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THE MORNING SUGAR: A Window into your Type One Management

I lie in bed with one eye open, ears still ringing from my poorly selected, overplayed alarm tone. I sit half hunched over my glucose monitor attempting the first blood-drop-to-test-strip co-ordination of the day. Its 05h30, I have fasted for 6 to 8 hours, it’s time to dive into diabetes. My test strip sucks up the drop of blood and counts down to my first glucose reading of the day:

BEEP: 4.6mmol/l (84)

OR

BEEP: 9.6mmol/l (173)

OR

BEEP 16.6mmol/l (299)

The good, the average and the ugly.
These are the 3 general ranges of readings that might greet me at the first finger prick of the day. It’s only one of the many sugar readings that lie ahead, but it is a special one to pay attention to, as your morning glucose reading can provide important insight into your diabetes control.

A fasted reading has a myriad of information which you can choose to ignore, or preferably dissect and investigate for optimum diabetes control. I believe it is vital to ask myself why? Why is my blood glucose this level and what were my preceding actions?

I will take you through my 3 ranges and my general approach to morning sugar readings and how I personally troubleshoot these readings. We each tackle diabetes differently, but hopefully the following brings some insight into your morning sugars or encourages you think critically of those interesting rise and shine numbers!

The “Gem”
My personal values are 3.8-5.6mmol/l

Oh this is a sweet, gem of a reading. It’s the real “roll out of bed on the right side” number.
Perfectly in range, it is still important to acknowledge the formula that achieved this number. We could all do with a little positive reinforcement and mindfully recognize and enjoy our diabetes successes! I always ask myself, “What did I do well?”

This sugar reading generally informs me that I have correctly dosed my long acting insulin as it did not bring me into the clutch of hypoglycaemia when fasting during my sleep. It was also sufficient to meet the cascade of morning hormones such as cortisol and hyperglycaemia it brings along with it. This sugar happily greets me when I don’t snack after dinner and I eat around 3 hours before bed-time. This plan allows for an honest, stable blood sugar reading before bed where my injected insulin has already peaked in activity, and I can expect predictable glucose readings as I sleep.

The “Meh”
My personal values are 6-9mmol/l

It’s a sugar range that is higher than I would like for a fasting blood glucose level, but it’s not remotely the end of the world. To solve this morning glucose and to prevent it creeping higher, I have my insulin dosage for my breakfast plus a dash more insulin to correct. I wait 20-30 minutes for my insulin to start working and bring my glucose down before having my breakfast. I ask my “why?” and make a mental note of how I could improve and act accordingly. If went to bed with a great blood glucose level and I woke up high, it could be various things:

1. Insufficient long-acting insulin: The Dawn phenomenon

When I have my continuous glucose monitor (CGM), the Dexcom, attached, this will be displayed as a nice steady graph with readings in glucose range for the first 2/3rds of sleep, only to find in the few hours before waking my blood glucose slowly and steadily increases. This is due to the get-up-and-go hormones that pump through your body to prepare you for waking and tackling the day. These sneaky buggers include growth hormones, cortisol, glucagon and epinephrine and they increase your insulin resistance, causing blood sugar to rise.

2. Too much insulin: The Somogyi effect

This is an interesting stress response of your body, a rebound effect of low blood glucose while sleeping. If you have too much insulin, long acting or short acting, and you experience a low while sleeping your body mounts a survival response and encourages your body to release sugar back into your blood via adrenaline and cortisol. This low may not be rapid or severe enough to cause a seizure, but sufficient to mount a physiological survival response from your body.

3. Not enough short-acting insulin

This is usually prompted by snacking before bed and eating late. My stomach is still full and has not emptied. My blood sugar will be in range when I get to sleep, but as my tummy works to digest my food, sugar trickles into my blood which I thought I had sufficiently covered by my short-acting. This especially occurs if I eat meals that have a carbohydrate, protein and high fat content. It has even been dubbed “The Pizza Effect”, where fats and protein delay the absorption of carbohydrates from a meal. The most challenging part is that you don’t know when the carbohydrates are going to be dumped into your bloodstream as sugar. It could be more than 5 hours until you feel the true effect of your meal. This could also be a reason for a really high morning blood glucose reading, the one where you would rather turn over and head back to sleep, which brings me to my final morning range, which I like to call the “Lie in Bed for a Few Minutes in Denial”.

