How diabetic women's pregnancy chances can be boosted

Watching what you eat, exercising properly and ensuring adequate nutrition with a vitamin supplement which has adequate amounts of folic acid may improve chances of conception in diabetic women.

Women with diabetes face a special challenge-getting and then staying pregnant. Poor glucose control may create an environment where the high sugars prevent both conceiving as well as maintaining the pregnancy, Diabetic Living India reported.

Women who develop diabetes can be prone to developing other disorders such as thyroid disease or autoimmune premature ovarian failure.

Miscarriage rates among women with poorly controlled diabetes can be as high as 30 to 60 percent during that crucial first trimester of pregnancy. The risk of birth defects is also high, and also stems from uncontrolled blood sugar levels around the time of conception.

A baby’s brain, heart, kidneys and lungs form during the first eight weeks of pregnancy, therefore high blood glucose levels are especially harmful during this early stage.

The main diabetes complication, including gestational diabetes, related to pregnancy is macrosomia – or a big baby (higher than the 90th percentile in birth weight).

Women with Type 1 diabetes will require insulin before, during and after their pregnancy.

However, if a woman has type 2 diabetes then she will require oral medications with or without insulin to achieve appropriate control of your diabetes.

In order to enhance chances of delivering a healthy baby, diabetic women should work with health care team to get their blood glucose under control before getting pregnant.

Did Trauma Cause My Diabetes?

What caused killer t-cells to attack the beta cells in my pancreas, preventing them from producing insulin, making my blood sugar skyrocket and triggering my Type 1 diabetes? That was in 1962. No one has come up with a convincing explanation yet. Scientists aren’t even close to figuring out the interactions between the environment, genes, the immune system and who-knows-what-else that result in Type 1 (T1) or Type 2 (T2) diabetes. If you travel around the Internet, it appears that the entire world is one big “risk factor” for these conditions.

Suspects identified by researchers that might play a role in T1D include the smoked mutton consumed by Icelanders between Christmas and New Year’s, various viruses, respiratory infections in early childhood, early exposure to cow’s milk, psoriasis, the timing of infants’ first solid foods, low levels of Vitamin D, and many more. Risk factors for T2D, besides the well-known ones like obesity, could include not enough sleep and phthalates in soaps, lotions, plastics and toys.

But the culprit that interests me the most doesn’t get much attention in the research labs: trauma and major stress. When I was a kid, the conventional wisdom was that traumatic events — loss of a loved one, accidents — played an important role in diabetes onset. This appeared to be substantiated by a number of population studies in the ensuing decades, but the evidence hasn’t impressed major players in diabetes research. In a long summary of biochemical and environmental risk factors for T1D, the NIH barely touches upon the matter, gives it a few throwaway lines:

Although investigations of stress and IDDM [insulin dependent diabetes] have, in general, reported positive associations, most studies have been retrospective and suffered from methodological difficulties in assessing stress and measuring its frequency, intensity, and duration. Thus, prospective evaluations of the interaction among stress, the immune system, and the occurrence of autoimmune diseases are warranted.

Sorry, NIH, but I am convinced that a specific traumatic event played a major, albeit partial, role in triggering my diabetes.

In a blog post that was mainly about my mother and Sonya Sotomayor’s parents, I described the onset of the disease 51 years ago. It happened very soon after my grandfather died. In my grandmother’s apartment in Manhattan, I was so terrified by the mournful screams from my mother and grandmother when they embraced that I ran away and hid. Within two days, after an earache, sniffles, a sore throat and ravenous thirst, I was hauled to a hospital and suddenly became a kid with a scary disease.

By now, I understand that the trauma of mourning contributed to a process that was probably primed to happen anyway. Maybe my pancreas was already getting ravaged before my grandfather died and before any symptoms appeared. Maybe I would have been hospitalized at about the same time even if the women I loved hadn’t shocked me with their keening. Hard-nosed, data-driven scientists might call it a coincidence that those screams occurred just before the diagnosis. As the NIH notes, more research is needed on this one.

