Diabetes Health Talk

Stress may play a key role in the development of type 2 diabetes in obese black women, U.S. researchers say.

“Much attention has been given to the role of obesity in the development of type 2 diabetes, but stress may be as important in this at-risk population,” study co-author Anastasia Georgiades, of Duke University in Durham, N.C., said in a news release.

The study included 62 healthy, non-diabetic black women who were asked to recall stressful life events. As they did, the researchers measured the women’s levels of blood sugar and epinephrine, the “fight or flight” hormone that’s released in reaction to stress.

Women with high epinephrine levels (25 picograms or more per milliliter of blood) while recalling stressful events and with more belly fat (33 percent or more of total body fat) had significantly higher fasting glucose scores (about 100 milligrams per deciliter) than women with lower epinephrine levels and less belly fat (85 mg/dl). A fasting blood glucose level of 100 mg/dl is considered within the low range of pre-diabetes, and a level of 125 mg/dl is the benchmark for type 2 diabetes.

Women with high epinephrine levels and more belly fat also had bigger increases in blood sugar levels during the stress test.

The findings were to be presented this week at the annual scientific meeting of the American Psychosomatic Society.

“While we don’t fully understand the nature of the association, women with abdominal obesity may be more vulnerable to the impact of stress — causing their body to increase blood sugar production and elevating their risk for diabetes,” Georgiades said.

A new animal study may help explain why diets high in the sugar fructose have been linked to insulin resistance, a precursor to type 2 diabetes.

Scientists found that a particular gene, known as PGC-1 beta, appears to play a key role in the development of insulin resistance in response to a high-fructose diet. Rats that had the gene’s activity blocked were protected from insulin resistance despite feasting on a diet loaded with fructose.

A sweetener known as high-fructose corn syrup has been widely used in sodas and processed foods since the 1980s, and some researchers have blamed this trend at least in part for the concurrent rise in obesity and diabetes.

The authors of the current report, in the journal Cell Metabolism, explain that some studies have shown that fructose is metabolized differently than glucose is, being more readily converted into fat.

Other studies have linked diets heavy in high-fructose corn syrup to elevated risks of high triglycerides (a type of blood fat), fat buildup in the liver, and insulin resistance, note Dr. Gerald Shulman and colleagues at Yale University School of Medicine.

For their study on the genetic underpinnings of fructose-induce insulin resistance, they zeroed in on PGC-1 beta because it activates another gene that governs the production of fat by the liver.

When the researchers blocked the gene’s activity in rats fed a high-fructose diet, the animals did not develop insulin resistance and elevated triglycerides.

The implication, according to Shulman’s team, is that inhibiting PGC-1 beta could help treat some cases of high triglycerides, fatty liver disease and insulin resistance. Much more research remains to be done, however..

Great list from the American Diabetes Association:

1. Improve blood glucose management. Activity makes your body more sensitive to the insulin you make. Activity also burns glucose (calories). Both actions lower blood glucose.

2. Lower blood pressure. Activity helps your heart pump stronger and slower.

3. Improve blood fats. Exercise can raise good cholesterol (HDL) and lower bad cholesterol (LDL) and triglycerides. These changes are heart healthy.

4. Take less insulin or diabetes pills. Activity can lower blood glucose and weight. Both of these may lower how much insulin or diabetes pills you need to take.

5. Lose weight and keep it off. Activity burns calories. If you burn enough calories, you’ll trim a few pounds. Stay active and you’ll keep the weight off.

6. Lower risk for other health problems. Reduce your risk of a heart attack or stroke, some cancers, and bone loss.

7. Gain more energy and sleep better. You’ll get better sleep in less time and have more energy, too.

8. Relieve stress. Work out or walk off daily stress.

9. Build stronger bones and muscles. Weight-bearing activities, such as walking, make bones stronger. Strength-training activities, such as lifting light weights (or even cans of beans), make muscles strong.

10. Be more flexible. Move easier when you are active.

These tips aren’t just for Diabetics, though, if Diabetics needed motivation, show them this list, or take them to heart yourself.

As always, ask your health care provider what level of exercise you can do, safely. Walking is a great way to start. When I got back into walking after gaining significant weight, I could only walk a few yards, at most. Now I can walk for hours! Good Luck.