The “Lie in Bed for a Few Minutes in Denial”
My personal values are anything double digit

The “Man, I messed up” feels. I most likely did not give myself enough insulin for the previous night’s meal, or I ate complete rubbish, did a massive carbohydrate count guestimate (that’s right folks- guess and estimate can really be combined into one perfect word), it could be “the pizza effect”, or I forgot my long acting insulin.

The alternative explanation is that I woke up with low in the middle of the night and quite passionately, dove into my bedside glucose stash, bathed myself in sugar before falling back asleep in a pile a sweet wrappers. (Yes, I have awoken with gummy sweets melted into my back and bed sheet).

If my sugars are really bad in the morning, there is usually a pretty grand, blatantly obvious reason as to why they are absolutely deranged. I find myself glancing in the mirror, at my poor, hard-done-by face to ask myself why? My expression smirks, “Oh girl, you know why. You know.”

This is where the power of the mind can transform your day. You can switch to victim. You can choose guilt and actively bring yourself down. You can choose to let a number on a plastic monitor define your day or you can free yourself from mental binds, for you are capable, you are strong and you are going to tackle the day.

My go-to plan of action:

1. Massive bottle of water with loads of top ups
2. Small simple, low sugar breakfast (I find waiting for my sugars to come down before eating leaves me more frantic and stressed)
3. More water
4. Add Insulin
Tip: Don’t give yourself 70000 units because you are panicking and desperately want your sugar to go down as quickly as possible (TRACY SANDERS I am talking to you girl). A resultant severe hypoglycaemia does not make it easier to improve the day.
5. Forgive yourself, give thanks to your body for all the other goodness it brings to you and power forward.

Transform your WHY’s into WISE, pay attention to each nugget of information your body and glucometer communicates to you. By building up an understanding of your sugars, you build a stronger relationship with your body and mind. Work closely with your support network, endocrinologist and diabetes educator to make the correct adjustments to suite your body, always ask questions and challenge your knowledge and experience of type one.

Lyfestories: Rebekah’s Journey with Ulcerative Colitis (IBD)

I was diagnosed in 2009 with Ulcerative Colitis, I literally had no idea what this disease was, or how it would have such a huge impact on my life. After about a year and a half of trying every medication to try and control the flare up I was having, an extremely kind doctor suggested for me to have this life changing operation, to remove my bowel and replace it with an Ileostomy. He promised me I’d wake up symptom free and he was not wrong.

To this day, he is my hero, this amazing person who didn’t even know who I was, saved my life and gave me my life back and to this day I can’t thank him enough for that. I went from being in and out of hospital every other week, going to the toilet 20+ times, not being able to hold a job down to being this whole new independent person that could leave the house without worrying I was going to have an accident! I even got myself a job and I saved for a house.  I was also told I’d never be able to have kids and in 2015 I had the most precious little boy.

I created my Instagram account to raise awareness for others just like myself who have possibly been newly diagnosed, going through a flare up or have had a life changing operation and to show them that they are not alone in this battle. I’ve also been battling a condition called pyoderma gangreosum which is an incredibly rare skin condition to have next to the Stoma site and is usually associated with crohn’s patients. Again, I didn’t even know that this existed until I was diagnosed. My goal is to raise awareness–to let people into “thebaglifeofbeck” and for them to know the good and the bad times, and it’s OK to not be OK. It just helps us separate the good days from the bad, and since I’ve had my bag, the good days outweigh the bad. We’ve got this.