But was it a coincidence that after a major earthquake in California, in 1994, the Children’s Hospital of Los Angeles experienced a sudden, unusually large influx of kids with newly-diagnosed T1D? Or that after Israel’s second war with Lebanon, the post-war incidence of T1D was higher than normal in areas in northern Israel that had been attacked, and there was no change in other regions? Or that, in Denmark, the children of mothers who were bereaved during their pregnancies were more likely to develop T1D, according to one study?

Or that the British physician Thomas Wills, in the 17th century, noticed that, “Sadness, or long sorrow, as likewise convulsions, and other depressions and disorders of the animal spirits, are used to generate or foment this morbid disposition [diabetes]”?

According to one theory, psychological and/or physical stress are among the factors that cause beta cell “stress” and “accelerate the auto-immune process that leads to their own destruction,” as one researcher puts it. There is at least some evidence that infants under stress have a higher incidence of the “auto-antibodies” — cells that turn around and destroy healthy cells — that are associated with this morbid disposition.

That’s enough evidence for me. But even if you doubt that my reaction to those screams was related to the destruction of my beta cells, you cannot possibly come up with a credible argument against psychologist David Felten, who tells us:

We can no longer pretend that the patient’s perceptions don’t matter … Your mind is in every cell of your body. And your emotions are the bridge between the mental and the physical, or the physical and the mental. It’s either way. Now there is overwhelming evidence that hormones and neurotransmitters can influence the activities of the immune system, and that products of the immune system can influence the brain.

This is hardly headline news. But thinking of the bodymind as one, integrated entity has never come naturally to me. I am, at heart, a Western guy, who has stayed alive mainly by doing what conventional Western physicians have told me to do. I reflexively consider balancing diet, insulin and exercise as the regimen needed to help my diabetic body. But meditation, and doing xi kung, and telling myself not to get angry at the guy who cuts in front of me on the movie line somehow feel like they are meant to help… something else, something I can’t locate, something that is closer to my authentic self than the clanking, flawed, corroding body that is wrapped around it.

Reading more, of late, about diabetes, the brain and behavior has helped to remind me that the physical aspects of this condition should not be placed in a category that is separate from the psychological aspects; they are part of the same condition. But the quickest way to remember that is to picture a frightened 7-year-old boy, running down a hallway in Manhattan. I am still doing my best to help him feel better, and that means dealing with everything that is churning within him, from high blood sugar to the terror that his cells have not forgotten.

Orginally published in The Insulin Chronicles and, with a different title, in Strangely Diabetic.


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What you need to know about diabetes

There are two types of diabetes – type 1 and type 2 – but the one that is usually in the news because of its association with rising obesity rates in America is type 2 diabetes.

Type 1 diabetes: Previously called juvenile diabetes, type 1 is usually diagnosed in children and young adults. In this type, the body does not produce insulin, a hormone needed to convert sugar, starches and other foods into energy. Insulin, by shot or pump, must be started right away. Exercise and nutrition are also important in managing type 1 diabetes. It is caused by one’s immune system attacking and destroying insulin-producing cells in the pancreas. It is thought to be caused genetic and environmental factors.

Type 2 diabetes: This type, which may be prevented through lifestyle changes in diet, weight loss and exercise, accounts for 90 percent to 95 percent of all diabetes cases in the U.S. It occurs when an indivdual’s body doesn’t make enough insulin or use it well. This results in “insulin resistance.” 

Diabetes can be diagnosed using three blood tests – fasting blood sugar test, hemoglobin A1C test and a glucose challenge test.

“Patients are often asymptomatic, but the risks associated with prediabetes and diabetes, like heart attack and stroke, are happening before the diagnosis,” said Dr. Scott Setzer, a family doctor in Lemoyne.

People with prediabetes have blood sugar levels that are higher than normal – between 100 and 125 mg/dl – but not high enough to be called diabetes, the label given when fasting blood glucose is 126 mg/dl or higher. Sometimes, early treatment of prediabetes can return blood glucose levels to normal and prevent escalation to diabetes.

