Johns Hopkins Health Alerts - Diabetes

Treating Type 2 Diabetes With Lap-Band Surgery

Thu, 14 Jan 2010 06:00:00 CST

If you are obese and have diabetes, losing weight can help improve your blood glucose control and lower your risk of diabetic complications. A recent report suggests that bariatric surgery may help those patients with diabetes who have not been able to lose weight through diet and exercise.

Bariatric surgery for the treatment of obesity is a tempting option for some people with type 2 diabetes, since weight control is crucial for managing diabetes. Now, the first formal study of its kind suggests that laparoscopic adjustable gastric banding (lap-band) surgery may be effective for certain patients with diabetes. The study was reported in the Journal of the American Medical Association (Volume 299, page 341).

Australian researchers randomized 60 obese participants (body mass index [BMI] between 30 and 40) recently diagnosed with type 2 diabetes to either a conventional weight loss plan of diet, exercise, and medication or lap-band surgery, which helps control appetite by slowing the passage of food through the gastrointestinal tract.

After two years, diabetes remission was achieved in 73% of the lap-band participants compared with 13% of those in the conventional weight loss group. Average weight loss was 21% in the surgery group versus less than 2% in the conventional weight loss group.

It's worth noting that all of the subjects had relatively mild cases of diabetes, so it's still not clear whether obesity surgery is effective for people with advanced diabetes. The American Diabetes Association does not yet emphasize bariatric surgery as a major treatment option for type 2 diabetes, but that opinion may change with more results like this.

Is Diabetes in Your Genes?

Thu, 25 Feb 2010 06:00:00 CST

Approximately 24 million people in the United States have diabetes. In fact, in the United States, nearly 10% of adults age 20 and older have diabetes. And a large number -- more than 10 million -- are age 60 or older. If you’re in this huge group, you may wonder if you inherited your diabetes. Here’s the answer, in brief.

Scientists are still sorting out how heredity influences the risk of diabetes, but there is no doubt that the genes we receive from our parents play a vital role. It's important to keep in mind, though, that inheriting a given gene or set of genes does not guarantee you will develop diabetes. Instead, certain genes increase the susceptibility for developing the disease. And environment -- your eating habits, activity levels, stress, etc. -- also plays a significant role.

Genes are units of biochemical information found in the nucleus of every cell that dictate how the body appears and functions. Scientists have discovered that "variations" in certain genes seem to increase the risk of many diseases, including both major forms of diabetes. For instance, studies show that people with type 1 diabetes tend to have variations in genes that carry the code for producing immune system proteins. Variations in a number of genes appear to increase the risk of type 2 diabetes.

However, genes alone do not cause diabetes in most cases. Something in the environment must "trigger" onset of the disease in people whose genes make them susceptible. While several theories attempt to explain what triggers type 1 diabetes, most evidence suggests that a high-fat Western diet and lack of exercise interacts with a person's genes to cause type 2 diabetes.

Preventing Hypo- or Hyperglycemia During Exercise

Thu, 24 Dec 2009 06:00:00 CST

Everyone knows that regular physical activity is essential for good health, and research continues to prove that's especially true if you have diabetes. An analysis of more than 100 studies involving nearly 10,500 participants found that individuals with diabetes who were physically active had lower HbA1c levels (the hemoglobin A1c test is used to assess blood glucose control of the previous two or three months) than those who did not exercise.

If you have diabetes and take insulin or oral medication, you need to protect against hypoglycemia (low glucose levels) while exercising. A less common problem is hyperglycemia (high blood glucose) that may occur immediately after exercise.

Here's how to avoid the lows:

Check your blood glucose level beforehand. If your glucose is between 100 and 130 mg/dL and you have type 2 diabetes, it is safe to begin exercising. If glucose is lower than 100 mg/dL, have a carbohydrate snack such as a piece of fruit or three graham crackers before starting. Do not exercise if your blood glucose levels are 300 mg/dL or higher.

Always have a source of fast-acting carbohydrate (such as glucose tablets or hard candies) with you when exercising.

If you experience any symptoms of hypoglycemia (such as faintness, palpitations, or weakness), test your blood glucose levels immediately and have a snack if necessary.

Since blood glucose levels can drop hours after exercise, test your levels immediately after exercise and again a few hours later.

As for hyperglycemia, people who take insulin -- especially those with type 1 diabetes -- are often surprised to find that their glucose level actually rises after exercise. Almost always, this happens when the exercise is very vigorous. It is considered to be due to an "adrenaline rush" that occurs with extreme exercise. It, too, can be followed some hours later by a blood glucose drop (hypoglycemia).

Putting Portion Control to the Test

Thu, 01 Oct 2009 06:00:00 CDT

Eat fewer calories than you burn and you will lose weight. Sounds simple, but for many people – especially those with diabetes – it is a difficult challenge. Now research in the Archives of Internal Medicine suggests that portion control can help.

Everyone knows that cutting calories and losing weight require you to reduce how much you eat -- which means downsizing your portions. A recent study shows that controlling portions may be particularly helpful for individuals with diabetes who take insulin and often find it difficult to lose weight.

In a study from the Archives of Internal Medicine, Canadian researchers randomized 130 obese participants with type 2 diabetes, including 55 people taking insulin, either to use a portion-control plate for meals or to obtain usual care in the form of dietary teaching. The plate allowed for an 800-calorie meal for men with diabetes and a 650-calorie meal for women with diabetes.

After six months, individuals with diabetes who controlled portions lost an average of 1.8% of their body weight compared with those in usual care who lost an average of 0.1%. Among those taking insulin, those in the intervention group lost 2.6% of their body weight compared with 0.1% in the control group.

More portion controllers lost a significant amount of weight; almost 17% lost at least 5% of their body weight while only 4.6% of controls did. And 26% of the intervention group were able to decrease their use of glucose-lowering medications compared with 11% in the usual-care group.

Nutritionists point out that special plates and bowls, which are commercially available, can be helpful in controlling calories since people's idea of an average portion size has increased radically over the years. Studies have shown that the more that people have on their plate, the more they will eat -- so serving smaller meals on smaller dishes may help you cut back.

Should You Take Avandia for Diabetic Retinopathy?

Thu, 03 Dec 2009 06:00:00 CST

If you have diabetic retinopathy, what can you do to slow its progression? Of course, tight blood glucose control lessens the risk that retinopathy will get worse. And treating other conditions, such as high blood pressure and abnormal cholesterol levels, may also slow progression. What about Avandia? A reader asks: I’ve heard that the diabetes medication Avandia can slow the progression of diabetic retinopathy. Should everyone with this condition be taking it?

Johns Hopkins answers: Not necessarily. Rosiglitazone (Avandia) is currently prescribed to control high blood sugar in people with type 2 diabetes. Recently, a study in the Archives of Ophthalmology reported that it may also inhibit the growth of new blood vessels in the eye, delaying the onset of a more advanced stage of diabetic retinopathy known as proliferative diabetic retinopathy (PDR).

Researchers reviewed the medical records of 282 people with diabetes. This included 124 people treated with Avandia and 158 who were not. A total of 38 people were at significant risk of progression to PDR. Both groups were followed for an average of three years. Among the high-risk group, those who took Avandia had a 60% lower risk of PDR than those who didn’t take it. Also, fewer people in the Avandia group had a loss of three or more lines on a standard vision chart.

The news isn’t all good, however. The FDA now requires Avandia to carry a label warning that it has been shown to increase the risks of heart attack and heart failure.

