetes was incurable, so they primarily focused on how people should manage symptoms of the condition.

However, evidence now suggests that if individuals who are overweight or have obesity achieve and maintain weight loss, they can reverse type 2 diabetes.

In the present small, preliminary study, researchers have gone one step further and examined whether weight loss might reverse type 2 diabetes even in those whose weight falls within the moderate BMI range.

Medical News Today spoke with the studys first author, Dr. Ahmad Al-Mrabeh, a Transitional Research Fellow at the Centre for Cardiovascular Science at Queens Medical Research Institute at the University of Edinburgh in the United Kingdom.

He explained that they decided to explore whether weight loss could be effective at reversing type 2 diabetes for people with moderate BMI after looking at the results of their previous research.

We observed that the metabolic profile changed markedly after following a low calorie diet even when the change in body weight was [] minor. We, therefore, wanted to test whether inducing modest weight loss could achieve remission in those who are non-obese, said Dr. Al-Mrabeh.

According to the principal investigator of the study, Prof. Roy Taylor, Director of the Newcastle Magnetic Resonance Centre at Newcastle University, U.K., [o]ur previous research has shown that weight loss of 1015% can achieve remission in people with type 2 diabetes who are overweight or obese.

Doctors tend to assume, however, that type 2 diabetes has a different cause in those who arent overweight. This means that, unlike those who are overweight, those who are of [moderate] weight arent usually advised to lose weight before being given diabetes drugs and insulin.

Instead, theres a tendency to start them on insulin and other medication at a much earlier stage.

What weve shown is that if those of [moderate] weight lose 10-15% of their weight, they have a very good chance of getting rid of their diabetes.

This should be a wake-up call to doctors, and, with 1 in 10 of the 4.5 million people with type 2 diabetes in the U.K. of [moderate] weight at diagnosis, there is no time to be lost in getting the message across.

Prof. Taylor

The study involved just 23 people. Of these, 12 individuals had a type 2 diabetes diagnosis with an average age of 58.3 years and an average BMI of 24.5. The remaining 11 did not have diabetes and were of similar age and BMI. This group acted as the control.

The Centers for Disease Control and Prevention (CDC) classify BMI scores of 18.524.9 as healthy.

All participants followed a low calorie diet for 2 weeks, consuming no more than 800 calories each day. The researchers then supported them to maintain their new weight for 46 weeks.

They completed this cycle two or three times until all participants had reduced their body weight by 1015%.

The researchers measured each participants visceral fat and insulin sensitivity before, during, and after the study.

At the end of the study, the researchers matched the people with diabetes with control participants of the same age, sex, and BMI. The scientists found that the individuals with diabetes lost more than twice as much fat in their liver compared with the controls.

In the diabetes group, fat in the pancreas reduced from 5.1% to 4.5%. Also, their average triglyceride levels fell from 1.6 millimoles per liter to 1.0 millimoles per liter a significant reduction similar to the control group.

Most significantly, two-thirds of the participants found that their type 2 diabetes went into remission and could stop taking their medication.

Prof. Taylor says that [t]hese results, while preliminary, demonstrate very clearly that diabetes is not caused by obesity but by [carrying too much weight] for your own body. Its due to having too much fat in your liver and pancreas, whatever your BMI.

In the liver, this excess fat prevents insulin from working normally. In the pancreas, it causes the beta cells to stop producing insulin.

Dr. Al-Mrabeh said to MNT that the results may be reproducible in larger studies, however, it is important to understand the mechanisms of excess fat buildup within these vital metabolic organs (liver and pancreas) in non-obese people.

Speaking with MNT, Prof. Pl R. Njlstad, Leader of the Center for Diabetes Research at the University of Bergen, Norway, said that [t]he findings are interesting and indicate that weight loss is also important in non-obese individuals with type 2 diabetes.

Prof. Njlstad added that [m]ore studies are needed with an increased number of study participants and increased time of follow up, in addition to investigating the effect of other factors, such as age, sex, and ethnicity.

Dr. Al-Mrabeh said to MNT that he will continue developing the initial findings.