When they do present, symptoms include frequent thirst, extreme hunger, frequent urination as in every two hours, weight loss, blurred vision and fatigue, said Dr. Renu Joshi, medical director of endocrinology at PinnacleHealth System in Harrisburg.

Treatment can include lifestyle change in diet, exercise and weight loss, medications and insulin.

In the past several months, a new medication for type 2 diabetes called Invokana (generically called canagliflozin) was introduced that works by making blood sugar come out in the urine, Joshi said. It holds promise, but it can cause thirst, frequent urination and yeast infections. Patients must have completely normal kidney function to be able to take it, she said.

Get tested

The American Diabetes Association has set these guidelines for diabetes screening:

  • Anyone with a body mass index higher than 25, regardless of age, who has additional risk factors, such as high blood pressure, a sedentary lifestyle, a history of polycystic ovary syndrome, having delivered a baby who weighed more than 9 pounds, a history of diabetes in pregnancy, high cholesterol levels, a history of heart disease, or having a close relative with diabetes.
  • Anyone older than age 45 is advised to receive an initial blood sugar screening, and then, if the results are normal, to be screened every three years thereafter. 

Child obesity: Families 'in denial' over dangers of overweight …

Families in denial over dangers of child obesity
Families ‘need to recognise that obese children are in trouble’ (Picture: PA)

Obese children are having their chances of fighting the flab scuppered by relatives in denial, a report reveals.

Overweight youngsters face serious health problems in later life and need family members to recognise they are in trouble, the study states.

And with about 30 per cent of two to 15-year-olds in England classified as overweight or obese, the National Institute for Health and Care Excellence is calling for urgent action. ‘Efforts to manage a child or young person’s weight are not always supported, and are sometimes undermined, by members of the wider family,’ the Nice report says.

‘A lack of recognition or denial that the child is overweight can hinder uptake and adherence to a lifestyle weight management programme.’ Children with at least one obese parent are more likely to follow suit themselves, the Nice report added.

Meanwhile, 79 per cent of overweight early teens are likely to be so as adults, raising the risk of cancer, heart disease and type 2 diabetes.

Although critical of families who refuse to admit their children have a problem, Nice said local authorities should step in to help battle the bulge. Prof Mike Kelly said: ‘Parents should not have to face the challenge of obesity on their own.

We are recommending family-based lifestyle programmes are provided which give tailored advice.’

However, Tam Fry, of the National Obesity Forum, said councils have been handed a ‘poisoned chalice’ of dealing with it without proper funding.

Suffering from Obesity | Dances With Fat

Belly Bump with one of my heroes - Marilyn Wann

Belly Bump with one of my heroes – Marilyn Wann

I decided to repost this blog based on a few conversations I had and saw in the last few days.  I see people talk a lot about how we need to “do something,” and how abusive and exploitative things like The Biggest Loser are justified  because so many people are “suffering from obesity”.  I won’t presume to speak for everyone but I will say that while I sometimes do suffer because I’m obese, I’ve never suffered from obesity.

I’m suffering from living in a society where I’m shamed, stigmatized and humiliated because of the way I look. Where I’m oppressed by people who choose to believe that I could be thin if I tried (even though there’s no evidence for that), and that I am, in fact, obligated to try to be thin because that’s what they want me to do – as if personal responsibility means that I’m personally responsible for doing what they think I should do and looking like they think I should look (though this does not seem to be a two way street as none of these people has ever invited by commentary and suggestions on their life and choices.)

