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.

New diet to halt diabetes: Eating less meat and dairy can slash risk by half

They discovered that animal products such as meat, cheese and egg yolks trigger stomach acids linked to the killer disease.

But most fruits, including lemons and oranges which are widely perceived as acidic, effectively knock out these acids before they can have a harmful effect on the body’s metabolism.

Study leader Dr Francoise Clavel-Chapelon said: “A diet rich in animal protein may favour net acid intake, while most fruits and ­vegetables form alkaline precursors that ­neutralise the acidity.

“Contrary to what is generally believed, most fruits such as peaches, apples, pears, bananas and even lemons and oranges actually reduce dietary acid load once the body has processed them.”

Acid load, or excess acid, can spark serious complications with the metabolic system. This in turn reduces the body’s ability to regulate its insulin levels, leading to diabetes.

Dr Clavel-Chapelon’s team at the Centre for Research in Epidemiology and Population Health in Paris studied tens of thousands of women volunteers over 14 years.

They found those with the most acidic diets were more likely to develop type 2 diabetes.

And, alarmingly, women whose potential renal acid load (Pral) scores were in the top 25 per cent had a 56 per cent greater risk of getting diabetes than those in the bottom 25 per cent.

Pral refers to the potential impact of certain foods on kidney and urine acid levels. Meats can have a Pral value as high as 13.2, cheeses 26.8 and fish 10.8.

One-day diabetes awareness festival attracts hundreds

AURANGABAD: Hundreds of people visited the ‘Madhumeha Anandnagari’ at the St Francis School ground here on Sunday. The event was aimed at creating awareness about diabetes and its complications and also to commemorate the World Diabetes Day on November 14.

Customized diet plans, diabetes management, sugar-free and oil-free cooking and a focus on effective detection of the disease in the early stages remained the crowd pullers at the fair, hosted by Udaan, a voluntary organisation working for the well-being of diabetic children.

The Anandnagari was inaugurated by television actor Anup Soni, along with deputy commissioner of police (zone-II) Arvind Chawria. The duo appealed to the people to take preventive measures before the lifestyle disease starts taking a toll on the health.

Noted chef Archana Atre from Mumbai gave a demo of over 10 oil-free and sugar-free nutritional dishes that could be easily cooked. The recipe books of the same were distributed by Udaan.

Chawria said, “I am a diabetic for about eight years. Initially I was reluctant in accepting it but gradually I brought the required discipline in my lifestyle and diet. Now, having a disciplined schedule makes me feel fitter than any of my non-diabetic colleagues.”

“The aim of the festival is to erase the fear of diabetes from the minds of people and create awareness in a joyful way to lead a healthy life. The focus of the fair is on detection of diabetes as early as possible and proper management for patients. There are stalls providing guidance on every aspect associated with it like a heart kiosk, exercise kiosk, etc,” said diabetologist Archana Sarda.

Sarda added that it was an attempt to spread awareness about the disease, which is fast spreading among the younger population and appealed to both the diabetics as well as non-diabetics to maintain a healthy lifestyle as cases of diabetes has been reported even in six-month-old babies.

Services such as measurement of blood glucose, blood pressure and body fat percentage, estimation of heart attack and stroke risk for diabetics, ECG, eye examination to detect diabetic retinopathy, were kept open at the fair. Street plays, games, tattoo making, bioscope watching, etc, were also arranged for visitors.

To bring awareness about the lifestyle disease, Udaan has conducted essay writing competitions on ‘Role of children and youth to control diabetes’ and ‘My dream – Diabetes-free India’ in about 140 schools, and around 300 students participated in the contest. Actor Soni judged the street plays for college students and awarded the best five winners.

“Often, people don’t realise the severity of diabetes and leave treatment after two or three months of the diagnosis, exposing themselves to various life threatening diseases. Diabetes is a lifestyle disorder, and stressful life together with unhealthy living is a major factor behind the huge diabetic population we have in our country,” Sarda said.

Let's link hands against diabetes

A 68-year old Mrs. S. developed high fever and had to be hospitalised since her blood sugars were very high. With no personal income or medical insurance, she had to depend on her son for paying hospital expenses for which he was not too willing.

Mr. S, 58, a watchman in a company, developed fever and infection in the foot. He had very high blood sugars and was hospitalised. Despite all efforts, his left leg had to be amputated and he had to use his entire savings which he had kept aside for his daughter’s wedding. This was a sad story of a man who lost his leg and his personal savings because he had diabetes, of which he was unaware. Innumerable are such pathetic cases.

Diabetes is one of the major health and development challenges of the 21st century. In India, it is estimated that around 62 million people have diabetes. One in two people with diabetes doesn’t know he/she has it. But diabetes and its complications are largely preventable, and proven, affordable interventions available. Everyone is concerned and everyone has a role to play in helping to turn the tide of diabetes to protect our future.

What can be done?

There are two major components of the burden of diabetes in India — genetic and environmental factors. Environmental factors such as physical inactivity and unhealthy diet pattern play an important role. There is an immediate need to seek the involvement of several stakeholders in prevention and control of diabetes.

To start with, the media plays a major role in not only creating awareness of the risk factors but also making policymakers and others focus on various avenues leading to a better living environment. The existing knowledge of prevention of diabetes can be disseminated to all with the help of the Ministry of Information and Broadcasting, NGOs and healthcare centres in both the private and public sectors.

