When Ostracizing Type 2 Diabetes Became an Accepted Lifestyle

When it comes to Diabetes, and the messages being put out there in the media, it is really hard for myself and other folks not to become angry -- if not downright furious. I have to tell you, I generally look through articles, and skim through different headlines, and just tend to "cherry pick" whats going to be real news, and ignore and pass over the fluff. If I were to read it all, I might be en route to a heart attack in less time than you can say "duck fiabetes."

But on Wednesday, just having gotten home from a long, physically and mentally exhausting shift at work, I failed to listen to my own advise. A dear friend of mine shared a news article, in my "Living with Diabetes" Facebook group... and I just lost it. I dont think I have ever been so outraged by an article before. (Well, except maybe for Wendell Fowlers abusive tirade against little Type 1 Diabetic children having ice cream. OMG, how dare they! Thats almost as dangerous as Paula Deen having a cheeseburger! *snark, snark*) I was seeing so many shades of red, and purple, I just could not think straight. I said a bunch of things, in my group, about the article, and to my husband... went and kicked a few things around... flipped off Dr Oz on the TV... and then I felt like my head was going to explode. It was just too much.

Having taken at least, a few days, to calm down... I can probably now tell you what I really think about this piece, with a little more perspective. The piece is called "Curing Diabetes: How Type 2 Became an Accepted Lifestyle" (Yes, you are reading right... That IS the headline for this article), and it was written for The Atlantic, by reporter John-Manuel Andriote, who has supposedly been specializing in HIV/AIDS reporting since 1986. I guess, I would like to think that being exposed to such a world would have given Mr. Andriote some perspective, and a keener sense of tact, and to an extent it has... but, apparently, not enough to have helped him rethink such a terrible headline.

The article itself makes a few key mistakes, which well, to an outsider would not be as self evident. And why would they? Our current government, medical advisory agencies, and medical industry want to do all they can to pass blame onto the Type 2 patient, entirely, and take on NO responsibility themselves. Ive shared on this, before, many times. Especially, the deep denial of how multi-faceted the triggers are for Type 2 Diabetes, and the roles pollution and other medications, etc., have in the development of the disease. It is unfortunate that everyone in the industry quotes such poorly done research studies that do not take these complexities into account, or even consider to do so, to blanket claim that 80% of all Type 2 Diabetes is "largely preventable." These simplistic allegations lead to discrimination, misunderstanding of a very complex disease, denial of health management resources and tools by the insurance industry, and uneducated reporting that often leads to societal abuse, bullying, and further discrimination.

Still, there is some good, among the bad, to be found in this article. I do feel that, had the author taken some time to meet with members of the diabetic online community, this article could have really shed some light more adequately, on a lot of issues that affect our community, without contributing so much to the problems it so tries to address.


The Good in this Article: 

• Right off the bat, the article addresses the issue that the medical industry does not like to discuss with patients, or at least seldom does, the idea that they can manage their diabetes without medications, much less what Diabetes even IS. This is, indeed, a struggle we have right now. But it is a deep, and complex problem involving a lot of ethical concerns which affect almost every aspect of the health industry, including the American Diabetes Association itself (its probably not an accident that they recommend diabetics keep their blood glucose levels at or below 180 mg/dL -- a very high, and potentially long term dangerous, blood glucose level), as well as other diabetes medical guideline agencies. The fact is, many medical professionals receive kick backs and incentives from the pharmaceutical industry -- large kickbacks and benefits -- and its in their pocketbooks best interests to keep as many of their patients taking certain medications. This is not something exclusive to the diabetes industry, though. I am sure this is one of the prime reasons why there are now, commercials on mainstream media, for prescription only medications. Its BIG business, and theres no better salesman out there than your doctor. 
• Andriote does some thinking outside the box, which is helpful: Chronic illness, particularly obesity and diabetes, are multi-faceted diseases which do not have just one contributing factor to them (though at times he seems to suggest they do) and thus, will need a multi-sector response. He speaks about our sedentary jobs, and a poor transit system, and the lure of the food industry, and how addicting high fat/high sugar/high salt/food combinations can be... and the supposed "myth" that healthy foods cost more than unhealthy foods. He even quotes an article from someone who supposedly "destroyed" this myth. What is perhaps not understood by people who claim that healthy food is cheaper than fast food is that most dedicated Type 2 diabetics dont consider healthy food what they consider healthy food, and they have to cut back on carbohydrates in order to control blood glucose, and not rely solely on their medications for control. Id like to see Andriote actually trying to live a lower carbohydrate lifestyle, at a grocery store, with a maximum of $350 for 2 people, for a month worth of groceries, and not being able to eat as many starches, grains, and other foods which ARE the cheaper foods, for their value and how far they go. Living on lean proteins, and veggies, and cutting back on all those starches and breads, and grains is NOT cheap. Also, per the fast food cost example he uses, if one assumes poor people buy value meals at fast food joints to feed all of their family members, one might be very, very naive: there is such a thing as a dollar menu, or less, at these places... And people KNOW this. How can you beat $2 for two double cheeseburgers at McDonalds??? It costs me $2.88 a lb alone, for chicken! (And its cheaper in Iowa, than in many places...) 
• Andriote talks about the need for balance in media industry reporting (Surprisingly): On the one hand, you dont want people dismissing diabetes as not serious enough, but on the other, you dont want to create a public backlash for patients. "When the media do focus on type 2 diabetes, said Sarah Gollust, assistant professor at the University of Minnesota School of Public Health, they give twice as much coverage to the behavioral risks for it than any of the other factors that contribute. But this over-emphasis on personal responsibility tends to blame and stigmatize people with type 2 diabetes or who are obese. Those living with the disease may feel its their fault if they cant always maintain the ideal blood sugar level. Worst of all, said Gollust, public support could erode as people are expected to cover the costs, however they can, of a medical condition its believed they brought on themselves ... Public support for addressing diabetes is imperative when you consider the tremendous amount of money it costs to manage the disease." This is a very important reality that we, as Type 2 Diabetes patients face as we strive to manage this disease. We NEED support, and we cant succeed without it. However, many of the undercutting remarks Andriote makes, including his headline, are FAR from being fair and balanced, and certainly not supportive! On page 2, Andriote has a "listing" of facts, and goes on to say that "Although there is a genetic predisposition for type 2 diabetes, the vast number of cases are the outcome of poor diet, obesity, and a sedentary lifestyle." Of course, this is contradictory... because ALL cases are of genetic predisposition. If not, then ALL obese persons would have diabetes -- and this is simply not the case. (I wont even go into his usage of the phrase "people of color" to talk about African-Americans, Latinos, and other minorities...) 

