Diabetic Live

Gastrointestinal Surgery and a Diabetic Cure: Significant research by Dr. Francesco Rubino of New York-Presbyterian Hospital/Weill Cornell Medical Center indicates that a surgical procedure in the gastrointestinal tract may effectively reverse diabetes.

This information was originally revealed in the spring of 2008 with a spotlight on what is typically called lapband surgery. This surgical procedure is typically suggested for individuals who are excessively obese. Dramatic weight loss is generally thought to be the reason for the reversal in diabetic symptoms. Is it possible something else is at work in this medical reversal of fortunes?

The surgical procedure Dr. Rubino has studied is a gastric bypass operation that effectively circumvents the duodenum and jejunum of the upper small intestine. In a Science Daily report, Rubino is quotes as saying, “When we bypass the duodenum and jejunum, we are bypassing what may be the source of the problem.”

Gastric bypasses have been performed on diabetic individuals in a variety of weight classes and in each instance it appears blood glucose levels were altered significantly.

While the primary focus of research has been to regulate blood sugar levels Rubino’s study opted to review the source of blood glucose regulation and reverse diabetic abnormalities.

The study seems to indicate this surgery is not a good idea for those who do not suffer from diabetic symptoms.

So, why is the surgery a possible cure for diabetes? Rubino believes the upper small intestine becomes dysfunctional in diabetics and sends wrong signals promoting the release of hormones the counter the effects of the body’s naturally produced insulin. Rubino explains this battle, “”In healthy patients, a correct balance between incretin and anti-incretin factors maintains normal excursions of sugar levels in the bloodstream. In some individuals, the duodenum and jejunum may be producing too much of this anti-incretin, thereby reducing insulin secretion and blocking the action of insulin, ultimately resulting in Type 2 diabetes.”

In essence the good doctor seems to be saying that when you bypass the upper small intestine in a diabetic you effectively remove the production and distribution of hormones that render insulin less effective. When the insulin no longer is at war with the anti-incretin the body resumes the normal cycle of insulin production resulting in proper blood sugar regulation.

Further, this means that the pancreas can resume normal function by creating a typical amount of insulin without trying to make more than it was designed to produce.

The findings of this study allow Dr. Rubino to conjecture, “The lesson we have learned with diabetes surgery is that diabetes is not always a chronic and relentless disease, where the only possible treatment goal is just the control of hyperglycemia and minimization of the risk of complications. This is a major shift in the way we consider treatment goals for diabetes. It is unprecedented in the history of the disease.”

As of this writing surgery is not an option most primary care physicians offer. They may not even be aware of existing research into the role of the upper small intestine in diabetes. Rubino hopes that one day this surgical option will allow those who suffer from diabetes to experience complete remission in their disease.

Three Diseases That Can Lead to Diabetes: Is it possible to receive a diagnosis indicating the presence of diabetes and have it only provide half the story? Yes, and this article is dedicated to a few of the most conspicuous diabetic contributors.

The first is a disease is known as Hemochromatosis and acts in almost every way like diabetes. The problem is if this disease is treated only as diabetes it address a few symptoms without treating the actual problem. The truth is when Hemochromatosis is treated correctly many diabetic symptoms are eliminated with proper care.

This disease generally affects joins, heart, liver and pancreas, which is why it can appear to fit the mold of diabetes. The problem is there is no subtle shift in symptoms for those who have this disease. Hemochromatosis seems to attack rapidly. Since this disease attacks the organ the sooner you can get accurate treatment the better.

If Hemochromatosis is the root cause of your problem you may reverse some of the diabetic issues you encounter by treating the originating disease.

The primary culprit for Hemochromatosis is a toxic buildup of iron in your body cells. While your body needs this mineral, too much of it can be the causal agent for this disease.

Chronic Pancreatitis is another disease that can appear to be diabetes simply because the disease affects the pancreas in much the same way diabetes can.

The onset of this disease is generally related to the prolonged use of alcohol, which inflames the pancreas and damages tissue. Because the disease is symptomatic of diabetes it is often treated as diabetes. Even if Chronic Pancreatitis is treated there may likely be cause to continue with secondary diabetic treatment.