The bottom line: It’s premature to recommend taking Avandia to prevent the progression of diabetic retinopathy. There are many other effective oral medications for type 2 diabetes. For now, if your condition is under control while using another medication, there’s no reason to switch -- even if you have diabetic retinopathy.

New Approach to Slow Diabetic Kidney Disease

Thu, 12 Nov 2009 06:00:00 CST

A study reported in The New England Journal of Medicine (volume 358, page 2433) sheds light on a promising new approach that is effective for treating diabetic nephropathy (kidney disease) -- a complication of long-term diabetes.

About 30 to 40% of people with type 1 diabetes and 20% of those with type 2 diabetes eventually develop some kidney damage, though by no means do all of them go on to kidney failure. The damage occurs in tiny blood vessels throughout the kidneys, which act as filters to remove waste products from the bloodstream.

High blood pressure (hypertension) worsens kidney disease (nephropathy), so controlling hypertension is an essential part of managing diabetic nephropathy. For many people, existing antihypertensive drugs fail to slow kidney damage, but the new drug aliskiren (Tekturna) may offer much-needed additional protection.

Researchers randomized a group of 599 people with diabetes, hypertension, and kidney disease: Half took 150 mg of Tekturna daily for three months, then 300 mg a day for the next three months; the other half received placebos. All took the antihypertensive drug losartan (Cozaar) in addition to drugs to lower blood pressure.

Participants taking Tekturna had reduced proteinuria (loss of protein in the urine) -- a sign of failing kidneys -- by 20%, on average. In addition, almost 25% of the Tekturna takers had a 50% reduction in protein loss in urine, compared with 13% of the placebo group. Little difference in blood pressure was seen between the two groups.

Many common antihypertensive drugs work by interfering with angiotensin, a chemical that raises blood pressure by constricting blood vessels. Tekturna also blocks renin, the enzyme that produces angiotensin.

Why You Should Consider Insulin Therapy For Type 2 Diabetes

Thu, 10 Sep 2009 06:00:00 CDT

Approximately 40% of people with type 2 diabetes eventually require some type of insulin treatment to control their blood glucose, either because their diabetes gets worse or it no longer responds to oral drugs. But now a study in The Lancet suggests that starting insulin early may do more than just control diabetes – it may induce remission in type 2 diabetes.

People with type 2 diabetes typically do not take insulin until they can no longer control blood glucose levels with lifestyle changes and oral medications. However, several studies have shown that early use of insulin by those newly diagnosed with type 2 diabetes may induce a "remission" of the disease that can last for a year or more.

A study reported in The Lancet (volume 371, page 1753) suggests why. Researchers randomized 382 newly diagnosed people with type 2 diabetes into three groups: One received multiple daily insulin injections, the second used insulin pumps (which provide a continuous infusion), and a third was given intensive treatment with oral medications. The aim was to achieve rapid glycemic control in all groups.

A year later, just 27% of participants taking oral medications were in remission, compared with 45% injecting insulin and 51% who used insulin pumps. Remission was defined as the ability to maintain normal glucose levels with diet alone. More participants taking insulin achieved blood glucose control than those on oral medications and in less time, too.

Insulin may confer benefits in addition to glucose lowering that promote remission, such as reducing inflammation and improving the function of beta cells that produce insulin. Importantly, treating type 2 diabetes early with aggressive insulin therapy may slow and even prevent the onset of complications.

Meet the Diabetes Nurse Educator

Thu, 20 Aug 2009 06:00:00 CDT

If you have diabetes, you probably rely on your endocrinologist or primary care physician for the basics of your treatment plan, including diet and medications. Increasingly, however, the day-to-day management of diabetes falls to a diabetes nurse educator, a person with a Certified Diabetes Educator (CDE) credential. In this Health Alert, Johns Hopkins explains the role of the nurse educator.

People with diabetes must assume a great deal of responsibility for their own care. At times, learning how to manage diabetes may seem daunting -- as though there should be a school for it. That's why a diabetes educator can be an invaluable resource.

Diabetes educators are healthcare professionals who work closely with individuals to help them understand how to control their diabetes and lower the risk of complications. They teach everything from explaining the role of healthy eating and exercise to instructing people on how to monitor blood glucose and inject insulin.

Diabetes educators may work with people individually or in groups. Doctors and nurses may serve as diabetes educators, but trained professionals from a variety of fields also fill the role, including dietitians, pharmacists, exercise physiologists, and others.

There are about 15,000 certified diabetes educators in the United States, according to the American Association of Diabetes Educators. Studies show that patients who work with diabetes educators have lower HbA1c levels (a test used to assess blood glucose control over the previous two to three months) than those who do not. What's more, a recent study found that people with diabetes who attend at least one educational session may reduce their chances of being hospitalized by up to 34%. Your doctor can refer you to a diabetes educator in your community.

Diagnosing Diabetes with the HbA1c Blood Test

Thu, 30 Jul 2009 06:00:00 CDT

Type 2 diabetes usually develops gradually over many years and the initial symptoms may be almost unnoticeable. In fact, many people find out that they have type 2 diabetes when a routine laboratory test shows high blood glucose levels. Increasingly endocrinologists are using the hemoglobin A1c (HbA1c) test -- which is now used to monitor glucose control in existing patients -- to diagnose diabetes.

If you have any of the common symptoms that suggest the presence of diabetes, your doctor can order a blood glucose test to confirm or rule out the diagnosis. Three blood tests commonly used to diagnose prediabetes and diabetes:

casual plasma (blood) glucose

fasting plasma glucose (FPG)

oral glucose tolerance test (OGTT)

About six million people with diabetes in the United States don't know they have diabetes, and up to one quarter of U.S. people with diabetes have evidence of serious complications by the time they are diagnosed. That's why a panel of experts -- including Dr. Christopher D. Saudek, the author of The Johns Hopkins Diabetes White Paper -- convened to consider whether the HbA1c test would be a more effective tool for screening for and diagnosing diabetes. The HbA1c test measures the amount of glucose attached to hemoglobin. The test is routinely used to assess blood glucose control over the previous two to three months.

The current tests used for the diagnosis of diabetes -- FPG and OGTT -- have flaws. They must be administered when a person has fasted for at least eight hours, which is often a deterrent. And their results may not be entirely accurate, improving with short-term lifestyle changes such as when a person eats healthier and exercises in the days prior to the test.

An HbA1c test, by contrast, can be administered at any time and offers a long-term view of an individual's glucose control. With these and other factors in mind, the panel recommended using an HbA1c cutoff of 6.5% as a screening test for diabetes and suggested follow-up tests to confirm the diagnosis of diabetes. These recommendations await consideration by major medical associations, but one day they may allow many people to become diagnosed sooner. Reported in the Journal of Clinical Endocrinology and Metabolism (Volume 93, page 2447).

Clues to the Cause of Type 1 Diabetes

Thu, 18 Jun 2009 06:00:00 CDT

Why do some people get type 1 diabetes? Researchers are still trying to figure it out. It's possible that combined genetic susceptibility and an environmental trigger -- perhaps a virus -- may cause this serious autoimmune disease.

When our bodies are humming along smoothly, we rarely think about all the complex processes that are going on. But when we don't feel well and we're unable to perform our usual activities, we want to know what's causing the problem and how it can be fixed. Type 1 diabetes is an autoimmune disease. Something triggers the body to mount an immune system attack against itself, in the same way the immune system normally attacks harmful bacteria and viruses.