The Bad in this Article: 

• Andriote, sort of, implies that most Type 2 Diabetics could manage their condition without the need for medications, if they just try a little hard, and then they would be cured. There is a BIG disconnect in here: 
• For one -- he fails to realize that by the time the average person is diagnosed with Type 2 Diabetes, their disease is so advanced, they have lost nearly 40-80% of their beta cell function, making it extremely challenging to near impossible to control blood glucose levels without the assistance of oral medications, or insulin. Again, being the multi-faceted disease that it is, diabetes NEEDS a more aggressive and aware medical community, as well as increasing efforts in continuous education FOR the medical professionals, as well as patients. A medical professional who cannot think diabetes, and catch all the symptoms and markers of diabetes, in an age when its being considered as an "epidemic," is a medical professional who will endanger lives, and contribute to the rising costs of the disease when it comes to complications that are not being caught on time. 
• Secondly -- The kind of lifestyle changes to achieve true remission and euglycemia, are a lot more stringent than what the ADA might tout. You *cannot* reach euglycemia -- true euglycemia -- while thinking that blood glucose numbers below 180 mg/dL are normal. True euglycemia are levels that are below 140 mg/dL or lower, after 2 hours of eating, and in fact, rarely exceed that. In fact, some might even say below 120 mg/dL at 2 hours, or less. Not everyone can achieve those levels -- especially, if they struggle with hypoglycemia, or  have other health related dietary considerations to make that might not allow them to easily cut back on carbohydrates, or increase certain levels of exercise, etc. I, for example, have to consume 80-100 grams of carbohydrate a day, at a MAXIMUM, in order to maintain my euglycemia. This is unrealistic to many people... and its not a character flaw! It is HARD, often unrealistic, work. 
• Thirdly, he goes on to claim that if folks worked hard at it, they could "cure themselves," and he uses an opinion paper, mind you, to try to back up his assertions. He even goes as far as claiming that this is the opinion of the American Diabetes Association (ADA), by claiming that the ADA says that "maintaining normal blood sugar without medication for at least a year could be considered a "complete remission,"" when in fact, the ADA specifically highlights a the end of the second paragraph, in that same opinion paper that "The opinions and recommendations expressed herein are those of the authors and not the official position of the American Diabetes Association." Moreover, the panel of those expressing their opinions recognized that they had clear conflicts of interest in the matter, and also, found it difficult to reach consensus considering the wide arrange of questions to be considered. The group does, though, make a very telling distinction between a cure, and a remission... which the author of this article seems to gloss over, quite nicely, to what he could take out of context, and better fit into his piece: "Medically, cure may be defined as restoration to good health, while remission is defined as abatement or disappearance of the signs and symptoms of a disease (3). Implicit in the latter is the possibility of recurrence of the disease. Many clinicians consider true cure to be limited to acute diseases. Infectious diseases could be seen as a model: acute bacterial pneumonia can be cured with antibiotics, but HIV infection, currently, can at best be stated to be in remission or converted to a chronic disease. The consensus group considered the history of childhood acute lymphoblastic leukemia, which evolved from a uniformly fatal disease to one that could be put into remission to one that can now often be considered cured (4). Conversely, chronic myelocytic leukemia is now considered to be in prolonged remission, but not cured, with therapies such as imatinib ... For a chronic illness such as diabetes, it may be more accurate to use the term remission than cure. Current or potential future therapies for type 1 or type 2 diabetes will likely always leave patients at risk for relapse, given underlying pathophysiologic abnormalities and/or genetic predisposition. However, terminology such as “prolonged remission” is probably less satisfactory to patients than use of the more hopeful and definitive term “cure” after some period of time has elapsed. Additionally, if cure means remission that lasts for a lifetime, then by definition a patient could never be considered cured while still alive. Hence, it may make sense operationally to consider prolonged remission of diabetes essentially equivalent to cure. This is analogous to certain cancers, where cure is defined as complete remission of sufficient duration that the future risk of recurrence is felt to be very low."

You see, it is one thing to call something a "cure," because it is more hopeful, and more satisfactory to a patient... than for that to be, actually, a cure. The likelihood might be low, but it is, in fact, not a cure. As a comparison to HIV made above, for example, people like Magic Johnson have had their HIV infection in remission for years, but would would we say that hes cured? Not in a million years. Just because I cant "infect you" with diabetes does not mean Im cured. This debate among colleagues does not equate to something actually being "officially" considered a cure. Obviously, operationally, we cannot treat presently uncontrolled diabetes in the same way as diabetes in tight control, or in remission... So DUH, it can be "operationally" a cure, but not in truth. Remission is remission. A cure, is a cure. This is truly, irresponsible journaling at its best. 

I would add that the amount of mental focus that is required in maintaining diet, food carbohydrate counts, exercise, and meal planning often borders on obsessive and unhealthy, and ends in many an eating disorder for many diabetes patients. The psychological ramifications of attaining euglycemia, at all costs, for many... have NOT been assessed, and yet, they are just as much a part of the disease as hyperglycemia and other markers. Diabetes is NOT just a disease of high blood glucose!  

• The author uses statistical scare tactics to put the fear of God in you: But he does not put them in perspective. Its one thing to discuss how the rate of diabetes will triple, or double, or whatever. Its quite another to not discuss the rate of population growth, right along with that. Obviously, people ARE reproducing, and diabetes isnt just happening in a vacuum where the rate is growing by leaps and bounds larger than what it is. Its hard to say, because what will the population be in 2050? Our population is EXPLODING to what are potentially unsustainable levels, and of course, thats going to make numbers for any disease seem scary high, without some perspective. What would the rate be in RELATION to total population at that time? THAT is what the question should truly be... In addition, the author wrongly states that the prevalence of obesity has been increasing, year after year, when the prevalence of obesity has remained STEADY for the last 12 years.  Could it change, tomorrow? Sure... but for now, I think we can say many folks are starting to be more conscious of obesity, and their health, even if they might not see themselves as overweight. Andriote fails to keep balance in the picture hes trying to paint.
• While Andriote wants to instill a sense of seriousness to diabetes, while claiming we need support, he attacks commercials with friendly faces and role models, claiming that persons who are fit, or joggers, or younger folks -- are not what most Type 2 Diabetics are like. Perhaps not (some) newly diagnosed Type 2 Diabetics, but is it wrong to have positive role models to aspire to? Is it wrong to see that some of us HAVE made changes, and CAN live a healthful life? Is it wrong for me to see another 35 year old I can relate to, on the tv? I fail to see just what he wants to accomplish, here. Does he want a fat, old Joe, sitting on a sofa, not able to move, and popping pills, or doing leg exercises from a chair, because he cant move? Would THAT be more appropriate? Or perhaps, he wants people with their limbs amputated, like the city of New Yorks shocking diabetes ad campaign? Im not sure whats the alternative hes looking for, here, and whats running through his mind. 

Of course, I cant end without discussing... that headline. "Curing Diabetes: How Type 2 Became an Accepted Lifestyle" ... Im guessing hes trying to say most people just "accept" and take the diagnosis as a given, that they will need to live with this disease, forever... and take pills forever. But boy, is it an uneducated headline. Yes, people can live pill free, for a while... and depending WHEN they were diagnosed, if it was late in life -- maybe they might never have to take any meds, ever. But no, its not a cure. Type 2 Diabetes IS a progressive illness, and the likelihood of a need for medications increases with the LENGTH of time weve had this disease -- and not exactly with how well weve taken care of it. Time goes by, and not in vain... our bodies DO age. Things break down. My father was in remission for years, yet he was never cured; diabetes still progressed, and still took his life. It happens.

Diabetes is not an "accepted lifestyle" anyone chose, anymore than people who got AIDS or HIV (by whatever method), CHOSE that as their lifestyle. I bet you $1,000,000 that this author would NEVER dream of writing "Curing HIV: How HIV Became an Accepted Lifestyle," merely because he read an opinion piece on how one can keep HIV in remission for YEARS. The headline even seems to sort of imply that we "coddle" people into being lazy about their care, and lazy about "curing themselves," so that we dont need to support them. Its not a disease, if you would, its a "lifestyle." Yes, because Type 2 Diabetes is sooooooo glamorous. Its the lifestyle of the fat, and sloppy, and just give me my Metformin, over here. Ill take it with a side of that value meal, please. 