I’m suffering from doctors who have bought into a weight=health paradigm so deeply that they are incapable of giving me appropriate evidence-based healthcare.  I’m not just talking about diagnosing me as fat and giving me a treatment plan of weight loss (which is using a completely unreliable diagnostic and then prescribing a treatment that has the opposite result 95% of the time).  I’m also talking about the two doctors who tried to prescribe me blood pressure medication without taking my blood pressure or looking at my chart to see that it is always 117/70 (which means that taking blood pressure medication would have been dangerous).  I’m talking about a doctor trying to get me to lose weight to treat me for Type 2 Diabetes when I actually had anemia.  I’m talking about a doctor telling me that my strep throat was due to my weight. I’m talking about people who are supposed to be scientists abandoning science and research in a way that strongly resembles the time when the Catholic church told Galileo to sit down and shut up.

I’m suffering from a societal witch hunt where instead of putting me in a river they put me on a scale.  People look at my body and feel comfortable blaming me for everything from global warming to healthcare costs despite a lack of evidence for either. People send me ridiculous hate mail, say nasty things to me at the gym (although making fun of a fat person at the gym is something I will never understand).  People who are drenched in thin privilege try to use that position of privilege to make me feel bad about myself.

I’m suffering from the misinformation campaign that is led by the diet industry, weight loss pharmaceutical industry and surgeons who profit from mutilating people who look like me, none of whom are willing to be honest about the risks or horrible success rates of their interventions long term, and some of whom just don’t seem to care.

I am suffering from living in a society that tells me that the cure for social stigma, shame, humiliation and incompetent healthcare is for me to lose weight, when the truth is that the cure for social stigma is ending social stigma.

What has lessened my suffering is that I now realize that this isn’t my fault – although it becomes my problem. One of the reasons that I choose to pursue a life of social justice work is that nothing makes me feel better than knowing that I am doing what I can to fight this and making some kind of difference – whether it’s in the lives of individuals or in society, or just in my own life.  I deserve better and so does everyone else and I and lots of others are fighting for it and we’re going to win.  But to be clear, we shouldn’t have to.  Nobody should have to fight to be treated with basic human respect.   And that’s what I find so sad – all of this suffering of fat people could end right this second and nobody needs to lose a pound – society just needs to stop trying to shame, stigmatize, humiliate and hate people healthy.  We can work on access to healthy foods, we can work on access to safe movement options that people enjoy, we can work on making sure that people have access to appropriate, evidence-based healthcare.  If we give up being a horribly failed example for making people thin, we could be a successful example for giving people options for health.

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William Petit Joins Company Developing Diabetes Device

Dr. William Petit is a partner in a company that’s developing a new device for testing diabetes.

Petit is one of four principals in Quick LLC, a Farmington-based company that announced Thursday the start of a fundraising campaign to raise money for developing a prototype of the device and testing it.

Petit said he got involved with the company because it’s an opportunity to be involved with something that could solve the long-discussed problem of how to make it easier to measure glucose levels in diabetes patients. He is friends with Scott Fox, the president and CEO of the company.

“Over the course of a number of rounds of golf, he told me about what was going on,” Petit said.

David Mucci and Ron Clark, both doctors at the Hospital of Central Connecticut who developed the device, demonstrated it to Petit.

Instead of using a finger prick to test blood, the device measures glucose levels in saliva. It’s easier and less painful, Petit said, especially for people who need to test themselves several times each day. Some people don’t test themselves as often as they should, Petit said, because of the pain and inconvenience.

“It’s a fascinating idea and I give credit to Dave Mucci and Ron Clark,” he said in a telephone interview. “People have been looking for ways to measure glucose levels for some time.”

The device also connects to smartphones so that parents can track their children’s tests.

A former medical director of the Joslin Diabetes Center at the Hospital of Central Connecticut, Petit hasn’t practiced medicine since 2007, when his wife and two daughters were killed in a brutal attack in their home. Since that ordeal, he has worked for the Petit Family Foundation, which has raised and donated more than $1 million to causes that match the interests of his wife and daughters.

He has also advocated for reforming the state’s death penalty law and has served with the Hartford County Medical Association and the Connecticut State Medical Society.

The new device, called the iQuickIt Saliva Analyzer, has been in development for about 18 months, Fox said. The company hopes to raise $100,000 over the next two months on the crowdsourcing website Indiegogo.com, which allows people to raise money for specific goals with contributions from many people.