In type 1 diabetes, the immune system produces antibodies that attack and destroy the insulin-secreting beta cells in the pancreas. As the number of beta cells decreases, the amount of insulin that is produced decreases as well. Fortunately, the immune system attack doesn't affect the body's ability to respond to insulin. That's why people with type 1 diabetes can compensate for the lack of insulin production by injecting insulin.

The cause of type 1 diabetes remains poorly understood, but a recent study reported in the journal Diadabetologia (volume 49, page 900) lends support to one leading theory. Some experts speculate that infections trigger type 1 diabetes in people who are genetically susceptible to diabetes. They believe that exposure to certain viruses may cause the immune system to mistakenly attack the pancreas and to destroy cells that produce insulin. If that's true, then outbreaks of viral infections within a community would likely cause "clusters" of new type 1 diabetes patients -- that is, an unusually large number of new diabetes diagnoses that arise over a brief period.

In the largest study of its kind to date, a group of British researchers examined the medical histories of more than 4,000 people under age 30 who were diagnosed with type 1 diabetes in Yorkshire, United Kingdom, between 1978 and 2002. The team discovered that new cases of type 1 diabetes often occurred in bunches, within confined sections of Yorkshire, specifically among youths ages 10-19. The study's findings suggest that something in the environment that people encounter on an irregular basis -- such as a virus -- may be more likely to cause type 1 diabetes than a more consistent environmental factor such as diet.

Why Is My Blood Glucose High?

Thu, 28 May 2009 06:00:00 CDT

Keeping blood glucose levels within normal range can be a frustrating challenge for someone with diabetes. Many patients wonder: Why do my blood glucose levels sometimes go up for seemingly no reason? Here are some insights from Johns Hopkins.

Blood glucose levels naturally fluctuate, so don't get exceptionally worried if they go up for no apparent reason -- we can never explain every rise and fall. But when looking for the culprit, food and drink are an obvious starting point. "Harmless" energy drinks, for instance, often have more sugar or caffeine than you realize and can cause a spike in blood glucose. Bagels, which contain 60 g or even 90 g of carbohydrate, are a well-known offender. Stress or an illness can also provoke a temporary jump, and a cortisone injection (into a knee or shoulder, for instance) will predictably raise blood glucose a lot.

Your average blood glucose level (HbA1c) is the best indication of how well you are managing your diabetes over time. That doesn't mean you shouldn't monitor your blood glucose levels at various points in the day. Finger-stick tests can give an early indication that your glucose is rising faster than it should.

The HbA1c test measures the amount of glucose attached to hemoglobin -- the oxygen-carrying protein in red blood cells that gives blood its color. As blood glucose levels rise, so does the amount of glucose attached to hemoglobin. Since hemoglobin circulates in the blood until the red blood cells die (half of red blood cells are replaced every 120 days), the HbA1c test measures average blood glucose levels over the previous two to three months.

The American Diabetes Association recommends keeping your HbA1c levels at less than 7%, which is equivalent to an average blood glucose level of about 170 mg/dL or less. Your doctor may give you a different level to aim for, depending on your age, weight, and other factors. HbA1c tests are usually performed every three months to see if you are maintaining your blood glucose within the target range. If you have stable blood glucose levels and are meeting your treatment goals, you may need less frequent HbA1c testing.

Bottom line: Keep in mind that blood glucose naturally goes up and down, and sometimes the fluctuations are unpredictable. No matter how hard you try, your levels will not be normal every time you test. As long as they don't stay too high, you should be in good shape.

I Have Diabetes … Should I Take a Statin?

Thu, 07 May 2009 06:00:00 CDT

A reader writes: I've read that because I have type 2 diabetes, I should take a statin medication even though my cholesterol levels are normal. Is this true? Here's the answer from Dr. Christopher D. Saudek and colleagues at the Johns Hopkins University School of Medicine.

Dr. Saudek: That depends on what you mean by "normal" and on your own individual risk. Type 2 diabetes is itself a major risk factor for coronary heart disease (CHD). In fact, recent research has shown that people with type 2 diabetes without a history of CHD have as much risk for heart attack as people without diabetes but with CHD. Reducing this risk is perhaps the most important thing you can do to improve your longevity.

If your LDL cholesterol is not at the target of less than 100 mg/dL (or less than 70 mg/dL if you have had a heart attack), the American Diabetes Association recommends treat- ment with a statin drug. Several large studies have shown a significant reduction in heart attacks and strokes in people with diabetes who took statin drugs to lower their LDL cholesterol. Six statins are available: atorvastatin (Lipitor); fluvastatin (Lescol); lovastatin (Mevacor); pravastatin (Pravachol); rosuvastatin (Crestor); and simvastatin (Zocor).

The American Diabetes Association recommends niacin (nicotinic acid) for people with diabetes who have low levels of HDL cholesterol (less than 40 mg/dL in men or 50 mg/dL in women) and fibrate drugs (Lopid, Lofibra, Tricor) for elevated levels of triglycerides (more than 200 mg/dL). Since niacin can increase blood glucose levels, your diabetes doctor will monitor you while you are using the drug.

Any drug has potential downsides and for statins, the most common side effects are muscle aches, diarrhea, and upset stomach. Be sure to discuss with your doctor whether statin therapy is the best treatment decision for you.

Keeping Tabs on Your Glucose 24-7

Thu, 16 Apr 2009 06:00:00 CDT

Several high-tech devices can monitor glucose levels 24 hours a day rather than at just one point in time, giving you unprecedented information on how well you are managing your diabetes. Most useful to avoid hypoglycemic episodes in those whose diabetes requires insulin, continuous monitoring can benefit all individuals with either type 1 or type 2 diabetes. But is a continuous glucose monitor really right for you? Here's information to help you decide.

Continuous glucose monitors can enable you to spot general trends in how well you are controlling your blood glucose, recognize whether it is on its way up or down, and help determine adjustments in your treatment. Better yet, the new sensors even include alarms that can warn you if your blood glucose is too low or too high. Such continuous glucose monitoring has been compared to having your own security camera rather than just occasional snapshots of your home. Whereas traditional finger-prick blood tests give a snapshot of your blood sugar levels, continuous glucose monitors track fluctuations continuously over several days.

Six continuous glucose monitors are approved by the U.S. Food and Drug Administration (FDA): CGMS System Gold, Guardian REAL-time System, Guardian RT, MiniMed Paradigm REAL-Time System (all from Medtronic), DexCom STS, and The Abbott FreeStyle Navigator.

All of the devices use a tiny, flexible sensor that is inserted via a needle under the skin of your abdomen to measure blood glucose levels in the fluid outside of cells (extracellular fluid). The sensor connects to a transmitter that is attached to the skin by an adhesive patch; the transmitter sends real-time data every one to five minutes to a pager-sized receiver with a visible display that attaches to your belt or the waistline of your pants.

The amount of glucose in the extracellular fluid reflects the level in your bloodstream, although there is a lag time of 20-30 minutes before changes in blood glucose are reflected in the extracellular fluid. The readings can be downloaded later to a computer to produce charts that show the average trends of a person's glucose levels over three days. As with other home glucose tests, all continuous glucose monitors must be calibrated with a finger-prick blood test and checked to make sure they are working properly.

Unfortunately, continuous monitors are costly and health insurance coverage is presently a real problem. The few successes in obtaining coverage have required strong advocacy by the prescribing physician. You will definitely need a doctor's prescription and a strong letter of medical necessity before you can expect coverage. So carefully consider the cost not only of the device, which can run in the thousands, but also of the disposable supplies. The sensors may cost about $35 a day, which is a big expense over the course of a year.