I have recently moved to the University of Edinburgh to establish an independent research program looking into the mechanisms of how excess fat causes damage to the pancreas in type 2 diabetes. My aim is to dissect these mechanisms using both human and animal studies.

See the rest here:
Diabetes: Losing visceral fat more important than overall weight - Medical News Today

Oct. 1, 2021 -- Almost half of young adults with type 2 diabetes develop a potentially blinding eye complication called diabetic retinopathy within a dozen years after diagnosis, new research reveals.

The findings, from one of the longest-running nationally representative studies in the U.S. focusing on youth-onset type 2 diabetes, provide crucial guidance on diabetes management and eye care to young patients and their families, as well as doctors and the public, says study author Rose Gubitosi-Klug, MD, a pediatric endocrinologist at UH Rainbow Babies and Childrens Hospital in Cleveland, OH.

My colleagues and I in pediatrics are alarmed, Gubitosi-Klug says.

Initially, about 14% of participants had very early changes to the eye. When we looked a second time just 7 years later, about half are now experiencing changes to the eye, some with advanced disease thats not normally seen until someone is in their fourth or fifth decade of life.

The study was published online Sept. 16 in the journal Diabetes Care.

Half of Patients with Average Age of Just 25 Had Signs of Eye Damage

Diabetic retinopathy -- the leading cause of blindness in working-age adults and one of the top reasons for preventable blindness -- is characterized by damage to the blood vessels at the back of the eye. These abnormal vessels resemble scar tissue that can pull the retina out of place, causing blurriness, floaters, or severe vision loss.

Scientists had believed that U.S. rates of diabetic retinopathy would double between 2010 and 2050, but with this new data, we expect this rate will more than double, says Gubitosi-Klug, whos also a professor of pediatrics at Case Western Reserve School of Medicine in Cleveland.

Previously, the TODAY (Treatment Options for Diabetes in Adolescents and Youth) study had reported a 13.9% prevalence of diabetic retinopathy in young people who had had type 2 diabetes for an average of about 5 years. Seven years later, between 2017 and 2018, 420 of the original 517 participants again had retinal photograph tests that were evaluated for the presence of diabetic retinopathy and its advance.

In the later analysis, 49% of participants -- whose average age was just 25 -- had developed diabetic retinopathy. While 39% had mild or very mild cases of the eye condition, about 4% had its most severe form. Compared with mildly affected patients, those with more extreme progression had higher blood sugar and blood pressure levels, as well as more health problems.

Participants represented diverse racial and ethnic groups, including Hispanic, Black, and Native American people considered at higher risk of developing type 2 diabetes, making the findings generalizable to the American public, Gubitosi-Klug notes.

Treat Youths Early, Prevent Complications

About 210,000 youths in the U.S. under age 20 are estimated to have diabetes, according to the American Diabetes Association. These patients should strive to tightly control blood sugar levels and work closely with their doctors to do so, Gubitosi-Klug advises.

Even if their vision is OK now, diabetes likes to take effect on your tissues earlier, so see your doctors and follow up with an ophthalmologist, she says. And dont skip those eye screenings.

Beyond the study findings related to eye health, doctors should understand that children at a young age are not only developing diabetes, but developing the complications of diabetes, Gubitosi-Klug continues.

I think theres been hesitancy to aggressively treat them with medications for diabetes or high blood pressure because theyre young. But waiting is putting them on the path to developing these complications.

Even people without diabetes should be aware of this issue, she says.

We need to work with families to overcome barriers to make sure healthy food is available to all, and that schools and kids can focus together on healthy eating and activity to help prevent these kids going on to have diabetes.

And routine eye exams should also include the extra step of dilated retinal testing, Gubitosi-Klug says. With about 1 in 10 Americans diagnosed with diabetes, and another 88 million with prediabetes, such testing could reveal early signs of diabetic retinopathy or other dangerous vision changes.

Theres good news: If we catch early lesions and improve diabetes control, we know from other studies that some eye findings can improve, she says. So, theres always a benefit in trying to improve your diabetes management.

