Tuesday, October 31, 2017

Large declines seen in teen substance abuse, delinquency

Surveys over a decade indicate positive behavioral shifts

In recent years, teens have become far less likely to abuse alcohol, nicotine and illicit drugs, according to researchers. Teens also are less likely to engage in behaviors like fighting and stealing, and the researchers believe the declines in substance use and delinquency are connected.

More than a decade of data indicates teens have become far less likely to abuse alcohol, nicotine and illicit drugs, and they also are less likely to engage in delinquent behaviors, such as fighting and stealing, according to results of a national survey analyzed by researchers at Washington University School of Medicine in St. Louis.

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The data come from the National Survey on Drug Use and Health, an annual survey of 12- to 17-year-olds from all 50 states that is sponsored by the Substance Abuse and Mental Health Administration, an agency of the U.S. Department of Health and Human Services. The data include information from 2003 through 2014, the last year for which survey numbers are available. A total of 210,599 teens -- 13,000 to 18,500 each year -- were part of the study.
The findings are reported Oct. 25 in the journal Psychological Medicine.

The researchers found that the number of substance-use disorders among 12- to 17-year olds had declined by 49 percent over the 12-year span, along with a simultaneous 34 percent decline in delinquent behaviors, such as fighting, assault, stealing, selling drugs or carrying a handgun.

The drop in substance abuse among teens parallels findings in other recent surveys, but until now no one has looked at how the drop-off may be linked to other behavioral issues.

"We've known that teens overall are becoming less likely to engage in risky behaviors, and that's good news," said first author Richard A. Grucza, PhD, a professor of psychiatry. "But what we learned in this study is that the declines in substance abuse are connected to declines in delinquency. This suggests the changes have been driven more by changes in adolescents themselves more than by policies to reduce substance abuse or delinquent behavior."

Other researchers have found that teens are delaying sex and using seat belts more often than their parents and grandparents. Grucza's team focused on substance-use disorders -- involving alcohol, nicotine, marijuana, opioids and the abuse of other prescription drugs or nonprescription drugs -- and delinquent behaviors.

"It's not clear what is driving the parallel declines," Grucza said. "New policies -- including things like higher cigarette taxes and stricter anti-bullying policies -- certainly have a positive effect. But seeing these trends across multiple behaviors suggests that larger environmental factors are at work. These might include reductions in childhood lead exposure, lower rates of child abuse and neglect, and better mental health care for children."

Although heroin and opioid abuse have become epidemic in many areas of the United States, the use among teens has fallen, according to the survey data.
"Opioid problems continue to increase among adults," he said. "But among the 12- to 17-year-old population, we saw a drop of nearly 50 percent."

Based on the survey data, Grucza and his team estimated that in 2014 there were nearly 700,000 fewer adolescents with substance-use disorders than in 2003. And because it's possible for a person to be addicted to nicotine while abusing alcohol or marijuana, the researchers estimate the total number of substance-use disorders among adolescents declined by about 2 million.

Washington University School of Medicine

Thursday, October 26, 2017

Breaking the Chain: Dramatic Advances Loom in Drug Treatment

More than 200,000 people worldwide die every year from drug overdoses and drug-related illnesses, such as HIV, according to the United Nations Office on Drugs and Crime, and far more die from smoking and drinking.

Brain researchers often refer to "the toolkit" that exists for drug addiction. New additions to "agonist" drugs and psychologic "talk" therapy are emerging rapidly. We look at a promising one here: brain stimulation.
Addiction is a brain disease. Learn about the brain and your health. Click here!