Fox, Mucci and Clark are the founders of the company. They brought Petit onto the management team to serve as the diabetes advisor. Among other tasks, he’ll oversee the clinical trials when the device gets to that stage.

In a best-case scenario, Fox said, the device could be on the market in about two years.

Petit made news earlier this month when he confirmed that he was considering running for Congress. Petit said Thursday he was still considering a run for the Republican candidacy in the 5th District, and is weighing the time it requires to other commitments, including the foundation, his work with Quick LLC and the fact that he and his new wife are expecting a baby in six weeks.

Keith Vaz: Diabetes was a real wake-up call

Keith, who is chairman of the Home Affairs Select Committee, is making sure his teenage children Luke and Anjali are aware of the condition and are tested regularly.

“Diabetes does run in families and if people are aware of that they can make changes to their life and delay the onset,” he says.

It’s not known for sure why people from Asian and African backgrounds are more prone to the condition but it may be due to the different way in which their muscles burn fat. One study concluded the rate among these communities in the UK was “astonishingly high”.

Keith adds: “Awareness is so critical. Our job is to harvest people and send them to their GPs.”

Medication and improvements in his diet mean that although there is no cure, Keith’s diabetes is under control.

“I’ve had to increase my tablets,” he says. “Diabetes will affect my health as I get older. If I don’t look after myself then blindness, liver failure and amputations are all concerns.

“I’m never going to go to a gym but I intend to get an exercise bike for my home.”

For more information about Silver Star visit www.silverstaruk.org

Vitamin D pill every day can beat diabetes

US Professor Philip Raskin, who will lead the study at the UT Southwestern Medical Center in Dallas, Texas, said: “If you could prevent development of diabetes that would save people a lot of anguish and ­diabetes medication cost.”

The four-year trial across America will track 2,500 people age 30 or older who have pre-diabetes – a precursor to diabetes where blood glucose levels are higher than normal.

They will be given daily doses of vitamin D about five times higher than usually recommended.

Dr Raskin said: “The side-effects of vitamin D3 in the doses we’re going to use are few. It’s a fairly safe and inexpensive treatment.”

Extreme Obesity, And What You Can Do About It

Too much weight can take a toll on your body, especially your heart. The good news is that there are steps you can take to get healthier — and even losing a little body weight can start you on the right path.

Why lose weight?
If you’re extremely obese, losing weight can mean “less heart disease, less diabetes and less cancer,” said Robert Eckel, M.D., past president of the American Heart Association. “Metabolic improvements start to occur when people with extreme obesity lose about 10 percent of their body weight.”

Losing weight can reduce your risk of heart disease and stroke; risk factors like high blood pressure, plasma glucose and sleep apnea. It can also help lower your total cholesterol, triglycerides and raise “good” cholesterol — HDL.

Understanding Extreme Obesity
A healthy BMI ranges from 17.5 – 25 kg/m2. If your body mass index is 40 or higher, you are considered extremely obese (or morbidly obese.) Check out the American Heart Association’s BMI calculator for adults to determine if your weight is in a healthy range. (Note: BMI in children is determined using a different BMI calendar from the CDC.)

A woman is extremely obese if she’s 5 feet, 4 inches tall and weighs 235 pounds, making her BMI 40.3 kg/m2. To reach a healthy BMI of 24.8, she would have to lose 90 pounds to reach a weight of 145 pounds.

A man is extremely obese if he’s 6 feet, 2 inches tall and weighs 315 pounds, making his BMI 40.4 kg/m2. To reach a healthy BMI of 25.0, he would need to lose 120 pounds to reach a weight of 195 pounds.

Doctors use BMI to define severe obesity rather than a certain number of pounds or a set weight limit, because BMI factors weight in relation to height.

How to Get Healthier
If you’re extremely obese, taking action to lose weight and improve your health may seem overwhelming. You may have had trouble losing weight or maintaining your weight loss, been diagnosed with medical problems and endured the social stigma of obesity.

