Shoelson SE, Lee J, Goldfine AB. Inflammation and insulin resistance. J Clin Invest. 2006 Jul;116(7):1793-801. Review. Erratum in: J Clin Invest. 2006 Aug;116(8):2308.
Fleischman A, Shoelson SE, Bernier R, Goldfine AB. Salsalate Improves Glycemia and Inflammatory Parameters in Obese Young Adults. Diabetes Care. 2007 Oct 24; [Epub ahead of print]
Goldfine AB, Silver S, Aldhahi W, Cai D, Tatro E, Lee J, Shoelson SE. Use of Salsalate to Target Inflammation in the Treatment of Insulin Resistance and Type 2 Diabetes, Clinical and Translational Science, 2008 May;1(1):36-43
Goldfine AB, Fonseca V, Jablonski KA, Pyle L, Staten MA, Shoelson SE; for the TINSAL-T2D (Targeting Inflammation Using Salsalate in Type 2 Diabetes) Study Team. The Effects of Salsalate on Glycemic Control in Patients With Type 2 Diabetes: A Randomized Trial. Ann Intern Med. 2010 Mar 16;152(6):346-357.

Experts who were not involved in the multi-center trial agreed larger trials were needed, and said the impact of the drug on blood glucose levels[—.5% reduction in A1c over three months at the highest tested dose of 4g daily—]was moderate. But they said the findings were exciting because they suggested Type 2 diabetes could be treated by targeting the underlying inflammation....
Since atherosclerosis is also considered an inflammatory state, this approach may also potentially reduce the risk of cardiovascular complications associated with diabetes...
Salsalate sells for less than a quarter a pill, and does not present the opportunity for profit that would attract large pharmaceutical companies to do the research...
The patients continued with their regular Type 2 diabetes treatment regimen throughout the study.

"Then we realized that there were other salicylates, chemically similar to aspirin, that don’t carry the same risk of bleeding.” The drug they’re studying now, salsalate, was widely used not too long ago to treat arthritis, but it got “back-shelved” when other drugs were developed for the treatment of pain and arthritis.
The researchers’ first salsalate studies showed that blood glucose control and glucose metabolism improved in people with diabetes; salsalate also lowered inflammation markers and improved levels of cholesterol and triglycerides in the blood. The second round of studies, investigating whether the drugs could have a beneficial impact on overweight people who do not have diabetes but are at risk for developing it, found that blood glucose levels improved, as did inflammatory markers and other risk factors for disease.

Each percentage point decrease in A1C lowers the risk of long-term diabetes complications by 37%.
Diabetes is more common and often more severe in African Americans. To determine if people in this population could lower their A1C levels by talking regularly with others who had successfully controlled their blood glucose levels, researchers recruited 118 African Americans at the Philadelphia Veterans Affairs Medical Center who hadn’t been successful at lowering their A1C[:]
Those in the usual care group were provided with specific goals for A1C.
Participants in the financial incentive group were given $100 for lowering their A1C by one point (for example, from 7.9% to 6.9%) and $200 for lowering their A1C by two points or for hitting an A1C level of 6.5% or lower.
Those in the peer-mentoring group were connected with someone with diabetes who had once had poor blood glucose control but who had brought it to target levels (an average of 6.7%). The mentors were paid $20 and told to meet with their “mentees” at least once per week for the duration of the six-month study.
Mentors and mentees spoke an average of four times during the first month of the study and twice a month thereafter. The researchers were not sure whether this decrease in contact was due to reduced motivation or to a perceived lack of need for more frequent communication.
[Peer-mentoring participants] achieved the greatest reduction in A1C levels: Among those in the usual care group, A1C was reduced, on average, from 9.9% to 9.8%; among those in the financial incentive group, A1C was reduced from 9.5% to 9.1%; and among those in the peer-mentoring group, A1C was reduced from 9.8% to 8.7%.
“Perhaps the most obvious attraction of this type of peer mentoring is that it is virtually free, almost certainly enhancing its cost-effectiveness relative to more expensive interventions, such as nurse care management, telemedicine, and group medical appointments"...
The researchers note that all participants in the study were veterans, so the sense of camaraderie among them may not translate to other groups of people with diabetes, and they call for future studies that look into whether the blood glucose effects seen in this trial are sustainable....
{T]o find a diabetes mentor, check out the article “Peer Support, Education, and Mentoring,” [link] by certified diabetes educator Martha Mitchell Funnell.

I have had many patients – with type 2 diabetes – ask if they can get rid of it. I always explain that by making healthy food choices, exercising, managing their stress and losing weight they can get their blood glucose level down. Once their numbers are consistently in the “normal” range (70-110 mg/dL before meals and less than 140 mg/dL 2 hours after meals) they will feel better, have a greatly reduced risk of long-term complications, and they will appear to not have diabetes. However, diabetes is still lurking there: if they were to return to their old habits/lifestyle, their numbers would go right back up.

The article linked above discusses the “remission” of diabetes after gastric bypass/banding. It is very common for diabetes to go away after someone has this type of weight loss surgery. If the person follows a healthy lifestyle consistently – healthy eating and regular exercise – they can keep their blood glucose levels down. Unfortunately, even in these people, returning to unhealthy eating habits and/or lack of exercise can land them back in diabetes-ville. I’ve had patients for whom this has happened.

Healthcare professionals historically used the term, “borderline” to describe what is now called “pre-diabetes”. To those of us in the field, this means type 2 diabetes is knocking on the door, and without sufficient lifestyle adjustments (changes), it’s going to come right in. We no longer say “borderline”, because people just didn’t take it seriously. How many times have you heard someone say, “I’m just borderline. I don’t have to worry about it.” Just as type 2 diabetes can be prevented with a healthy lifestyle, diabetes remission can be prolonged the same way. Regardless, I think it’s risky to call this a “cure” or even “reversal”. I worry that people might truly believe it’s gone, whereas even “remission” implies that it could come back.

[A study published in the November 23/30, 2011, issue of The Journal of the American Medical Association] detailed the results of a blinded crossover trial in which 75 subjects ate either canned soup or homemade soup for five days. Half ate canned soup, followed by a two-day washout period and then homemade soup. The other half ate homemade soup first, followed by a washout period, then canned soup. Aside from the soup, they could eat whatever they liked.
When subjects ate the nationally distributed canned soup, their urinary levels of BPA were 20 times higher than when they ate a similar homemade soup, averaging 1.1 mcg/L when they ate homemade soup for five days and soaring to 20.8 mcg/L when they ate the canned soup for the same amount of time. This wasn’t all soup all the time, people: It was one serving of soup per day at lunch. Just think of all the food and drink we consume out of cans. All day long. (Not to mention the water we drink that comes to us through plastic water pipes.)

An emerging body of research suggests that Alzheimer's disease may be linked to insulin resistance, constituting a third type of diabetes.  This model is based on several observations including an increased risk of developing Alzheimer's disease for diabetic patients, and reduced insulin levels in the brain tissue of Alzheimer's disease patients. Though intriguing, the existing evidence does not reveal if defective insulin signaling is causative of Alzheimer's or how insulin resistance impacts cognitive function.
Type 2 diabetes is known to increase the risk for Alzheimer's disease. Recent research has found that insulin resistance also develops in the brains of patients with Alzheimer's, which scientists sometimes call "brain diabetes." This brain insulin signaling deficit results in learning and memory disability and could potentially be known as Type 3 Diabetes.
There is much that still remains unknown about the cause of Alzheimer's disease (AD), a form of dementia that affects memory, thinking, and behavior. Two brain changes have long been known to form in the brains of patients with dementia – neurofibrillary tangles and beta-amyloid plaques. Tangles are twisted fibers of tau protein that builds up inside the cells. Plaques are accumulations of protein fragments that build up in the spaces between nerve cells. The two abnormal structures combine to block communication between nerve cells and disrupt the processes needed for them to survive.
But now, a third brain change is emerging as a likely suspect contributing to cognitive deficits in patients with Alzheimer's disease. Brain levels of insulin and insulin receptor (IR) are lower in AD and insulin signaling impairments have been documented in human postmortem analysis and in animal models....
The University of Pennsylvania team examined insulin signaling in human brain tissue postmortem, and concluded that the activation state of many insulin signaling molecules were highly related to memory and cognitive function. They further suggest that insulin resistance is a common and early feature of Alzheimer's disease.
The De Felice group further observed impaired insulin signaling in Alzheimer's brain tissue in rodent and non-human primate model systems as well as from tissue from human patients. They went on to show in a mouse model system of Alzheimer's disease that treatment with a new anti-diabetic drug normalized insulin signaling and remarkably improved cognitive function. Cumulatively, these two new studies strongly support a connection between insulin resistance and Alzheimer's disease and provide hope for new therapeutics in Alzheimer's disease treatment.

