What's New in Diabetes

Researchers at the Friedman Diabetes Institute and at other institutions around the country are conducting research that aims to improve the prevention and treatment of diabetes and may one day lead to a cure.

Because of this research and the organizations that support it, people with diabetes have new options that can help them live healthier lives. Some recent advances in diabetes include:

The approval of new medicines to help people with diabetes better control their blood sugar levels.
New technologies such as continuous glucose monitors and smaller, hidden insulin pumps.
Greater awareness of the benefits of tight blood sugar control through nutrition, exercise, and medicines.

Diabetes research is advancing at a rapid pace, so this page will be updated regularly with information that can help you better manage your condition.

New Approaches to Chronic Disease
www.healingchronicdisease.org/
Developed by the Center for Health and Healing, Beth Israel Medical Center, this NIH-funded multimedia website in English and Spanish provides the latest information on the integrative approach to Diabetes. You'll also find online self-care exercises to help you learn new ways to manage stress and build coping skills, annotated research, and high quality resources to maximize your health.

Dr. Gerald Bernstein Reviews

Dr. Bernstein's blogs at AOL Health
www.aolhealth.com/bloggers/dr-gerald-bernstein

12.2.09 – TRAVEL TIPS FOR PEOPLE WITH DIABETES

Where are you going and for how long? It is important to know what type of foods are commonly available, as well as opportunity for physical activity. Obviously, with domestic travel it’s less of an issue. Most conventional foreign travel will allow dietary flexibility, but in some esoteric spots it may not be so easy.

Another vital point is proper clothing, especially shoes and socks are important to protect the feet. If travel is foreign, look up and know what medical resources are available, especially, diabetes based programs. Check with your local diabetes association for help.

Medications are essential as well. If possible, have duplicate supplies of pills. Carry one set with you and the other in checked luggage. Even if you do all carry on, it is a good idea to have meds in 2 places. Have a set of prescriptions for everything both for customs (rarely necessary), and if you need refills.

Remember, insulin is stable for 3-4 weeks at room temperature. Again, regardless of what system(syringes, pens, pumps) you use, duplicate supplies are essential. If possible, refrigerate unused insulin, but, again, it is not necessary. Extra syringes should be placed in checked luggage.

Hypoglycemia - always be prepared for possible low blood glucose. The security people are more generous in allowing liquid glucose preparations. Items such as Glucose Rapid Spray, tablets and gels will cover most ordinary episodes and Glucagon for injection will be helpful for a severe event.

Testing supplies - calculate how many strips you will need for the trip, and, again, have your meter and strips at hand with a backup supply in another bag.

Time Zones: Before you leave, if you are going to a significantly different time zone, work out a time line with your diabetes educator or endocrinologist to adjust your basal insulin. Have their names and contact numbers available. Bolus insulin simply goes with the immediate circumstances.

It has been my experience, having travelled to close to 50 countries, that there is almost no hassle about diabetes supplies. Occasionally, an inexperienced security person will not be clear about pens and needles, but a supervisor will correct them. Have a good trip.

9.29.09 – METFORMIN: ARE WE ONTO SOMETHING ELSE
Please keep in mind that we are speaking of small groups of observations rather than a definitive study.

Metformin, the most commonly prescribed oral agent for Type 2 diabetes mellitus has been associated with a reduction in cancer risk. We know metformin has more effects, for the good, such as better lipids, perhaps weight control and a multitude of others beyond its effect on the liver to control glucose production. It has been noted and studied in the past that there appears to be an “anti-cancer” quality seen in animals and in the laboratory. In the last year a retrospective study showed fewer cases of pancreatic cancer in people on metformin than in a control group. Because this was retrospective the controls managed in a definitive study are approximated. Similarly was a small study suggesting a benefit in breast cancer. This is something we should all keep an eye on.

Follow up: Search engine (e.g. google) metformin and cancer

NEW CONCEPTS IN DIABETETES MELLITUS: PREDIABETES AND RISK

Diabetes mellitus has been described for thousands of years, but only recently has a perspective been developed that puts this disease in the forefront of threats to the welfare of millions of people around the world. We tend to look at a disease as having a beginning, occurring as a result of an event in the body. It may be from an injury or exposure to an infective agent but there is a clear onset. Type 1 diabetes has an onset sometime after exposure to an environmental stimulus. The story of Type 2 diabetes is a whole other thing.

When a patient walks into the doctor’s office for a checkup and is told “your blood sugar is elevated, you have diabetes” the OLD assumption was that the risk for complications begins at that point. The NEW assumption is that the risk began as long as twenty years earlier. First of all, let's look at the numbers we use to diagnose different diabetic states. Normal FASTING blood glucose is below 110mg/dl. A diagnosis of diabetes is made when the FASTING blood glucose is above 126 mg/dl.. In between 110 and 126 is called IMPAIRED FASTING GLUCOSE (IFG). A normal blood glucose level after a meal is 140 mg/dl.. A diagnosis of diabetes is also made when a random or post meal glucose is greater than 200 mg/dl.. If the post meal glucose at 2 hours is between 140 and 199 it is called IMPAIRED GLUCOSE TOLERANCE (IGT).

These numbers are arrived at by a consensus of a lot of smart people and have been changing as more data is accumulated. What is important - they each represent an increased risk for progression to clinical diabetes or its complications. Screening and treatment are often about reducing those risks, just like seat belts and air bags reduce risk for injury in an auto accident. Although things may actually start earlier, the first clinically detectable abnormality in the natural history of Type 2 diabetes is a rise in the blood glucose levels 2 hours after a meal or a glucose drink. As indicated above - this is IGT. IGT is associated with increased risk for cardiovascular disease whether or not that patient actually develops diabetes. This means that when diabetes actually is found IGT and cardiovascular risk have been present for years.

IFG occurs long after IGT does. It adds additional risk and brings the individual closer to clinical diabetes. This is of particular concern in children who may start IGT in their teens and show cardiovascular changes in their thirties. The NEW CONCEPT would be expressed in a question: is all of this one continuous disease with some progressing to diabetes and some lingering at IGT? The additional NEW CONCEPT would have to do with early and aggressive treatment of IGT and certainly clinical diabetes,

Two major organizations, the American Diabetes Association (ADA) and its European equivalent (EASD) set out a new algorithm for intervention. First, life style change (diet, exercise) such as you would learn at the Friedman Diabetes Management Program, then a pill called METFORMIN, and as a next step not another pill but early use of INSULIN. This helps bring the blood glucose back to normal faster and rests the insulin producing cells of the pancreas.

The take away message: risk starts early so screening and detection of IGT is important. Early intervention may preserve the insulin producing cells and slow the progression of IGT to diabetes.