WebMD Health News

Diabetes Care: Development and Progression of Diabetic Retinopathy in Adolescents and Young Adults With Type 2 Diabetes: Results From the TODAY Study.

More here:
Alarming Number of Youths with Type 2 Diabetes Have Eye Damage - WebMD

ONE in ten people could have diabetes by 2030, experts warn.

Rising obesity levels mean 5.5 million adults will have the disease within a decade up from 4.9 million today, charity Diabetes UK said.

1

And a further 17 million will be at risk of Type 2 because of their weight.

CEO Chris Askew said: Were at the tipping point of a public health emergency and need action today to stop it.

Its a sobering thought that, if we dont act, hundreds of thousands more will face the life-changing news that they have Type 2 diabetes.

With the right care and support, diabetes complications can be avoided and cases of Type 2 diabetes can be put into remission or prevented altogether.

Most people with Type 2 diabetes around 90 per cent of all cases get it because of an unhealthy lifestyle. Type 1 cannot be prevented.

Diabetes UK has called for government investment in weight-loss programmes, diabetes prevention and check-ups to stop patients getting complications.

Two-thirds of Brits are overweight. The NHS is already delivering the worlds largest type 2 diabetes prevention programme.

Read more:
One in ten people 5.5 million adults could have diabetes by 2030, experts warn... - The US Sun

Significance

Methods to detect type 1 diabetes (T1D) progression prior to clinical diagnosis are needed. T1D results from autoreactive T cells infiltrating the islets of Langerhans, destroying insulin-producing -cells. Overt disease takes years to present, and at diagnosis, there is substantial -cell loss. Therapeutic intervention to preserve -cell mass is hampered by an inability to follow presymptomatic T1D progression. Several immunotherapies can delay T1D development. However, identifying at-risk individuals and tracking whether therapeutic interventions are impacting disease progression, are lacking. We present ultrasound imaging of nanodroplet (ND) contrast-agent accumulation within the islet. ND accumulation is dependent on immune infiltration; therefore, it tracks presymptomatic T1D development and progression to diabetes. This provides an opportunity to guide therapeutic treatments to prevent T1D.

Type 1 diabetes (T1D) results from immune infiltration and destruction of insulin-producing cells within the pancreatic islets of Langerhans (insulitis). Early diagnosis during presymptomatic T1D would allow for therapeutic intervention prior to substantial -cell loss at onset. There are limited methods to track the progression of insulitis and -cell mass decline. During insulitis, the islet microvasculature increases permeability, such that submicron-sized particles can extravasate and accumulate within the islet microenvironment. Ultrasound is a widely deployable and cost-effective clinical imaging modality. However, conventional microbubble contrast agents are restricted to the vasculature. Submicron nanodroplet (ND) phase-change agents can be vaporized into micron-sized bubbles, serving as a microbubble precursor. We tested whether NDs extravasate into the immune-infiltrated islet microenvironment. We performed ultrasound contrast-imaging following ND infusion in nonobese diabetic (NOD) mice and NOD;Rag1ko controls and tracked diabetes development. We measured the biodistribution of fluorescently labeled NDs, with histological analysis of insulitis. Ultrasound contrast signal was elevated in the pancreas of 10-wk-old NOD mice following ND infusion and vaporization but was absent in both the noninfiltrated kidney of NOD mice and the pancreas of Rag1ko controls. High-contrast elevation also correlated with rapid diabetes onset. Elevated contrast was also observed as early as 4 wk, prior to mouse insulin autoantibody detection. In the pancreata of NOD mice, infiltrated islets and nearby exocrine tissue were selectively labeled with fluorescent NDs. Thus, contrast ultrasound imaging with ND phase-change agents can detect insulitis prior to diabetes onset. This will be important for monitoring disease progression, to guide and assess preventative therapeutic interventions for T1D.

Author contributions: M.A.B. and R.K.P.B. designed research; D.G.R., M.C., A.K.U., V.T.P., and R.K.P.B. performed research; D.G.R. and M.C. analyzed data; and D.G.R. and R.K.P.B. wrote the paper.