Real Talk with Dave: Tips and Tricks on Making Peace with your Diabetes

All Diabetics know how difficult it can be to find a common ground with their Diabetes daily, between the highs, the lows, the fears, and the pain, however, at some point, this can lead to a burn-out phase in our Diabetic lives, making it much harder to keep on moving forward. At the start of the new year, I have almost gained a new mindset for my Diabetes in which I am a bit more relaxed, knowing that it will all be okay in the end, that is why I want to share some of my own personal tips and tricks on how I manage my Diabetic stress & anxiety in the best way possible.

Over the past 9 years of living with T1D, I have come to realized that Diabetes is a really hard thing to go through in life, but finding ways to cope with your Diabetes as much as possible can be so rewarding in the long run! Don’t do Diabetes alone. Find a group of people to lift you up and motivate you to keep up the hard work you do! Diabetes is already a stressful thing to deal with, that is why these three helpful tips I use daily may help in finding a light at the end of the Diabetic tunnel:

1) Plan ahead – When out and about with T1D, many times you may not want to even think about Diabetes and don’t want it to get in the way of your outing, no matter where you are headed, however, always being prepared for the worst is the best way to avoid any unwanted stress, as T1D is a serious disease that needs to be treated and cared for 24/7. Just imagine how it would feel to be an hour or more away from your house, all to realize you forgot your Insulin at home… and your blood sugar is high (that wouldn’t be fun). In that case, I definitely recommend making a checklist (yes, an actual list) where you list all the necessary items that have top priority in managing your Diabetes on any outing, whether at school, work, and especially on a vacation. Each time you plan on going somewhere, be sure to check off the list prior to your outing and make sure you have all you need, and maybe even some extra supplies, all packed in a designated pouch or bag in which you can transport quickly on your way out. Better to be over prepared and over packed than the other way around.

2) Self-talk – One thing that I still struggle with is being in a constant fear of going low or excessively high when I am in a space (such as school) in which I cannot get out of very easily or am surrounded by many others who may not be aware of my T1D. In cases like these, I feel as though it is strictly up to me to take care of myself and make sure I am okay at all times, but, as we all know, Diabetes is an unpredictable disease. We all wish to never have lows or highs at certain times, but they can honestly happen whenever, wherever. In that case, let it be. If you go low, treat. If you go high, treat. Yes, you may have a bit of anxiety in having to deal with that all alone sometimes, but it is more important that you treat and take care of yourself, rather than the horrible outcomes of a severe high or low. The theory of self-talk comes into place by you having to mentally think to yourself that everything is going to be just fine. Think how you’ve been low and high before and made it out just fine each time, some were more difficult than others, but somehow, you managed to survive it… and like a pro!

3) Finding a support system – Most of the work I do in the Diabetic community is done via Instagram, @type1livabetic, where I try and encourage other T1D’s to look at life in a positive light and make life any way they want, regardless of their Diabetes. I didn’t always have that intention though. During my first few years as a Diabetic, I didn’t fully feel motivated or see the positive side to Diabetes as I do now. How did I overcome that? Well, I began to find other Diabetics via social media and just…talk! I began to connect with them and start talking with others on the true daily struggles we face and the feeling of connecting with someone who simply understands EVERYTHING you are feeling is indescribable. I found my support group online, but there are many other ways to do so. There are many in-person support groups at local hospitals, nowadays, a new trend is hosting a Diabetic meet-up, and simply attending a local Diabetic organization research walk or event can be life-changing and memorable.

In short, if you want to find peace with your Diabetes, give these three tips a try! Always have your medical supplies (and a backup plan) ready and with you in an accessible manner at all times, remember to think only good thoughts to yourself, especially in the hardest times, and find a group of people that you can be 100% yourself around, Diabetic and all, and hang on for the ride, because Diabetes is a huge roller coaster with many ups and downs. Find what brings you peace with your Diabetes and go with it!

Live well,

Dave

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Suicide by insulin a risk in people with diabetes

Experts warn that insulin can be abused by people with diabetes istockphoto

Insulin typically saves the lives of those with diabetes, but it can also be a way for some people to kill themselves, a new review warns.