A serious cocaine addict who’d relapsed several times after treatment, Patrick Perotti finally resorted to an experimental treatment—the application of electromagnetic pulses to his prefrontal cortex— at a clinic in Padua, Italy. It worked. Psychiatrist Luigi Gallimberti has used transcranial magnetic stimulation on other patients with similar success. He and his colleagues are planning a large-scale trial. The technique is now being tested for other types of addiction by researchers around the world.
Patrick Perotti scoffed when his mother told him about a doctor who uses electromagnetic waves to treat drug addiction. “I thought he was a swindler,” Perotti says.
Perotti, who is 38 and lives in Genoa, Italy, began snorting cocaine at 17, a rich kid who loved to party. His indulgence gradually turned into a daily habit and then an all-consuming compulsion. He fell in love, had a son, and opened a restaurant. Under the weight of his addiction, his family and business eventually collapsed.
He did a three-month stint in rehab and relapsed 36 hours after he left. He spent eight months in another program, but the day he returned home, he saw his dealer and got high. “I began to use cocaine with rage,” he says. “I became paranoid, obsessed, crazy. I could not see any way to stop.”
When his mother pressed him to call the doctor, Perotti gave in. He learned he would just have to sit in a chair like a dentist’s and let the doctor, Luigi Gallimberti, hold a device near the left side of his head, on the theory it would suppress his hunger for cocaine. “It was either the cliff or Dr. Gallimberti,” he recalls.
Gallimberti, a gray-haired, bespectacled psychiatrist and toxicologist who has treated addiction for 30 years, runs a clinic in Padua. His decision to try the technique, called transcranial magnetic stimulation (TMS), stemmed from dramatic advances in the science of addiction—and from his frustration with traditional treatments. Medications can help people quit drinking, smoking, or using heroin, but relapse is common, and there’s no effective medical remedy for addiction to stimulants like cocaine. “It’s very, very difficult to treat these patients,” he says....
Source: National Geographic 

 VIEW IMAGESBREAKING THE CHAIN A serious cocaine addict who’d relapsed several times after treatment, Patrick Perotti finally resorted to an experimental treatment—the application of electromagnetic pulses to his prefrontal cortex— at a clinic in Padua, Italy. It worked. Psychiatrist Luigi Gallimberti has used transcranial magnetic stimulation on other patients with similar success. He and his colleagues are planning a large-scale trial. The technique is now being tested for other types of addiction by researchers around the worlGallimberti, a gray-haired, bespectacled psychiatrist and toxicologist who has treated addiction for 30 years, runs a clinic in Padua. His decision to try the technique, called transcranial magnetic stimulation (TMS), stemmed from dramatic advances in the science of addiction—and from his frustration with traditional treatments. Medications can help people quit drinking, smoking, or using heroin, but relapse is common, and there’s no effective medical remedy for addiction to stimulants like cocaine. “It’s very, very difficult to treat these patients,” he says.

 VIEW IMAGBREAKING THE CHAIN A serious cocaine addict who’d relapsed several times after treatment, Patrick Perotti finally resorted to an experimental treatment—the application of electromagnetic pulses to his prefrontal cortex— at a clinic in Padua, Italy. It worked. Psychiatrist Luigi Gallimberti has used transcranial magnetic stimulation on other patients with similar success. He and his colleagues are planning a large-scale trial. The technique is now being tested for other types of addiction by researchers around the world.

Monday, October 23, 2017

Tobacco Use a Serious Health Concern in LGBT Community

Smoking contributes to a range of negative health outcomes, such as cancer, heart disease, and respiratory illness. In fact, tobacco use is the leading preventable cause of disease and death in the United States.

What is less commonly understood is that smoking is even more of a problem for the LGBT population. That’s because LGBT young adults are nearly twice as likely to use tobacco as other young adults. As a consequence, each year tens of thousands of LGBT lives are lost to tobacco use. Further, of the more than 2 million young adults ages 18-24 who identify as LGBT in the United States, more than 800,000 smoke occasionally – that’s 40%! So a campaign to prevent them from engaging in this harmful health behavior could be lifesaving.

Learn about the unique stressors that affect the health of LGBT/Q Youth. Click here.

“We know LGBT young adults in this country are nearly twice as likely to use tobacco as other young adults,” said Mitch Zeller, J.D., director of the FDA’s Center for Tobacco Products. “We want LGBT young adults to know that there is no safe amount of smoking. Even an occasional cigarette can have serious health implications and lead to addiction.”
FDAThisFreeLife - cropped May 2016
"This Free Life" Campaign
This Free Life  that communicates serious information about the ugly side effects of smoking in a unique and engaging way. The new campaign is part of the FDA’s ongoing efforts to prevent death and disease caused by tobacco use and will complement the agency’s at-risk youth education campaigns. The $35.7 million “This Free Life” campaign is funded by user fees collected from the tobacco industry, not by taxpayer dollars.

Smoking and People Living with HIV
Just as in the LGBT community, smoking rates are disproportionately high among people living with HIV. According to CDC data, 42% of adults living with HIV were current smokers compared to about 21% of the general public. Unfortunately, smoking cigarettes can intensify the health risks of HIV, even for people who have their condition well controlled. Smoking increases the chances of heart disease, cancer, serious lung diseases and infections, which are all conditions that those with HIV are more vulnerable to developing. So quitting smoking—or never starting—may be one of the most important steps toward better health that a person living with HIV can take.