Sadly, Andriote could have done SO MUCH to advocate and help our community, but instead he chose the low road of blame, and veiled vitriol in between his lines. How someone who has written for the AIDS community can be so close minded about the needs of another equally ostracized community is BEYOND me. 

Diabetes Risk Factors This four Owned Women Only

Diabetes Risk Factors This four Owned Women Only - The majority of risk factors for type 2 diabetes in men and women is the same. But based on a study of 1 million women found that there are only a few factors that are owned by women. What are they?

Studies conducted by Denice Feig of the Department of Medicine and Department of Health Policy, Management and Evaluation, University of Toronto, Canada and his colleagues revealed that there are two conditions related to pregnancy and can increase the risk of type 2 diabetes include preeclampsia and gestational hypertension (high blood pressure during pregnancy).

Though estimated 5-8 percent of pregnant women reported experiencing preeclampsia, a deadly condition in which a mother had high blood pressure, fluid retention (water retained in the body in excess) and proteinuria were found in his urine when the pregnancy reaches 20 weeks of age.

Whereas gestational hypertension is a condition in which a prospective mother suddenly develop high blood pressure when entering the womb 20 weeks of age but did not find any proteinuria in his urine. This condition is also erred to as pregnancy-induced hypertension (pregnancy-induced hypertension).

The conclusion was obtained after the researchers analyzed data from 1,010,068 pregnant women who reported giving birth between April 1994 and March 2008. Information about the presence of gestational hypertension, preeclampsia and gestational diabetes in participants was collected and evaluated.

According to the findings of previous studies, gestational diabetes is also said to be one of the risk factors for type 2 diabetes. This condition usually appears in the third trimester of pregnancy.

As a result, 30 852 people suffer from gestational diabetes; 27 605 people suffer from gestational hypertension and preeclampsia 22 933 people. In addition, 2,100 people are known to suffer from gestational diabetes as well as gestational hypertension, whereas participants who experienced gestational diabetes and preeclampsia reached 1,476 people.

When in-followup, 35 077 people (3.5 percent) reported having diabetes type 2. However, as quoted Emaxhealth, the magnitude of the risk of type 2 diabetes based on the presence of pregnancy-related conditions specified above are:

- 1.95 times greater in patients with gestational hypertension

- 2.08 times more likely to develop preeclampsia

- 12.77 times greater in patients with gestational diabetes

- 15.75 times greater in participants who develop gestational diabetes and preeclampsia

- 18.49 times greater in participants who have gestational diabetes and gestational hypertension

But apparently in addition to pre-eclampsia and gestational hypertension, the researchers also found two other diabetes risk factors were not found in men, which gave birth to a baby weighing more than 4.5 kilograms and the polycystic ovarian syndrome (PCOS).

Because women who have PCOS are known produce androgens (male hormones) in the number of abnormal so they experience symptoms such as hair loss on the scalp, acne, weight gain, hair appears on the face, irregular menstruation, insulin resistance to fertility problems . As has been long known to weight gain and insulin resistance also encourages a persons risk for developing type 2 diabetes.

The Privilege of Living with Diabetes

Dear Beautiful Person (who happens to have diabetes),

Today, you are here. Is there a purpose to your being here? A universal, master purpose? Many claim to have the answer to this, but the honest response is that no one knows. The question is, in fact, irrelevant. You are here. That is a fact. Everything else is just speculation.

It matters not if its an illusion, a grand plan, a godly design, or a happenchance. You are here.

And while you are here, think upon the magnitude of your existence: The last science knew, the universe was 13.8 billion years old. During much of that time, Earth was a big, hot mess. Life only began to evolve 3.5 billion years ago. Modern man, alone, has only existed for about 200,000 years...  and only in the last 30 years or so, have we seen vast improvements in industry, technology, education, science... and medicine.

Medicine.

If you would have been diagnosed with diabetes (of almost any type) back in the 1800s, it was most certainly a death sentence -- if not, a very challenging life.

Insulin wasnt discovered as a treatment for diabetes until the 1920s, thanks to Banting and Best, when many children were literally dying of malnutrition and emaciation. Banting had the heart to insist on not patenting their new-found medicine, so that it could reach as many as needed it.

Metformin was invented in the 1920s as well, and has been used in other countries since the 40s, and 50s. It was not, however, approved in the United States for use with type 2 diabetes until 1994! Yes, that is not a typo. 1994.

Back in the pre-insulin days, starvation was all people knew to do to control diabetes. To eat basically no carbohydrates, or really anything much -- as proteins and fats can also raise glucose (though, admittedly, to a lesser degree). Many simply died because it was so stressful -- or they just couldnt resist pinching food, while no one was watching.

It wasnt until the 1980s when a person with diabetes was able to monitor their levels, independently, and the first glucose monitors appeared. If they had insulin -- that was a good tool -- but if they didnt, all they knew to do was avoid eating sweets. Diabetes has always been with us, at least in the archaeological records, since Egyptian times, and weve known its a disease about high glucose, but aside from that, there wasnt much monitoring of glucose levels until well into the 80s. Ask anyone who was diagnosed many years ago, and they will tell you stories of urine testing (sometimes, once a month, at a doctors office), and sharpening and boiling their own needles, for sterility.

In fact... we really didnt know that diabetes was not a disease caused by eating excess sugar and sweets, until at least the early 90s. The other day, I saw a very old VHS tape for an old Vitamix blender I have acquired, and in it, they recommended diabetics substituting honey, in place of sugar. I guess in their minds, anything that was natural sugar, was not really sugar.

And here we are now... 2013. With a variety of different types of insulin, mimicking both basal and bolus outputs from our pancreas, insulin pumps and CGMs to allow us to eat with more freedom and catch hypoglycemic events, the knowledge of counting carbohydrates and the freedom to eat cake, diabetes alert dogs, and glucose meters small, sleek, or indistinguishable from an iPod, small, and painless needles... and on the thresholds of smart insulin, biohub and artificial pancreas options, and noninvasive glucose testing.

. . .

Yes. Diabetes is still hard. But we are blessed to live in 2013, and not 1913. We can see ourselves as the victims of fate, or as the blessed recipients of a grand universal lottery. Think about the kind of life you have the chance to pursue, right now... that you would have never had a chance to pursue back then. Let it sink in -- let its blessings humble you. 

Yes... diabetes can be embarrassing. But all disease is humbling. 

Even if you never had diabetes, life is much of an embarrassing process, as well... At birth, and near death... someone has to wipe our behinds. We get old, and lose our good looks... we may get cancer, and lose our breasts, we may get alopecia, and lose our hair... We may be like Farrah Fawcett, and get colon cancer -- colon cancer. 

Illness is humbling -- for we have to accept that we are frail, that we get sick, that we get old, and yes, sometimes... that we havent always done the best to take care of ourselves. But, can you think of anyone who has been perfect -- all of their lives? Always perfect? I know one or two who claim they were -- and you know what -- I honestly dont like them very much. For one, they are liars. They may have read the manual on living, but they havent actually lived very much. No one learns to ride a bike from reading a book -- and thus it is with living. Some of us just have to fall a few more times, than others... and it is our beautiful, gnarly scars, which make us who we are.

I never thought of Farrah Fawcett as much of a hero -- until her war with colon cancer. And I never thought much at all, about Ryan ONeal, until his passionate devotion to the woman he sought to wed on her deathbed. 