People with the blood sugar disease tend to suffer higher rates of depression, the researchers explained. And suicide or suicide attempts using insulin or other diabetes medications that lower blood sugar levels may not always be an easy-to-spot attempt at self-harm, they added.

“Some suicides with insulin are likely missed in people with diabetes, just as [suicide may be missed] in people without diabetes using other medications or after a car accident. Could a suicide using insulin be missed? Absolutely,” said Alicia McAuliffe-Fogarty, vice president of lifestyle management at the American Diabetes Association.

Insulin is a natural hormone produced by the body. Its job is to help usher the sugar from foods into the body’s cells to provide fuel for those cells. But insulin is also a complex medication.

People with type 1 diabetes no longer make enough insulin and must give themselves insulin to stay alive. People with type 2 diabetes don’t use insulin efficiently — this is called insulin resistance — and eventually don’t make enough insulin to keep up with the body’s demands. At this point, people with type 2 diabetes also need to take insulin.

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Insulin can be given by multiple injections every day or via an insulin pump. Insulin pumps deliver insulin through a small tube that’s inserted under the skin. The site of the insulin pump must be changed every few days. But once the tube is in, someone who uses an insulin pump only needs to push a few buttons to deliver a dose of insulin.

However, getting the right amount of insulin is no easy task. Many factors affect the body’s need for insulin. Exercise decreases the need. Foods that are higher in carbohydrates increase the need. Stress and other moods can affect the need for insulin, as can illness or hormonal shifts, such as those that occur with menstruation.

People with diabetes often have to make adjustments to their insulin doses. If they make a mistake and take too much, an extremely low blood sugar level (hypoglycemia) can occur. If they give themselves too little insulin, their blood sugar levels rise (hyperglycemia). Either condition can be very dangerous.

According to Dr. Alyson Myers, director of inpatient diabetes at North Shore University Hospital, in Manhasset, N.Y., “If someone comes in with hypoglycemia, you think, ‘Oh, they overdid it.’ And, sometimes when people come in with hyperglycemia or DKA (a complication of hyperglycemia), the intention to self-harm can be missed.”

Myers is also the lead author of the review, published recently in the journal Current Diabetes Reviews.

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It’s not clear exactly how high the rates of suicide are in people with diabetes, though Myers said the rates are higher than in the general population.

Plus, an attempt at suicide using insulin or other blood sugar-lowering medications may ultimately fail. “The body is a resilient thing,” Myers said, explaining that the body has ways to protect itself, such as releasing a natural form of sugar from the liver.

Instead of automatically assuming there was an error in care, Myers recommended that physicians consider the possibility of a suicide attempt or self-harm through the use of insulin and other medications.

She suggested that doctors follow the guidelines from the diabetes association on psychosocial care for people with diabetes that includes a multi-disciplinary team, including a behavioral health specialist.

McAuliffe-Fogarty agreed that when doctors see patients — whether it’s in the hospital or for an office visit — they should screen for psychosocial concerns.

If a doctor identifies a potential concern, “refer to a mental health care provider so people can get the help they need to live a full and happy life,” she said.

Given that 20 percent to 25 percent of people with diabetes screen positive for depressive symptoms at some point, people may need help sometimes.

“If you see signs of depression, changes in people’s sleep patterns or eating behaviors, a loss of interest in things they once enjoyed; if they say things like, ‘when I’m not here things will be better,’ or express an intention to self-harm, make an appointment with a mental health-care provider. People often need some help coping and figuring out how to deal with things,” McAuliffe-Fogarty said.

“If you’re very nervous that they might harm themselves, call their doctor or bring them to the hospital. Or call 911 if you think they’re in immediate trouble,” she advised.

If you’re concerned that a loved one or friend may be considering suicide, McAuliffe-Fogarty said it’s OK to ask, though some people consider the word suicide to be taboo. “Ask, ‘Are you thinking of hurting yourself or thinking of not being here?’ Sometimes people are relieved and will open up.”