Despite these limitations, the use of the glycohemoglobin measurement is still a powerful tool! Many studies have correlated the A1C level with the risk of developing complications. Many such complications may even result from the glycosylation of various tissues of the body in a manner similar to the glycosylation of hemoglobin. Thus, the glycosylation of hemoglobin may represent a surrogate of what is occurring to other tissues, and the measurement of glycohemoglobin may actually measure one of the processes that leads to the complications of diabetes.

If you have diabetes, a number of dietary measures as well as nutritional supplements can help with blood sugar control. I recommend the following:

Eat magnesium-rich foods daily. Good sources include spinach, tofu, almonds, broccoli, lentils, pumpkin seeds and sunflower seeds.
Eat fish, take fish-oil supplements, or include in your diet another source of omega-3 fatty acids such as walnuts or freshly ground flaxseed daily.
Eat foods low in glycemic load.
Take chromium, atrace element that works with insulin to regulate blood sugar by helping to transport glucose into cells. I recommend taking up to 1,000 micrograms of GTF chromium daily.
Take alpha lipoic acid, an antioxidant that can enhance the uptake of glucose into cells and help inhibit glycosylation (the abnormal binding of sugar to proteins, resulting in disease-promoting compounds). It also helps to promote and maintain eye health. Start with 100 mg per day.
Take 400 mg of magnesium glycinate daily, which can help promote healthy insulin production.
Supplement with coenzyme Q10 (CoQ10), a powerful antioxidant that can help maintain a healthy heart. The dose is 60-100 mg of a softgel form with your largest meal.
The following botanicals may also help. Look for standardized extract forms and follow the dosage directions on the packages:

Asian bitter melon (Momordica charantia)
Ayurvedic gurmar (Gymnema sylvestre)
Blueberry (Vaccinium myrtillus)
Prickly-pear cactus (Opuntia).

[Some useful information in both column and comments, and yet this is atypically dodgy for David Spero, who depends on a dubious source who markets mulberry leaf with questionable tactics; unhelpfully fails to distinguish between peaks and excursions; and seems to swallow a scare story about "hidden" spikes happening within an hour after meals, when it is well established that type 2 diabetics is to peak and/or have excursions considerably _later_ than non-diabetics. My comment about the first of these flaws was never published, although the column seems to have been delisted in the column history.—DMM]

Jenny Ruhl at Diabetes Update says different people and different foods spike differently. So to find the very highest spike, you might have to try different times. “Meals heavy in fat digest more slowly than those that are made up mostly of starches and sugars,” she says. “Large meals of any composition may produce a slightly delayed spike.” High protein meals may spike even later. It will take some experimenting to find out.

It’s also valuable to learn how fast blood sugar levels come back down, and how low. So you might want to check again an hour after the peak. Ruhl says that, “When you take a second reading is up to you and depends on how many strips you have and what [you already know] about how your blood sugar works. Most of us will find it informative to [check] an hour after the peak occurs to see how fast our blood sugar is dropping from its peak.”

[Researchers analysed the results of four studies on white rice consumption and diabetes risk: two in China and Japan and two in the USA and Australia]. All participants were diabetes free at study baseline.
White rice is the predominant type of rice eaten worldwide and has [a high glycemic index]. High GI diets are associated with an increased risk of developing type 2 diabetes. [Chinese eat an average of four portions a day while Westerners eat fewer] than five portions a week.
A significant trend was found in both Asian and Western countries with a stronger association found amongst women than men. [The] authors estimate that the risk of type 2 diabetes is increased by 10% with each increased serving of white rice (assuming 158g per serving).
White rice has a lower content of nutrients than brown rice including fibre, magnesium and vitamins, some of which are associated with a lower risk of type 2 diabetes. [Low intake of these nutrients may increase risk in addition to the high glycemic index and glycemic load.]

When you’re exhausted, who wants to exercise? But I’m not talking about vigorous training for a triathlon kind of exercise. I’m talking about treating yourself gently, and moving your body in ways that feel good. Studies show that gentle exercise reduces fatigue by up to 65%. Gentle exercise is actually more energizing than vigorous exercise, according to this University of Georgia study.

It could be tai chi or qigong, water exercise, yoga, walking, or seated exercises, or anything else that feels good. I have a lake near me, where it’s fun to go watch the birds. Maybe you have a place like that to walk. Or a mall or something.

Being completely sedentary makes you more tired. You get more out of shape, so it gets harder and harder to move. To feel better, you don’t even need formal exercise. Housework can be turned into a form of exercise just by concentrating on the movements as you do them, instead of stressing about how dirty everything is. Fatigue specialist Majid Ali, MD, says that exercise should be “slow, sustained, and nontraumatic.”

Some studies have suggested that consumption of diet soft drinks may be associated with Type 2 diabetes and development of the condition known as metabolic syndrome — high blood pressure, abdominal obesity and other risk factors. Now a 10-year epidemiological study has found a link between diet soft drinks and cardiovascular disease.

[Among] 2,564 adults over 40 living in Manhattan,] diet and regular soft drink consumption were both associated with a number of risk factors for cardiovascular disease.

Even after controlling for many of those risks, including diabetes, the researchers found that daily consumption of diet soda was still independently associated with an increased risk for stroke, heart attack and death.

Among those with type 1 diabetes, patients with the highest quartile of TNFR2 values were three times more likely to have renal decline than those in the other quartiles, and the risk associated with high TNFR1 values was slightly less than that seen in those with elevated TNFR2.
These studies found that levels of circulating tumor necrosis factor receptor 1 and 2 (TNFR1 and TNFR2) predict kidney disease in both type 1 and type 2 diabetes.

Still allowing plastic in your kitchen? In your food? In your children's toys?

Even minuscule amounts of BPA (used in everything from pesticides to water bottles) can scramble hormone signals, and trick fat cells into taking in more fat or mislead the pancreas into secreting excess insulin. Among the most ubiquitous and scrutinized of these...endocrine disruptors is bisphenol, better known as BPA. The chemical is a common ingredient in plastics and food-can linings.
Angel Nadal, a BPA expert at the Miguel Hernandez University in Spain stated that, "When you eat something with BPA, it's like telling your organs that you are eating more than you are really eating"[—]the chemical triggers the release of almost double the insulin actually needed to break down food. High insulin levels can desensitize the body to the hormone over time, which in some people may then lead to weight gain and Type 2 diabetes....
BPA fools a receptor into thinking it is the natural hormone estrogen, an insulin regulator. [Even the tiniest amounts of BPA—a quarter of a billionth of a gram—do] the trick. The effect disappeared when the researchers stripped the specific receptors from the study mice, evidence that they had in fact pinpointed BPA's chemical mechanism, which had previously eluded scientists. In laboratory tests of human cells, the response was even more pronounced....
An estimated 90% of people in developed countries have BPA circulating in their blood at levels often [sic] higher than the threshold for causing hormone disruption used in Nadal's study. This high incidence is due not only to exposures from leaching food packages but also BPA-infused cash register receipts, dental sealants and toilet paper.
Frederick vom Saal, another expert in endocrine disruptors at the University of Missouri-Columbia stated that, "People are seeing effects of BPA down to 1000-fold below [Nadal's threshold]." "It takes so little of this chemical to cause harm."