The authors declare no competing interest.

This article is a PNAS Direct Submission. M.V.H. is a guest editor invited by the Editorial Board.

This article contains supporting information online at https://www.pnas.org/lookup/suppl/doi:10.1073/pnas.2022523118/-/DCSupplemental.

All data and analysis are available to be shared upon request. Raw data, including czi microscopy files (for histology), Vevo ultrasound data files (for ultrasound images), and glucose and mIAA data have been deposited at https://www.ebi.ac.uk/biostudies/studies/S-BIAD189.

View original post here:
Detecting insulitis in type 1 diabetes with ultrasound phase-change contrast agents - pnas.org

Like most providers, Julie Valdes used toprescribe medicationbased on a patients diagnosis. But for those with uncontrolled diabetes, the approach wasnt working.Despitegivingthem the best medications available, they kept returning with high blood sugar levels.

It kind of forced me to say, You know what, medications arent number one. The person as a person is number one,said Valdes, who works as a clinical pharmacist at Zufall Health Center in Dover, New Jersey.

Now, whenshemeets with a patient, shebeginswith a series of questions, seemingly unrelated to diabetes: Where do you work? Where do you live? Do you have appliances in your home?These questions helpValdes get a better understanding of what kind ofmedication regimenwill be best for the patient, given their circumstances. If they dont have a fridge at home,for example,temperature-sensitive insulinis not going to be an effectivetreatment, despite being the gold standard in diabetes care.You cant always just go by the book. You have to go by where [the patient is] at, what theyre willing to do, what is in their capacity to do.

Valdes spends up to an hour with patients far longer than the typical 15-minute provider visit identifyingbarriers to gettingpatientsdiabetes under control.

Most of the time, its money.I would say poverty or socioeconomics is probably the number one risk factor for diabetes, she said.

Some patients simply cant afford their diabetes medication.Other times, socioeconomic troubles make it difficult for patients to live a healthy lifestyle, particularly when it comes to diet.If you make minimum wage or less, think about the quality of food you can buy, said Valdes. Many of her patients are financially strapped,oftenforcedto choose between payingutilities andbuying groceries. Aloaf of wonder bread, like cheap white bread, is a dollar.To get whole grainbread is $4.Soif you only have $10, are you going to buy the white bread or the wheat bread?

The healthcenterprovides patients with bags of food, grocery store gift cards, and information on how toaccessthe local food pantry.This combined with education on nutrition, which Valdesprovidesas a certified diabetes educator, has helped patients achieve dramatic results one patient reducedtheir A1C score, a measure of blood sugar over athree-monthperiod by three hundred percent.

Still, other patientsjust dont have the time to take their medication. Valdeshaspatients who work12-hour shifts and cant get a break to inject their insulin. For these patients, she prescribes a once-daily oral medicationthats easier for them to take on the job.The drug theyre actually willing to swallow and take, thats the drug thats going to work, even if that means taking a drug thats technically less effective. We can have another medication that is doubletheefficacybut if theyre never going to take that, [then] having the drug thats only half as good that theyre going to take a hundred percent of the time, thats the medication for them.

Valdes also workswith patientsto overcomepreconceived notionsabout diabetes medication.In my population, insulin is the number one feared thing, saidValdes.They said,Oh, my grandma started insulinand then a month later she lost her leg or,I Googledinsulinor I GoogledMetformin and it says it breaks your liver.Thoughthese side effects have not beenproven,all drugs have effects, says Valdes and alot of times the risk of uncontrolled diabetes is way worse.

But some patients need more than just a tailored medication regimen.For many, psychological struggles are the main barrier to achieving good health.

If you dont have good mental health and youre not in the right space, youll never be able to implement all the dietary things, taking your medication ontime.It requires like a lot of organization and a lot ofself-care,said Valdes.

Thats where the healthcenterssocial workerscome in.A lot of our patients have been through things that are traumatic that can increase their risk for chronic conditions, said Sarah Aleman, a licensed clinical social worker and the director ofbehavioralhealth at Zufall Health Center.Someof her patientshave experienceddomestic violence,childhood abuse, or witnessed gang violence.