Treatment with the blood pressure drugs perindopril and indapamide can help prevent kidney problems in patients with type 2 diabetes, according to a report in the Journal of the American Society of Nephrology. In fact, these drugs work even for patients who already have pressures at or below recommended values.

This is great news! There were countless people with kidney failure secondary to diabetes that I saw when I was on Dialysis. Diabetes was responsible for so many kidney failures, it was sad to see, because diabetes is such a preventable disease.

Lead author Dr. Vlado Perkovic, from the University of Sydney, Australia, and colleagues note that current guidelines recommend that drugs be given to diabetics to keep blood pressures below 130/80 mmHg. If kidney disease is already present, then they should aim for a pressure below 125/75 mmHg.

Whether aiming for even lower pressures might protect the kidneys further has been unclear.

The ADVANCE study featured 11,140 patients with type 2 diabetes who were randomly assigned to receive perindopril-indapamide or an inactive “placebo” pill, regardless of their initial blood pressure.

Over an average follow-up period of 4.3 years, treatment with the drug combo reduced kidney filtering problems, such as protein leakage into the urine, by 21 percent, the investigators report. As noted, the benefits were evident regardless of starting blood pressure.

With each drop in systolic blood pressure (the upper number on a standard reading), the risk of kidney problems also dropped. This was apparent even with a pressure below 110 mmHg.

Still, whether the effects on kidney filtering problems translate into more long-term clinical benefits is unknown. “Most of the findings related to early manifestations of kidney disease and the study was not large enough to assess the impact of the intervention directly on the risk of kidney failure,” Perkovic said in a statement.

You’ve heard that you will eat more during meals if you watch TV. But could it cause you to eat more later on, too?

Yep, that’s the sneaky little result of a recent study. People who ate lunch while glued to the tube did a whole lotta extra snacking later on — long after the meal, which adds unwanted pounds and raises blood glucose levels.

Memory Meltdown
The reason? Recall may have something to do with it. When women who lunched while watching a comedy show were later asked what they had for their midday meal, their recollection was fuzzy. And they also snacked on more cookies afterward, which will raise blood sugars.

The lesson? Take time to focus on what you put into your mouth so that you can remember every bite. Your memory of your most recent meal helps shape your snacking choices.

Saying Bye-Bye to Extra Bites

Try these other tips and tricks for keeping between-meal bites to a lminimum:
Rev up your heart. Regular aerobic workouts appear to dull your appetite.
Eat mini meals. That’s right: Multiple mini meals do a better job of controlling hunger throughout the day.
Choose the right fat. Some fats turn hunger on, others turn it off.

Need some choices for a great snack if you’re diabetic? You’re in luck! David Edelman of Diabetes Daily posted these good-for-you snacks (and not just for diabetics! For the complete list, see his website.

1. Peanut butter
2. Cheddar cheese
3. String cheese
4. Cottage cheese
5. Broccoli with melted cheese
6. Salad with free veggies and low-carb dressing
7. Tomato and mozzarella salad
8. Celery with peanut butter
9. Fresh strawberries or blueberries with low-fat plain yogurt
10. Veggies with hummus

Keeping blood pressure down is critical for African Americans with type 2 diabetes as high pressures increase the risk of kidney disease progression, according to a report in The American Journal of Medicine.

“Lower blood pressure targets are clearly recommended in patients with diabetes,” Dr. Mohamed G. Atta from Johns Hopkins University School of Medicine, Baltimore, told Reuters Health. “Even though physicians are aware of the importance of blood pressure control, they are not as aggressive as you would expect.”

Atta and colleagues examined the progression of kidney disease in 186 African American patients with type 2 diabetes participating in Project Sugar, a study of interventions to improve diabetes control. The team specifically looked for demographic and modifiable factors that influence progression.

When the study began, 60 patients had kidneys that leaked small amounts of protein into the urine. During 3 years of follow-up, all of the patients developed more severe leakage problems.

Disease progression was not associated with age, duration of diabetes, underlying heart disease, or the use of cholesterol-lowering drugs, the researchers note. By contrast, progression was associated with the need for blood pressure medications.