Dont be angry at your loved ones, beautiful person (who happens to have diabetes). It is not a matter of blame. It is not a matter of fault. Dont leave this world, and lose hope... for these massive amount of events I have listed had to have gone through... and for you to be here, in this point in time. Your loved one, well... your loved one simply LOVES you. They are in deep fear because they do not want to be without you -- at least -- not sooner than life will will. Can we blame them? 

I was angry once... at my father for (in my own warped perception) not trying harder, at life and circumstance, and God, and you name it. I was once that angry loved one... living in FEAR. Sheer fear. But, you see... for whatever reason, you are here -- in this very moment in time, and a time when you happened to meet your loved one. This is a very precious moment in time... In fact, to quote Lawrence Krauss -- a renowned Theoretical Physicist: 

“Every atom in your body came from a star that exploded. And, the atoms in your left hand probably came from a different star than your right hand. It really is the most poetic thing I know about physics: You are all stardust. You couldn’t be here if stars hadn’t exploded, because the elements - the carbon, nitrogen, oxygen, iron, all the things that matter for evolution and for life - weren’t created at the beginning of time. They were created in the nuclear furnaces of stars, and the only way for them to get into your body is if those stars were kind enough to explode . . . The stars died so that you could be here today.”

Is diabetes embarrassing? Well, sometimes... But I am in fact honored to be so privileged to be alive, today... right now... Experiencing this universe, the love of friends, and family... The patter of rain on my window pains, the loving purr of my cat, and the imperfect love and friendship of that idiot that still lives here which I call my husband.

Yes, I am honored... to be living here, and living with diabetes.

Medicaid Disease Management No Impact on Emergency Room Utilization or Inpatient Costs for Enrollees with Diabetes

Regular readers of the Disease Management Care Blog know that Medicaid is coming. While many of the nations Governors have declined President Obamas invitation to run Medicaid the Affordable Care Act way, others have agreed to use the ACAs generous funding to enroll millions of their indigent citizens into this vastly expanded public insurance program.

"No problem!" says the disease management vendors.  For years, theyve been offering their services to state Medicaid programs and would be happy to expand their contracts.

Unfortunately, an article by Matthew Conti that was just published in the journal Health Services Research suggests that that may not be a good idea.  The articles title is Effect of Medicaid Disease Management Programs on Emergency Admissions and Inpatient Costs.  The only thing thats missing are the words "The Lack of Any" at the front of that sentence.
   
The article studied the impact of diabetes "opt-out" disease management on diabetic patients emergency room utilization and admissions in three states Medicaid programs: Washington (started in 2002), Texas (started in 2004), and Georgia (started in 2005).

These states with were compared to states without diabetes disease management.  These control states were selected on the basis of baseline Medicaid enrollment trends that were similar to the three study states. These control states were Hawaii, Kentucky, Massachusetts, Maryland, Maine, North Carolina, Nebraska, South Carolina and Tennessee.

To perform the comparison, Dr. Conti used the Agency for Health Care Research and Qualitys (AHRQ) National InPatient Sample (NIS) from the Health Care Cost and Utilization Project ("HCUP"). These databases contain patient-level and longitudinal hospital information on inpatient stays, including cost, payer, admission type (e.g., emergency, urgent and elective), age, gender, primary payer, and total charges. The span of data that was used went from 2000 through 2008.

A complicated pre-post "difference in differences" model was used to compare baseline vs. follow-up:

1) total inpatient charges/Medicaid enrollment (which averaged $430 per diabetic enrollee, with a 95% confidence interval of $265 to $700) and

2) emergency admissions/inpatient admissions (a ratio of 0.37 per admission with a standard deviation of plus or minus 0.12)  All Medicaid enrollees with diabetes were included in the analysis, whether or not they had been enrolled or opted out.  The author used this approach figuring that if a statewide disease management program enrolled up to a third of eligible persons with diabetes (that was the case in Texas), there should have been an observable impact on the entire population. Thats the approach favored by the Disease Management Purchasing Consortium.
 
The results?  No state with disease management had lower emergency room utilization or inpatient costs for their Medicaid enrollees with diabetes. The DMCB couldnt find a table with numbers, but the figures (which cant be reproduced without permission) show little impact over time.

What can readers conclude?  Assuming that, during the period of study, the three states Medicaid programs suffered from the programs endemic issues of underpayment to providers with a relative lack of access to primary care:

1. "Blanket" call-everyone telephonic disease management cannot make up for fee-for-service Medicaids shortfalls.  It remains to be seen if the ACAs revitalization of Medicaid will make up for this and increase the parallel impact of disease management. 

2) This also means that Medicaids experience with disease management cant be generalized to other types of insurance with better provider payment rates and patient access to care.

That being said, the DMCB has two concerns:

1. If the DMCB is reading this right, it appears all persons of any age with diabetes were included in the study, including Type 1 diabetics.  If thats correct, that could have also blunted the impact of any disease management program, since children are over-represented in Medicaid and the impact of remote telephonic coaching in Type 1 is widely viewed (even among the disease management vendors) to be ineffective.  Insulin-requiring kids need lots of face-to-face hands-on care.

2. The DMCB is unfamiliar with the three study states disease management programs, but if they were set up the "old fashioned way" to contact all persons with diabetes without the modern regard to future risk and "impactibility," then its little wonder that the programs failed.  State-of-the-art population health management tailors its programs by focusing on subsets of persons with chronic conditions that are most likely to benefit.  Any impact on emergency room use or inpatient charges for these patients would be lost in the data "noise" of everyone elses utilization.

Should Medicaid programs that are facing huge jumps in enrollment abandon Medicaid as a result of this study?  Based on this study, the DMCB doesnt think so.  The findings are interesting, but more research is needed.

Smoking marijuana can lower the risk of diabetes

You would have to know the negative effects of smoking marijuana. But it turns out marijuana also has benefits. Recent research has shown that people who regularly smoke marijuana have a lower risk of developing diabetes.

Marijuana users had lower insulin levels. This indicates control blood sugar better. If the link between cannabis and prevention of diabetes clarified, then it is likely researchers will develop diabetes treatments using the substance in cannabis, namely THC (tetrahydrocannabinol).

The study, published in The American Journal of Medicine found that people who smoke marijuana regularly have insulin levels 16 percent lower compared with those who never smoked marijuana.

Those who used marijuana also known to have a smaller waist, while a large waist circumference can increase a persons risk of developing diabetes.

Currently marijuana is generally used in patients with cancer or experiencing severe pain. The use of marijuana as medicine is allowed in 18 states, as reported by the Daily Mail.

The study looked at 4,657 patients. Approximately 579 people use marijuana, 1,975 marijuana use in the past but had stopped, and 2,013 people have never used marijuana. Insulin and glucose were then measured through participants blood samples after fasting for nine hours.

As a result, users of cannabis had insulin levels 16 percent lower than those who had never used marijuana at all. Murray Mittleman of the Cardiovascular Epidemiology Research Unit at Beth Israel Deaconess Medical Center also explained that in previous studies researchers found that rates of obesity and diabetes is lower in cannabis users.

Although the substance in the cannabis plant is known to control and prevent diabetes insulin, Indonesia would allow the use of marijuana for treatment?

Type 2 Diabetes Rates Increasing Among Teenagers

A poor diet and lack of exercise arent leaving their mark on just adults.