But McAuliffe-Fogarty also cautioned that every misuse of insulin may not be a deliberate act of self-harm.

“It’s not always self-harm or a suicide attempt,” she stressed.

One such example, “Some people use insulin omission to lose weight. It’s a type of disordered eating, but they’re not trying to hurt themselves,” she explained.

Getty Images/iStockphoto

Olivia Yang was stunned when she learned she had type 2 diabetes six years ago, when she was 19. Her doctor was shocked, too. In fact, her physician tested her twice to be sure there wasn’t some mistake. Yang was young, had a normal weight for her 5-foot-2-inch frame, and didn’t consider herself a particularly bad eater. She certainly didn’t seem like someone at risk.

olivia-yang.jpg
Olivia…

Ten signs of uncontrolled diabetes

Uncontrolled diabetes can be fatal. It can also lower quality of life.

People who do not manage the condition well may develop uncontrolled diabetes, which causes dangerously high blood glucose. This can trigger a cascade of symptoms, ranging from mood changes to organ damage.

People with type 1 diabetes, a disease that causes the body to attack insulin-producing cells in the pancreas, are diagnosed, typically, in childhood. However, as many as a third of adults with the most common type 2 diabetes variant of the disorder, do not know they have it. Without taking measures to treat it, these people can develop uncontrolled diabetes.

The following 10 symptoms are signs of uncontrolled diabetes. Anyone experiencing them should consult a doctor promptly.

High blood glucose readings are the most obvious symptom of uncontrolled diabetes.

As diabetes raises blood sugar levels, many people with diabetes think it is normal to have high blood glucose. Normally, however, diabetes medication and lifestyle changes should bring blood glucose within target ranges.

If blood glucose is still uncontrolled, or if it is steadily rising, it may be time for an individual to review their management plan.

FREQUENT INFECTIONS

Diabetes can harm the immune system, making people more prone to infections. A person with diabetes who suddenly gets more infections, or who takes longer to heal from an infection they have had before, should see a doctor.

Some of the most common infections associated with diabetes include:

• skin infections, such as cellulitis
• urinary tract infections
• yeast infections

Yeast feeds on sugar, and so the combination of lowered immunity and high blood glucose makes people with diabetes particularly at risk from frequent yeast infections.

INCREASED URINATION

Increased urination is known as polyuria. Most adults urinate 1-2 liters per day, but people with diabetes urinate 2-3 liters per day, and sometimes more.

People with diabetes urinate more frequently because the body tries to rid the blood of excess glucose. With uncontrolled sugars, people also drink more frequently, causing them to produce more urine.

A rare form of diabetes not related to blood glucose, called diabetes insipidus, can also increase urination.

INCREASED THIRST

People with diabetes sometimes experience polydipsia, a form of extreme thirst.

High blood glucose can make people with diabetes very dehydrated, so that they feel thirsty. It also undermines the body’s ability to absorb water. A person may feel an overwhelming need for water, may have a chronically dry mouth, or may feel dizzy.

Even though people with polydipsia drink more fluids,…

A blood test for multiple sclerosis? Expect one in late May

Six panels of an MRI scan.

The medical toolbox for treating multiple sclerosis (MS) has progressed in leaps and bounds over the last two decades, as highlighted by the recent approval of Ocrevus for the most severe and treatment-resistant form of the disease.

Despite this success, the underlying disease mechanisms and triggers are not well understood. This makes diagnosis a challenge — with very high stakes. The longer the disease progresses without treatment, the more irreversible neurological damage can be done.

To that end, Nashville, Tennesee-based IQuity will launch a first-of-its-kind blood test for MS in late May. The technology, originally licensed from Vanderbilt University, analyzes long non-coding RNA (lncRNA) in the patient’s blood to identify patterns indicative of the disease.

“To our knowledge, we’re going to be the first blood-based RNA test for multiple sclerosis, and definitely among the first – if not the first – in the field of autoimmune diseases,” said Chase Spurlock, CEO and cofounder of IQuity, via phone.