“In general, 40 percent of African Americans above the age of 20 have (high blood pressure), highlighting the magnitude of this problem,” Atta said. “The message then is to increase awareness, early recognition of the problem, and aggressive interventions.”

There are programs out there to help people get the medications they need. Pharmaceutical companies have low-income programs to donate needed medications. There are state and federal programs, such as medicare, medicaid and other low-income medication programs that get much needed medications in the hands of those that need them.

ADA-funded researchers Drs. Hollie Raynor, Rena Wing and Chantelle Hart have published findings that were highlighted in the January 9, 2009 issue of ScienceDaily News. In their research study conducted at Brown University School of Medicine in Providence, Rhode Island, they investigated the eating and activity patterns of children ages 2 to 12. They hypothesized that the early patterns of unhealthy eating and exercise habits in preschool can contribute to the onset of childhood obesity in school-aged children. Hollie Raynor, PhD, RD is the recipient of an ADA Healthy Food Choices Award. Rena Wing, PhD is the recipient of a Mentor-Based Postdoctoral Fellowship Award of which Chantelle Hart, PhD was the postdoctoral fellow from June 2006 to June 2007.

Quantitative data was collected on the parent’s age, height and weight. The child’s height and weight were collected from their previous medical records. Parents completed a questionnaire on their child’s eating and activity habits. The questionnaire results showed that parents of school-aged children had increased reports of their child consuming unhealthy foods such as sweet drinks, salty and sweet snacks. They also reported other behaviors such as eating dinner less with parents, which led to their less healthy food choices and more time in front of the TV. On the other hand, a greater percentage of parents with preschool children reported that their child was “just as” or “a little more” active than their peers.

So parents out there, watch what your kids eat, institute famiily meals with no tv or electronics of any kinds at the table. Good luck.

One of the best exercises Diabetics can do for themselves is walking.

Walking helps regulate blood sugar, keeps insulin levels in check, is great for your heart, helps lose weight, tone your body. The only investment is a comfortable pair of walking shoes and your time.

A comfortable daily walk is a good place to start if you want to live younger and longer.

But include a few spurts of power walking, too. This kind of “interval training” can be a great way to boost your exercise capacity — an emerging marker of longevity.

Build Up Your Steam
In a large study of women, exercise capacity — a measure of how hard you’re able to work out — was tightly connected with mortality rates. The women who had low exercise capacity were almost twice as likely to die during the study follow-up period, compared with the women who had more exercise power.

Boost Your Grade with Intervals
So how can you increase your exercise capacity? Interval training helps. Just add a few short bouts of more intense exercise to any moderately paced activity. For example, throw some 1- to 2-minute jogging sessions into a long, brisk walk. Or if you’re a steady biker, add a block of rapid pedaling here and there.

Whichever you choose, be sure to include intervals of fast and slow. Be sure to check your blood sugar if you’re feeling light-headed, dizzy or nauseous. This could be an indication your blood sugar has dropped. Carry hard candy (not sugar free this time) for these occasionas your blood sugar drops.

Turns out, they all work just as well, having no huge difference between them in productivity or outcome.

Researchers at the Harvard School of Public Health and the Pennington Biomedical Research Center put four popular diets — high carb, high fat, low-fat and high protein — to the test to see which of the regimens resulted in more weight-loss success.

After two years of monitoring the participants, “all the diets were winners,” said study co-author Dr. Frank Sacks, a professor of cardiovascular disease prevention at the Harvard School of Public Health. “All produced weight loss and improvements in lipids, reduction in insulin.

“The key really is that it’s calories. It’s not the content of fat or carbohydrates, it’s just calories,” said Sacks. The findings are published in the latest edition of the New England Journal of Medicine.

For the study, 811 overweight adults in Boston, Massachusetts, and Baton Rouge, Louisiana, were assigned to one of four diets.

Regardless of diet, most participants had dramatic weight loss after six months, losing an average of 13 pounds.

According to Sacks’ research, many of the 800-plus participants regained weight after a year, but about 80 percent of them lost at least eight pounds after two years. And 15 percent of the participants lost at least 10 percent of their body weight.

The study, funded by the National Heart, Lung and Blood Institute of the National Institutes of Health, showed little difference in users’ satiety, hunger or satisfaction with their diets.