Researchers who analyzed data from the 1999-2000 National Health and Nutrition Examination Survey (NHANES) found that 1 in 10 boys (10%) and 1 in 25 girls (4%) between the ages of 12 and 19 had a pre-diabetic condition. For overweight teens, the rate jumped to 17.8%. After an 8-hour fast, these adolescents had a blood glucose level between 100 and 125 mg/dl, a condition known as impaired fasting glucose (IFG).

People with IFG are at increased risk for developing diabetes and cardiovascular disease as they age.

For adults, theres evidence that lifestyle changes can prevent this progression. From the National Institutes of Health (NIH):

"Progression to diabetes among those with pre-diabetes is not inevitable. Studies have shown that people with pre-diabetes who lose weight and increase their physical activity can prevent or delay diabetes and even return their blood glucose levels to normal. "

The study was published in the November issue of Pediatrics. The authors are examining whether these rates may have increased in the 5 years since their analysis.

________
For a summary of the study:
Study: 2M Adolescents Have Pre-Diabetes

For the study itself:
Prevalence of Impaired Fasting Glucose and Its Relationship With Cardiovascular Disease Risk Factors in US Adolescents, 1999–2000

Antidepressants increase the risk of diabetes in women

Antidepressants increase the risk of diabetes in women? - Women who are elderly should be caul if you want to take anti-depressant drugs. Recent research suggests that the anti-depressant drug could increase the risk of diabetes and cardiovascular disease in older women.

The results obtained after the researchers looked at data from several hundred women who have undergone menopause for eight years. Women taking anti-depression drugs are known to have a higher BMI, had a circumference larger dish, as well as signs of inflammation are more than women who did not take anti-depressant drugs.

All symptoms are associated with increased risk of cardiovascular disease and diabetes, as reported by U.S. News. These results are reported researchers in the American Journal of Public Health, published on 13 June.

"Its important to keep an eye on the depressed women after menopause and taking antidepressant medication. They must be vigilant to prevent diabetes and cardiovascular disease," said lead researcher Dr. Yunsheng Ma of the University of Massachusetts Medical School.

Although this study suggests that the consumption of anti-depressant drugs associated with increased risk of cardiovascular disease and diabetes, but this study did not show a causal link.

Retail Clinics for Chronic Conditions Like Asthma Hypertension Lipids and Diabetes Mellitus A Look At the Value Proposition

Is there a business model in there?

To the delight of skeptics, pundits and bloggers everywhere, U.S. health orm continues to follow its predicted trajectory: fiscal shortfalls are now biting the nominally "wealthy," the Feds arent about to admit that theyre in over their head on implementing their health insurance exchanges, opportunities for cronyism are increasing and the DMCB spouse is wondering why her supposedly expert-husband cant find health insurance for less than a thousand a month.

In the meantime, theres no sign that Washington DC will ease up on the "accomodative" money-printing presses that are feeding "QE Infinity."  Thats no problem, though, because Europe is reminding us that once the paper currency is undermined, selling gold is a handy way to quell grumpy voters and prop up the welfare state.

Yet, Clayton Christensen tells us a fix is at hand: much of health cares quality and costs travails, he says, can be solved by embracing the disruptive innovation of non-physician treatment of acute and chronic conditions.  His supporters are undoubtedly cheering Walgreens recent decision to to have its 330 Take Care Clinics add hypertension, diabetes, high cholesterol and asthma care to its portfolio of nurse practitioner services.

After reading the usual retail clinic policy tomes both for ("access to care") and against ("health care balkanization" plus "missed diagnoses"), the Disease Management Care Blog isnt convinced that Walgreens decision is such a slam dunk.

Thats because these clinics business proposition is less about innovation and more about being a loss leader that increases retail pharmacy foot-traffic. In fact, offering free retail clinic services has been tried. The premise is that the retail customer-patients will stop by the pharmacy window for new drugs and, while theyre at it, renew those other high margin prescriptions.  If they pick up some diapers and nail polish while making their way to the front of the store, all the better.

While that certainly sounds good, retail clinics are not a build-it-and-they-will-come cash machine.  Recall that CVS had to pull the plug on its retail clinics several years ago.  Foot traffic didnt materialize and the supposed loss leader turned into a money pit. 

The good news for Walgreens is that they have Jeffrey Kang in their corner.  Prior to this, he led health insurer CIGNAs disease management initiatives. He undoubtedly understands retail, population-based outcomes and care coordination. If anyone can pull this off, he can.

The DMCBs conclusions?

It wont be easy. While Walgreens we-accept-all-insurance plans-VISA-Mastercard-and-American Express foray into primary care might work, it could also fail. Large health care systems use their primary care providers to feed their high margin and still-profitable specialty care services.  On the other side, small physician-owned practices are learning that hustling, high service standards, attention to overhead, accurate billing, patient mix and ancillaries can be profitable. Walgreens has neither. It remains to be seen whether this publicly owned companys bottom line will be aided by salaried NPs chasing pharmaceuticals narrowing margins.

Speaking of margins, the DMCB wonders if Walgreens will use its clinics to steer patients toward favored formularies or aid rebate and market share agreements. Could they also use and eventually monetize the Big Data like Target to further the companys business interests? If any one knows, please contact the DMCB.

Commoditization?  The DMCB thinks so and its not alone. Over time, the professionals staffing these clinics may find primary care is more complex and that they and their patients deserve better.

Ease of Exit? For who? Given that this is ultimately a business, it would be corporate malfeasance if Walgreens didnt have an exit strategy. Unfortunately, one companys exit could be another patients abandonment. Thats a real risk for the patients who come to count on Walgreens for their longitudinal care.

Patient Centered Medical Home Threat... or Friend?  The DMCB doesnt think so. If the medical home offers the value that its advocates say, savvy health care consumers will be able to vote with their feet. If the PCMH falters, it wont be because of Walgreens; in fact, the threat of competition may force help medical homes be more efficient.  In the meantime, medical homes should treat retail clinics like a community resource and er (or outsource) appropriate patients for routine health care. Why not?

Diabetes And Life Expectancy

According to the CDC, people in the US who were born in 1950 (all races combined) are estimated to live about 68.2 years (men 65.6, women 71.1). People born in 1960 are estimated to live about 69.7 years (men 66.6, women 73.1).
(See CDC: Health, United States 2006, Table 27 for more information.)

Those are averages. The course of your life and the choices you make can affect how long you live. A recent study suggests that having diabetes can shave off quite a few years from those averages.
________
We know that people with diabetes have an increased risk for heart disease and that most will die from a heart attack.

Researchers reporting in the Archives of Internal Medicine last month reinforced this knowledge in their analysis of participants of the Framingham Heart Study.¹ They found that men and women in this population who had diabetes more than doubled their risk for developing cardiovascular disease (CVD).

However, the leading cause of death in this country for all people is heart disease. And these researchers found that both diabetics and nondiabetics live about the same number of years with heart disease.

So, does having diabetes cause people to die any sooner than if they didnt have the disease? These researchers say yes, an average of 8 years sooner:

"Diabetic men and women 50 years and older lived on average 7.5 and 8.2 years less than their nondiabetic equivalents."

Also,

"The differences in life expectancy free of CVD [for diabetic men and women 50 years and older] were 7.8 and 8.4 years, respectively."

This is because people with diabetes get CVD earlier than those without diabetes.

A few more findings (keep in mind that people with diabetes in this group tended to be older than those without diabetes):

• There were more men with diabetes than women.
  