Research shows thesetypes ofexperienceshinder a persons ability to manage stress, making it moredifficult to turn off the fight or flight response.Whenstress hormonesareconstantly surging through the body,chronic diseasebecomes more likely. The hormones that are going through your body when youre stressed can increase your sugar levels,andover timecan putsomeone at higher risk for diabetes, explained Aleman.

In addition,several studies have documented the link betweentraumaandfeelings ofhelplessness.When someoneis exposed to harm they have no way of escaping,they have a harder time removingthemselvesfromunhealthy situationslater onin life. As researcherand psychiatristDr.Bessel van der Kolkputs it,peoplebecome unable to take action to stave off the inevitable.For those with a chronic disease, thiscan manifest as putting off treatment or forgoing care altogether.When people have experienced trauma, the self-image and self-esteem, the depression, can make it much harder for them to reach out for help,explained Aleman.

Maria Menzel, a licensed clinical social worker at Zufall Health Center, notes another impact of trauma: self-sabotage. She has seen patientsrefuse to take their medication orevenstop takingitafter seeing improvements.Historically, this has led providers to blame or scold patients, but as Valdes found, this kind of approach has yielded poor results.Now, providers likethose atZufall Health Center, are practicingtrauma-informedcare.

Trauma-informed care means assuming people have been through something and shifting from whats wrong with this person to whats happened to them, said Aleman. When we can think[about]whats happened to them, we can get them connected to resources in anonjudgmentalway.

For Valdes, this kind of approachrepresents a shift inhealth care.I think as a field, medicine is learning that its not alwaysthe data and its now always the clinical trials and labs, she said. Its about the person.

Direct Relief, together with BD, has provided Zufall Health Center with a $150,000 grant to expand home monitoring diabetes care for at-risk patients by providing them with equipment and supplies, including blood glucose kits and blood pressure cuffs. The funding, part of the Helping Build Healthy Communities initiative, is also being used to deploy a dedicated care team that will tailor clinical interventions to meet the individual needs of patients and provide them with education and online assistance in multiple languages.

Read the original here:
Managing Diabetes Takes More Than Medication. This Health Center is taking a Patient-Centered Approach. - Direct Relief

Ask people 'What was the big health story of the last year?', and nearly everyone will say COVID-19, understandably. But throughout the pandemic that has dominated our headlines and lives, another one has been raging. Last year, diabetes killed three times as many people as COVID-19. Type 2 diabetes generally develops in adulthood, as a result of simple choices you make every day. So what can you do to reduce your risk? Plenty, starting by avoiding this common habit that can lead to diabetes. Read on to find out moreand to ensure your health and the health of others, don't miss these Sure Signs You May Have Already Had COVID.

Diabetes is the body's inability to process sugar (a.k.a. glucose). When a non-diabetic person consumes sugar, their pancreas releases an enzyme called insulin to convert it to energy. A diabetic person's pancreas either doesn't make insulin, or the body becomes resistant to it. Sugar then builds up in the blood, potentially damaging the arteries and leading to heart disease, stroke, eye problems, and even amputation.

Type 2 diabetes, however, is exploding in the United States. Experts predict that one in 10 people will have diabetes by the year 2045. And it's directly connected to diet and lifestyle choices.

RELATED: Over 60? Reverse Aging With These Health Habits

There are many risk factors for type 2 diabetes. One of the biggest is a diet high in added sugar. When the body is swamped with sugar (and many processed foods contain simple carbs that break down into sugar), it can become resistant to insulin.

"Diabetes is when your body cannot provide enough insulin to allow glucose (sugar) into the hungry cells of your body," explains Thomas Horowitz, DO, a family medicine specialist at CHA Hollywood Presbyterian Medical Center in Los Angeles. "The best way to avoid it is to be on a diet that does not task your insulin supply."

That means avoiding sugar-sweetened drinks like soda, processed foods and refined grains like white breads, cookies, chips and baked goods. Choose foods that are low in added sugar and contain complex carbohydrates that break down slowly, like whole grains and vegetables instead of refined grains or sweets.