Participants with diabetes were stratified by insulin therapy at baseline: group A treated with insulin only; group B treated with insulin and oral hypoglycemic agent; and group C receiving no insulin treatment.
During a mean follow-up of 3.9 years, the researchers found that 4.6% of the cohort without diabetes died, compared with 15, 12.5, and 7.3% of groups A, B, and C, respectively. The hazard ratios (HRs) for all-cause mortality were 4.3, 4.2, and 2.0 for groups A, B, and C, compared with individuals without diabetes. The leading cause of death in groups A, B, and C were ESRD, ESRD and CAD, and CAD, respectively. The HRs for these conditions were at least twice as high as the HRs for all-cause mortality, extending to 17.3, 17.9, and 5.1 in groups A, B, and C, respectively, for ESRD.
"Excess mortality persists among people with young-onset diabetes of long duration, with ESRD and CAD as the leading contributors to mortality," the authors write.

[Excuse me? Don't the numbers, if correctly reported, suggest that insulin-and-drug therapy increases mortality by over two-thirds, and insulin-only therapy more than doubles mortality?—DMM]

[Some Type 1 diabetics show differences in] HLA genes that normally help the immune system to work. In addition, there are probably at least 16 other areas of DNA where differences can increase your risk of getting Type 1 diabetes....
In most cases, you need more than one DNA difference to get Type 2 diabetes. [At least 12 genes are implicated] in Type 2 diabetes, and there are probably more that scientists know nothing about yet.
In most cases, having DNA differences isn't enough to make you diabetic—it can only increase your chance. To actually get diabetes, something else has to happen....
Early diet may be important.
Type 1 diabetes may be less common in people who were breastfed. Additionally, certain infections or even cold weather might be able to trigger Type 1 diabetes in some people.
You can decrease your chances for Type 2 diabetes by exercising and eating right.
Type 2 diabetes is more common in overweight people or people who don't get enough exercise....
A classic example of all of this is the Pima Indians of Arizona. A Pima Indian with diabetes was virtually unheard of for 2000 years or so.
Recently, many of them have adopted a more typical American lifestyle—little exercise and unhealthy food. Almost overnight, around half of the Pima Indians in Arizona ended up with Type 2 diabetes.
Obviously their DNA didn't change so quickly. The DNA differences for increased Type 2 diabetes risk were always there.
But, with their old life style, it didn't matter. In other words, the DNA wasn't enough to cause the diabetes. Their environment had to change before they developed the disease....
Identical twins share the exact same DNA. So if some trait is completely due to DNA, then both identical twins would always share that trait....
If your identical twin has Type 1 diabetes, you have less than a 50% chance of getting it too. And if your identical twin has Type 2 diabetes, you have about a 75% chance of getting it. So DNA alone doesn't make you diabetic—environment is also important....
DNA, weight, physical activity, diet, and age all affect a person's risk of diabetes. No one thing alone can predict whether or not a person will get diabetes.

In general, the risk of diabetes for a sibling of a patient with type 2 diabetes is about the same as that in the general population. However, there are some exceptions to this general statement. If the patient developed diabetes despite being lean, then the sibling’s risk is about twice the general population risk. Or, if the patient has a parent with type 2 diabetes, the sibling’s risk is almost three times the general population risk. If both parents have type 2 diabetes, the sibling has a fourfold risk, or nearly a 50% chance of developing diabetes.
The genetics of type 2 diabetes is complex. While type 2 diabetes may have a strong genetic basis in some patients (something less than a third of them), the development of diabetes in most patients is dependent upon the effects of environmental and behavioral factors (obesity and sedentary lifestyle) on an underlying susceptibility that is poorly understood....
Joslin researchers and others have identified about six genes that produce MODY[—maturity-onset diabetes of the young, a rarer form of type 2—but they only account for the diabetes in about one-third of affected] families....Similar patterns can be found in studies of families with the more common form of type 2 diabetes, only the age of onset differs.
The susceptibility to certain diabetes complications also seems to be linked in some ways with genetics. For patients with susceptibility genes for complications, good blood glucose control is still an important mitigating factor.

The stress response, sometimes called the “fight-or-flight” response [raises blood sugar levels (to provide fuel to the muscles) and increases] insulin resistance (so the other cells won’t use up the glucose the muscles need). It also raises our heart rate and blood pressure so we can run faster, and increases blood clotting in case we are injured.
By increasing insulin resistance, stress can make us extremely tired. Under stress, only the muscles and nerves being used for fight or flight will open to insulin and the glucose it’s carrying. All the other cells are supposed to take a nap. But if the stress goes on a long time, our bodies and brains will not have enough fuel, so they want to just keep napping.,,,
According to the book Overcoming Adrenal Fatigue, by Kathryn Simpson, MS, stress puts pressure on the adrenal glands. Those glands produce adrenaline, cortisol, DHEA, and other chemicals that make up the stress response. If they have to keep producing at high levels...they start to wear out. Sort of like beta cells are thought to wear out if they have to produce too much insulin.
When the adrenals wear down, cortisol levels will drop. That’s when fatigue really sets in. Cortisol helps us wake up in the morning. It also helps control the immune system: Cortisol starts inflammation when needed to fight an injury or infection and stops it when the problem is under control. When cortisol levels are too low, inflammation can go into overdrive and damage healthy cells.
We now know that inflammation is a major cause of the blood vessel and pancreas damage we see in diabetes. Diabetes is often called an inflammatory disease, and to the extent this is true, we need to control stress to deal with it.
Inflammation also makes you very, very tired. Your body is telling you to rest so the infection or injury can be healed. But when cortisol levels are low, you’ll get the same message when there is no injury or illness. It just goes on, and we feel constantly tired.
[Threats and stresses] can be environmental, like being too cold or too hot or being exposed to toxic chemicals....Another major stressor is hunger. Unfortunately, some diabetes diets and most weight-loss diets can leave people feeling hungry, so those diets might need to be changed or avoided.
Since most stressors these days are emotional or economic, we can sometimes reduce stress by changing the way we think about the difficult things in our lives....Anything we can do to actually change situations that threaten us [reduces stress]...
We can also reduce stress by treating infections, by getting enough sleep, and by getting regular moderate exercise (but not overdoing the workouts! That’s stressful too.). It’s also important to eat regularly and not to go hungry. Simpson says five or six small, balanced meals a day may be ideal for most people’s adrenals. She advises protein, fat, and complex carbs at each meal....
Effective stress reduction methods include prayer, meditation, breathing, and gentle exercise like tai chi or qigong. Getting help with stressful life problems, as from a counselor, coach, or friend can also reduce stress....
A number of supplements might help, including Vitamins C and D, chromium, zinc, magnesium, B vitamins, and fish oils. Simpson also suggests taking digestive enzymes and says taking small amounts of hydrocortisone (which is identical to natural cortisol) can be very helpful if your levels are low. Anti-inflammatory medicines like aspirin or salsalate might help, too.

Richard Kahn, formerly the chief medical officer of the American Diabetes Association, claims that we don’t know enough right now about the biological processes underlying the body’s regulation of weight to develop effective weight-loss programs that can be applied on a large scale. In the meantime, he writes, public health officials and medical groups should concentrate on finding ways to help people control their diabetes once it develops. This, he believes, is a better use of valuable time and research dollars, since effectively controlling blood glucose levels has shown to be sustainable and leads to a greatly reduced risk of diabetes complications....
As an article published at DiabetesInControl.com notes, several doctors associated with Boston’s Joslin Diabetes Center released a statement indicating strong disagreement with Kahn. Osama Hamdy, medical director of the center’s Obesity Clinical Program, asserted that Kahn was advocating “a surrender in the face of one of the greatest threats to public health the world faces.” Hamdy goes on to say that while maintaining weight loss is “a lifelong battle,” Joslin programs have shown that weight loss can be sustained for long periods of time. One program, he notes, led to a 50% reduction in diabetes medicines taken by participants and a 27% reduction in overall health-care costs....
Is it foolish to suppose that programs administered by a leading diabetes research center can be effectively duplicated across the country? Or is Kahn’s approach too pessimistic — or even, as one writer suggests, possibly distorted by ties to diabetes drug manufacturers?
[The ADA's conservatism on preventive strategies and intimacy with the post-diagnosis treatment industry has long been a thorn in the side of many.—DMM]