Sunday, October 22, 2017

TV & Food & Diabetes

For many years, Americans watched commercials on TV and in print that actually promoted cigarette smoking. One infamous campaign said, promoted a doctor-actor saying "Reach for a cigarette instead of a sweet." Ronald Reagan promoted the benefits of Chesterfields. LSMFT meant "Lucky Strikes Means Fine Tobacco." Then in 1963 came the Surgeon General's report that said simply, "Cigarette smoking causes cancer." The public just didn't know, until then. With an obesity and diabetes epidemic looming (if not already here) we are going to need a similar awakening regarding food.

Television Watching and “Sit Time”

Fast food advertising

Research conducted at Harvard first linked TV watching to obesity more than 25 years ago. Since then, extensive research has confirmed the link between TV viewing and obesity in children and adults, in countries around the world. And there’s good evidence that cutting back on TV time can help with weight control-part of the reason why many organizations recommend that children and teens limit TV/media time to no more than two hours per day. This article briefly outlines the research on how TV viewing and other sedentary activities contribute to obesity risk, and why reducing screen time and sedentary time are important targets for obesity prevention.

TV Viewing and Childhood Obesity

Studies that follow children over long periods of time have consistently found that the more TV children watch, the more likely they are to gain excess weight. Children who have TV sets in their bedrooms are also more likely to gain excess weight than children who don’t. And there’s evidence that early TV habits may have long-lasting effects: Two studies that followed children from birth found that TV viewing in childhood predicts obesity risk well into adulthood and mid-life. 
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Several trials designed to reduce children’s TV use have found improvements in body mass index (BMI), body fat, and other obesity-related measures. Based on this evidence, the U.S. Task Force on Community Preventive Services recommends that communities roll out behavior-change programs aimed at curbing screen time, since there’s “sufficient evidence” that such programs do help reduce screen time and improve weight. 
Some of these successful TV-reduction trials have been delivered through the schools: The Planet Health trial, for example, used middle school classroom lessons to encourage less TV viewing, more activity, and improvements in diet; compared to the control group, students assigned to receive the lessons cut back on their TV time, and had lower rates of obesity in girls. Another trial found that third- and fourth-graders who received an 18-lesson “TV turnoff” curriculum cut back on TV time and on meals eaten while watching TV, compared with children in the control group, and they had a relative decrease in BMI and other measures of body fatness. TV “allowance” devices, which restrict TV watching to a set number of hours per week, may help limit children’s screen time, and in turn, help with weight control. 

TV Viewing and Adult Obesity

There’s convincing evidence in adults, too, that the more television people watch, the more likely they are to gain weight or become overweight or obese. And there’s emerging evidence that too much TV watching also increases the risk of weight-related chronic diseases. For example, the Nurses’ Health Study followed more than 50,000 middle-age women for six years. For every two hours the women spent watching television each day, they had a 23 percent higher risk of becoming obese and a 14 percent higher risk of developing diabetes. A more recent analysis that summarized the findings of this study and seven similar studies found that for every two hours spent watching TV, the risk of developing diabetes, developing heart disease, and early death increased by 20, 15, and 13 percent, respectively. 
TV reduction trials have focused largely on children, not adults. But a small pilot study in 36 men and women suggests that an electronic TV “lock-out” device could help adults with weight control. Half of the volunteers were assigned to use a lock-out device that would cut their TV viewing time by half; the other half were assigned to a control group with no limits on TV. The volunteers who used the lock-out device watched less television and burned more calories each day, and they had a greater reduction in BMI than the control group. The difference in BMI did not reach statistical significance, however. (22) Given the study’s small size, more research is needed to confirm these results.

How Does TV Watching Increase the Risk of Obesity? A Closer Look at Food Marketing