• There were fewer smokers among diabetics. (If smoking increases the risk for developing diabetes, can you speculate why this was found?)
  
• Among those with diabetes, twice as many had a family history of the disease.
  
• Systolic blood pressure was higher among diabetics (149 mm Hg vs. 137 mm Hg).
  
• Body Mass Index (BMI) was higher among diabetics (27.5 vs. 26.0).

The authors concluded, not surprisingly:

"These findings underscore the importance of diabetes prevention for the promotion of health aging."

________¹ Associations Of Diabetes Mellitus With Total Life Expectancy And Life Expectancy With And Without Cardiovascular Disease

Seafood Rich Diet Of Alaska Natives May Reduce Risk Of Diabetes

A new study of Yup’ik Eskimos in Alaska suggests that high intake of omega-3 fats, the type found abundantly in seafood, may protect against obesity-related diseases such as diabetes:

Associations of obesity with triglycerides and C-reactive protein are attenuated in adults with high red blood cell eicosapentaenoic and docosahexaenoic acids, European Journal of Clinical Nutrition, March 2011

Of the 330 people living in the Yukon Delta region of Alaska who took part in the study, 70% were either overweight of obese, yet only about 3.3% had type 2 diabetes, compared to 7.7% for the total US population.

Senior author Alan Kristal, Dr. PH:

"The new finding was that obesity did not increase [risk factors for heart disease and diabetes] among study participants with high blood levels of omega-3 fats.”

Lead author Zeina Makhoul, Ph.D:

“Interestingly, we found that obese persons with high blood levels of omega-3 fats had triglyceride and CRP concentrations that did not differ from those of normal-weight persons.” ... “It appeared that high intakes of omega-3-rich seafood protected Yup’ik Eskimos from some of the harmful effects of obesity.”

This was an epidemiological study. To determine whether it was indeed the omega-3 fatty acids in seafood that protected the Yupik people, or some other genetic or lifestyle factor, a clinical trial is needed. Lead author Makhoul cautioned against taking high doses of supplements based on this research.
________
Results of poll: How often do you eat seafood?


________The study was led by researchers at the Fred Hutchinson Cancer Research Center. Their press release:
Study of Yupik Eskimos suggests high consumption of Omega-3 fats reduces risk of obesity-related disease
Photo of salmon drying outside an Alaskan home by Camille Lieske from The Center for Alaska Native Health Research.

The Important Look AHEAD Action for Health in Diabetes Study No Benefit from Exercise and Weight Loss in Diabetes

Diabetes? Exercise and then die just as soon.

It makes sense, doesnt it? If persons are overweight and have diabetes, diet and exercise-based "prevention" should translate into fewer heart attacks, strokes and deaths, right?

Wrong.

It turns out that a just-published and high quality research study shows its not so simple.  Whats more, the Disease Management Care Blog brazenly suggests that the disease management/population health vendors discovered this years ago.

The just-published study is here in the prestigious New England Journal of Medicine. The DMCB suspects that, thanks to the mainstream medias fixation on Snowden, SCOTUS, and Shakira possibly hawking Obamacare, this important research may not get the front-page attention it deserves.  Considering that it was ten-year, prospective, randomized multi-center academic study involving over 5000 patients, thatd be a shame.

Heres the DMCBs summary:

Eligibility: Participants had to be between 45 and 75 years of age with adequately controlled (A1c less than 11) "type 2" diabetes, an "overweight" body mass index (BMI) of 25 or more, blood pressure less than 160/100, an ability to exercise and access to a primary care provider. 

Recruitment: This went from August of 2001 through April of 2004. It was also tailored to keep insulin-using participants to less than 30% of the study group.

Interventions That Were Compared: Participants were randomly assigned to an "intensive lifestyle intervention" study arm or a "support and education" study arm.  The intensive group received weekly group and individual counseling for six months that subsequently tapered over the subsequent duration of the study. The counseling included a 1200-1800 calorie diet plus 175 minutes of moderate physical activity per week that was aimed at achieving a weight loss of at least 7% of body weight.  The support group got only three group sessions per year. Medicines and their doses were generally left to the primary care provider.

Outcomes Studied: Participants waist circumference, weight, blood pressure, medications and exercise tolerance were assessed once a year. Hospital and other medical records were reviewed to assess the number of deaths and cardiovascular events, such has heart attack or stroke.

The Study Population: 5,124 persons were enrolled; 2570 were randomly assigned to the intensive group while 2575 were assigned to the support group. The average age was 59 years, 60% were women, the median duration of the diabetes diagnosis was 5 years and the average body mass index was a hefty 36. Only 4% were lost to follow-up.

Outcomes:  After a median of 9.6 years of follow-up......

• patients assigned to the intensive group lost approximately three cm. from their waist and six kg. in weight vs. zero cm. and four kg., respectively, in the support group. This translated to a weight loss of 6% of body weight (vs. the target of 7%) in the intensive group vs. about 3.5% in the support group.

• the A1c, which is a test of overall blood sugar control, was about two tenths of a point (7.4% vs. 7.2%) lower (i.e. better) in the intensive group. LDL cholesterol was also lower. Better control of the diabetes meant that the persons in the intensive group were taking fewer medicines at lower doses.

• But it was all for naught.  During the course of the study, there were 403 cardiovascular deaths, non-fatal heart attacks or heart-related ("angina") hospitalizations in the intensive group, vs. 418 in the support group. The calculated rates of 1.8 vs. 1.9 events per 100 person years was too small to be statistically significant and was more likely the result of chance or randomness.

The Disease Management Care Blogs take?

The early painful lesson of the "disease management" industry was that a broad life-style intervention applied to a large group of diabetics was not going to meaningfully improve outcomes. Critics believed that while the interventions were conceptually sound (diet, exercise, weight loss), the delivery was flawed. 

This just published NEJM study would suggest the intervention itself is futile. If so, that is bad news.

"Not so fast!" says the DMCB.

In addition to renaming itself (now "population health"), the industry responded to the science and the critics by retooling.  It learned to channel tailored interventions at population sub-segments who are most likely to experience a specific benefit. Instead of an "intensive" weight loss intervention for all overweight diabetics, population health can use baseline survey, insurance or clinical data to spot (risk stratify) those diabetics who are most likely to achieve a specific benefit that could range from (for example) a sustained 7% weight loss to reduced readmissions.

This NEJM study tried to benefit all diabetics.  A better approach is to find which diabetics will benefit.

As an aside there were some other issues with the study to bring up when debating the study with colleagues and foes:

The BMI of 36 suggests this was a very obese study population that lost only 6% of their body weight during the course of the study.  Since weight was still a health risk at the end of the study, the DMCB wonders if the intervention would have shown more benefit with a less heavy population.

The support group also lost weight and lowered their A1c, which could have obscured the clinically significant benefit in the intervention group. 

This accompanying editorial points out that lower statin and ACE drug use in the intervention group could have paradoxically increased their risk, since these drugs are known to lower the incidence of stroke and heart attack.

The editorial also points out that spin-off studies have already shown that the intervention group benefitted from higher quality of life.

Diabetes in Children A Growing Concern

The Centers for Disease Control and Prevention (CDC) warns that type 2 diabetes is a "growing problem among US children and adolescents," and recommends better physician awareness to combat the problem.