Raspberry ketones are on the FDA’s GRAS (generally recognized as safe) list. But in terms of their fat-burning ability, the only research to support this claim dates back years…and that study was done with mice. Not humans. So we really don’t know if this supplement works. And it’s not without some possible serious side effects: increased heart rate and blood pressure, difficulty sleeping, agitation, and maybe hypothyroidism (underactive thyroid). Avoid taking this supplement if you have high blood pressure or thyroid issues. We don’t know enough about it how it affects diabetes control, either....
[Glucocil] is targeted to people with Type 2 diabetes, and its claim to fame is that it can reputedly stabilize postmeal blood glucose levels, decrease carbohydrate absorption, decrease appetite, and promote weight management. Pretty hefty claims for a supplement whose key active ingredient is mulberry leaf extract....
[This supplement also] contains alpha lipoic acid, banaba leaf extract, chromium picolinate, cinnamon bark powder, gymnema sylvestre extract, fish oil, and a few other things thrown in for good measure. Glucocil’s Web site clearly lists the research — but only for each separate ingredient. Nowhere on the site could I find research citing the effectiveness of the actual supplement....As far as mulberry leaf extract goes, a few small studies (mostly done with rats) show some reduction in glucose after ingesting it, but not enough to boast about....
We don’t know if the blend of these ingredients actually live up to Glucocil’s claims of glucose and weight control, nor do we know if the amount of ingredients in this supplement are in the right proportions to be effective. The Web site states that people under the age of 18, pregnant women, and people with liver and kidney problems should not take Glucocil. Also, they state that if you take insulin and don’t have cardiovascular, liver, or kidney problems, you can “consider” taking Glucocil. Side effects include “minor GI discomfort,” such as gas and loose stools.

[Having received an inappropriately substituted prescription in an effort to lower their copay, the patient and his wife] sat for two days at home without insulin administration, choosing not to test his glucose since they knew they didn't have a way to inject the insulin, until the Home Health nurse arrived.
The Home Health nurse reviewed syringe technique with the patient and they ultimately chose to go with the pen. The Home Health nurse expedited the original Rx and reviewed the sliding scale and glucose results from fingersticks. The patient is doing well....
Navigating what doctors prescribe and what insurance companies charge for co-pays can be a major problem. Copays can range from no cost to more than $100, depending on which tier the medication is in....
With the difficulty of navigating...benefits, co-pays and different tiers, following up with patients is imperative. The Home Health nurse visit truly averted disaster.

Individuals who are genetically predisposed to have low levels of high-density lipoprotein (HDL[, "good"]) cholesterol or high levels of triglycerides have an increased risk of developing type 2 diabetes....
[Using data from 2,447 patients with type 2 diabetes from the Nurses' Health Study and 3,052 control subjects free of diabetes from the Health Professionals Follow-up Study, researchers analyzed genotype scores for low-density lipoprotein (LDL) cholesterol, HDL cholesterol, and triglycerides. Only] HDL cholesterol and triglycerides scores were linearly associated with an increased risk of type 2 diabetes. For each point of the HDL cholesterol genotype score, there was a 3 percent increase in the risk of developing type 2 diabetes, and for each point on the triglyceride genotype score, the increase was 2 percent. Comparing the highest and lowest quartiles of genotype scores, the odds ratios for type 2 diabetes were 1.39 for HDL cholesterol and 1.19 for triglycerides.
"In conclusion, genetic predisposition to low HDL cholesterol or high triglycerides is related to elevated type 2 diabetes risk."

We sleep more deeply (non-REM sleep) in the early part of the night. As morning approaches, we move more into REM (dreaming) sleep. Both are important, but the earlier sleep may be more restful....
Frequent trips to the bathroom can be sleep killers. Nocturia (urinating at night more than once) can be due to bladder or prostate problems, which should be checked. But people often wake up and decide their bladders must have woken them, when something else is really the cause....
Since sleeping on the back promotes OSA, sleeping on a side or having the head elevated might stop it....There are also dental appliances that help keep the throat open, and CPAP (continuous positive airway pressure) machines that keep the airway open by pushing air through. There are also medicines to reduce swelling and stuffiness in the nose. It’s worth trying any of these approaches, if you have a problem with OSA....
[I]t’s important to know how to get back to sleep. Don’t start thinking! Concentrate on your breathing until you can nod off again....Adding daytime sleep to your schedule [may make up for the normal, age-related decay in the quality of nighttime sleep. Naps may “improve learning, memory, and creative thinking. Researchers] advise keeping naps short (20–30 minutes,) finding a “dark, quiet, cool place,” scheduling naps instead of waiting until you’re exhausted, and not feeling guilty about it....
We have to get over thinking that sleep is a waste of time, or that life will pass us by if we sleep too much. Sleep is good for us, which means it’s good for the people in our lives. It may also be the number one remedy for fatigue...

There are 300 recipes for macaroni and cheese on the Food Network’s Web site. I’m using mac-n-cheese here as a symbol for all of those starch- and fat-laden comfort foods we love and like to occasionally indulge in.
Mac and cheese with two cheeses. Three cheeses. Four cheeses. SEVEN cheeses! Mac and cheese with ham…with bacon…with corned beef. With heavy cream (four cups in at least one recipe). With Tater Tots.
The recipes were from such celebrity chefs as Ina Garten (the Barefoot Contessa), Alton Brown, Giada De Laurentiis, Guy Fieri, and Emeril Lagasse (who once had an episode called “Pork Fat Rules.” BAM!). And, oh yeah, Paula Deen. Who, admittedly, deep-fries mac-n-cheese.
But people are only complaining about Paula Deen cooking starch- and fat-laden foods. Why? Unless you live in a cave, you probably heard last week that Deen was diagnosed with Type 2 diabetes. Three years ago. Therefore, she should have stopped cooking those decadent foods. Immediately! Fessed up. Admitted her sins.
And her critics are crawling out of the woodwork: “5 Paula Deen recipes that could give you diabetes” proclaims one headline. (Psst! Food does NOT give you diabetes!)

Federal regulators have warned Johnson & Johnson that it could face fines and other sanctions for selling faulty insulin pumps and delaying disclosures of serious injuries to diabetics who were using its OneTouch Ping and 2020 pumps. The FDA ordered the Animas Corp. unit of J&J to explain why it kept selling pumps known to fail and also to submit a plan to rectify a failure to promptly report cases in which its device might have caused or contributed to death or serious injury....
In the issue with the Animas insulin pumps, some pump keypads for controlling how much insulin is injected were deteriorating prematurely, leading to failures. "We decided to go with a new keypad because it's more durable," [spokesperson Caoline] Pavis said.
But while Animas was lining up the new keypad supplier, it was still selling the older ones. The FDA demanded documents about the company's decision to do that.

People with diabetes are three to four times as likely to have major depression as people without diabetes, and depression appears to increase the risk of Type 2 diabetes in certain populations. Depression is also known to increase the risk of complications in people with Type 2 diabetes. Now, new research indicates that treating people for both depression and diabetes simultaneously can significantly improve both conditions.
Depression may affect a person’s ability to carry out diabetes self-management tasks, such as taking medicines and monitoring blood glucose. And the stress of managing diabetes can contribute to an increased risk of depression. (There may be other biological factors, such as inflammation, contributing to the association as well)....
[Intervention subjects] and their doctors worked along with integrated care providers to identify and deal with issues that might interfere with [taking] medicines as advised, such as the price of the medicine or a lack of social support. The managers then crafted tailored programs to help these individuals stick to their diabetes medicine and antidepressant regimens....
At the end of the 12 weeks, 60.9% of those receiving the integrated treatment approach had improved their blood glucose levels, compared to only 35.7% of people receiving standard therapy. Moreover, 58.7% of participants in the integrated treatment group showed signs of remission in their depression, compared to only 30.7% of those in the usual treatment group.