Spurlock said the test, dubbed IsolateMS, has proven accuracy greater than 90 percent. It can also deliver results in as little as seven days. What’s more, the disease markers were present at the earliest stages of the disease.

“This was pretty exciting because, a lot of times, the molecular patterns that we can discern from the immune cells precede the physical manifestations of disease,” Spurlock stated.

By comparison, today’s diagnostic criteria actually include “the dissemination of space and time.” In other words, neurologists look for disease progression in successive MRI scans and lumbar punctures (spinal taps), an invasive process that can take months or years.

That’s far from ideal. Some 80 percent of patients have a relapsing-remitting form of MS, characterized by cycles of disease remission and flares or “attacks” when the immune system does irreparable damage to the brain. By rapidly diagnosing the disease, physicians can intervene more aggressively to prevent a loss of function.

“Early scans paired with blood tests like ours would give more information to the provider that they have traditionally had,” Spurlock said, noting that it’s intended to be used in concert with tools such as MRIs for a faster, more definitive diagnosis.

A spokeswoman for the National MS Society said the organization is still…

Low oxygen reverses neurodegenerative disease in mice

When the cells’ mitochondria do not work properly, the human body can develop a mitochondrial disease. New research paves the way for treating mitochondrial diseases that affect the brain, showing that oxygen deprivation has unexpected therapeutic benefits – at least in mice.

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New research reveals the therapeutic benefits of hypoxia for Leigh syndrome, a neurodegenerative disease.

Mitochondria are the small compartments within a cell, responsible for turning sugar and oxygen into energy.

Mitochondrial diseases can take many forms, as cells can be found everywhere in the human body. Mitochondrial disorders can affect the brain, kidneys, eyes, and many other organs.

Leigh syndrome” is one such kind of mitochondrial disorder that affects the brain. The condition is rare; it is thought to affect only 1 in 30,000 newborns.

Leigh syndrome is a neurodegenerative disorder. It is characterized by brain lesions, a progressive loss of motor skills and muscle tone, and delays in development. Complications can lead to poor heart, respiratory, and kidney function.

Most of the time, Leigh syndrome cannot be treated. A new study in mice, however, suggests that hypoxia – that is, a deprivation of oxygen – may have the unexpected benefit of protecting the brain against this form of mitochondrial disease.

The study was carried out by researchers from the Massachusetts General Hospital (MGH) in Boston, and the findings were published in the journal PNAS.

The therapeutic role of hypoxia in mitochondrial disease

The new research builds on previous work by the same team. In their previous study, the researchers used a traditional mouse model of Leigh syndrome – with mice that had the so-called Ndufs4 gene knocked off – and placed them in an environment that had just 11 percent oxygen. This is the equivalent of roughly half of what is found at sea level.

The Ndufs4 gene encodes a protein that is key for the mitochondrial complex 1 – an enzyme complex that is part of the respiratory chain of the mitochondria.

The researchers found that the hypoxic environment significantly decreased typical symptoms of Leigh syndrome and prolonged the rodents’ survival.

By contrast, an environment with levels of oxygen higher than normal caused premature death in the animal model but had no impact on normal, healthy animals.

In the new study, the team aimed not only…

Four myths about diabetes debunked

You don’t have to be overweight or obese to have type 2 diabetes.

The World Health Organisation estimates that the number of people with diabetes is 422m, globally. And between 1980 and 2014 the number of people with the condition almost doubled. Despite the high prevalence of the disease, it is often misunderstood. Here are some common misconceptions about diabetes.

1. Diabetes is purely a disorder of the pancreas

Diabetes does affect the pancreas, but it shouldn’t just be thought of as an illness that affects the body from the neck down. If we take this viewpoint we miss the psychological impact of living with this condition. And it’s a big one. As well as the issue of adjusting to the diagnosis of a long-term health condition, people with diabetes are more likely to develop depression. There is even a specific form of depression associated with diabetes known as diabetes distress. It’s when a person is struggling to cope with managing their condition.