Our recommendation: At the moment, we consider continuous monitoring most useful for people who have had severe swings in their blood glucose despite good self-care patterns and, especially, for those who have been troubled by severe hypoglycemia. We are aware that insurance coverage is still spotty but hope that it will improve.

Advice to Help You Avoid Diabetic Retinopathy

Thu, 05 Mar 2009 06:00:00 CST

Diabetic retinopathy usually has no symptoms, so if you have diabetes it’s important to follow these five steps to protect against retinopathy or slow its progression.

Diabetic retinopathy, a potential long-term complication of diabetes, is an eye disorder caused by damage to blood vessels in the retina, the light-sensitive tissue at the back of the eye. Mild forms of the disorder are common: Almost all people with type 1 diabetes and more than 70% of people with type 2 diabetes will experience some degree of retinopathy. Without treatment, diabetic retinopathy can progress from mild, nonproliferative retinopathy to more serious proliferative retinopathy, which can lead to blindness.

What can you do? People with diabetes can take these steps to help reduce their risk of developing retinopathy or having their retinopathy progress.

Retinopathy Tip 1: Have Regular Eye Exams. Regular visits to an ophthalmologist are essential to detect early retinal damage so it can be monitored and, if necessary, treated with laser therapy. An annual eye exam is recommended for people who have had type 1 diabetes for more than five years. Everyone with type 2 diabetes should have an eye exam as soon as diabetes is diagnosed, and annually thereafter.

Retinopathy Tip 2: Control Blood Glucose. The most important way to prevent diabetic retinopathy is to keep blood glucose levels as close to normal as possible. This is because high blood glucose levels can damage blood vessels in the retina. The best way to achieve tight glucose control and reduce your risk of developing diabetic retinopathy is to measure your blood glucose levels frequently with a glucose monitor and to follow the advice of a doctor who manages diabetes aggressively. It is also important to have a hemoglobin A1c (HbA1c) test every three to six months to evaluate your blood glucose control. Experts recommend that people with diabetes maintain an HbA1c level below 7%. Studies have found that every 10% reduction in elevated HbA1c levels is associated with a 39% reduction in the risk of diabetic retinopathy.

Retinopathy Tip 3: Control Blood Pressure. High blood pressure can also damage blood vessels in the retina and cause retinopathy. Research shows that keeping blood pressure as close to normal as possible can help prevent the onset and progression of retinal damage. Experts recommend that people with diabetes keep their blood pressure at or below 130/80 mm Hg to prevent long-term complications.

Retinopathy Tip 4: Control Cholesterol Levels. Studies have reached conflicting conclusions as to whether high blood cholesterol is associated with the development or progression of diabetic retinopathy. However, lowering blood cholesterol levels is already a priority for people with diabetes because of their increased risk of heart attack and stroke, and preserving vision may be an added benefit of taking steps to lower cholesterol.

Retinopathy Tip 5: Stop Smoking. Some -- but not all -- studies find that smoking cigarettes is a risk factor for diabetic retinopathy. Even if there is no direct link, the blood pressure-raising effect of smoking can increase the risk of retinopathy.

Recognize the Warning Signs of Retinopathy: Diabetic retinopathy usually has no symptoms. However, any of the following visual changes could indicate retinal damage, and you should contact your eye doctor immediately if you experience any of them:

sudden loss of vision in one eye

blurred vision

problems reading

double vision

pain in one or both eyes

pressure in your eyes

the appearance of spots or floaters

problems seeing things with your peripheral vision

Better Mood Equals Better Glycemic Control

Thu, 12 Feb 2009 06:00:00 CST

If you have diabetes, you know how important it is to control your blood glucose and keep it within normal range. But sometimes, depression can get in the way. Now a study in Diabetes Care links the antidepressant Wellbutrin XL with improved control.

Individuals with diabetes who are depressed may benefit from the antidepressant bupropion (Wellbutrin XL), which can lift their spirits and improve blood glucose control, according to an article in Diabetes Care (Volume 30, page 4590).

While similar results have been reported before, lower glucose levels were thought to result from the weight loss and improved self-care that often accompany successful depression treatment. But researchers are now finding that a better mood alone may lead to improved glycemic control over the long haul.

In a two-phase, open-label trial, 93 participants with type 2 diabetes and major depression took Wellbutrin XL, an antidepressant associated with weight loss, for just over two months. Of the 75 volunteers who stayed on Wellbutrin XL for 10 weeks, 84% reported improved mood, weight loss, and better self-care with diet and exercise. At the same time, the participants experienced a 0.5% reduction in HbA1c levels.

Looking at whether these improvements would last if they took the medication longer, a positive mood was most important for keeping glucose under control for another six months, regardless of weight loss or self-care changes.

While the exact mechanisms behind better glycemic control need further study, treating any accompanying depression is clearly important for managing diabetes.

What Is the Glycemic Index?

Thu, 22 Jan 2009 06:00:00 CST

If you have diabetes, you may be wondering, "What is the glycemic index, and should I use it to help control my blood glucose levels?" In this Health Alert, Johns Hopkins endocrinologist Dr. Christopher D. Saudek sheds light on this controversial topic.

A number of books and diet doctors advocate low-glycemic-index diets. Proponents of these diets claim that foods with a low glycemic index (such as whole grains and most fruits and vegetables) are more healthful than foods with a high index (such as white bread, candy, and soda) because they do not produce as rapid an increase in blood glucose levels when eaten.

Q. What is the glycemic index, and should it be used?

A. The glycemic index measures how much a given amount of a carbohydrate-containing food raises glucose levels within two hours in comparison to eating white bread, which is a reference point with a glycemic index of 100.

Foods with a glycemic index higher than 100, such as instant rice, cause a faster and greater surge in blood glucose. Kidney beans score low at 38, as glucose jumps much less after eating them.

The glycemic index can be complicated to use regularly since it is not listed on most food labels and the wide variability of numbers across websites makes it impossible to know what is correct. Foods are also rated as consumed individually, which is not how people usually eat -- it does not take into account, for instance, the fat in a meal. Finally, carrots, corn, and raisins score at the high end of the glycemic index, but these are clearly nutritious foods that don't need to be eliminated.

A useful, related concept is "glycemic load," which multiplies the glycemic index by the amount of carbohydrate in a typical serving, thus more accurately reflecting its effect on blood glucose.

Bottom line advice on the glycemic index: The most recent nutrition guidelines from the American Diabetes Association recommend monitoring carbohydrate intake as the key strategy for glycemic control, and that using the glycemic index and load may provide a modest, additional benefit. We agree.

9 Steps to Help You Control Blood Glucose Levels During an Illness

Thu, 20 Nov 2008 06:00:00 CST

If you have diabetes you know that getting sick (even a cold or flu) can trigger a rise in blood glucose levels. Here are nine steps to help you take control of your blood glucose levels if you get sick this winter.

People with diabetes must be especially careful when suffering from an illness like a cold or the flu. Illness not only affects your eating, sleeping, and exercise, it may cause the liver to make and release glucose into the bloodstream. This increase in glucose provides extra energy to combat the stress of an illness, but in people with diabetes it can cause blood glucose to rise too high, whether or not you are eating.

At the same time, an illness decreases the sensitivity of cells to insulin and makes it more difficult for these cells to remove glucose from the bloodstream. To minimize fluctuations in blood glucose levels, follow these sick-day precautions.

Inform your health care professional when you become sick. This precaution is particularly important if you are unable to eat regular foods, have diarrhea or vomiting for more than six hours, or have had a fever for a couple of days.