Participants could attend individual sessions where dieticians educated them and group sessions where they discussed their experiences with one another.

Those who had better attendance in the sessions had stronger weight-loss results. “These findings together point to behavioral factors rather than macronutrient metabolism as the main influences on weight loss,” according to the study. Macronutrients are the three main nutrients the body uses in relatively large amounts: proteins, carbohydrates and fats.

“No one of those diets are necessarily better than any other diet,” Sacks said.

In an accompanying editorial in the New England Journal of Medicine, Martijin B. Katan wrote the researchers’ hypothesis is “plausible,” but said the “differences in macronutrient intake were too small.”

Pears and apples, winter’s finest fruits, complement lean beef in this hearty stew.

Number of Servings: 6
Serving Size: 1 cup with 3-4 oz beef
Today’s recipe is brought to you by:

——————————————————————-Ingredients
canola oil 1 Tbsp —
chopped onion 1 cup —
garlic cloves, minced 3 ea —
carrots, cut into 1-inch slices 2 ea —
lean stew beef, cut into 1-inch cubes — 1 1/2 lb
low-fat, low-sodium beef broth 3 cups —
paprika 1 tsp —
fresh ground pepper and salt to taste 1 ea —
mixed pears and apples, unpeeled and chopped into 1-inch pieces 1 1/2 cups

Preparation Instructions

Heat the oil in a large stockpot over medium-high heat. Add the onion and garlic and sauté for 5 minutes. Add the carrots and sauté for another 5 minutes. Add the meat and brown. Drain off any accumulated fat. Add the broth, paprika, pepper and salt (if desired).
Bring to a boil over high heat. Reduce the heat and simmer, uncovered, for 1-1/4 hours. Add the apples and pears and cover. Cook over low heat for 15-20 minutes until the apples and pears are soft, but not mushy.

——————————————————————————–

This recipe is from Flavorful Seasons Cookbook, published by the American Diabetes Association. It offers great-tasting recipes for winter, spring, summer, and fall. Some dishes are perfect for one season but wrong in another. Award winner Robyn Webb assembled 400 recipes, 100 for each season, with dishes and menus for every holiday.

Not all recipes presented here are necessarily appropriate for all people with diabetes, nor will all recipes fit into every meal plan. No two meal plans are alike. Work with your health care provider, diabetes educator or dietitian to design a meal plan that’s right for you, and includes the foods you love. A key message for people with diabetes is “Carbs Count.” Foods high in carbs (carbohydrates) — bread, tortillas, rice, crackers, cereal, fruit, juice, milk, yogurt, potatoes, corn, peas, sweets — raise your blood glucose levels the most.

For many people, having 3 or 4 servings of a carb choice at each meal and 1 or 2 servings at snacks is about right. Keep an eye on your total number of servings. For example, if you choose to have dessert, cut back on potatoes.

Here are some quick “news-you-can-use” highlights of research from a meeting of Doctors at the American Diabetes Association.

1) Don’t forget your ABCs
Healthy A1C, blood pressure, and cholesterol levels are important to good diabetes control. This year’s Scientific Sessions reinforced this message. Three major studies presented at the meeting looked at tight blood glucose control and cardiovascular disease, such as heart attack and stroke. While each study had somewhat different research objectives and patient populations, they all showed that people with diabetes must maintain healthy ABCs to prevent both types of diabetes complications — microvascular (kidney disease, blindness, and nerve damage) and macrovascular (heart disease and stroke).

So just in case you forgot, here are your ABC’s.

A is for A1C. The A1C test–short for hemoglobin A1C–measures your average blood glucose (sugar) over the past 3 months.
How often: At least twice a year

B is for blood pressure. High blood pressure makes your heart work too hard and can cause damage to your kidneys and eyes.
How often: At every visit

C is for cholesterol. Bad cholesterol, or LDL, builds up and clogs your arteries, leading to heart attacks and strokes.
How often: At least once a year

Talk to your health care team to see if these levels are attainable for your personal health goals.