They cite the following markers for diabetes in this age group:

• Between 10 and 19 years old
  
• Obese
  
• Strong family history of type 2 diabetes
  
• Insulin resistance
  
• Poor glycemic control (A1C = 10% to 12%)

A recent study appearing in the August issue of Archives of Pediatrics & Adolescent Medicine found one more predictor - waist size:

"Waist circumference is a predictor of insulin resistance syndrome in children and adolescents and could be included in clinical practice as a simple tool to help identify children at risk."

WebMD features a summary of the study, including examples of risky waist sizes:

• A 5-year-old boy or girl with a waist size of 22 inches or more
  
• A 10-year-old boy with a waist size of 26 inches or more
  
• A 10-year-old girl with a waist size of 25 inches or more
  
• A 15-year-old boy with a waist size of 31 inches or more
  
• A 15-year-old girl with a waist size of 28 inches or more

________
For the study itself (abstract only, subscription required for full article):
Can Waist Circumference Identify Children With the Metabolic Syndrome?

For WebMDs summary:
Kids Waists May Show Pre-Diabetes Problem

For the CDCs fact page on children and diabetes:
Epidemiology of Type 1 and Type 2 Diabetes Mellitus Among North American Children and Adolescents

The Important of sport to prevent diabetes

The Important of sport to prevent diabetes - Research shows, one of the best ways to avoid the risk of diabetes is to always handle the weight, then work out. This can be achieved by conducting regular physical activity as well as undergoing "a healthy diet pattern" which focused on the "fruits and vegetables".

Many people are reluctant to work out on the grounds that busy and there was no spare time. In fact, physical activity is an important means to prevent many serious diseases and conditions health disorders.

Some studies have shown the importance of regular exercise, even the experts still debate how long it an ideal sport to prevent diabetes disease. As a result, recommendations were also wide, ranging from 1 hour, 30 minutes, and 15 minutes.

In fact, recent studies claim, make physical activity a day for 1 minute (eg jogging) can substantially reduce the risk of a serious disease such as diabetes type 2.

Moreover, researchers argue that doing physical activity with the short time span can also help, but also help treat diabetes, although more research is needed on this matter.

In recent research, for example, members of the Department of Health, University of Bath, involving several participants asked to do a sprint cycling two times (20 seconds) for three times a week. The experiment lasted for six weeks. After that, the scientists did some physical measurements and tests. This research result shows that an increase in insulin function participants 28 percent on average.

Researchers say this is not the first findings that show positive effects from short-term physical activity to increase insulin function and blood sugar levels. In principle, regular physical exercise with the proper amount proved to be the best way to prevent type 2 diabetes and keep blood sugar low.

However, factors such as lifestyle, habits, bad habits, poor motivation, and they often become barriers busy and contributing greatly to the lack of physical activity most of us.

Tea drinkers Rare Diabetes Reduce diabetes ridk

Tea drinkers Rare Diabetes | Tea drinkers can avoid type 2 diabetes, is certainly the best news for tea lovers. This is the latest research results. However, this can happen when we drink four cups of tea a day.

A study of populations in Europe found that the countries who drank four cups of tea a day - the average community in the UK - have a risk 20 percent lower risk of type 2 diabetes.

Researchers said the benefits of drinking tea seems most evident among drinkers of 4 or more cups of tea a day. While those who drank one to three cups a day does not have a reduced risk of diabetes.

The research team led by Christian Herder of the Leibniz Center for Diabetes Research at Heinrich Heine University Duesseldorf, Germany, said previous research shows tea consumption was associated with a lower incidence of type 2 diabetes.

"Obesity is a major risk factor for developing type 2 diabetes, but dietary factors may also play a role. One interesting factor is the consumption of diet tea. Tea consumption may lower risk of type 2 diabetes affect the digestion of glucose, glucose absorption, and to protect the beta cells from free radical damage. this beneficial effect may be caused by the content of polyphenols in tea, "said Herder.

"Drink at least four cups of tea per day was associated with a 20 percent lower risk, while drinking one to three cups per day did not lower the risk of diabetes compared with non-tea drinkers," he added.

Herder said, it is not certain whether the amount of tea intake influences. Therefore, he examined the association between tea consumption and the number of cases of type 2 diabetes in European populations.

Research was conducted at 26 centers in eight European countries, and consists of 12 403 incident cases of type 2 diabetes plus thousands of other volunteers who do not have the disease.

"Improving our understanding of lifestyle modification associated with the development of type 2 diabetes become very important because the prevalence of diabetes continues to increase rapidly."

"In line with these findings, no association of tea consumption when studied as a continuous variable. This may indicate that the protective effect of tea was limited to those who consumed the highest amounts of tea," he said.

7 Ways To Preventing Diabetes

Though incurable, diabetes mellitus type 2 can be prevented easily. The disease is caused by an unhealthy lifestyle. Therefore, adopting a healthy lifestyle will be able to minimize the risk of contracting diabetes.

Diabetes can be prevented by adopting a healthy lifestyle because it can basically be prevented. Regular exercise and eat less high-calorie foods will help ward off diabetes.

There are many ways to prevent or minimize the risk of diabetes. Variety of ways, among others;

1. Regular exercise
Regular exercise can help increase the bodys sensitivity to insulin which helps maintain blood sugar levels within a normal range. With exercise, the body use insulin more efficiently to 70 hours afterward.

Exercising 3-4 times a week for 20-40 minutes will be very beneficial ward off diabetes. In addition, aerobic exercise and fitness can also maintain ideal weight remains.

2. Maintain ideal body weight in order to stay
Most people with diabetes are overweight or obese. Excess body weight and body fat may increase the risk of developing diabetes.

3. Do not overeat (overnutrition)
Excessive nutrients are the major risk factors that can lead to diabetes. The more excess nutrients, the greater the chances of developing diabetes. Balance your food intake with emphasis on eating fruits and vegetables.

4. Avoid stress
When stressed, the body will secrete the stress hormone cortisol. These hormones increase heart rate and sends glucose into the blood to be converted into energy for muscles. Most importantly, stress will make people eat a lot. In the end, it can lead to obesity at risk of diabetes.

5. Get enough rest and sleep
Rest and sleep is basically a mechanism to detoxify the body. In addition, it is also powerful enough rest to relieve stress.

6. Avoid pollution
Air pollution contains many free radicals that are harmful to the body. The presence of free radicals can worsen cell function, and trigger diabetes and blood vessel damage. One study found that pollution can trigger insulin resistance and increased levels of fat in the abdomen and internal organs.

7. Perform health checks
The young age of about 25 years is usually the period from the development of diabetes. Therefore, blood sugar levels should be checked once a month, especially for people who are at risk and have a family history of diabetes.

Diabetes Diet Nutrition and Herbal Treatment That Works

Diabetes or diabetes mellitus is a disease tormenting many these days. The advent of modern technology and craze for high profile life style is the root of several serious ailments including diabetes. The patient suffering from diabetes has an increased glucose level in blood. Our food intake supplies us with carbohydrates which get converted in to glucose. The hormone insulin secreted by pancreas breaks down the glucose and aids the metabolic process by making the glucose enter in to body cells and energizing the body as a whole.
When the cells of the pancreas become incapable of producing sufficient insulin or when body cells become resistant to insulin, glucose collects in blood and soon the level shoots up resulting in diabetes. There are three major types of diabetes: Type1, Type2 and Gestational diabetes. Type1 diabetes occurs when the amount of insulin produced by pancreas falls short of the bodys requirement of insulin. Type2 diabetes occurs when body cells become non-responsive to insulin or do not take in insulin in the amount they should have taken in.