food marketing (cereal_and_tv.jpg)Researchers have hypothesized that TV watching could promote obesity in several ways: displacing time for physical activity; promoting poor diets; giving more opportunities for unhealthy snacking (during TV viewing); and even by interfering with sleep.
Many studies show that TV viewing is associated with greater calorie intake or poorer diet quality, and there’s increasing evidence that food and beverage marketing on television may be responsible for the TV-obesity link. The effects of TV viewing on physical activity are much smaller than on diet, so they don’t seem to play as strong a role. Some research findings that support the food marketing-TV-obesity link:
  • The thousands of food-related TV ads that children and youth see each year are primarily for high-calorie, low-nutrient foods and drinks, according to a comprehensive review of the evidence by the Institute of Medicine (IOM). Food marketing influences children’s food preferences and purchase requests, and marketers rely on this “pester power” to influence what parents buy.
  • Branded foods, drinks, and restaurants are often featured in TV shows and movies (the ad industry term for this is “product placement”), and these product placements are overwhelmingly for unhealthy foods. An analysis of food brands that appeared in prime-time television programming in 2008 found that children and teens saw roughly one food brand per day, and three out of four of these brand appearances were for sugary soft drinks.
  • Laboratory studies find that TV food ads influence food consumption. In one experiment, for example, children who watched cartoons with food commercials ate 45 percent more snack food while viewing than children who watched cartoons with non-food advertising.
  • More evidence that exposure to food ads, rather than watching television itself, contributes to obesity comes from a study that tracked the TV viewing habits and change in BMI of 1,100 young children over a five-year period. The more hours per day of commercial TV children watched at the start of the study, the more likely they were to have a relative increase in BMI at the study’s end. There was no link between non-commercial TV watching and change in BMI.
Source: Harvard University, T.H. Chan School of Public Health

Saturday, October 21, 2017

Shame and Blame: Fast Food and Diabetes

It's horrible not to be able to eat what you want.

And nothing frustrates a newly diagnosed insulin-dependent Type-2 diabetic than well-meant, but confusing advice from everyone and every place about what to consume. Apple cider vinegar? Lemon juice and water in the morning? Strict low-carbohydrate intake? Fruits and vegetables only? 

And then there's fast food. 

Confusion easily leads to shame, depression, misunderstandings...and stress-eating.

Try living with a pernicious disease in a culture that
promotes the very diet that got you here and could keep you here.
On every corner, there they are: McDonald's, Wendy's, Burger King, Arby's, Taco Bell, Kentucky Fried Chicken. A constant marketing campaign lures us to these stores. Time-pressures of life today makes it impossible to resist the convenience. 

There's got to be a reasonable answer.

  1. Eating junk food can contribute to weight gain. This makes it more difficult for people with diabetes to regulate blood sugar levels.
  2. Saturated and trans fats raise your cholesterol level. This puts you at a greater risk for heart disease, heart attack, and stroke.
  3. People with diabetes can control their intake of harmful fats and sugars by becoming educated consumers.
Junk foods are everywhere. You see them in vending machines, rest stops, stadiums, and hotels. They’re sold at movie theaters, gas stations, and bookstores. And if that wasn’t enough, incessant advertising promotes junk food on television.
Junk foods are high in calories but low in nutritional value. In general, these foods include processed and prepared snack foods with long, often unpronounceable ingredient lists.
Consuming excess sugars and fats found in these foods can contribute to weight gain. This excess weight is associated with diabetes.
One of the top risk factors for developing type 2 diabetes is being overweight. When you carry too much fat tissue, especially around your midsection, your body’s cells can become resistant to insulin. Insulin is a hormone that moves sugar out of your blood and into your cells.
When your cells are unable to use insulin properly, your pancreas mistakes this as a need for more insulin, so it pumps out more. Eventually your pancreas will wear out and stop producing enough insulin to keep your blood sugars under control. This causes you to develop diabetes, a condition characterized by high blood sugar levels.
Junk foods are highly processed and high in calories. They tend to have few vitamins and minerals, and are usually low in fiber. Junk foods also often contain large amounts of added sugar and are high in saturated fats and trans fats. This can cause them to digest more quickly, which can spike blood sugar levels and increase bad cholesterol levels.

Saturated and trans fats

According to the American Diabetes Association (ADA), saturated fat raises your cholesterol level. This puts you at a greater risk for heart disease, heart attack, and stroke. The ADA recommends people get less than 10 percent of their calories from saturated fats.
Trans fat also increases your cholesterol level. It’s even worse than saturated fat because it raises bad cholesterol levels and lowers good cholesterol levels. Trans fat is liquid oil that has solidified, also called hydrogenated fat. It can be tricky to spot because food producers can list 0 grams of trans fat on labels if there is less than 0.5 grams in the product.

Avoiding junk food

For people with diabetes, it’s important to limit sugars and fats found in junk food. This helps keep your weight and blood sugar levels under control. The ADA recommends limiting these foods because they usually take the place of other more nutritious foods in your body.
It can be as hard to break a junk food habit as many other bad habits. Even if you avoid foods obviously laden with sugars and fats, such as cakes and fried dishes, fats and sugars can lurk in foods where you least expect them. Tortilla chips, noodles, muffins, croissants, and the cream you splash in your coffee may be high in simple sugars and contain harmful fats. Sugar also shows up in flavored yogurt and condiments like salad dressings, mayonnaise, and ketchup. It’s also found in high quantities in some fat free foods, as it’s used to substitute for fat.