Exocrine pancreatic insufficiency is another disease that may exist in tandem with diabetes, but may need treatment beyond typical diabetic assistance. This disease exists when the symptomatic loss of pancreatic cells reduce the bodies ability to create certain digestive enzymes that aid in solid waste elimination and proper absorpotion of certain minerals.

It is believed that Exocrine pancreatic insufficiency is actually the result of one of two additional diseases, Cystic Fybrosis and Shwachman-Diamond Syndrome.

The effective treatment of Exocrine pancreatic insufficiency may serve to reduce the severity of diabetic symptoms.

There are about a dozen known contributors to onset diabetes. Today you’ve met three. Diabetes isn’t always an end of the road diagnosis. It may only be symptoms of something else. Many times that ‘something else’ can be treated in a way that either reverses diabetes or minimizes its impact on your everyday life.

If you have been diagnosed with diabetes it may be possible there are some underlying causes for the diagnosis. By learning more about the disease as well as contributing factors you may be able to help your health care provider determine what those causes might be. If you can address those key issues you can reduce or in some cases eliminate the symptoms most closely linked to diabetes.

Your primary health care provider can provide testing for Hemochromatosis Chronic Pancreatitis and Exocrine pancreatic insufficiency. If you have questions or concerns you should talk with your doctor.

Using Diabetic Software For Better Results: Managed care for diabetes has gone high tech. Sure there are huge advancements in testing equipment, but perhaps the most noted tools are to be found in software for your home computer.

Many manufacturers have developed software to help you track and trend your blood glucose levels while allowing you to import other data and develop management plans. Some allow that data to be easily accessed by health care providers and pharmacists so action can be taken quickly to adjust your care. Other software manufacturers are more concerned with nutrition and exercise.

Let’s look at a few software products developed specifically for those living with diabetes.

ACCU-CHEK 360o Software
According to company data the Accu-Chek 360o offers the following…

1. Automatically detects your ACCU-CHEK meter or insulin pump.
2. One-click downloads of meter and insulin pump data.
3. Print, e-mail or fax from any page-easily send reports to your healthcare team.
4. View simple reports or manage comprehensive health information.
5. Create easy-to-read charts and graphs showing:

• Blood glucose
• Ketones
• Blood pressure
• Cholesterol
• Weight
• Carbohydrates
• Exercise
• Kidney screenings

The fee to purchase this software product is around $50.

Bayer’s WinGLUCOFACTS™
Bayer’s WinGLUCOFACTS™ is another software product that allows:

• Easy download of test results into a computer and or in printable logbook form.
• Data analysis to review trends.
• Configurations for beginners and advanced users.

The software is available at no cost through download from the company website.

The Fitness Assistant
This software product differs from the first two because it is designed to key in on fitness and nutrition. Here’s a company listing of product benefits.

• Reach Your Goals. SMART Calorie Monitoring System dramatically boosts your chances of reaching your target weight on the target date
• Not Just A Calorie Counter. Fitness Assistant is not yet another calorie counter. It is a program that actually adapts to your metabolism and gives you precise calorie advice customized to your unique body and metabolism. Say goodbye to *average person* calorie estimations.
• Enjoy a Flexible Eating Lifestyle. Fitness Assistant does not use ineffective fixed calorie diet plans. You have the absolute freedom to eat more or less than the program tells you and it will automatically correct the calorie plan for the remainder of the goal period.
• Eat your Favorite Foods. You can have the body you want by eating your favorite foods. Fitness Assistant will simply correct the amounts you eat.
• Powerful Training Log. Log, track and organize your workouts. Count only the additional calories you burn exercising and subtract the calorie overlap with your usual activities.

You will likely discover several software solutions for use with specific brands of blood sugar testing equipment or insulin pumps.

There are also multiple online tracking services that may make sense for your need.

The primary idea behind the software releases is to assist you in tracking what may or may not be working within your current strategy and allow you to gain encouragement from positive gains in your managed care plan. This article isn’t an endorsement of any one product, but a platform from which you can explore the possibilities of using software in your managed care plan. For further choices use your favorite search engine and conduct a search for additional diabetic software titles.