Follow the treatment plan for the sickness. For example, take any necessary medications, such as antibiotics for an infection, according to schedule.

Test blood glucose levels more often than usual. If you have type 1 diabetes, test blood glucose and urine ketone levels every four hours, even during the night. If you have type 2 diabetes, testing blood glucose levels four times during the day is probably enough; if blood glucose levels exceed 250 mg/dL, test urine for ketones. Call your health care professional if blood glucose levels are consistently above 250 mg/dL and are accompanied by ketones in the urine.

Take your diabetes medication as usual,unless, of course, your health professional advises otherwise. Being sick causes blood glucose levels to rise, even if you are not eating.

If you use insulin, keep a bottle of rapid- or very rapid-acting insulin handy. You should take this precaution even if you do not take these types of insulin regularly.

Watch for any symptoms of dehydration, ketoacidosis, or hyperosmolar nonketotic state (extremely high blood glucose levels in people with type 2 diabetes). The symptoms of dehydration include dry mouth, cracked lips, and dry or flushed skin. Ketoacidosis symptoms include nausea, vomiting, and lack of appetite, while hyperosmolar nonketotic state is characterized by increased hunger, nausea, or stomach pain.

Prevent dehydration by drinking plenty of liquids. You should consume at least one large (8 oz.) glass of clear fluid each hour while awake.

Try to consume a normal amount of carbohydrates. Eating many small portions throughout the day may help. Eat easy-to-digest foods such as gelatin, crackers, soup, and applesauce.

Rest as much as possible. If necessary, get someone -- such as a family member or friend -- to help care for you.

Women, Diabetes, and Sexual Health

Thu, 01 Jan 2009 06:00:00 CST

Many of us want to enjoy a healthy sex life as we get older. However, diabetes can make this goal difficult to attain. In this Health Alert, Johns Hopkins endocrinologists discuss two common complaints of women with diabetes.

If you have diabetes, over time, high blood glucose can damage the nerves and blood vessels essential to a natural sexual response. In men with diabetes, this can mean problems with erections. In women with diabetes, it can lead to poor vaginal lubrication and infections as well as decreased sexual desire.

Researchers have studied men more extensively than women, but there's little doubt that controlling blood glucose is the best way to prevent diabetes-related sexual problems regardless of your gender. And when improved blood glucose control is not enough, help is available to overcome the ways that diabetes can take the joy out of sex.

Decreased Lubrication – A recent survey found that poor vaginal lubrication was the most common cause of sexual difficulty in women with type 1 diabetes. Women with type 2 diabetes also appear to have a higher risk of vaginal dryness, which can cause irritation and discomfort, especially during sexual intercourse.

Why it occurs. Nerve damage from diabetes can reduce or block the production of lubricating fluids in the vagina. Poor blood flow due to blocked arteries can worsen the problem.

What you can do. Personal lubricants, such as K-Y Jelly, can reduce the friction that causes painful intercourse. Vaginal moi turizers such as Replens or Lubrin can provide longer relief. These lubricants and moisturizers are available without a prescription at your local pharmacy.

Vaginal Infections -- Women with diabetes have an unusually high risk of vaginal yeast infections.

Why it occurs. -- Vaginal yeast infections are caused by an overgrowth of a fungus called Candida albicans. High blood glucose levels feed the spread of this fungus and weaken the immune system's ability to destroy it. Symptoms of a yeast infection include vaginal itching or burning, pain during intercourse, and vaginal discharge resembling cottage cheese.

What you can do. Yeast infections are treated with antifungal medicine, which may be applied topically as a cream or lotion, or taken in the form of a pill or liquid. Some of these treatments, such as clotrimazole (Gyne-Lotrimin and other brands) and miconazole (Monistat and others) are available over the counter. Others, such as fluconazole (Diflucan), require a prescription.

What's Better for Diabetes Prevention -- Weight Loss or Exercise?

Thu, 30 Oct 2008 06:00:00 CST

Diet and exercise are the cornerstones for preventing type 2 diabetes. These measures are especially important for people with risk factors for diabetes, such as prediabetes, obesity, a family history of diabetes, diabetes during pregnancy (gestational diabetes), or an ethnic background (black, Hispanic, Asian, or Native American) that puts them at higher risk.

While being overweight and not getting enough exercise can both raise your risk for type 2 diabetes, a new study reported in Diabetes Care (Volume 30, page 53) suggests that shedding pounds may be more important for preventing diabetes.

Researchers followed close to 69,000 participants in the ongoing Harvard Nurses' Health Study. None of the women had a history of diabetes, cardiovascular disease, or cancer when the study began. Sixteen years later, 4,030 women had been diagnosed with diabetes. After adjusting for age, smoking, and other diabetes risk factors, increased waist size and body mass index (BMI) had a substantial impact on developing the disease.

Women who were considered very obese -- with a body mass index (BMI) of 40, for example -- had a 28 times higher risk of diabetes than normal or underweight women whose BMI was below 21. A lack of physical activity was not as big a factor. Even in those who exercised at least 20 hours a week, the risk of diabetes was 11 times greater in obese participants than in lean ones.

Bottom Line on Diabetes: These findings don't mean you should scale back on physical activity, which often goes hand and hand with losing weight. But since exercise may not always be enough to help you drop the pounds, watching what you eat should be an equally important goal.

More Good News About Exercise and Diabetes

Thu, 18 Sep 2008 06:00:00 CDT

Should you exercise if you have diabetes? The answer is a resounding, "Yes."

A recent study found that people with type 2 diabetes who walked three miles a day -- or performed an equivalent amount of physical activity -- lost weight and lowered their heart rate, blood pressure, cholesterol and triglyceride levels, and HbA1c.

And now there's more proof that regular exercise really does work for people with diabetes: A recent meta analysis (analysis combining the results of multiple studies) showed that individuals with type 2 diabetes who increased their physical activity levels experienced improved blood glucose levels. The data were reported in the journal Diabetologia (Volume 50, page 913).

Interestingly, individuals with diabetes who focused only on boosting exercise achieved better results than those who tried to change their diet, exercise, and medication adherence at the same time.

The evaluation of 103 studies, encompassing 10,455 participants with diabetes, compared exercise-only interventions with lifestyle measures that also targeted multiple health behaviors. This was the first meta analysis to explore the effect of various methods of inspiring people to exercise, from sessions with a personal trainer to watching others exercise as a motivation method.

The researchers found that HbA1c levels dropped by 0.45% in those who exercised more compared with inactive participants. The type of approach used to get participants moving did not affect glucose readings. Blood glucose improved twice as much among individuals who focused on exercise only, compared with those who tried to improve other lifestyle factors as well.

Perhaps it may be more effective for people with type 2 diabetes to try to change one behavior at a time and avoid becoming overwhelmed by making multiple modifications all at once.

Your Guide to Key Diabetes Lab Tests and Physical Exams

Thu, 09 Oct 2008 06:00:00 CDT

If you have diabetes, you are not alone. It is estimated that 21 million people in the United States have diabetes –- 90-95% of these people have type 2 diabetes. The good news is that diabetes is very treatable. Despite your diabetes, you can lead a normal, productive life if you stay in good control and see your doctor regularly. In this Health Alert, Johns Hopkins provides a checklist of tests for people with diabetes.

To prevent or delay the development of complications from type 1 or type 2 diabetes, you need to take a proactive role in the management of your health care. This includes making regular visits to your primary care physician and other professionals on your healthcare team.