Many people with diabetes find that the best way to control their intake of harmful fats and sugars is to become an educated consumer. This includes learning how to read nutrition labels to spot harmful fats and sugars. It also includes cooking more often at home to control ingredients.
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You can also control your blood sugar level and diabetes by eating:
  • foods that are low in sodium
  • foods that are low in saturated and trans fat
  • whole unprocessed carbs such as vegetables, fruits, and whole high fiber grains
  • a managed amount of carbohydrates
  • an adequate amount of protein
Also, eating smaller meals instead of three large meals a day can help you manage your hunger better. Getting plenty of exercise will help you lower your blood sugar too.
You can also keep a food journal to note when you eat and how much. This will help you see:
  • if you’re overeating or stress-eating
  • if you have any other bad eating habits
  • if you eat a particular junk food often
Try to swap out junk foods with healthy alternatives. If you enjoy eating out, it’s best to avoid fast food restaurants. If you do occasionally indulge, the ADA has these tips for making your fast food dining healthier:
  • Don’t fall into the trap of ordering a deluxe or super-sized food option because it’s a good money value. It may save you money, but it doesn’t save on calories, sugar, or fat consumption.
  • Avoid fried foods and go for grilled or broiled instead. Choose lean meats such as turkey or chicken breast.
  • Watch the condiments. Mustard is healthier than mayonnaise, ketchup, or rich sauces.
  • In the morning, stick with whole-grain high fiber buns, bread, or English muffins, which are lower in calories and fat.
  • Order your burger without cheese, which has additional calories and fat.
  • Salad bars are good, but limit toppings such as bacon and cheese. Choose healthier fat options such as nuts, seeds, and avocado. Load up on carrots, peppers, onions, broccoli, cauliflower, and celery as well as greens.
  • If eating pizza, choose whole-wheat thin crust and veggie toppings.


Considering how pervasive junk food is in the United States, it can be hard to resist. People with diabetes have to pay special attention to their diets to control their weight and ultimately their blood sugar level. Resisting the urge to overeat junk food may be even more challenging. You should limit junk food and choose healthy alternatives whenever possible. This is ideal not just for diabetes, but also for overall health.
Source: www.healthline.com

Thursday, October 19, 2017

Diabetes: Good sleep really, really matters

From the National Institutes of Health

Recent scientific evidence suggests that sleep disorders may contribute to the development of diabetes; conversely, diabetes itself may contribute to sleep disorders.

Sleep appears to moderate the brain hormones that regulate blood sugar. Sleep deprivation and sleep disorders contribute to changes associated with the development of type 2 diabetes. In people who already have diabetes, sleep deprivation contributes to elevations of hemoglobin A1c. 

Symptoms that occur as a result of diabetes, such as neuropathic pain, may in turn contribute to sleep disturbance and exacerbate sleep deprivation. Researchers are exploring the scientific basis for the associations between diabetes and sleep, identifying gaps in the understanding of the empirical underpinnings of these relationships, and proposing directions for future research.

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Tuesday, October 17, 2017

Diabetes: The lonely disease

Diabetes is the elusive, frustrating, invisible, lonely disease. It does't appear overnight, but rather builds over years and decades. It's causes are complex and patients are left to self-manage this potentially deadly disease. And it is becoming more prevalent in a fast-moving stressful world, churned by coffee, the Internet, fast food and constant advice and suggestions by well-meaning but confusing friends, partners, doctors, and pharmacists. It is a disease that demands constant attention among people in lower incomes or socio-economic groups least able to afford it. A disease that demands fast decisions at a time when, because of the abnormal blood sugar levels, the brain cannot discern clear answers.

Source: National Institute of Diabetes and Digestive and Kidney Diseases

Know Your Blood Sugar Numbers: Use Them to Manage Your Diabetes

Checking your blood sugar, also called blood glucose, is an important part of diabetes care. This tip sheet tells you:

  • why it helps you to know your blood sugar numbers
  • how to check your blood sugar levels
  • what are target blood sugar levels
  • what to do if your levels are too low or too high
  • how to pay for these tests

Why do I need to know my blood sugar numbers?