Turning Back the Tide of Type 2 Among Teens: One third of American adolescents are overweight. This may be described as an epidemic among American teens not just because of the weight gain, but because obesity among the young has brought a condition something primarily aging Americans have has to live with in the past. Doctors have seen an alarming number of young people developing Type 2 diabetes. WebMD.com reports, “The rate of type 2 diabetes among children has increased more than tenfold in the last two decades, from 3% to nearly half of all new pediatric diabetes cases.”

We have previously reported that a stomach bypass has worked to successfully place diabetes in remission for adult test subjects in recent research. New studies indicate a similar possibility for teens. This could open the way for new and effective ways to treat onset diabetes for a new age group.

The Cincinnati Children’s Hospital Medical Center conducted the research on 11 obese adolescents who had developed Type 2 diabetes. One test subject weighed in excess of 400 pounds.

In each case the patients were subjected to a gastric bypass operation. Their progress was compared to a select group of adolescents who had medically managed diabetes care options throughout the entire study.

Following the one-year study 10 of the 11 patients who underwent a gastric bypass had lost considerable weight, and their diabetes was in remission. The patients who relied on medication to manage their care saw some positive news during their regulated treatment. However, there were no remissions among the second test group.

Lead author Thomas Inge is reported by DNJ.com as saying, “The remarkable thing is that the teens who underwent these procedures did not have any major complications.”

DNJ.com further stated, “The patients came off all diabetic medications, returned to normal blood glucose and insulin levels and significantly improved their blood pressure and cholesterol.”

While some are lauding this new research as a potential cure for Type 2 diabetes among teens there are those that provide a note of caution. DNJ.com further reported that Michael Freemark, chief of pediatric endocrinology and diabetes at Duke University Medical Center said, ”It’s encouraging, but the results should not at this point be applied in the general community.”

What this likely means is that Freemark and others might be more enthused about the findings if there were more tests and test subjects to substantiate this initial research. Perhaps this comment may be best considered guarded optimism.

However, now with research indicating that both adults and teens may find relief from diabetes if a gastric bypass is conducted soon after original diagnosis of their disease there may indeed be several additional studies. Perhaps the primary reason for the additional research is the sheer numbers of diabetic patients who remain vitally interested in a way to pull the plug on their disease.

Inge defends his findings by saying, “This opens up a discussion about what may be appropriate treatment and offers pediatric endocrinologists another tool.”

For those teens that may be at risk for developing Type 2 diabetes the National Diabetes Education Program offers the following prevention tips.

• Stay at a healthy weight.
• Be more physically active.
• Choose to eat the right amounts of healthy foods.

The Encouragement Factor: A friend who once lived in England said, “I don’t know what it is about America, but the moment I set foot in your country I gained twenty pounds and I’ve never been able to lose it.”

The environment in America is one of continuous excess. We are invited to enlarge our meals and indulge in comfort foods. Some suggest those who make the food are responsible for conditions that could result in diabetes, but I won’t make that claim.

Each of us is responsible for the foods we consume. We may be somewhat ignorant of the foods that result in a healthy lifestyle, but the burden of our health rests on our own shoulders. After all if consumers had sincerely demanded healthy food and more health clubs business owners would have responded. Our actions and choices tell them otherwise. These entrepreneurs simply appealed to what they thought we wanted and then worked to supply it in abundance. We all agreed it was good.

The lifestyle we lead is also geared toward a sedentary or inactive lifestyle. We sit at the computer, we sit in front of the TV and we sit at sporting events. We are no longer required to be active for many occupations. This too contributes to conditions that may be more in tune with the development of diabetes.

It can be hard to break the cycle of inactivity. It may require a grieving process to make healthier food choices. The sad truth is if we don’t make those changes ourselves prior to onset diabetes we may be faced with the consequences of our inaction.

No one wants to hear those dreaded words, “You have diabetes”, yet we often place ourselves in long-term situations that can almost invite the disease to set up shop in our bodies.

If you have diabetes you should know that you can slow the effects of the disease by making the hard choices now to give your life outlook a whole new makeover. You can choose to manage your blood glucose through diet. You can choose to influence good health by developing and maintaining a body that is physically fit.

Perhaps one of the greatest problems for diabetics is there can be feelings of depression and fatigue that can make it easy to lay aside the good intentions you may have. You may need to seek out an accountability partner to help you keep your goals in view and keep your body in the best shape possible.