• High blood glucose makes your blood “sludgy,” slowing circulation so cells can’t get the oxygen and nutrients they need. Margaret commented, “I can tell if my sugars are high in the morning, because ‘groggy’ doesn’t begin to describe it. ‘Drugged’ is how it feels.”
• Low sugars levels also cause fatigue, because when blood sugar is low, there is not enough fuel for the cells...
• [With vascular inflammation caused by igh blood glucose,] immune cells called monocytes come into the brain, causing fatigue....
• [P]eople with diabetes are more likely than others to have thyroid problems. If your thyroid level is low, you are likely to feel tired, sleepy, and depressed.
• Low testosterone levels, especially in men. Men with diabetes are much more likely to have low testosterone.
• Infections: People with diabetes often have infections they don’t know about. Infections take energy to fight, which can cause fatigue and raise blood sugar levels. A common source is urinary tract or “bladder” infections. They often hurt, but sometimes have no symptoms, except for the fatigue. Silent dental infections and vaginal infections are also common and fatiguing.
• Undiagnosed heart disease : If you get tired after tasks that you used to sail through, it could be time to for a heart check-up....
• Many drugs for diabetes, blood pressure, depression, pain, and other issues can cause fatigue. Read labels, ask your doctor or pharmacist....
• Some people are too wound up or too busy to sleep. Or they’re up to use the bathroom all night, or they have obstructive sleep apnea (OSA), which can wake them up many times an hour....
• [Rotating shifts or working nights] can cause fatigue directly by messing with your body clock or indirectly by disrupting sleep.
• Depression is very common with diabetes. Most depressed people feel fatigued, even if they don’t feel sad. Even at low levels, depression can sap your motivation....
• Doing too much: If you’re ripping and running all day, not taking breaks or even stopping to breathe much, you are courting fatigue....
• Stress: In small doses, psychological or physical stress can give you energy, but if it goes on too long, it will wear you out...
• Too much carbohydrate — especially refined carbs — can make anyone tired, especially with diabetes. Kat wrote, “now that I am eating a higher protein/fat, lower-carbohydrate diet, I have shaken off that really sleepy/extreme fatigue that I used to have every day.”
• According to WebMD, too much caffeine can cause fatigue through a rebound effect. They also say that dehydration, or not drinking enough liquid, is a major cause of fatigue.
• Being out of shape or having weak muscles: Not moving our bodies contributes to fatigue. Of course, it’s hard to exercise when you’re fatigued.

[After increasing] intake of low-glycemic-index foods, participants as a group lowered their weight, body mass index, waist circumference and [hemoglobin A1c reading]....
[Miller's claim—“I think we have enough data to say that consuming a low-glycemic-index diet has beneficial outcomes for people with diabetes"—is significant] because no guidelines currently exist for consumption of low-glycemic-index foods...[Miller believes a focus on the glycemic index in foods rather than carbohydrates and sugars is not too complicated for patients with diabetes to follow, as long as they receive adequate nutrition education—]another finding of hers in a study published in 2009.
The glycemic index is represented by a scale from 1 to 100. Foods that tend to slow the speed of digestion and prevent rapid increases in blood sugar include many vegetables, whole grains, dairy foods, nuts and seeds, beans and fruits. They are considered low-glycemic-index foods if they have an index of 55 or fewer points. Foods with a point value of 100 are the equivalent of pure glucose....
“What we found is that those who felt more committed to [their respective] goal felt the goal was less difficult. And those who had a higher level of self-efficacy[—agency—]felt that the goal was less difficult"....
It wasn’t until the trial was completed that researchers learned that many participants entered the study already eating about six servings per day of foods with a low glycemic index.
“We learned that we should set the goal for low-glycemic-index foods higher. We also learned that we need to set an individualized goal. We know that people can increase their consumption by almost two servings a day if that specific goal is set"...
Research on goal-setting also emphasizes that people should plan to take action rather than stop doing something. They also can set a substitution goal...a low-glycemic-index food for a high-glycemic-index food.
“One way to build self-efficacy is by helping people set a specific goal that is moderately difficult, action-oriented, and achievable in small successive steps"...

“Previous studies have demonstrated that those who get less sleep are more likely to also be obese, have diabetes or cardiovascular disease, and are more likely to die sooner, but this new analysis has revealed that other sleep problems, such as difficulty falling asleep, staying asleep, or even too much sleep, are also associated with cardiovascular and metabolic health issues"...
The researchers examined associations between sleep disturbances and other health conditions, focusing on perceived sleep quality, rather than just sleep duration. After adjusting for demographic, socioeconomic and health risk factors, patients with sleep disturbances at least three nights per week on average were 35% more likely to be obese, 54% more likely to have diabetes, 98% more likely to have coronary artery disease, 80% more likely to have had a heart attack, and 102% more likely to have had a stroke.
Grandner and colleagues analyzed data from the 2009 Behavioral Risk Factor Surveillance System (BRFSS) of 138,201 patients[—]the world’s largest telephone survey, designed to monitor health-related behaviors in the general population.
“This study is one of the largest ever to link sleep problems with important cardiovascular and metabolic diseases. It joins other studies that show that sleep is an important part of health, just like diet and physical activity"...

In a study of more than 4,000 black women in Los Angeles, those...living in neighborhoods with high levels of nitrogen oxides, pollutants found in traffic exhaust, were 25% more likely to develop diabetes and 14% more likely to develop hypertension than those living in sections with cleaner air.
According to the Centers for Disease Control and Prevention, forty-four percent of all black women in the U.S. have high blood pressure and about 11% have diabetes, compared with 28% and roughly 7%, respectively, of white women. Black Americans are also exposed to higher levels of air pollution than white Americans...
The findings on their relative risks for those conditions take into account several other potential influences, including how heavy the women were, whether they smoked and other stressors, including noise levels at participants' homes.
The researchers measured average pollution levels near participants' homes for only one year and the patterns remained relatively constant over the entire study period. While Dr. Coogan and her colleagues estimated nitrogen oxide concentrations near participants' homes, they did not account for commuting habits or exposure to air pollution at work...Americans, on average, spend about 70% of their time at home.
In addition to measuring nitrogen oxides, a proxy for traffic pollution, the researchers evaluated levels of fine particulate matter. Women who lived in areas with higher fine particulate exposures also faced an increased risk of diabetes and high blood pressure, although statistically the link was weak and could have been due to chance.
Previous reports have suggested that air pollution particles small enough to make their way into the bloodstream may contribute to a narrowing of blood vessels, which can lead to high blood pressure and reduce sensitivity to insulin.

Many rural American Indians live on reservations where it is difficult to obtain healthful foods, a likely scenario for many residents of rural America at large. Without access to markets with adequate food choices, many people rely on food from local convenience stores, including canned meat....
[More than 68% of study subjects] ate more than two servings of processed meat a week. Less than 1% reported never consuming any processed meat during the past year. Participants who ate processed meats at least twice a week had a 63% higher risk of diabetes compared to participants who ate processed meat less than twice a month.
Participants who reported eating canned meat at least twice a week had double the risk of diabetes, compared to those who reported never consuming canned meat....
Processed meats are rich in additives and preservatives, such as sodium nitrate. Processed meats also contain high amounts of advanced glycation end products, substances formed during the heating and processing of meats that influence inflammation and oxidative stress, both of which are risk factors for diabetes.
The researchers also note that disadvantaged participants who rely on canned meats may have other, unmeasured lifestyle factors, such as inability to comply with medical advice, that may contribute to the development of diabetes.

I may say some nasty and completely true things about the medical establishment.
I only started paying attention [to the ACCORD study] when the intensive blood sugar control arm was canceled. The more I found out about it, the angrier I got...ACCORD is a great example of most of what is wrong with American medicine, and with the way our media covers it....
From the beginning, ACCORD was a drug trial. The study called for participants to receive diet and exercise counseling if they wanted it, but set no guidelines for the counseling. There was no self-management group. It was all, repeat all, about the drugs.[Encouraging participating doctors to unsystematically and aggressively prescribe multiple drugs all but guaranteed drug interactions and adverse effects.]
In February, NHLBI stopped the intensive blood sugar control arm because more of the participants in that group were dying than in the normal care group.
Then came the outrageous part: NHLBI and media dummies came out saying that the intensive group’s blood sugars had been too low....
What kind of madness is this? You throw scads of drugs at sick people, treating only their numbers, not their bodies and lives as a whole. Then, when they die, you say it couldn’t have been the drugs. It must be the numbers. And you tell people with diabetes to get their blood sugars up.
You better believe that if ACCORD had shown a 10% decrease in cardiac deaths from intensive blood glucose management with drugs, those drugs would have become standard therapy for every person with Type 2 in the country. Nobody in the media would have said, “It wasn’t the drugs.” The drug companies would have made billions. That was the goal of the trial.