Gestational diabetes is the result of pregnancy. Glucose levels in blood rise during pregnancy in some women. Heredity, obesity, stress, over-intake of carbohydrates, nutritional deficiencies, and any other disease causing damage to pancreas are diabetes-triggering factors. Diabetes needs timely diagnosis and treatment, or else it may cause serious damage to heart, kidney, eyes, liver and nervous system.

Symptoms

1. Frequent urination
2. Increased hunger
3. Increased thirst
4. Fatigue
5. Loss of weight
6. Blurry vision
7. Palpitation
8. Constipation
9. Yellowish urine with a sweet acidic odor
10. Itching around genitals

Herbal treatment for diabetes

Nature gives us a wide range of herbs that may be used to treat diabetes the natural ways. Some of the herbs may be listed as follows.

1. Onion and garlic have excellent sugar-reducing properties.

2. Bitter melon or balsam pear juice supplies the body with insulin like polypeptide-p and thereby lowers blood sugar.

3. Fenugreek seeds, rich in nicotinic acids and alkaloid trigoneline, prove very effective in treating diabetes.

4. The holy basil is a highly beneficial herb in treating diabetes.

5. Ivy gourd leaf extracts are quite effective in treating retinal disorders due to diabetes.

6. Fully grown curry leaves are an effective cure for congenital diabetes and obesity.

7. Indian gooseberry juice is a pancreas stimulating drink. It stimulates the pancreas to produce more insulin.

8. Butea leaf extracts are useful in lowering sugar levels in blood.

9. Cinnamon is an effective herb for managing diabetes.

10. Powdered, dry mango leaves may be taken in empty stomach for controlling diabetes.

11. Indian plum seeds regulate the metabolic process and also stimulate pancreas.

Article by : Dr Andrew Napier

Article Source : Diabetes Diet, Nutrition and Herbal Treatment That Works

White Rice Increases Risk of Diabetes

White Rice Increases Risk of Diabetes | Diabetes epidemic in several Asian countries allegedly have anything to do with the habits of Asian people eating white rice. Research on this team of researchers from Harvard School of Public Health.

"We found was: white rice increased risk of type two diabetes, especially in populations of white rice consumption is quite high as in Asia. But instead of white rice just to watch, but the overall diet," said Qi Sun, researchers.

Respondents research in Asian countries on average consume white rice 3-4 times a day, while those in Western countries only consume one to two times a week.

White rice is a type of rice most widely consumed in the world. Aside from being a source of energy and protein, rice also contains minerals. But the process on white rice causes most of the minerals and fiber are also wasted.

Meanwhile, the opposite is red rice. It contains more fiber, magnesium and vitamins. Rice also has a low glycemic index so it does not quickly raise blood sugar levels.

A lack of research conducted Sun is not available details on what data is consumed by respondents in addition to rice. Even so Sun says there is consistency of the four studies.

Diabetes mellitus currently affects about 350 people around the world as well. A diet is just one of the factors triggering the disease caused by the bodys inability to process the hormone insulin. Lack of exercise and obesity is also a risk factor for this disease.

To ensure that diabetes or Diabetes Mellitus

Health for human | To ensure that diabetes or diabetes mellitus that is the presence of symptoms of diabetes include frequent urination, drinking lots, lots of eating, and was followed by decreased body weight and blood sugar in check when / without fasting is> 200 mg% or it could be the onset of symptoms such as itching, tingling, blurry eyes, wounds difficult to heal, the body feel sluggish but accompanied with fasting blood sugar> 126 mg% and blood sugar 2 hours after eating> 200 mg%.

For example this guy after checking the sugar content is still within normal limits, mean there are other causes that make frequent urination, other possible causes are the most common urinary tract infections, may also occur diuretics or hormonal disorders referred to as Diabetes Incipidus, and other causes are muscle-bladder muscle buffer that has begun to weaken.

If after checking the result was fasting blood sugar 220 mg%, most likely this man was hit by diabetes. And what is the treatment?

Treatment of diabetes is quite complex because it includes meal planning, regular exercise, and medication regularly.
In the pancreas gland function was good or just a mild disorder, it could just do a treatment with diit tight, but this must be followed by regular blood sugar checks for memonitoringnya. Because if this diit off guard just a little blood sugar can rise again.

To monitor blood sugar levels is best is by examination of HbA1c every 3 months, due to the high level of accuracy. Regarding the fruit be eaten is not too sweet fruit such as papaya, tomato, melon, pear, barking, watermelon, banana and so on.

Diabetes Drugs Safe to Use But

Diabetes Drugs Safe to Use, But ....

When patients with diabetes have set meals and doing enough exercise, but blood sugar is still not under control, it would require the help of drugs to increase insulin secretion or reduce insulin resistance.

There are a variety of diabetes medications, either oral or injection. At oral medication usually begins with a relatively small dose and then increased gradually if necessary.

As with other drugs that are not free from side effects, as well as for diabetes medication. These side effects can occur if the drug is given too much or individual reaction. Some recent studies even indicate a link between diabetes drug to increased risk of cancer.

"All drugs have side effects. Therefore, after the drug was released, there is the so-called post surveillance," said Dr. Ronald Hukom Sp.PD-KHOM, internal medicine physicians who are also experts in the cancer field when asked for his opinion on the use of diabetes medications that can trigger cancer.

Ronald says, post surveillance is defined as supervision of medication that has been widely circulated and approved by the competent authority, to be seen how far the side effects that may result from the drug in the long term. In Indonesia, surveillance is conducted in a rigorous and documented by the Food and Drug Supervisory Agency (BPOM).

Ronald rate, people do not have to worry related to the findings that suggest the risk of the use of diabetes medications such as metformin, insulin and sulfonylureas on the development of pancreatic cancer. Because according to him, as long as can keep the dose and handled by an expert, the drug would not be harmful.

"Drugs are good for diabetes drugs metformin and cheap. Proof is not an attractive drug regulatory authorities and refer to this dangerous drug," said the doctor who practiced daily in Dharmais Cancer Hospital Jakarta.

Even though there are side effects, but if the risk is much smaller than the benefits it does not need to worry about.

"No need to worry about being watched and used along with the correct dose,"

he added.

Ronald also recommended that any physician providing information to patients about drug side effects that may result if used in a long time. This is so that patients can also use it with reasonable limits.

"If you are still worried, consult your doctor who gave drugs. Because the side effects of drugs on each person is different," he explained.

According to Ronald, each drug has harmful side effects if in its consumer does not follow procedures. He took the example of the use of chemotherapy drugs. Chemotherapy drugs can be categorized as a dangerous drug because it can cause cancer.

"That is, after several years of chemotherapy drugs a person can get cancer. But with the proper dose and appropriate, it will not harm," he said.

Meanwhile, Dr. Rianto Setiabudy, SpFK (K), Professor of the Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Indonesia said, bardasarkan existing literature, he never found any data showing that the use of diabetes drugs trigger dangerous side effects.

"We have here the POM. If something is harmful to society, POM must act," he said.

But according to Riyanto, these drugs may still be dangerous if taken alone in its use (self medicine) - without consulting your doctor.

"Its not my intention to send someone to the doctor. But diabetes drugs that includes prescription drugs. If used without supervision it can be dangerous," he said

He also called for the public to avoid the habit of treating the disease itself. "If a mild disease may not be anything. But if such as diabetes, hypertension and heart, they should see a doctor," added Riyanto.