“The key to getting started is to find a compassionate doctor with expertise in treating extreme obesity,” said Dr. Eckel, who is also professor of medicine and Charles A. Boettcher II Chair in Atherosclerosis at the University of Colorado Anschutz Medical Campus in Aurora, Colo. “Bonding with your physician is the best way to get past first base and on the path to better health.”

If you’re extremely obese, Dr. Eckel recommends that you become more active, but not to start a vigorous workout program without getting physician advice and not until you’ve lost about 10 percent of your body weight.
“You can continue the level of physical activity that you’re already doing, but check with your physician before increasing it,” Dr. Eckel said. “Some people with extreme obesity may have health issues like arthritis or heart disease that could limit or even be worsened by exercise.”

Treatment Options
Talk to your doctor about the health benefits and the risks of treatment options for extreme obesity:

  1. Change your diet. You may be referred to a dietician who can help you with a plan to lose one to two pounds per week. To lose weight, you have to reduce the number of calories you consume. Start by tracking everything you eat.

    “You have to become a good record-keeper,” Dr. Eckel said. “Reduce calories by 500 calories per day to lose about a one pound a week, or cut 1,000 calories a day to lose about two pounds a week.”
     

  2. Consider adding physical activity after reaching a minimum of 10 percent weight-loss goal.
     
  3. Medication. Some people can benefit from medication to help with weight loss for extreme obesity. Keep in mind that medication can be expensive and have side effects.
     
  4. Surgery. If changing your diet, getting more physical activity and taking medication haven’t helped you lose enough weight, bariatric or “metabolic” surgery may be an option. The American Heart Association recommends surgery for those who are healthy enough for the procedure and have been unsuccessful with lifestyle changes and medication. Risks can include infections and potentially dangerous blood clots soon after the operation, and concerns about getting the right amount of vitamins and minerals long-term.

Get The Social Or Medical Support You Need
Although some people can modify their lifestyle and lose weight on their own, many need extra help. A social support system can help encourage your progress and keep you on track. Decide what support best fits your needs — either a weight-loss support group or one-on-one therapy.

Some people with extreme obesity suffer from depression. Talk to your doctor about the best treatment, as some anti-depressant medications can cause weight gain.

Learn more:

  • BMI Calculator
  • BMI in Children
  • 5 Goals to Losing Weight
  • Losing Weight With Life’s Simple 7 Infographic
  • Preventing Childhood Obesity: Tips for Parents and Caretakers
     

Baobab: The ancient African fruit that fights diabetes

Paul Gugenheim of Minvita, the company which sells baobab in the UK in tablet and powder form, and is partnered with The Eden Project in Cornwall says: “This exciting research confirms that Baobab is a fruit with extraordinary health-giving properties.

Diabetes is one of the main health issues of our time, and is projected to affect millions of people and cost the NHS billions of pounds over the next 25 years. If a natural, readily available product can be found to be useful in controlling the symptoms of this dreadful disease it can only be of benefit to us all.”

Dr Sarah Brewer says: “Baobab offers a number of nutritional health benefits which are only now being recognised in the West. It carries high concentrates of anti oxidants, energy, immune boosting vitamins and minerals and bone strengthening calcium.

“Rich in iron, high in potassium and containing vital blood clotting ingredients it can even help support the circulatory system whilst the high-fibre content benefits the digestive system.”

But Bridget Benelam, senior nutrition scientist at the British Nutrition Foundation says: “Many sources say that it is high in vitamin C and calcium but you have to eat it in a processed form such as a powder or jam rather than the whole fruit.”

She adds: “I am sceptical of how much difference such foods actually make to people’s nutrient intakes as realistically, most people will not eat them that frequently or in large quantities compared to the foods that are a more staple part of the diet.”

Boabab is available from Holland Barrett, Planet Organic and health food shops, priced from £8.49 for a 250g tub of superfruit powder.  £19.99 for 90 tablets. Or order online from minvita.co.uk