Having diabetes affects your mental abilities too. Research suggests that diabetes can affect your ability to think clearly, focus and recall memories.

Diabetes also affects other brain processes, such as how we weigh up food choices. Researchers are also investigating how hormones, such as insulin, seem to regulate food choices. These particular brain effects, within a system called the midbrain dopamine system, offer one potential explanation for why some diabetics find it difficult to follow health advice, no matter how often they are given it.

2. Only overweight or obese people get diabetes

There is a strong association between type 2 diabetes and obesity, but that doesn’t mean that everyone who is diabetic is overweight or obese. Nor does it mean that everyone who is overweight or obese will develop diabetes.

However, a Public Health England report said that obese adults in England were five times more likely to develop type 2 diabetes than adults of a normal weight. But there is still a lot of work to be done to fully understand the link between diabetes and obesity….

Diabetes can’t stop you from climbing Everest

Oren Liebermann and his wife, Cassandra Kramer, at Annapurna Base Camp in Nepal.
Oren Liebermann and his wife, Cassandra Kramer, at Annapurna Base Camp in Nepal.

Oren Liebermann is CNN’s Jerusalem correspondent and author of “The Insulin Express: One Backpack, Five Continents, and the Diabetes Diagnosis That Changed Everything.”

(CNN)I made the most important decision of my life because of diabetes.

While volunteering in Nepal, I was diagnosed with type 1 diabetes at age 31. It was Valentine’s Day 2014, and my wife and I were in the middle of a backpacking trip around the globe. We had just finished a hiking trip in the Himalayas that almost killed me.

I had been losing weight and had to run to the bathroom constantly. And I had never in my life been so thirsty. I dismissed the symptoms as consequences of the dry weather, until I stepped on a scale and saw how much weight I’d lost: about 40 pounds.

Oren Liebermann at Machu Picchu, Peru, being zen with his insulin kit.

A trip to a local doctor gave me the diagnosis that would change my life and land me in two hospitals in Nepal before I was cleared to fly home. I spent a month learning about diabetes and understanding the ins and outs of a chronic autoimmune disease. Then it was time to make my decision.

My wife, Cassandra Kramer, and I resolved to get back on the road and finish what we had started. I knew that if I accepted limitations so early in my life with diabetes, I would always accept limitations, and that was a dangerous state of mind.

We caught a flight to Bangkok and made our way through Southeast Asia, South America and Iceland before coming home.

Diabetes is a disease with which the body no longer produces enough insulin to regulate blood sugar. In type 1 diabetes, the pancreas stops producing insulin altogether, requiring daily injections of artificial insulin and constant blood sugar monitoring. In type 2 diabetes, the body’s insulin isn’t used effectively, which is sometimes the consequence of being overweight. Type 2 diabetes can require some combination of lifestyle change, medication and insulin injections.

Diabetes is one of the fastest-growing diseases in the United States, with 1.4 million Americans diagnosed every year. Nationwide, 29 million Americans have diabetes — nearly 10% of the population. Worldwide, 415 million people have it. That number is expected to reach 642 million by 2040.

The search for what triggers type 1 diabetes

Yet the cause of diabetes is unknown. Although some cases of type 2 may be a result of obesity, that answer does not apply to everyone, and there are no such clues for type 1.

Diabetes still has a stigma attached to it, largely because of a lack of education and…

Scientists find new genetic locations for type 2 diabetes

Scientists from University College London and Imperial College London in the United Kingdom have identified new genetic locations that might make some people more prone to developing type 2 diabetes.

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Scientists identify 111 new genetic locations that indicate susceptibility to type 2 diabetes.

Type 2 diabetes affects hundreds of millions of people worldwide, and the numbers have skyrocketed in recent years. According to the World Health Organization (WHO), the number of people with diabetes has almost quadrupled in the past few decades, from 108 million in 1980 to 422 million in 2014.