This Excel database documents - and also provided a tracking and management tool for - the process by which I lost 100 pounds of fat and rendered myself, according to my doctor, "no longer diabetic" within a year of a diagnosis of type 2 diabetes. Please note that I do not claim, despite my doctor's use of the word, to have "cured" myself of diabetes. I believe I have documented putting myself into remission - normoglycemia - an asymptomatic state. Day-to-day data are self-reported. All medical outcomes are documented by Kaiser-Permanente.

A single night of total sleep loss in young normal weight men curbed the energy expenditure the next morning...[S]ubjects had increased levels of hunger...[Researchers have] systematically examined which regions in the brain involved in appetite sensation are influenced by acute sleep loss....
“After a night of total sleep loss, these males showed a high level of activation in an area of the brain that is involved in a desire to eat...[O]ur results may explain why poor sleep habits can affect people’s risk to gain weight in the long run. It may therefore be important to sleep about eight hours every night to maintain a stable and healthy body weight.”

A [rancher] was referred to me for assistance in helping with glycemic control....[Over the prior 2-3 years, his injected insulin type had been changed several times in an attempt to improve his fasting blood sugar control. When I saw him, his dose had been increased at each recent doctor visit due to continued high morning blood sugars. He WAS checking blood sugar in the middle of the night and was not having any lows that might trigger a morning spike.]
At our first visit, I asked him to bring his insulin vial/syringes/glucometer, etc. with him on his next visit.
At our second visit, he pulled out a syringe that had been used so many times the numbers were totally worn off! He said he had "gotten good at guessing" when drawing up his dose! I asked him how often he changed syringes. He replied that he had never been told to change syringes—and did not even have a prescription for them—he had been using the present one for over a year and it was from a set of syringes he had used to give his cattle shots!
I gave him a sample of new syringes, made sure he got a prescription, and saved his old syringe as a reminder to myself to never forget to ask the simple questions [about what we assume] people know.

Lesson Learned:
Asking the right questions and having the patient bring their medications and devices and...demonstrate their techniques can prevent future or current problems.

Jeri Mills, MHR, RD/LD, CDE

"Bariatric surgery (gastric bypass, sleeve gastrectomy, or gastric banding) leads to complete remission in only about one third of patients with type 2 diabetes, and should be viewed as a means for improving glycemic control, not as a cure."
Using the recently updated American Diabetes Association (ADA) standard, which defined diabetes remission as hemoglobin (Hb) A1c levels below 6% and fasting glucose levels less than 100mg/dL.(5.6 mmol/L ) at least 1 year after bariatric surgery without hypoglycemic medication, the researchers found remission to be substantially lower than had been reported with earlier criteria[:] 40.6% after gastric bypass (65/160 patients), 26% after sleeve gastrectomy (5/19 patients), and 7% after gastric banding (2/30 patients). "The remission rate for gastric bypass was significantly lower with the new definition than with the previously used definition (40.6 versus 57.5%...)." Remission rates for the other 2 procedures were not significantly different according to the new vs the old criteria...
[O]n average, patients remained obese after surgery (preoperative body mass index [BMI], 48 kg/m2 vs postoperative BMI, 35 kg/m2). After surgery, oral hypoglycemic medications were still used by 29.4% of gastric bypass patients, 63% of sleeve gastrectomy patients, and 83% of gastric banding patients.
HbA1c levels were significantly lower after surgery in all 3 surgical groups, with mean levels of 6.2% (compared with 8.1% before gastric bypass), 6.8% (7.5% before sleeve gastrectomy), and 6.3% (7.7% before gastric banding...
The authors [recommend] "establishing realistic expectations among patients, clinicians, and policy-makers" regarding bariatric surgery in the management of type 2 diabetes. They suggest that emphasis should shift to bariatric surgery as an aid in achieving glycemic control, rather than as a tool for achieving remission...
"The principal benefit of surgery, however, would not be to improve glycemic control per se but rather to reduce microvascular and macrovascular complications associated with diabetes. [We] emphasize the need for intensive follow-up of patients with type II diabetes following bariatric surgery, in order to review pharmacological treatment, monitor for complications of diabetes, and ensure that adequate glycemic control is achieved."

Statin use in postmenopausal women is associated with a significantly increased risk of diabetes mellitus.
New data from the Women's Health Initiative (WHI) [indicates risk of diabetes is higher than previous studies have suggested: 48% increased risk]....
Recently published data reported the potential risk of diabetes with statin therapy. Dr. Kausik Ray (St. George's University of London, UK) and colleagues published a meta-analysis of [five trials testing high-dose statin therapy,] and found a significant increase in risk of diabetes with higher doses of the lipid-lowering drugs. A meta-analysis published in The Lancet in 2010 by Dr. Naveed Sattar (University of Glasgow, UK) also showed that statin therapy was associated with a 9% increased risk of diabetes.
[The present study produced an unadjusted risk model associating statin use at baseline] with a 71% (95% CI 1.61–1.83) increased risk of diabetes. After adjusting for potential confounding variables, the risk...declined to 48% (95% CI 1.38–1.59). The association was observed for all types of statins.
Dr. Kirsten Johansen,[ Editor of the Archives of Internal Medicine, noted that previous meta-analyses show no benefit of statins on all-cause mortality in the setting of primary prevention]...
[S[tatins are used with increasing frequency, including in primary prevention, and—based on the JUPITER trial—in patients with normal LDL cholesterol, but elevated C-reactive protein (more than 2.0 mg/L). In the present study, baseline statin therapy was associated with a significant 46% and 48% increased risk of diabetes in women with CVD and without CVD, respectively.
Just 7% of women in the WHI study were taking statins in the analysis, but today that number would be significantly higher, making the potential risk of diabetes at the population level much more widespread.

The researchers found that B12 deficiency was present in 5.4% of people with diabetes who were taking metformin, compared to 2.4% of people with diabetes not taking metformin and 3.3% of people without diabetes. They further noted that use of supplements containing B12 was not linked with a reduction of B12 deficiency in people with diabetes, compared to a two-thirds reduction in deficiency among people who did not have diabetes. It is currently recommended that people 50 and older consume 2.4 micrograms of vitamin B12 daily from either fortified foods or supplements.

Millions of women over age 50 on statin drugs are at a significantly increased risk of developing diabetes, according to a new study from UMass Medical School published online Monday, Jan. 9, in the Archives of Internal Medicine. Senior author Yunsheng Ma, MD, PhD, associate professor of medicine and an epidemiologist at UMMS, said the study found that postmenopausal women on statin drugs showed a 48 percent increased rate of diabetes compared to those not on the cholesterol-lowering medications....
According to surveys by the National Center for Health Statistics, the rate of Americans over age 45 taking statins has increased tenfold over the last 20 years: from 2 percent in the period from 1988 to 1994, compared to 25 percent from 2005 to 2008, the most recent years for which figures are available. The federal data also shows that figure jumps to 50 percent of men ages 65 to 74 taking statins, while 39 percent of women age 75 and older are doing so.

The researchers analyzed respondents' reported access to three primary health-care attributes:
Comprehensiveness, which includes the provision of care for new health problems, preventive care and referrals to other health-care professionals.
The availability of evening and weekend office hours.
Patient-centeredness, meaning that their health-care provider listened to and sought the patient's advice when deciding on treatments.
The researchers found that after adjusting for age, health status, weight, tobacco use and other health characteristics, greater reported access to the primary-care attributes was associated with significantly lower mortality (hazard ratio 0.79) during up to six years of follow-up....
The team also found evidence that racial/ethnic minorities, poorer and less educated individuals, and those lacking health insurance reported significantly lower access to the primary-care attributes than others.

[Among 15,000 people tracked over a period of 14 years, from high school until their early 30s, at] every point in time, people with diabetes were behind their peers in both education and income. High school students with diabetes were 6% likelier to drop out than those without diabetes. People with diabetes were less likely to go to college, and at age 30 they were 10% less likely than those without diabetes to have a job. Based on data from the study as well as outside data on salary trends, it was found that people with diabetes earn, on average, at least $160,000 less over the course of a lifetime than people without diabetes.