You might even try keeping a daily log that can assist in some self-encouragement to succeed. If you have weight loss goals be encouraged by those moments of success.

You are not in competition with someone else you are simply competing with yourself to manage your disease in the best way possible. You want to resist negative trends and instill a better series of opportunity that can result in a better self-image and an improved medical prognosis.

You will likely gain inspiration along the way from individuals who have lived with this disease for some time. In turn you may one day discover that you are the person who is encouraging someone else who may have been recently diagnosed with diabetes.

There is a fraternity involved in this disease. One that is developed when individuals face similar struggles and respond with care and comfort in the both good times and bad.

It’s never too late to change directions. Maybe this is your call to action. How do you respond?

Diabetes Insipidus – An Overview: There are many diabetic types that you may be used to hearing, Type 1, Type 2, gestational and diabetes mellitus. What may be less common and perhaps even misunderstood is a disease known as diabetes insipidus (DI).

This disease is not a branch of Type 1 or Type 2 diabetes. In most ways they aren’t related. If you are diagnosed with diabetes insipidus you will not need to take insulin and you may not need to worry about sugar intake.

So what is it?
Diabetes insipidus is diagnosed when the body can’t seem to balance fluid intake with urine output. Individuals with this disorder urinate frequently and excessively. The majority of the fluid release is water instead of urine. Patients typically must drink significant amounts of water to balance the loss of fluid through urination. In most cases they can gain some relief through medication.

Three Primary Types – Same Result
Doctors contend with three distinct types of diabetes insipidus and while they all cause frequent urination they are treated differently because the source of complication is unique in each cases.

The National Institute of Health provides the following facts about DI.

• Diabetes insipidus (DI) is a rare disease that causes frequent urination and excessive thirst.
• DI is not related to diabetes mellitus (DM).
• Central DI is caused by damage to the pituitary gland and is treated with a synthetic hormone called desmopressin, which prevents water excretion.
• Nephrogenic DI is caused by drugs or kidney disease and is treated with hydrochlorothiazide (HCTZ), indomethacin, or a combination of HCTZ and amiloride.
• Most forms of gestational DI can be treated with desmopressin.
• A doctor must determine which type of DI is involved before proper treatment can begin.

It should be noted that there is such a thing as gestational diabetes insipidus and it affects about 1 in every 25,000 pregnancies. Like other cases of diabetes insipidus it is treated with a balance of water intake to urine output along with medication.

Diagnosis
Doctors must conduct a urinalysis to determine if a patient may be suffering from diabetes insipidus. This also allows them to determine which disease type they may have. The diagnosis is important in implementing a treatment plan that works for the patient.

Another diagnostic tool is a fluid deprivation test. This can help doctors determine the best treatment option following testing of the primary causes for DI.

The Diabetes Insipidus Foundation provides a list of symptoms that may be associated with the disorder.

 

• Increased thirst
• Increased drinking
• Increased urination
• Bed-wetting
• Getting up at night to urinate

The Universal and Variable Symptoms of Diabetes Insipidus occur:

 

• In the absence of high blood and/or urine sugar
• Are sometimes associated with various other symptoms due to concomitant damage to other hormones or organs

Sodium and DI
The role of sodium can be critical to those suffering with DI. With this disease too much sodium can result in dehydration. This can throw off the delicate balance of water intake compared to urine output. In some cases medical intervention will be required.

Good News
The Diabetes Insipidus Foundation indicates that unlike diabetes mellitus this disorder is not a progressive disease. What that means is if you are diagnosed with DI it is usually treated without additional complications. Most DI suffers lead a normal life in all other ways.

Diabetes And College Scholarships: Breanne is a senior in high school this year. She wants a good education and she’s worked hard to get good grades. She’s done so because there have been numerous expenses related to the care of her Type 1 diabetes. She knows her family will do almost anything to get her into a good college, but she wants to help. Her grades reflect that willingness. She’s applied for many scholarships and she prays some of them will come through.

No one wants to live with diabetes. It is a disease that many young people live with in the form of Type 1, which is also known as Juvenile diabetes along with a rising number of teens that have developed Type 2 diabetes.

When it comes to diabetes the difficulties are many. One of the challenges for families is finding a way to pay for college. That being said there are several college scholarship opportunities for students who have this disease. Let’s explore a few of the possibilities.