RELATED: This is a "Significant" Factor in Getting Dementia, Study Shows

It's especially important to limit or avoid beverages with added sugar, like sugar-sweetened sodas. One can of sugar-sweetened Coke contains 39 grams of added sugarmore than a person should consume from all sources in an entire day, experts say.

RELATED: I'm a Virus Expert and Warn it's Dangerous Entering Here

To reduce your diabetes risk or manage your diabetes, getting more physical activity is key. "Together with diet and behavior modification, exercise is an essential component of all diabetes and obesity prevention and lifestyle intervention programs," said researchers in a 2017 study published in the Cleveland Clinic Journal of Medicine. Exercise improves insulin sensitivity and builds lean muscle, which can speed your metabolism, helping you reach and maintain a healthy weight. And to get through this pandemic at your healthiest, don't miss these 35 Places You're Most Likely to Catch COVID.

Read more here:
This Common Habit Can Lead to Diabetes, Studies Warn | Eat This Not That - Eat This, Not That

An ounce of prevention

The very high incidence of heart disease in patients with long-standing diabetes makes preventative measures worthwhile. As a result, statin therapy is recommended for all individuals over age 40 with an LDL (low-density lipoprotein) of more than 70 mg/dL. In comparison, for those patients without diabetes, that LDL is considerably higher; the AHA 2019 guidelines for primary prevention set the bar at 190 mg/dL. The guidelines for treatment for those individuals with heart disease rather than primary prevention are different.

We have known for some time, based on observational trials and randomized controlled trials, that statins increase insulin resistance and raise glucose levels. The current research explored how those changes play out in the management of diabetes. Are the metabolic benefits of statins on lipids outweighed by statins harmful impact on glucose metabolism?

The Study

This was a retrospective chart review of patients within the VA system comparing a group of statin users to a matched cohort control being prescribed a medication for ulcers. Patients were entered into the study at their first prescription and followed until they left the VA system or the end of the study period 12 years.

From 700,000 eligible patients, the researcher created 83,000 pairs of statin users and controls. Being a VA population, it was predominantly male (94%), white (68%), or black (21%). Among the statin-user group, roughly 60% had diabetes at the study initiation, compared with 40% in the control group. By the end of the study, all patients in both groups had been diagnosed with diabetes that by itself should give us all a moment of pause. All of the statin users had significant reductions in LDLs, which the researchers rightly concluded represented not only being prescribed a statin but actually taking the medication.

Statin users had a 37% higher rate of progression of diabetes than their matched cohort. Progression as measured by

More importantly, there was a dose-response greater LDL reduction was associated with worsening diabetes management.

The Tradeoff

The metabolic imbalance between statins advantage for LDLs and disadvantage for glucose metabolism is most often cited as a statin advantage with a 15% reduction in heart attacks and stroke and a 9% reduction in mortality [1]. As the researchers point out, the metabolic cost on diabetic management is infrequently measured. They point to national statistics demonstrating increasing hospitalization and deaths for poorly or uncontrolled diabetes. To be fair, the deaths from these hospitalizations were a fraction of a percent.

There is little doubt within the medical community regarding the value of statins in secondary prevention, our euphemistic way of treating heart disease once it becomes clinically apparent. For individuals at higher risk for heart disease, statins do provide protection. But it is clear from this study that for patients with diabetes, those statins come with health risks in the short term their ability to manage glucose is impaired. This may require more close monitoring to tweak care. It may be an ideal setting for continuous glucose monitors, reducing the persistently elevated, poorly or uncontrolled blood sugar levels.

[1] These numbers are taken from one of many meta-analyses of statins and are ball-park figures for statins used before the onset of vascular disease primary prevention.

Source: Association of Statin Therapy Initiation With Diabetes Progression A Retrospective Matched-Cohort Study JAMA Internal Medicine DOI: 10.1001/jamainternmed.2021.5714

Read the original:
The Unintended Entanglement of Diabetes and Statins | American Council on Science and Health - American Council on Science and Health