How frequently you see each member of your team varies, but, in general, individuals with diabetes should have a comprehensive physical once a year and have their diabetes assessed at least every six months.

During these visits, you may undergo tests and exams that indicate how well you are maintaining your health and if any complications of diabetes are emerging or progressing. Individuals with diabetes should know about the tests and exams their doctors perform, the goal for each test and exam, and how often each is typically done. Here's a checklist.

Physical Exams For People With Diabetes

Blood pressure: Desirable Result -- less than 130/80 mm Hg
Frequency -- Every visit

Foot inspection: Desirable Result -- No ulcers, skin abnormalities, joint problems, or loss of sensation
Frequency -- Every visit: Visual inspection Yearly: Assessment of pulses and sensation

Eye exam: Frequency -- Yearly
Dental exam: Frequency -- Yearly

LABORATORY TESTS FOR PEOPLE WITH DIABETES

HbA1c:
Desirable Result -- less than 7%
Frequency -- Every three to six months

Low-density lipoprotein (LDL) cholesterol:
Desirable Result -- less than 100 mg/dL
Frequency -- At least yearly

High-density lipoprotein (HDL) cholesterol:
Desirable Result -- Men: greater than 45 mg/dL
Women: greater than 55 mg/dL
Frequency -- At least yearly

Triglycerides:
Desirable Result -- less than 150 mg/dL

Urine microalbumin test (random, spot collection):
Desirable Result -- less than 30 mcg albumin/mg creatinine
Frequency -- Yearly

Am I a Good Candidate for an Insulin Pump?

Thu, 17 Jul 2008 06:00:00 CDT

Insulin pumps are primarily used by people with type 1 diabetes, but more type 2 diabetes patients are starting to use the pump. The biggest advantage of the insulin pump is improved blood glucose control. For example, in a four-month study of 79 people with diabetes, pump users had an average HbA1c level that was 0.8 percentage points lower than that of people on injected insulin therapy. In this Health Alert Johns Hopkins experts answer the question: Am I a good candidate for an insulin pump?

Insulin pumps have been used to treat type 1 diabetes for the past 20 years. The external pumps are small, computerized devices that deliver insulin through a thin tube inserted via a needle into the skin of the stomach or thigh. Their big advantage is that they offer flexibility, convenience, and an insulin flow that is completely predictable since you program it yourself.

Most people with type 2 diabetes who require insulin have fairly stable blood glucose levels, often requiring just one or two injections per day, so an insulin pump isn’t needed. But in hard-to-treat individuals with type 2 diabetes -- when glucose levels become very unstable and multiple doses of insulin are needed daily -- the insulin pump may be beneficial. One study found that insulin pumps were comparable to multiple daily injections in keeping type 2 diabetes under tight control, and most of the participants preferred the insulin pump to shots.

Individuals who are considering insulin pump therapy must be knowledgeable about their diabetes and committed to regular glucose monitoring. Unlike shots, you have to make sure to set the delivery rate correctly, check the tubing for blockages and change it regularly, and keep the insulin storage chamber full.

Since insulin pumps use rapid-acting insulin, any malfunction can cause a rapid drop in insulin levels, so you need to monitor your blood glucose several times a day. If you think you would benefit from using an insulin pump, discuss it with your doctor.

Focus on Gastroparesis

Thu, 07 Aug 2008 06:00:00 CDT

Delayed emptying of the stomach, called gastroparesis, has several possible causes but usually is a complication of diabetes.

Gastroparesis -- literally "paralyzed stomach" -- is a serious condition manifested by delayed emptying of stomach contents into the small intestine after a meal. There is no cure for gastroparesis, but treatment can speed gastric emptying and relieve gastrointestinal symptoms.

Gastroparesis most often occurs in people with diabetes, especially in those who have had diabetes for a long time. The symptoms of gastroparesis include a feeling of fullness early after a meal, bloating, heartburn, upset stomach, nausea, and vomiting. These symptoms may be constant or may flare up from time to time with periods of relief in between.

Some patients have no overt symptoms of gastroparesis, and, in people with diabetes, the only sign of gastroparesis may be difficulty controlling blood glucose. If the gastroparesis remains untreated, it can lead to additional complications including malnutrition, dehydration, and electrolyte imbalances.

How is gastroparesis diagnosed? The gold standard for diagnosing gastroparesis is a test called solid-phase gastric scintigraphy. During this study, patients have their stomach scanned after ingesting solid food containing a radioactive substance to observe how quickly the radioactive isotope leaves the stomach. Other tests to detect delayed gastric emptying include a radioisotope breath test (to detect levels of carbon dioxide in the breath), electrogastrography (which uses electrodes placed on the skin over the stomach to measure the electrical activity of the stomach’s muscles), and an upper gastrointestinal series (in which x-rays are taken of the stomach after drinking a barium-containing liquid).

Treatment of gastroparesis is often twofold. Doctors aim first to improve gastric emptying and control symptoms and second to treat the underlying disease causing gastroparesis, if present.

Doctors recommend that people with gastroparesis eat a diet low in fat and fiber. Fat slows the emptying of the stomach, and some high-fiber foods can remain in the stomach for a long time. Also, eating six small meals a day, rather than three large ones, may allow the stomach to empty its contents easier.

A number of medications are somewhat effective in promoting gastric emptying and relieving the nausea and vomiting of gastroparesis. These medications include metoclopramide (Reglan and other brands) and erythromycin (Erythrocin and other brands) for gastric emptying and prochlorperazine (compro) for nausea.

Putting Your Feet First

Thu, 24 Apr 2008 06:00:00 CDT

Do you take good care of your feet? Many people with diabetes don't and risk foot ulcers or worse. In this Health Alert Johns Hopkins specialists provide the essentials of good foot care for people with diabetes.

People with type 2 diabetes are at higher risk for slow-healing foot injuries that can become infected and progress to amputation. The underlying reasons are poor blood flow to the extremities and less sensation to pain due to neuropathy (nerve damage). Insensitivity to pain means you may not notice cuts and wounds until they get infected. Poor circulation means the wound heals slower. Blood glucose itself fuels the infection. The result can be a foot ulcer -- an open, unhealed wound on the foot.

If you are at risk of foot ulcers it's important to do everything you can to prevent injuries or catch them early. The way to start is with good diabetes foot care:

Diabetes Foot Care Do's:

Inspect your feet every day, looking for any cuts or abrasions. If you have trouble seeing the bottoms of your feet, use a hand mirror. Ideally, have a regular examination by a podiatrist. Make sure your primary care provider inspects your feet at every routine office visit.

Wash your feet daily, but do not soak them in hot water. Use a skin lotion suggested by your diabetes doctor or podiatrist to prevent cracking and drying of the skin, but don’t apply it between your toes. If you have moist, sweaty feet, a light coat of foot powder between the toes helps to prevent fungus.

Your diabetes doctor should screen for diabetes-related nerve damage (neuropathy) of the feet. Neuropathy can make you less sensitive to pain, allowing cuts and abrasions to go unnoticed until they become infected.

Wear soft, breathable socks made of a material, such as a cotton-acrylic blend, that wicks moisture away from the skin. Avoid 100% cotton socks or those with elastic bands that could constrict blood flow.

Cut your nails straight across and carefully file the edges smooth without damaging the skin. If you find it difficult to trim your own nails for any reason, don’t do it. See a podiatrist.

Diabetes Foot Care Don'ts:

Don’t walk barefoot -- even indoors.

Don’t smoke. Smoking reduces blood circulation; this can lead to the loss of a leg.