In the United States, 29 million people currently have diabetes, and 86 million are thought to have prediabetes.

Until now, researchers were aware of 76 chromosomal locations, or “loci,” that underlie this metabolic disease. However, new research analyzed the human genome further and found an additional 111.

The new study – published in the American Journal of Human Genetics – was co-led by Dr. Nikolas Maniatis of University College London’s (UCL) Genetics, Evolution, and Environment department, together with Dr. Toby Andrew of Imperial College London’s Department of Genomics of Common Disease.

Identifying the type 2 diabetes genetic loci

Using a UCL-developed method of genetic mapping, Maniatis and team examined large samples of European and African American people, summarizing 5,800 cases of type 2 diabetes and almost 9,700 healthy controls.

They found that the new loci – together with the ones previously identified – control the expression of more than 266 genes surrounding the genetic location of the disease.

Most of the newly discovered loci were found outside of the coding regions of these genes, but within so-called hotspots that change the expression of these genes in body fat.

Of the newly identified 111 loci, 93 (or 84 percent) were found…

African-Americans are living longer, but racial disparity still exists, according to CDC

A report by the US Centers for Disease Control and Prevention (CDC) has shown there is still disparity between African-Americans (blacks) and whites in terms of life expectancy.

Although the overall death rate among blacks has fallen by about 25% in the U.S., life expectancy among blacks is still four years less than among whites.

Younger black people (in their 20s, 30s and 40s) are more likely to live with or die from conditions that usually only affect white people once they are older; conditions such as diabetes, stroke and heart disease.

The findings come from an analysis of health data from the US Census Bureau’s National Vital Statistics System and the CDC’s Behavioral Risk Factor Surveillance System. Age-specific data and death rates were analyzed for age groups 18–34, 35–49, 50–64 and older among black and white individuals between 1999 and 2015.

According to the report, death rates fell significantly for both races, as did the racial disparity in death rates, which was 33% in 1999, compared with 16% in 2015.

However, the data…

Guidance for persons living with diabetes

Do annual diabetic reviews

I see many persons with this disease. Having diabetes increases the risk of developing a wide range of foot problems, often because of two complications of the disease: nerve damage (neuropathy), and poor circulation.

For those living with diabetes, foot problems, such as the following, can lead to serious complications:
• Corns
• Calluses
• Cracked heels
• Hammertoes
• Bunions
• Ingrown toenails
• Ulcers (sores) that do not heal
• Skin infection (cellulitis) from an open wound
• Abscess formation (collection of pus under the skin)
• Osteomyelitis (bone infection)

Untreated diabetes can result in other conditions, such as:
Diabetic peripheral neuropathy – this condition does not emerge overnight. Instead, it usually develops slowly, and worsens over time. Some patients have this condition long before they are diagnosed with diabetes. Having diabetes for several years may increase the likelihood of having diabetic neuropathy. It is a condition that affects the nerves and symptoms are usually numbness, tingling, burning, pins and needles.
Charcot foot – is a condition in which the bones of the foot are weakened enough to fracture. It is a sudden softening of the foot’s bones, caused by severe neuropathy, or nerve damage, a common diabetic foot complication. It can trigger an avalanche of problems, including joint loss, fractures, collapse of the arch, massive deformity, ulcers, amputation, and even death. As the disorder progresses, the bottom of the foot can become convex, bulging like the hull of a ship. Since most people with Charcot cannot feel pain in their lower extremities, they continue walking on the foot, causing more injury. With sustained walking, the foot eventually changes shape. The joints then collapse, and the foot takes on an abnormal shape, with a rocker-bottom appearance.
Charcot cannot be reversed, but its destructive effects can be stopped if the complication is detected early. The symptoms of Charcot foot appear suddenly. They include warm and red skin, swelling, and pain. A person living with diabetes who has a red, hot, swollen foot or ankle, requires emergency medical care anyway, because these can also be symptoms of deep vein thrombosis, or an infection.
To prevent complications…

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