The researchers speculated as to how these results might have come about. It may be difficult for many people with diabetes to balance studying with the rigors of self-management, both in high school and in college. Employers may be less likely to hire people with diabetes, even in spite of nondiscrimination laws, because of concerns about productivity and health insurance costs. And people with diabetes may seek out jobs that pay less but make self-management easier, or stay at jobs to avoid disrupting their health insurance coverage when others might seek higher-paying employment. The study controlled for factors such as being overweight, family income, and several other factors that might have an effect on income independently of diabetes.

The research [mapped] variation in DNA methylation - a naturally occurring mechanism for regulating genes and protect[ing DNA - instead of] conventionally mapping variation in DNA sequence. [A proof-of-concept study among 1,169 type 2 diabetes patients and a healthy control group revealed] a clear-cut, disease-predisposing DNA methylation "signature." This is a first report in the scientific literature of epigenetic risk factor for this kind of diabetes.
DNA methylation is one of the regulatory processes spoken of as epigenetic, in which an alteration in gene expression occurs without a change in the sequence of nucleotides (molecules that make up DNA)....
This analysis revealed, for the first time not only a clear-cut epigenetic signature in diabetes, but telltale methylation signature marks on the DNA of young people who later developed impaired glucose metabolism, even before signs of clinical diabetes showed up.
The HU findings seem likely to lead to the understanding of similar mechanisms in a long list of common human diseases, including many metabolic, autoimmune and psychiatric disorders.
[Epigenetic marks are sensitive to a wide range of environmental influences including diets, chemical exposures and intrauterine environments, as well as to therapeutic drugs;] these findings may open the way for the development of new prevention and/or intervention epigenetic therapies...
Human Molecular Genetics, Dec. 2011

As many as 85% of people with diabetes identified fatigue as one of their leading daily challenges, according to a recent survey of 8,000 diabetes patients. Only 6% of survey respondents noted that they use energy drinks. "Chronic fatigue may be symptomatic of [diabetes] and can make it difficult for someone with diabetes to be active enough to control weight and properly self-manage their disease," stated Richard Corlin, chairman of Diabetica's diabetes advisory board. "People with poorly controlled diabetes are often dehydrated and vitamin-B-depleted. These can be significant factors causing fatigue." Diabetica Research Solutions

The reviewers determined whether the selected guidelines concurred with 7 evidence-based conclusions from the 2007 systematic review. Using 2 domains (rigor of development and editorial independence) from the Appraisal of Guidelines Research and Evaluation (AGREE) tool, 2 reviewers independently evaluated guideline quality based on 7 key elements of systematic review and reporting.

Although the search retrieved 1000 citations, screening identified only 11 guidelines meeting the inclusion criteria. Of these, 7 guidelines agreed that metformin is the preferred first-line agent, and 10 guidelines agreed that thiazolidinediones compared with other oral medications are linked to increased rates of edema and congestive heart failure.

One of the 11 guidelines addressed no evidence-based conclusions, and at the other extreme, 5 guidelines agreed with all 7 evidence-based conclusions. According to AGREE criteria, the overall quality of all of the guidelines was poor, particularly in use of systematic methods to identify evidence. Furthermore, most guidelines were susceptible to bias.

The guidelines varied greatly in domain summary scores for the rigor of development (median, 28.6%; range, 16.7% - 100.0%) and editorial independence (median, 75.0%; range, 8.3% - 100.0%). Higher-quality scores were associated with a greater number of recommendations consistent with the evidence-based conclusions.

[Medicaid patients using mobile-phone-based healthware] for an average of 12 months reduced their ER visits and hospital stays by 58% compared to the 12 months prior to the program....[Diabetes Manager provides real-time coaching for patients and clinical decision support to their healthcare providers, extending care beyond traditional office visits. One year results of the first randomized controlled trial (RCT) of a mobile phone-based diabetes coaching and decision support intervention met the trial's primary endpoint of reducing blood glucose levels over a usual-care control group (Diabetes Care, 2011-09)]. Patients using the DiabetesManager had an average decline in A1C of 1.9 percentage points compared to a 0.7-percentage-point decline seen among [controls]. Results were similar regardless of baseline A1C.... WellDoc® [builds technology to help manage chronic disease by providing patients and their healthcare providers with real-time, actionable information they can use to increase engagement and adherence].

A study published in The New England Journal of Medicine by Seligman and Schilling in 2010 found that adults with the most severe food insecurity are more than twice as likely to have Type 2 diabetes.

Beta cell function can improve after just 12 weeks of weight loss in patients with type 2 diabetes...[F]or the first time, these changes have been shown to correlate with a decrease in pancreatic polypeptide....
The study involved 74 subjects with type 2 diabetes who were treated with oral hypoglycemic agents. Mean age was 56.6 years, mean body mass index was 35.8 kg/m², and mean glycated hemoglobin level was 7.7%. Subjects were prescribed 12 weeks of a weight-loss diet alone (a reduction of 500 kcal/day) followed by 12 weeks of the same diet but with aerobic exercise added.

At baseline, 12 weeks, and 24 weeks, insulin sensitivity was measured using a hyperinsulinemic isoglycemic clamp, plasma concentration of gastrointestinal peptides was measured during a fasting state and during clamp-induced hyperinsulinemia, beta cell function was assessed during standard meal tests, and the insulin secretory rate was calculated by C-peptide deconvolution.

In the cohort, mean weight loss was 5.0 kg (P = .001) after 12 weeks of dietary intervention; weight did not change significantly after the addition of exercise.

Both fasting and stimulated plasma glucose and insulin concentrations decreased in response to the diet. In the case of glucose, there was no change after the addition of exercise, but plasma insulin decreased further with exercise. Similarly, plasma concentrations of C-peptide decreased in response to the diet and further in response to exercise.

In addition, peripheral insulin sensitivity and insulin secretion increased, and glucose sensitivity of beta cells increased by 26% in response to the diet without a significant change after the addition of exercise.

They also observed a marked decrease in both fasting and hyperinsulinemic concentrations of pancreatic polypeptide in response to dietary intervention and there was no significant change in other gastrointestinal peptides.

Pancreatic polypeptide is a novel marker, and the authors are showing for the first time in the context of caloric restriction that a reduction in pancreatic polypeptide correlated with an improvement in beta cell function. The main point is that it showed an improvement in beta cell function following a guidelines-based diet.

International Diabetes Federation (IDF) World Diabetes Congress 2011, Abstract O-0473, presented December 5, 2011

This app lets you log values such as glucose readings, food, exercise, and medications. Each event is entered by selecting a type (e.g., exercise), and a subtype (e.g., "swimming") from an easily customized subtype menu. This saves time because you don't have to type in the subtype each time. The app graphs your results, and allows you to export the results to email. It also allows you to set reminders.

Glucagon-like peptide 1 increases the period of postprandial satiety and slows gastric emptying in obese men.
The regulation of food intake is a complex process involving psychologic, social, and physiologic components. Physiologically, it is generally assumed that food intake is regulated by a central feeding drive that is later counterregulated by peripheral satiety signals that are activated during a meal. These satiety signals have been suggested to include gut peptides and multiple signals via gastric and small-intestinal vagal afferent nerve fibers (1–4). Glucagon-like peptide 1(7-36) amide (GLP-1) is one peptide that has been implicated in the short-term regulation of food intake (5).
[link to PDF]

Researchers at Salk Institute for Biological Studies in the US found proteins that control the body's biological rhythms, known as cryptochromes also interact with metabolic switches that are targeted by certain anti-inflammatory drugs....

The [finding suggests that serious adverse] effects of current drugs might be avoided by considering patients' biological rhythms when giving drugs...

Glucocorticoids are steroid hormones that occur naturally in the body and help control the amount of sugar in a person's blood, so that nutrient levels rise in the morning to fuel daily activities and fall again at night. They function in cells by interacting with glucocorticoid receptors, molecular switches on the outside of the nucleus, which play a role in regulating inflammation. They are used as anti-inflammatory drugs for diseases like allergies, asthma and rheumatoid arthritis as well as used to treat inflammation in cancer patients.