Don’t cut corns or calluses yourself.

Don’t use caustic chemical agents or any other irritants for the removal of corns and calluses.

Don’t wear open-toed shoes, particularly sandals with thongs between toes.

If the Shoe Fits, Wear It

Thu, 26 Jun 2008 06:00:00 CDT

If you have diabetes, it's particularly important to take good care of your feet and to always wear comfortable, well-fitting shoes. Here are some tips to keep in mind.

Foot health or fashion fetish -- you make the call. If you have diabetes, it would be wise to put your feet first and take a pass on attractive but ill-fitting shoes. What would otherwise be a small blister that heals in a few days could, in someone with diabetes, turn into an infected foot ulcer requiring hospital care or, in extreme cases, amputation.

Just about everybody could use a pair of shoes that fit well and don’t rub or chafe. But if you are at risk for slow-healing foot ulcers because of your diabetes, appropriate footwear is essential to your health.

Do special "diabetic" shoes or custom orthotics prevent foot problems in people with diabetes? The truth is that the research so far isn’t completely clear on this question. There is some evidence that people at increased risk of diabetic foot ulcers -- because of peripheral neuropathy (nerve disease), peripheral arterial disease (impaired blood circulation), or foot deformities -- may benefit from custom footwear.

What you don’t want your shoes to do is rub, squeeze, blister, or chafe your feet. Custom shoes should accommodate any foot deformities and defuse "hotspots" of pressure on the bottom of the feet so that walking does not injure the skin. You may need custom-made inserts for your shoes or a fully customized shoe. Talk to your podiatrist. He or she can refer you to a therapeutic shoe-fitting specialist, or pedorthist. Some podiatrists do the fitting themselves.

If you are not at special risk of foot ulcers, a good-quality, well-fitting shoe is probably all you need. For example, if you plan to walk frequently for exercise, buy a name-brand athletic or walking shoe. When shopping, try on shoes late in the afternoon, when your feet tend to be larger because of fluid retention.

Shop in person; buying shoes online means you can’t try them on. When shopping for dressier shoes, the front of the shoe (toe box) should be wide and deep enough to allow you to wiggle your toes. Look for shoes made of a breathable material, such as soft leather, instead of synthetics. Break your new shoes in slowly by wearing them for a short period every day. Don’t buy shoes that you like the look of but that don't fit, thinking you will "wear them in."

Myths and Misconceptions About Insulin Therapy

Thu, 05 Jun 2008 06:00:00 CDT

It’s unfair. You followed your doctor’s orders -- ate a healthy diet and exercised -- yet you still need insulin for your diabetes. Many people with diabetes who need insulin view it with concern, fear, or even panic. If you feel this way, here is a discussion of some myths and misconceptions about insulin therapy, which may make you feel more comfortable about starting this treatment.

Myth/misconception -- Needing insulin means that you failed. For instance, you should have done more -- lost more weight or exercised more often -- to control your diabetes.

Reality -- Needing insulin to control your blood glucose is not a sign of failure. Diabetes is a progressive disease, so at some point most people require additional or stronger medication to keep their blood glucose under control.

Myth/misconception -- You won’t be able to take insulin if you are afraid of needles or can’t stand the pain of injections.

Reality -- Most people who require insulin become quickly accustomed to injecting themselves. Needles used to inject insulin are small and produce little pain.

Myth/misconception -- Using insulin seems too demanding. It must be administered on schedule and at precise dosages.

Reality --With a little practice, most people are able to handle their insulin regimen with confidence. Many people find insulin pens, which contain a premeasured dose of insulin, are a simpler alternative to traditional syringes.

Myth/misconception -- Taking insulin will restrict your lifestyle. You won’t be able to be as free or spontaneous as before, and this will make traveling, dining in restaurants, and participating in other leisure activities more difficult.

Reality -- It’s true that taking insulin does require balancing your medication with your diet and leisure activities, but the availability of various short- and long-acting forms of insulin can easily accommodate most lifestyles.

Myth/misconception -- There are too many risks to taking insulin. Doesn’t insulin cause hypoglycemia? What about weight gain? It looks like the drug might do more harm than good.

Reality -- If too much insulin is taken or a meal is skipped, insulin can cause blood glucose to drop too low (hypoglycemia). This is less common in people with type 2 diabetes than it is in those with type 1 diabetes. Modest weight gain is possible with insulin therapy, though it can be offset with regular exercise and reducing calorie intake. For people with type 2 diabetes, adding the drug metformin (Glucophage) helps control weight gain. Uncontrolled diabetes is definitely not the way to lose weight.

Nutrition and Diabetes -- Taking the Mystery Out of Mealtime

Thu, 03 Apr 2008 06:00:00 CST

Michelle Bravo, diabetes educator at the Johns Hopkins Comprehensive Diabetes Center, talks about the basics of good nutrition for people with diabetes.

When you were diagnosed with diabetes, one of your first questions probably was: What should I eat? An excellent question, because more than any other health problem, diabetes requires careful attention to your diet, including what foods you choose and how much and when you eat them. Here is some nutritional information you’ll want to know and share with your friends with diabetes.

Q. Nutrition guidelines recommend specific amounts of carbohydrates, fats, and proteins. I feel like I need to plan every meal with a kitchen scale and calculator. Is there a simpler way to get the right portions and mix of nutrients?

A. “Mealtime should not be stressful,” says nutritionist Michelle Bravo, R.D., L.D.N., a diabetes educator at the Johns Hopkins Comprehensive Diabetes Center. To simplify meal planning, Bravo recommends meeting with a registered dietitian to develop a dietary plan that meets your needs.

If you have type 1 diabetes, getting the right amount of carbohydrates will be a big concern. If you have type 2 diabetes, you might need to lose a few pounds, so limiting calories will be a priority. Limiting the amount of saturated fat and cholesterol is important, too, because type 1 and type 2 diabetes increase the risk of heart disease.

Instead of weighing or measuring food and crunching numbers when you plan meals, a dietitian can show you how to control your intake of carbohydrates, calories, and fat by visualizing portions. For instance, one serving of cooked pasta is the size of an ice cream scoop, a serving of meat is no bigger than a deck of cards, and a serving of butter resembles one die.

Q. Should I use meal-replacement shakes or bars to lose or control my weight if I have diabetes? What advantages or disadvantages do they offer?

A. Meal preparation doesn’t get much easier than grabbing a chilled can from the fridge, stirring a packet of powder in a glass of water, or unwrapping a meal bar. Meal-replacement products eliminate guesswork, too. Their labels tell you exactly how many calories and what nutrients they contain.

However, some people find these products too chalky or chewy. More important, some say that meal-replacement shakes and bars don't satisfy their appetite as well as regular food, and they end up snacking between meals to quell the hunger. So if you have no problem with the taste and texture of meal replacement products and they satisfy your hunger, feel free to use them as a weight-control tool.

Stopping Insulin Resistance Before It Leads to Diabetes

Thu, 13 Mar 2008 06:00:00 CST

Researchers have identified a fat cell protein that may predict insulin resistance and help doctors to prescribe treatments to slow the development of type 2 diabetes.

In a healthy person the pancreas makes enough insulin to keep the supply and use of glucose in balance. In diabetes, the glucose balancing system is disrupted, either because too little insulin is produced or because the body’s cells do not respond to insulin normally -- a condition called insulin resistance. The result is an unhealthy rise in blood glucose levels.

If diabetes is left untreated, the two principal dangers are the immediate results of high blood glucose levels (which include excessive urination, dehydration, intense thirst, and fatigue) and long-term complications that can affect your eyes, nerves, kidneys, and large blood vessels.