The Diabetes Scholars Foundation funds college and conference scholarships to students with Type 1 diabetes.  For the upcoming 2009/2010 school year we will be awarding up to 15 $5,000 college scholarships to incoming freshmen with Type 1 diabetes.  The application can be found on our website at www.diabetesscholars.org.  The deadline to apply is May 15, 2009.

Novo Nordisk Donnelly Awards. These awards are intended to encourage a long and healthy life. The awards are given to high school students who engage in the team sport of tennis, but who also have diabetes. Two $5,000 awards are given annually. You can contact this organization at 512/443-1334 ext 201 or at:

Texas Tennis and Education Foundation
8105 Exchange Drive
Austin, Texas 78754

Diabetes Hope Foundation. This organization typically offers 100 separate college scholarships on an annual basis. The scholarship value is different for each recipient based on numerous variables. This Canadian Foundation has a website, but can also be contacted by phone (905) 670-0557 or at:

Diabetes Hope Foundation
6150 Dixie Road, #1
Mississauga, ON
L5T 2E2

While these are the major scholarship foundations for diabetes you should know there are numerous individual colleges that provide scholarships for individuals with diabetes. This may be in response to the Americans with Disabilities Act, but the fact that there are individual school scholarships is good news for those families who may already be struggling with finances related to the managed care of a loved one with diabetes.

By all means work to find all forms of scholarships available – ones that play to the academic or sports skills of your high school senior, but don’t forget to look into what possibilities exist for a scholarship specifically offered to students whose lives have been altered by diabetes.

If you find a scholarship opportunity in colleges or universities that your child may be interested in attending it can speak volumes to the importance the school places on the health care needs of their student body along with accommodations they may have in place to step in and help in case of an emergency.

This not only means a progressive ideology in terms of meeting the genuine needs of their student body, but demonstrates a concerted effort to ensure their school environment provides a positive welcome to students who might otherwise feel intimidated and unsure.

Conduct your online search. Be relentless is researching possibilities. Any help you receive can lessen the financial burden for your entire family and set a positive tone for your child’s educational future.

Diabetes: Statistically Speaking – Part 1: The U.S. Government (derived from the National Institute of Diabetes and Digestive and Kidney Diseases) provides some statistics on diabetes that is, at times, hopeful and, at others, sobering. This article is dedicated to these government findings.

Pre-diabetes

• In 1988 to 1994, among U.S. adults aged 40 to 74 years, 33.8 percent had Impaired Fasting Glucose (IFG), 15.4 percent had Impaired Glucose Tolerance (IGT), and 40.1 percent had pre-diabetes—IGT or IFG or both.
• In 1999 to 2000, 7.0 percent of U.S. adolescents aged 12 to 19 years had IFG.
• In 2003 to 2006, 25.9 percent of U.S. adults aged 20 years or older had IFG—35.4 percent of adults aged 60 years or older. Applying this percentage to the entire U.S. population in 2007 yields an estimated 57 million American adults aged 20 years or older with IFG, suggesting that at least 57 million American adults had pre-diabetes in 2007.
  After adjusting for population age and sex differences, IFG prevalence among U.S. adults aged 20 years or older in 2003 to 2006 was 21.1 percent for non-Hispanic blacks, 25.1 percent for non-Hispanic whites, and 26.1 percent for Mexican Americans.
• In the Diabetes Prevention Program, a large prevention study of people at high risk for diabetes, lifestyle intervention reduced the development of diabetes by 58 percent over 3 years. The reduction was even greater, 71 percent, among adults aged 60 years or older.
• Interventions to prevent or delay type 2 diabetes in individuals with pre-diabetes can be feasible and cost-effective. Research has found that lifestyle interventions are more cost-effective than medications.