Your blood sugar numbers show how well your diabetes is managed. And managing your diabetes means that you have less chance of having serious health problems, such as kidney disease and vision loss.
As you check your blood sugar, you can see what makes your numbers go up and down. For example, you may see that when you are stressed or eat certain foods, your numbers go up. And, you may see that when you take your medicine and are active, your numbers go down. This information lets you know what is working for you and what needs to change.

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How is blood sugar measured?

There are two ways to measure blood sugar.
  • Blood sugar checks that you do yourself. These tell you what your blood sugar level is at the time you test.
  • The A1C (A-one-C) is a test done in a lab or at your provider’s office. This test tells you your average blood sugar level over the past 2 to 3 months.

How do I check my blood sugar?

You use a blood glucose meter to check your blood sugar. This device uses a small drop of blood from your finger to measure your blood sugar level. You can get the meter and supplies in a drug store or by mail.
Read the directions that come with your meter to learn how to check your blood sugar. Your health care team also can show you how to use your meter. Write the date, time, and result of the test in your blood sugar record. Take your blood sugar record and meter to each visit and talk about your results with your health care team.

What are target blood sugar levels for people with diabetes?

A target is something that you aim for or try to reach. Your health care team may also use the term goal. People with diabetes have blood sugar targets that they try to reach at different times of the day. These targets are:
  • Right before your meal: 80 to 130
  • Two hours after the start of the meal: Below 180
Talk with your health care team about what blood sugar numbers are right for you.

How often should I check my blood sugar?

The number of times that you check your blood sugar will depend on the type of diabetes that you have and the type of medicine you take to treat your diabetes. For example, people who take insulin may need to check more often than people who do not take insulin. Talk with your health care team about how often to check your blood sugar.
The common times for checking your blood sugar are when you first wake up (fasting), before a meal, 2 hours after a meal, and at bedtime. Talk with your health care team about what times are best for you to check your blood sugar.

What should I do if my blood sugar gets too high?

High blood sugar is also called hyperglycemia (pronounced hye-per-gly-see-mee-uh). It means that your blood sugar level is higher than your target level or over 180. Having high blood sugar levels over time can lead to long-term, serious health problems.

If you feel very tired, thirsty, have blurry vision, or need to pee more often, your blood sugar may be high.

Check your blood sugar and see if it is above your target level or over 180. If it is too high, one way to lower it is to drink a large glass of water and exercise by taking a brisk walk. Call your health care team if your blood sugar is high more than 3 times in 2 weeks and you don’t know why.

What should I do if my blood sugar gets too low?

Low blood sugar is also called hypoglycemia (pronounced hye-poh-gly-see-mee-uh). It means your blood sugar level drops below 70. Having low blood sugar is dangerous and needs to be treated right away. Anyone with diabetes can have low blood sugar. You have a greater chance of having low blood sugar if you take insulin or certain pills for diabetes.

Carry supplies for treating low blood sugar with you. If you feel shaky, sweaty, or very hungry, check your blood sugar. Even if you feel none of these things, but think you may have low blood sugar, check it.

If your meter shows that your blood sugar is lower than 70, do one of the following things right away:
  • chew 4 glucose tablets
  • drink 4 ounces of fruit juice
  • drink 4 ounces of regular soda, not diet soda or
  • chew 4 pieces of hard candy

After taking one of these treatments, wait for 15 minutes, then check your blood sugar again. Repeat these steps until your blood sugar is 70 or above. After your blood sugar gets back up to 70 or more, eat a snack if your next meal is 1 hour or more away.

If you often have low blood sugar, check your blood sugar before driving and treat it if it is low.

What do I need to know about the A1C test?

The A1C test tells you and your health care team your average blood sugar level over the past 2 to 3 months. It also helps you and your team decide the type and amount of diabetes medicine you need.

What is a good A1C goal for me?

For many people with diabetes, the A1C goal is below 7. This number is different from the blood sugar numbers that you check each day. You and your health care team will decide on an A1C goal that is right for you.

How often do I need an A1C test?

You need to get an A1C test at least 2 times a year. You need it more often if:
  • your number is higher than your goal number
  • your diabetes treatment changes

How do I pay for these tests and supplies?

Medicare, Medicaid and most private insurance plans pay for the A1C test and some of the cost of supplies for checking your blood sugar. Check your plan or ask your health care team for help finding low cost or free supplies. Ask your health care team what to do if you run out of test strips. For more information about Medicare and diabetes, go to https://www.medicare.gov/ .

What if I have trouble getting to my blood sugar goals?

