The findings from a Veterans Affairs Diabetes Trial have showed that lowering blood sugar levels to near normal through intensive treatment may reduce the risk of cardiovascular disease and heart attacks for Type 2 diabetics, but only if treatment is begun relatively soon after diagnosis and if severe episodes of low blood sugar can be avoided. Data from three studies were presented over the weekend at a San Francisco meeting of the American Diabetes Assn., and although many questions remain unanswered, some generalizations are becoming possible.
All three studies suggest that the greatest reduction in the risk of heart attacks and cardiovascular disease is achieved by lowering cholesterol levels and by controlling high blood pressure. Controlling glucose can at best provide only a small further reduction in risk that may take many years to become apparent. But that does not mean that control of blood glucose levels is not a good idea.
Data from two of the studies confirmed that such control reduces the risk of kidney and eye disease, also complications of diabetes. New data from the VA study also show that severe hypoglycemic events should be avoided at all costs. And finally, data from the three studies may ease concerns about the oral diabetes drug rosiglitazone. An analysis last year of many previous studies suggested that the drug, sold under the brand name Avandia, increases the risk of heart attacks and death. But the new studies showed no such effects from the drug, which is still in wide use
Repaglinide (Prandin) is an oral medication for lowering blood sugar in diabetics. It is in a class of drugs for treating diabetes type 2 called meglitinides and is chemically unlike other anti-diabetic medication. In a three month study, Prandin dropped fasting blood glucose values by 61 mg/dL and post meal blood glucose values by 100 mg/dL. Prandin is short acting and given before meals. It is particularly beneficial in lowering blood glucose after meals and does not tend to lower fasting glucose levels to the same degree. Prandin has been used in combination with other medications, such as metformin (Glucophage), with impressive results. In 83 patients with type 2 diabetes, blood sugar control improved significantly with the addition of Prandin to Glucophage.
Prandin interacts with other medications. Therefore, the doctor must be aware of all other medications a patient is taking before prescribing Prandin. The usual starting dose is 0.5mg before each meal and can be increased to 4mg. The maximum daily dose is 16mg. Prandin is used with caution in people with kidney or liver abnormalities. Since Prandin increases insulin levels, it has the risk of causing abnormally low blood sugars. Blood sugars that remain severely low can result in sweating, tremors, confusion, and may lead to coma and seizure. In addition, the use of Prandin has been associated with headaches, muscle and joint aches, along with sinus infections in some individuals. This drug should not be used in pregnancy or by nursing mothers. The dose may need to be adjusted in older people, since the elderly may metabolize medications at a slower rate.
Pre-diabetes means that the cells in your body are becoming resistant to insulin and your blood glucose levels are higher than they should be. Since the levels aren’t as high as they would be if you had Type 2 diabetes, the term “pre-diabetes” is used. Your doctor may also call this condition “impaired fasting glucose” or “impaired glucose tolerance. According to the Center of Disease Control and Prevention, 41 million adult Americans between the ages of 40 and 74 have pre-diabetes.
There are several risk factors. The risk factors are the same for pre-diabetes as they are for Type 2 diabetes. Some of them are being overweight or obese, having a sedentary lifestyle, family history, age, or having a previous diagnosis of gestational diabetes.
Often there are no signs or symptoms for pre-diabetes. Many times it is discovered during a routine physical with basic screening for fasting blood glucose levels. The normal level is below 100 mg/dl. If it’s 100 to 125 mg/dl, this indicates that you have impaired fasting glucose or pre-diabetes. Over 126 mg/dl most likely means a diagnosis of Type 2 diabetes.
If you are diagnosed with pre-diabetes, it will put you at a higher risk for Type 2 diabetes in the future. But it doesn’t have to mean that you will get Type 2 diabetes. A healthy lifestyle change can lower your risk and improve the way your body uses insulin. A low fat diet and calories can help you lose weight. The less fat and more muscle you have, the less resistant to insulin you will be. Exercising regularly not only helps you to lose weight, but also help lower your blood glucose level by using glucose as energy.