Diabetes
Prevalence of Diagnosed and Undiagnosed Diabetes in the United States, All Ages, 2007

• Total: 23.6 million people—7.8 percent of the population—have diabetes.
• Diagnosed: 17.9 million people
• Undiagnosed: 5.7 million people
• About 186,300 people younger than 20 years have diabetes—type 1 or type 2. This represents 0.2 percent of all people in this age group.
• A total of 1.6 million new cases of diabetes were diagnosed in people aged 20 years or older in 2007.
• Based on 2002 to 2003 data, 15,000 youth in the United States were newly diagnosed with type 1 diabetes annually, and about 3,700 youth were newly diagnosed with type 2 diabetes annually.
• Diabetes was the seventh leading cause of death listed on U.S. death certificates in 2006. This ranking is based on the 72,507 death certificates in 2006 in which diabetes was listed as the underlying cause of death. According to death certificate reports, diabetes contributed to a total of 233,619 deaths in 2005, the latest year for which data on contributing causes of death are available.
• Overall, the risk for death among people with diabetes is about twice that of people without diabetes of similar age.

We thought it important to share the hope filled statistics related to pre-diabetes first simply because there is very strong evidence to show that a lifestyle change can result in a return to normal glucose. It also provides the best (and least expensive) way to potentially avoid onset diabetes.

On the other hand the statistics for diabetes are extremely sobering. What concerns most doctors is the growing number of young people who are developing Type 2 diabetes – a disease they would rather prevent than treat.

In part 2 of this report we will look at some of the diseases that seem to be more prevalent among those with diabetes and the complications they present to the diabetic.

Diabetes: Statistically Speaking – Part 2: In this second report focused on statistics we return to government data (derived from the National Institute of Diabetes and Digestive and Kidney Diseases) that helps provide a clearer picture of complications to those who suffer with diabetes.

Heart Disease and Stroke

• In 2004, heart disease was noted on 68 percent of diabetes-related death certificates among people aged 65 years or older.
• In 2004, stroke was noted on 16 percent of diabetes-related death certificates among people aged 65 years or older.
• Adults with diabetes have heart disease death rates about two to four times higher than adults without diabetes.
• The risk for stroke is two to four times higher among people with diabetes.

High Blood Pressure

• In 2003 to 2004, 75 percent of adults with self-reported diabetes had blood pressure greater than or equal to 130/80 millimeters of mercury (mm Hg) or used prescription medications for hypertension.

Blindness

• Diabetes is the leading cause of new cases of blindness among adults aged 20 to 74 years.
• Diabetic retinopathy causes 12,000 to 24,000 new cases of blindness each year.

Kidney Disease

• Diabetes is the leading cause of kidney failure, accounting for 44 percent of new cases in 2005.
• In 2005, a total of 178,689 people with end-stage kidney disease due to diabetes were living on chronic dialysis or with a kidney transplant in the United States and Puerto Rico.

Nervous System Disease

• About 60 to 70 percent of people with diabetes have mild to severe forms of nervous system damage.
• Almost 30 percent of people with diabetes aged 40 years or older have impaired sensation in the feet—for example, at least one area that lacks feeling.
• Severe forms of diabetic nerve disease are a major contributing cause of lower-extremity amputations.

Amputations

• More than 60 percent of nontraumatic lower-limb amputations occur in people with diabetes.
• In 2004, about 71,000 nontraumatic lower-limb amputations were performed in people with diabetes.

Dental Disease

• Periodontal, or gum, disease is more common in people with diabetes. Among young adults, those with diabetes have about twice the risk of those without diabetes.

Complications of Pregnancy

• Poorly controlled diabetes before conception and during the first trimester of pregnancy among women with type 1 diabetes can cause major birth defects in 5 to 10 percent of pregnancies and spontaneous abortions in 15 to 20 percent of pregnancies.
• Poorly controlled diabetes during the second and third trimesters of pregnancy can result in excessively large babies, posing a risk to both mother and child.

Other Complications

• Uncontrolled diabetes often leads to biochemical imbalances that can cause acute life-threatening events, such as diabetic ketoacidosis and hyperosmolar, or nonketotic, coma.
• People with diabetes are more susceptible to many other illnesses and, once they acquire these illnesses, often have worse prognoses. For example, they are more likely to die with pneumonia or influenza than people who do not have diabetes.
• Persons with diabetes aged 60 years or older are two to three times more likely to report an inability to walk a quarter of a mile, climb stairs, do housework, or use a mobility aid compared with persons without diabetes in the same age group.

In our third and final report we will look at a few ways diabetics are fighting back. A self-managed plan guided by your primary care physician can have an incredible impact on the way you live with diabetes. This last report should add the needed hope missing from so many raw statistics.