There may be times when you have trouble reaching your blood sugar goals. This does not mean that you have failed. It means that you and your health care team should see if changes are needed. Call your health care team if your blood sugar is often too high or too low. Taking action will help you be healthy today and in the future.

John's Story

At each visit, John and his health care team look at his A1C test results, his blood glucose meter and his blood sugar record to see if his treatment is working. At today’s visit, John’s A1C and blood sugar numbers are too high. John and his health care team talk about what he can do to get closer to his A1C and blood sugar goals. John decides he will be more active. He will:

  • increase his walking time to 30 minutes every day after dinner.
  • check his fasting blood sugar in the morning to see if being more active improves his blood sugar.
  • call his doctor in 1 month for a change in medicine if his blood sugar levels are still too high.
  • have his A1C tested again in 3 months to see if his new plan is working.

Things to remember

  • Check your blood sugar as many times a day as your health care team suggests.
  • Have your A1C checked at least 2 times a year.
  • Keep a record of your blood sugar and A1C numbers.
  • Take your blood glucose meter and blood sugar record to your visit and show them to your health care team. Tell your health care team how you think you are doing.
  • Call your health care team if your blood sugar is often too high or too low.
Work with your health care team and decide what changes you need to make to reach your blood sugar goals.

Sunday, October 15, 2017

Can type 2 diabetes be reversed? A researcher says yes.

Exercise and cutting calories can lead to curing type 2 diabetes within months.

From the Web site of Professor Roy Taylor at Newcastle University, UK 

Further information on the research on Reversing Type 2 Diabetes  

Thank you for contacting me about the studies on reversing type 2 diabetes. These have caused great interest amongst people with diabetes, and as of 2016, I have received over 3,000 enquiries and messages. Although I have replied to most of these personally, I am sorry to say that it is no longer feasible to do this. The research continues. I hope the following items will provide some useful information, but bear in mind that this is only factual information and only your doctor can provide personal medical advice.   

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What are the main research findings?   
1. The initial study was in people who had type 2 diabetes of up to 4 years. The CounterBalance study now shows that longer duration type 2 diabetes can be reversed. However, after more than 10 years of diabetes a return to normal glucose control, even with major weight loss, is much less likely.  
2. It is certainly possible to wake up the insulin producing cells of the pancreas by losing a substantial amount of weight.  
3. This happens at the same time as the fat content in the pancreas decreases. Previous studies have shown that fat stops insulin release, so it is reasonable to deduce that the removal of fat from the pancreas allowed insulin release to normalise.  

Could it work for me?   
 This research is in “type 2 diabetes”, the usual common form of diabetes. There are some rare forms of diabetes which may appear to be type 2 diabetes:  
a) Diabetes occurring after several attacks of pancreatitis is likely to be due to direct damage to the pancreas (known as “pancreatic diabetes”)  
b) Secondly, people who are slim and are diagnosed with diabetes in their teens and twenties, with a very strong family history of diabetes, may have a genetic form (known as “monogenic diabetes”)  
c) Thirdly, type 1 diabetes sometimes comes on slowly in adults, and these people usually require insulin therapy within a few years of diagnosis (“slow onset type 1”)  
None of these will respond in the same way as the common, true type 2 diabetes.  

 So, if you have the common form of type 2 diabetes, this could work for you. However, you should not underestimate just how much change in your day-to-day life will be necessary to bring this about. It requires motivation and persistence. 
Could it work for people with a normal BMI?   
 Yes, most certainly, provided that the diagnosis of type 2 diabetes is correct. Some people are unable to cope with even moderate amounts of fat in their liver and pancreas. Type 2 diabetes only happens when a Personal Fat Threshold is exceeded. Losing weight from a level, which is “normal” for the general population, is then essential for health. See the online article by Richard Doughty.  
Practical advice   
 The particular diet used in the 2011 study was designed to mimic the sudden reduction of calorie intake that occurs after gastric bypass surgery. By using such a vigorous approach, we were testing whether we could reverse diabetes in a similar short time period to that observed after surgery.   
 The essential point is that substantial weight loss must be achieved. The time course of weight loss is much less important.  
 It is a simple fact that the fat stored in the wrong parts of the body (inside the liver and pancreas) is used up first when the body has to rely upon its own stores of fat to burn. Any pattern of eating which brings about substantial weight loss over a period of time will be effective. Different approaches suit different individuals best.  
 It is also very important to emphasise that sustainability of weight loss is the most important thing to ensure that diabetes stays away after the initial weight loss. Ordinary steady weight loss, by cutting back on the amount eaten each day, may be preferable. However, if you are not able to lose around 2½ stone over, say, six months by this approach, then the very low calorie diet may be best for you. We now know that the very low calorie approach can be followed by very steady weight control.  