2) Brush your teeth!
Just as with any other infection, if you have periodontal (gum) disease, it’s more difficult to control your diabetes — but people don’t make the connection. Emerging research presented at ADA’s meeting indicated that healthy teeth and gums are important not only for oral health but also for the body’s overall health. It is estimated that people with diabetes are 2 to 5 times more likely to develop periodontal (gum) disease than people without diabetes, probably because people with diabetes are more susceptible to contracting infections. People who do not have their diabetes under control are especially at risk.

3) You might not need those expensive tests
Angina is the normal warning sign of a shortage of blood flow to the heart. However, due to a common form of nerve damage (neuropathy) in people with diabetes, that “warning” pain is often not felt or may only be experienced at such a low level that it is not perceived as a warning. This is known as silent ischemia.

A study at the Scientific Sessions explored whether doctors should perform regular, and expensive, myocardial perfusion imaging (MPI) screening on people with type 2 diabetes. The researchers separated the study participants into two groups, one that had the screening and one that didn’t.

The results were surprising. Only 22% of the screened group had silent ischemia. After an average of 4.8 years, about 2.8% had cardiac events. Those found to have defects at the outset had their doctors informed; some likely took action, which probably lowered their event rate. In the non-screened group, researchers can assume that about 22% probably also had MPI defects. So why didn’t they have a higher event rate? This suggests normal clinical care is catching potential problems and expensive screening may not be necessary.

Amputations Much More Common in Diabetics

Being diabetic, this is what i’m always concerned about. So I adjust my lifestyle accordingly.

Diabetics are eight times more likely than non-diabetics to have a lower limb amputated, according to a report published this month in the journal Diabetes Care.

The findings are based on a study of all lower limb amputations performed due to clogged leg arteries in residents of an area of Sweden from 1997 to 2006.

During the study period, 62 women and 71 men with diabetes and 79 women and 78 men without diabetes had a lower limb amputated, Dr. Anton Johannesson, of Lund University, Sweden, and colleagues report.

The rates of initial one-sided amputation per 100,000 persons per year were 197 for diabetic men and 192 for diabetic women, compared with just 24 for nondiabetic men and 22 for nondiabetic women.

In diabetics and nondiabetics, lower limb amputation rates rose with age.

The most common type of amputation was transtibial (an amputation above the foot but below the knee) accounting for 74 percent of all lower limb amputations, the investigators note.

Such an uncomfortable thought that amputations from diabetes are so common. Most, though, are preventable by limiting your carb intake, taking your medication and exercising. It is hard work, but that’s what motivates me to keep my carb count low by buying low carb bread, tortillas and wraps. Gone are the high starchy, carb loaded foods. Now I walk about 1 1/2 - 2 hours per day and I make certain to take all my medications at the correct time.

Amputations are life changing, no doubt, but if one has been amputated, there are many means and ways to live with one.

When does “putting on a few pounds” cross the line into needing to lose weight? Neither scale, BMI, pinch test or waist measurement tells the full story. DEXA scan — a low-radiation, full-body X-ray — is gold standard but expensive

We all pretty much know what overweight and obese is and how weight can affect diabetes. How do you measure? There are plenty of ways, and none are exact, but they do give you a general idea.

Step on the scale

Upside: Easy and handy. In a 2007 study published in the journal Obesity, researchers found that dieters who regularly and frequently weighed themselves appeared more likely to keep the weight off over time.

Body mass index (BMI)

Upside: Your BMI provides a lot more information than your bathroom scale, specifically a measure of body fat. “Fat is more important than weight,” says Peter Katzmarzyk, associate executive director for population science at the Pennington Biomedical Research Center in Baton Rouge, Louisiana. “Excessive fatness is the definition of obesity, not excessive weight — and having too much fat can cause serious health problems.” Try this BMI calculator from Web MD.

BMI of less than 18.5 is underweight. A BMI of 18.5–24.9 is normal. A BMI of 25–29.9 is overweight. A BMI of 30 or higher is obese.

Waist circumference

Upside: Simple and predictive. This measure — an indicator of abdominal obesity, which is an important predictor of risk for developing obesity-associated cardiovascular disease — can be conducted at home by wrapping a tape measure snugly around the abdomen slightly above the hipbone, level with the navel. “It helps reduce even the small number of mistakes that might be made with BMI,” says Steven R. Smith, M.D., assistant executive director of clinical research at the Pennington Center.