A report in the Archives of Disease in Childhood says there are a number of clues suggesting a link between low vitamin D Zipitis of Stockport National Health Service Foundation Trust and Dr. A. K. Akobeng of Booth Hall Children’s Hospital have reviewed all published research on vitamin D supplementation and diabetes risk. Overall, they found, infants who were supplemented with Vitamin D were 29 percent less likely to develop type 1 diabetes than children who had not received supplements.
Proper clinical trials are required to determine the optimal dose and formulation of vitamin D, as well as when and for how long children should be given the supplements, Zipitis and Akobeng conclude. In the meantime, Zipitis said, “I would advise parents to encourage their pediatricians to prescribe vitamin D supplements for their infants. However, parents can also obtain these over the counter and provided they are used as per manufacturer instructions they should be extremely safe to use.”
There are many critical diabetic testing supplies and other important items you should always have readily available. The number one thing would be insulin and if you are insulin-dependent it is vital to always keep several days supply on-hand in case of an emergency. The blood glucose meter is another must-have. Of course your blood glucose meter won’t function without the proper test strips. Always keep plenty of these handy, so that you can test your blood sugar level on time, every time. If your diabetes puts you at risk for hypoglycemia, a supply of glucose tablets should always be kept with your diabetes testing supplies. It will be convenient to have a diabetes supply carrying case to keep everything organized.
There are several other useful things to have on hand. One is to have medical identification to lets people know you have diabetes if you are in an accident and unable to communicate. Everyone should have extra batteries on hand for their testing meter. Stash some sugar free substitute in a handy place, especially if you are going out.
Having these diabetic test supplies readily available will allow you self-monitor your insulin levels, and protect yourself from short and long-term complications that may arise. Situations can arise unexpectedly so always keep a good amount of supplies on hand. This will also help if an emergency happens.
Type 2 diabetes affects over 250 million people worldwide. Intensive insulin therapy through daily injections is typically started late in the course of the disease. But researchers in China found that if this treatment is undertaken before the body loses the ability to control sugar levels in the blood, patients recover normal levels faster and are less at risk of remission.A team led by Jianping Weng of Sun Yat-Sen University in Guangzhou divided nearly 400 patients aged 25 to 70 with Type 2 diabetes into three groups. Two groups received intensive insulin therapy. The third group was given standard oral diabetic drugs. Treatment was stopped when regular blood glucose control had been restored for two weeks, after which patients regulated sugar levels through diet and exercise alone.
The study found that more patients in the two insulin-intensive groups hit normal levels, and did so faster, in four to six days rather than nine, compared to the control group. Also significant, remission rates were nearly twice as high in the first two groups.
A second study showed that a controlled diet and exercise over six years prevented or delayed diabetes onset by up to an additional 14 years. The two studies were published in the British journal The Lancet.
Insulin pumps are popular with children and teens, it helps them control type 1 diabetes. It has been reported that many of them have experienced skin problems at the infusion catheter insertion site. Although, few report thinking about stopping insulin pump therapy because of these problems.Insulin pump therapy has several advantages over insulin shots, including better control of glucose metabolism, Dr. Louise S. Conwell and colleagues from the Hospital for Sick Children in Toronto and colleagues note in The Journal of Pediatrics this month. “Over the years, studies have suggested that both injections and insulin pumps may cause dermatologic problems”, they add. “In the early days of insulin pump therapy, many patients developed infection and inflammation at the catheter site, but no study has looked at these complications in patients using modern pumps and rapid-acting insulin-like drugs.”
Conwell and colleagues surveyed 50 patients with type 1 diabetes who had used insulin pumps for longer than 6 months. 94 percent have reported scars smaller than 3 millimeters in diameter, two-thirds had swelling, just under two-thirds had lesions under the skin, and 42 percent had fat lumps under the skin.
The researchers reported that the thinner the patient, the more likely he or she was to have dermatologic complications of insulin pump use. Although, there was no relationship between long-term blood sugar control and risk of skin problems. Only 4 percent of parents and 2.4 percent of patients said they considered stopping insulin pump therapy because of related skin problems.