A screening test to identify people with insulin resistance could allow doctors to prescribe treatments or lifestyle measures to stop or slow the development of type 2 diabetes. Researchers have taken a step toward such a screening test, according to a new study reported in The New England Journal of Medicine (Volume 354, page 2552 ).

In the study, the researchers identified increased blood levels of a protein produced and secreted by fat cells in people who become insulin resistant. The protein’s name: retinol-binding protein 4 (RBP4).

Scientists already know that people with insulin resistance have increased levels of RBP4. The new study found that levels of RBP4 rose in parallel with the severity of insulin resistance in people who were obese or had prediabetes or type 2 diabetes and in healthy people with a family history of the disease.

Researchers are trying to determine whether lowering RBP4 with medication makes cells more sensitive to insulin. However, the study also found that about two thirds of the participants were able to decrease their RBP4 levels and reduce insulin resistance with a tried-and-true lifestyle measure: exercise.

Using a Continuous Glucose Monitor

Thu, 21 Feb 2008 06:00:00 CST

People with diabetes are encouraged to check their blood glucose levels frequently. And now the availability of the continuous glucose monitor (a sensor device) makes testing easier and less painful.

Self-testing of blood glucose with a blood glucose meter is the backbone of diabetes management. Results from the Diabetes Control and Complications Trial (DCCT) indicate that people with diabetes should be more aggressive in their daily monitoring of blood glucose levels if they want to reduce their risk of diabetes complications. This means not only more frequent blood glucose testing but also adjusting your diet, exercise, and doses of insulin or oral medications according to the results of your tests.

Frequent blood testing takes time and requires lots of finger pricks. But what if you could test your glucose 288 times a day without turning into a human pincushion? You might be able to with a continuous glucose monitor, according to a recent study of people with diabetes who used insulin.

A continuous glucose monitor consists of a small sensor wire inserted beneath the skin of the abdomen and held in place with an adhesive patch. Every five minutes, the sensor measures blood glucose and transmits the information to a pager-sized receiver with a digital readout that attaches to your clothing.

In the study, 91 people wore a continuous glucose monitor. Half of them saw their blood glucose levels displayed on the readout, were informed if their blood glucose levels were too high or too low, and heard an alarm when their blood glucose fell below 55 mg/dL. The remaining participants did not see their glucose levels on the readout or receive any warnings. Over a three-day period, volunteers who received feedback on their blood glucose levels spent 26% more time with their glucose under control and 23% less time with their glucose at hypoglycemia levels than those who didn’t receive the feedback. This study was reported in the journal Diabetes Care (Volume 29, page 44).

The Deadly Duet

Thu, 06 Sep 2007 06:00:00 CDT

Johns Hopkins Health Alerts - Diabetes

Treating Type 2 Diabetes With Lap-Band Surgery

Is Diabetes in Your Genes?

Preventing Hypo- or Hyperglycemia During Exercise

Putting Portion Control to the Test

Should You Take Avandia for Diabetic Retinopathy?

New Approach to Slow Diabetic Kidney Disease

Why You Should Consider Insulin Therapy For Type 2 Diabetes

Meet the Diabetes Nurse Educator

Diagnosing Diabetes with the HbA1c Blood Test

Clues to the Cause of Type 1 Diabetes

Why Is My Blood Glucose High?

I Have Diabetes … Should I Take a Statin?

Keeping Tabs on Your Glucose 24-7

Advice to Help You Avoid Diabetic Retinopathy

Better Mood Equals Better Glycemic Control

What Is the Glycemic Index?

9 Steps to Help You Control Blood Glucose Levels During an Illness

Women, Diabetes, and Sexual Health

What's Better for Diabetes Prevention -- Weight Loss or Exercise?

More Good News About Exercise and Diabetes

Your Guide to Key Diabetes Lab Tests and Physical Exams

Am I a Good Candidate for an Insulin Pump?

Focus on Gastroparesis

Putting Your Feet First

If the Shoe Fits, Wear It

Myths and Misconceptions About Insulin Therapy

Nutrition and Diabetes -- Taking the Mystery Out of Mealtime

Stopping Insulin Resistance Before It Leads to Diabetes

Using a Continuous Glucose Monitor

The Deadly Duet

Johns Hopkins Health Alerts | Diabetes |

Johns Hopkins Health Alerts | Diabetes |

High Blood Pressure and Diabetes – A Dangerous Combination

Johns Hopkins Health Alerts | Diabetes |

Johns Hopkins Health Alerts | Diabetes |

Older Is Better

Johns Hopkins Health Alerts | Diabetes | Older Is Better

Johns Hopkins Health Alerts | Diabetes | Older Is Better

Diabetes and Memory Impairment

Johns Hopkins Health Alerts | Diabetes |

Johns Hopkins Health Alerts | Diabetes |

Is Stress Reduction the Missing Step in Your Diabetes Plan?

Johns Hopkins Health Alerts | Diabetes |

Johns Hopkins Health Alerts | Diabetes |

Focus on Fiber

Johns Hopkins Health Alerts | Diabetes |

Johns Hopkins Health Alerts | Diabetes |

What Causes Type 1 Diabetes?

Johns Hopkins Health Alerts | Diabetes |

Johns Hopkins Health Alerts | Diabetes |

Research Findings on Diabetes, Alzheimer's Risk, and Vision Problems

Johns Hopkins Health Alerts | Diabetes | Findings on Diabetes, Alzheimer's Risk, and Vision Problems

Johns Hopkins Health Alerts | Diabetes | Findings on Diabetes, Alzheimer's Risk, and Vision Problems

How Injection Site Rotation Can Help You Control Your Diabetes

Johns Hopkins Health Alerts | Diabetes | How Injection Site Rotation Can Help You Control Your Diabetes

Johns Hopkins Health Alerts | Diabetes | How Injection Site Rotation Can Help You Control Your Diabetes

Research on the Impact of Stress and Adiponectin on Blood Glucose Levels

Johns Hopkins Health Alerts | Diabetes | Impact of Stress and Adiponectin on Blood Glucose Levels

Johns Hopkins Health Alerts | Diabetes | Impact of Stress and Adiponectin on Blood Glucose Levels

Research Updates on Exercise and Byetta

Johns Hopkins Health Alerts | Diabetes |

Johns Hopkins Health Alerts | Diabetes |

Recognizing and Treating Hypoglycemia

Johns Hopkins Health Alerts | Diabetes | Recognizing and Treating Hypoglycemia

Johns Hopkins Health Alerts | Diabetes | Recognizing and Treating Hypoglycemia

Peripheral Arterial Disease -- More Than a Pain in the Leg

Johns Hopkins Health Alerts | Diabetes |

Johns Hopkins Health Alerts | Diabetes |

Nonadherence and Diabetes - An Update

Johns Hopkins Health Alerts | Diabetes |

Johns Hopkins Health Alerts | Diabetes |

Balancing Carbohydrates and Type 2 Diabetes

Johns Hopkins Health Alerts | Diabetes |

Johns Hopkins Health Alerts | Diabetes |

Yet Another Good Reason to Eat More High-Fiber Foods

Johns Hopkins Health Alerts | Diabetes | Another Good Reason to Eat More High-Fiber Foods

Johns Hopkins Health Alerts | Diabetes | Another Good Reason to Eat More High-Fiber Foods

Closing the Loop on the Insulin Pump

Johns Hopkins Health Alerts | Diabetes |