However, the steroids can disrupt a person's normal metabolism, resulting in dangerous side effects, including excessively high blood sugar levels, insulin resistance and diabetic complications.

Nature, Dec 2012

biochemical B12 deficiency was greatest for people with type 2 diabetes taking metformin compared with those with type 2 diabetes but not taking metformin and those without diabetes.

Biochemical B12 deficiency was revealed in 5.8 per cent of patients with diabetes that took metformin as compared to 2.4 per cent of those who did not take metformin and 3.3 per cent of people that did not have diabetes.

In the US, it is currently believed that adults with type 2 diabetes that are over 50 should take 2.4 µg of synthetic vitamin B12 daily either in supplement form or in fortified food.

Researcher Godfrey Oakley commented "It is important to conduct further research to learn how much B12 is needed to correct the deficiency and to determine whether or not raising serum B12 levels improves the clinical picture for persons taking metformin who have low serum B12 concentrations."
Archives of Internal Medicine, Oct 2011

Numerous genetic variants predispose people to weight loss [and to weight regain after intentional weight loss.]

Linda M. Delahanty, R.D., from the Massachusetts General Hospital in Boston, and colleagues performed a randomized controlled study of 3,234 overweight/obese adults with impaired glucose tolerance. The subjects were randomly assigned to one of three treatment groups: 850 milligrams of metformin twice daily, rigorous lifestyle modification, or placebo. Consenting participants underwent genetic analysis.
[Specific genetic alleles were] linked to long- and short-term weight reduction regardless of treatment group. In addition, three of 16 obesity-predisposing genetic variants [were associated with weight regain irrespective of treatment group, while another two variants] demonstrated treatment-specific effects.

All-cause, cardiovascular, and respiratory mortality were elevated among participants with glucose intolerance. The hazard of coronary mortality rose from 2hBG = 4.6 mmol/l (83 mg/dl [95% CI 4.2-5.3]). The dose-response relation was best fitted by a single slope above this level, with no evidence of nonlinearity, compared with Cox models using other threshold levels, and those containing log 2hBG terms. There was no evidence for a dose-response relationship below 2hBG = 4.6 mmol/l. Between this level and 11.1 mmol/l (200 mg/dl), the age-adjusted hazard ratio was 3.62 (95% CI 2.3-5.6). The graded relationship was attenuated by 45% after adjustment for baseline coronary heart disease (CHD), BMI, systolic blood pressure, blood cholesterol, smoking, physical activity, lung function, and employment grade.
CONCLUSIONS:
A threshold model with linear slope [rising from 83mg/dL] best described the dose-response relationship between postload blood glucose and CHD mortality risk.

There is evidence that retinopathy begins to develop at least 7 years before the clinical diagnosis of type 2 diabetes....
At present, the most effective medical treatment to slow the progression of diabetic retinopathy is glycemic control. The relationship between hyperglycemia and retinopathy has been reported in well-conducted observational studies (70). The Diabetes Control and Complications Trial (DCCT) and the U.K. Prospective Diabetes Study (UKPDS) are two randomized clinical trials that conclusively showed the efficacy of glycemic control in preventing diabetic retinopathy (71–73).

In 2008, when the UK Prospective Diabetes Study (UKPDS) group presented their 30-year findings concerning the possible sustained effects of improved glycemic control after 10 years of extended follow-up in type 2 diabetic patients, a so-called “legacy effect” was reported to address the long-term emergent and/or sustained benefits of early improved glycemic control. Opposite results were obtained by the Hypertension in Diabetes Study (HDS) carried out in the frame of UKPDS, with no evidence of any legacy effect on cardiovascular (CV) outcomes for an initial 4-year period of tight blood pressure (BP) control. Thus, it was concluded that BP control has to be continued over time, since, although it had a short time-to-effect relationship in preventing stroke, BP control was associated with a short persistence of its clinical benefits once the intervention was discontinued. These findings are unique because, whereas most interventional trials in hypertension that included diabetic patients have shown a reduction in CV outcomes shortly after starting treatment, only the UKPDS-HDS specifically explored the possible persistence of clinical benefits after discontinuing intensive BP-lowering intervention. This article aims to provide a critical interpretation of the UKPDS findings of lack of BP legacy, in the context of the currently available evidence on the benefits of antihypertensive treatment. The importance of effective BP control in type 2 diabetic patients to prevent CV outcomes and other diabetes-related complications is underlined, with emphasis on early, tight, and continuous BP control to optimize patients’ protection.

Strict glycaemic control is strongly advocated in people with type 2 diabetes to prevent vascular disease. However, the outcomes of two large clinical trials have indicated the potential dangers of pursuing this policy in those at high risk of cardiovascular disease, with an excess of fatal vascular events being associated with a higher frequency of severe hypoglycaemia. Hypoglycaemia secondary to insulin and sulphonylurea therapy is often associated with serious morbidity; anecdotal evidence has long implicated hypoglycaemia as a potential cause of myocardial ischaemia or a cardiac arrhythmia. Hypoglycaemia provokes sympatho-adrenal activation and counterregulatory hormone secretion, which exert pronounced cardiovascular effects. Although well tolerated in healthy people, the superimposition of these profound physiological effects on a diseased coronary vasculature and a dysfunctional cardiac conductive system may induce serious or even fatal cardiovascular events. These risks should influence therapeutic targets and the approach to diabetes management in people with diabetes with established vascular disease in whom exposure to severe hypoglycaemia could be dangerous.

In the Whitehall Study of 18,403 male civil servants aged 40--64 years, 7 1/2 year coronary-heart-disease (CHD) mortality has been examined in relation to blood-sugar concentration 2 h after a 50 g oral glucose load. CHD mortality was approximately doubled for subjects with inpaired glucose tolerance (IGT), defined as a blood-sugar above the 95th centile (greater than or equal to 96 mg/dl). There was no trend of CHD mortality with blood-sugar below the 95th centile. Within the IGT group, age, systolic blood-pressure, and ECG abnormality (Whitehall criteria) were significantly predictive of subsequent CHD mortality. These findings are relevant to discussions on the criteria for diabetes which include the definition of an IGT category with increased risk of large-vessel disease, but without the high risk of small-vessel disease as occurs in diabetes mellitus.

RESEARCH DESIGN AND METHOD:

Twenty inactive subjects (mean age 53.5 years) with type 2 diabetes enrolled in the study. Baseline HbA1c, blood glucose levels, heart rate, and blood pressure were measured for each subject prior to the initiation of the exercise program. Subsequently, subjects were matched to age, waist circumference and sex and assigned to either isocaloric resistance or treadmill exercise groups, which met 3 times per week for 10 weeks.
RESULTS:

Both groups showed a reduction in pre and post-exercise blood glucose and HbA1c values. There was no change in resting blood pressure or heart rate in either group during the course of the 10 week intervention. The group receiving resistance exercises showed significant differences in the daily pre-exercise plasma glucose readings between the beginning and end of the exercise protocol (p < 0.001). There were significant improvements in the mean HbA1c reading pre and post training in both groups (p < 0.001). However, the greater reduction was noted in the resistance exercise group, and at 10 weeks their HbA1c levels were significantly lower than the group that received treadmill exercises (p < 0.006).
CONCLUSION:

Ten weeks of resistance exercises were associated with a significantly better glycemic control in adults with type 2 diabetes compared to treadmill exercise.

[Diabetes mellitus] has reached epidemic proportions in the US and more recently worldwide. The morbidity and mortality associated with diabetes is anticipated to account for a substantial proportion of health care expenditures. Although there are several drug treatments currently available, the need for new herbal agents for treatment of diabetes are required. The treatment goals for patients with diabetes have evolved significantly over the last 80 years, from preventing imminent mortality, to alleviating symptoms, to the now recognized objective of normalization or near normalization of glucose levels with the intent of forestalling diabetic complications. The present review stated several findings from an extensive literature search of natural plants that have been assessed for the anti diabetic activity over past 80 years. An attempt has been made to summarize the information in order to highlight those chemical entities and plant species which are of worthy for further investigation as leads to the drug developments. Over 100 plant species from wide range of families containing various chemical classes of compounds have been cited here which are worthy for the researchers and the industrialist concerned to diabetes.