A. The standard approach would involve:  
a) Decreasing total food (and alcohol) intake by about one half b) Using smaller plates c) Eating more slowly d) Recognising that the sensation of hunger is sign of success, not a signal to eat e) Enjoy that hunger.  Celebrate with a glass of water; maybe fizzy water 
However, if a person finds this difficult, the liquid meal approach could be used. 
More details about steady, sustainable weight loss are available on the Diabetes UK website.  
B. The research diet   
To carry out the Newcastle research study, the following diet was used:   
 One sachet of a liquid formula diet (~ 200 calories) three times per day. The study used Optifast, but there are many other brands.  
 Three portions of non-starchy vegetables per day. Lack of variety was a big problem of the diet, so we devised a few recipes to make the vegetables more interesting. The range of possibilities is infinite, but you can find the recipes we used on the website - http://www.ncl.ac.uk/magres/research/diabetes/reversal.htm.  
 No alcohol (merely because alcohol itself is so calorific – 7 calories in every gram).  
 You should consult your doctor before embarking upon any very low calorie diet. In particular, any medication you are taking may need to be adjusted.  Some general information about this is also on the website. None of this information is a substitute for proper, individual medical advice.   
 Our research subjects found the diet challenging to stick to especially in the first 36 hours. Motivated people were selected to take part in the research and support from the team was given frequently. Support from the families of the research volunteers was very important in helping them comply with the diet. Hunger was not a particular problem after the first few days, but the complete change in social activities (not going to the pub, not joining in the family meals etc.) was a challenge over the eight weeks. Careful planning in advance is essential.  

Although Optifast was used in the study, this is not readily available in the UK. An alternative liquid food supplement of similar calorific content is equally suitable. These are available from most local supermarkets; you should try several brands to find one most suited to your taste. One brand available on the internet is Exante. Do not be concerned by the high sugar content, as after the first day of very low calorie diet your body is able to handle this reasonably well. The product may need to be made up in water or skimmed milk. Always read the advice upon the particular product.  
After achieving your target weight - how do you keep your weight down in the long term?   
1. Once you are at your personal target weight, the critical thing now is to become accustomed to eating approximately 2/3 of the total amount you used to eat. Plan a gradual transition to normal eating over 2 -4 weeks. There need be no restriction upon any particular foodstuffs, although naturally foods that are very calorie-dense are best avoided. The goal is keeping the weight down [you may find your weight increases 1 – 2 kg over a few days on returning to a higher calorie intake; this is because your glycogen stores return to normal and glycogen is stored in the water inside your body].  
2. If you are increasing your exercise, do not eat more. It is so easy to over- compensate for exercise.  
3. Most people maintain a consistent healthy weight in the long term; most successfully by:  
a) Weigh weekly - write it down b) Watch portion size carefully and don’t eat between meals c) Walk, cycle, stairs.  Maintain a high level of everyday physical activity d) Party but payback. Enjoy life and especially occasions to celebrate, but there is a price. You must eat only about half your current intake for a few days  

How about exercise?   

 Do not increase your usual daily activity whilst losing weight. However, a sustainable increase during long term weight maintenance is wise, along with keeping food portion size under control.  
What research is going on?   
 Diabetes UK have funded a major 5 year study (DiRECT) to find out how many people can reverse or improve their diabetes by a low calorie liquid diet. This is being carried out entirely in Primary Care. Further details are available on the Diabetes UK website.  

 Further information will be posted on the website www.ncl.ac.uk/magres/research/diabetes.  
 Already available are the links to the full scientific paper describing the reversibility of diabetes study and also the scientific review of the existing knowledge in 2008, which described the “twin cycle hypothesis” which we have now tested. An up-to-date review of how weight loss works was added in 2013. In 2016, a review of what is happening to the insulin producing cells (beta cells) provides further explanation.  
 Also available is a paper, w hi ch describes what happened to diabetes when weight loss was achieved at home. This information was provided by many people around the world using email.  
 In the Information for Doctors, other research papers are available.  
 Also, all information will be added to the website, which is updated from time to time.  
 Please remember that this website and its links provide information and not personal medical advice. Do consult your Doctor for personal advice.  

Thank you for your interest in this work.