In fact, waist circumference may be even more important than BMI. There is a greater risk of developing conditions like type 2 diabetes and heart disease if a person carries excess fat — also known as visceral fat — around his abdomen. Fat located deep in the abdomen around the internal organs may be more dangerous than subcutaneous fat, which is located just under the skin, and peripheral fat found in places like the hips and thighs

But don’t become slaves to a scale or tape measure. Use common sense.

This is an interesting concept: For people with type 2 diabetes, diets high in either monounsaturated fatty acids or carbohydrates are good — as long as the calories they contain are limited.

Dr. Bonnie J. Brehm and colleagues at the University of Cincinnati, Ohio, ran a clinical trial in which 124 overweight or obese subjects with type 2 diabetes were assigned to either a diet high in monounsaturated fatty acids (MUFA) or one high in carbohydrates for one year.

The diet plans were individualized to provide 200-300 calories per day less than calculated daily requirements, the team explains in the medical journal Diabetes Care.

After a year, 69 percent for the high-MUFA group and 84 percent for the high-carb group were still participating.

Average weight loss was similar in both groups — 4.0 kilograms (8.8 pounds) in the high-MUFA group and 3.8 kg (8.4 pounds) in the high-carb group.

There were also similar improvements in body fat, waist circumference, blood pressure, “good” HDL cholesterol, A1C, and glucose and insulin.

Among 18 participants from each group who consented to a follow-up assessment 18 months after completion of the main study, the researchers found that weight loss and A1C improvement had been maintained.

“Our study results suggest that high-MUFA diets can be healthy alternatives to conventional lower-fat diets,” Brehm and colleagues conclude. Healthcare providers with diabetic patients “can offer ongoing counseling for a variety of diets higher in either carbohydrates or MUFA while controlled in energy,” they advise.

Dropping the ‘one size fits all’ philosophy and providing diet options, they suggest, may encourage people with diabetes to stick with a reduce-calorie diet.

Picking up a few extra pounds (and raising blood sugar) in cold weather — that dreaded “winter weight gain” — is maddening. Even though your metabolism speeds up a bit to keep you warm, you can’t eat much more than you did in summer without gaining weight and those dreaded side effects from diabetes. But those oh-so-chilly temperatures make steamy comfort foods and creamy hot drinks more tempting than ever. Here’s how to satisfy your natural warming instincts and stay slim.

1. Know what really keeps you full and warm.
In a word: protein. Your body creates more heat when digesting protein than it does when digesting fats or carbohydrates. Chow down on lean chicken and turkey breast, canned tuna, fish, and shellfish. Not a meat eater? Fill up a warmed low carb wrap with sauteed low starch veggies like peppers, spinach and add some tomatoes and a sliver or two of avocado.

2. Say no to foods that make you say “brrr.”
Follow your instincts . . . they’re right. Swap cold cereal for hot oatmeal at breakfast. Have a hearty soup instead of a sandwich at lunch. Even cook your salad ingredients: At the last minute, stir “winter greens” — spinach, kale, swiss chard, collards — into stews, soups, casseroles, and scrambled eggs. Why heat before you eat? Warm foods keep the shivers away because your body doesn’t waste energy heating them up for digestion.

3. Don’t count on hot spices.
Ginger, cinnamon, nutmeg, allspice, pepper, and cayenne pepper are considered “warming spices” because they tend to draw body heat to the surface of your skin. But when that warmth hits the surface, it quickly dissipates.

4. Switch to decaf after your first morning cup.
Ok, this may not work for me, but Real Age says Coffee may feel warm going down, but swilling cup after cup may just make you colder. That’s because caffeine has a dehydrating effect, which makes symptoms of a drop in body temperature even worse.

Craving something comforting at the coffee shop? Instead of a gingerbread latte topped with whipped cream, order a nonfat chai tea latte. It’ll warm you down to your toes, and you’ll save 130 calories and some goose bumps. At home, I’ma big saver on making my own mochas. Use strong coffee (instant is fine) a packet of sugar-free cocoa, with nonfat milk, add a drop of vanilla for extra richness, and top it with fat-free Cool Whip. You’ll feel like a kid again. A warm one, whose jeans fit.