Next, to put the knowledge into practice, it is necessary to create a conducive environment for the public to increase their physical activity. This needs earmarked funding for construction of parks, safe footpaths and cycle pathways.

In order to ensure healthy eating habits, retail shops, fast food outlets and chain restaurants should be encouraged to provide alternative healthy food choices. An additional tax could be levied on junk food. Regulation of pricing policy for fruits and vegetables is necessary.

The government should encourage small entrepreneurs to manufacture nutritious and palatable snacks for people belonging to different economic strata at an affordable cost. Agricultural research is also required for producing low glycemic cereals and grain. More operational research is necessary to develop strategies to reduce the burden of diabetes and its risk factors. Allocation of funds for such projects has to be given high priority by the funding agencies.

In order to help people with pre-existing diabetes, insurance companies should introduce policies which will cover both outpatient and hospitalisation costs.

This will help a large number of people in India with diabetes to have good control of their blood sugar levels and thus prevent dreadful complications.

Although various stakeholders are required to build the web of partnership for diabetes prevention, the most essential is individual commitment to a better living.

(The writer is Head and Chief Diabetologist, MV Hospital for Diabetes, and Prof. M Viswanathan Diabetes Research Centre, Chennai. Email: drvijay@mvdiabetes.com)

Diabetic eye disease: How regular eye exams could save vision

Individuals with diabetes are likely accustomed to regular insulin injections or a strict diet. But are they as familiar with regular eye examinations? According to the results of a new survey coinciding with National Diabetes Month, the majority of diabetic patients would say no, even though diabetes is a leading cause of vision loss in the US.

According to the National Eye Institute (NEI) of the National Institutes of Health (NIH), around 25 million Americans suffer from diabetes.

The Centers for Disease Control and Prevention (CDC) states that diabetes is the leading cause of blindness among adults aged between 20 and 74.

Figures from the CDC show that between 2005 and 2008, 4.2 million diabetes patients in the US had diabetic retinopathy – the most common form of diabetic eye disease. Of these, 655,000 suffered from advanced diabetic retinopathy, which can potentially lead to severe vision loss.

However, a new survey from Diabetic Connect – the largest social networking site for diabetes sufferers and their families – reveals that 25% of people with diabetes do not have the recommended annual dilated (retina) eye exam, which experts say could significantly reduce the risk of vision loss or blindness associated with diabetes.

Diabetic eye disease explained

Diabetic eye disease is defined as a group of eye-related health issues that are particularly common among diabetes sufferers.

Lady undergoing an eye exam
The NEI says the risk of severe vision loss from diabetic retinopathy could be reduced by 95% with early detection, timely treatment and appropriate follow-up.

According to the NEI, the most common forms of diabetic eye disease are diabetic retinopathy, cataract and glaucoma.

Diabetic retinopathy is the leading cause of blindness in diabetics – caused by a change in the blood vessels situated in the retina.

Some people with this disease experience swelling and fluid leaking from the blood vessels into the macula of the eye – the part of the retina that is responsible for sharp vision. This process is known as diabetic macular edema (DME).

Other people with diabetic retinopathy will have new blood vessels form on the surface of the retina. Both of these changes can lead to partial vision loss or complete blindness.

One major problem for patients with diabetic eye disease is that there are often no symptoms until the disease reaches an advanced stage. However, it can be detected early through a dilated eye exam.

“The best way to prevent unnecessary vision loss is through annual retina eye exams,” Dr. Carl C. Awh, retina specialist at Tennessee Retina, a group of nationally recognized specialists, told Medical News Today.

“Very often diabetic eye disease lacks any symptoms – meaning people may not know that their vision has been damaged until it’s too late.”

According to the NEI, with early detection through a dilated eye exam, timely treatment and appropriate follow-up, the risk of severe vision loss from diabetic retinopathy can be reduced by 95%.

Through early detection of diabetic retinopathy and other eye diseases, several treatment options can be offered to a patient.

These include laser eye surgery and injections of anti-vascular endothelial growth factor (anti-VEGF) medications. These block the actions of a protein that is the cause of abnormal blood vessel growth and leakage in the eye.

Below is a video from the NEI that explains the risk and treatment of diabetic eye disease:

Majority of diabetics ‘unaware of risk’ to eye health

Although people with diabetes are encouraged to have a dilated retina eye exam once every year, it seems many diabetes sufferers do not undergo these regular eye check-ups.

Diabetic Connect conducted an online survey of 1,674 patients with either type 1 or type 2 diabetes. The survey revealed that 1 in 4 people do not receive their annual eye exam, and the reasons for this are largely down to lack of awareness.

In detail, only 36% of people with diabetes said they had spoken with their doctor regarding their risk of vision loss when they were diagnosed, and 22% had never spoken to their doctor about this topic.

Of those who have never had a retina eye exam, 13% said it was because they believed they had not had diabetes long enough for it to affect their vision.

Over 50% of respondents were unaware that diabetic macular edema was a leading cause of vision loss or blindness for diabetes sufferers, and 32% did not know they needed a dilated eye exam.

Needless to say, the results of this survey are worrying, especially considering the millions of diabetes sufferers who are at risk of eye disease.

Dr. Awh said there is no doubt that there needs to be more awareness among diabetic patients regarding potential vision loss and the need for regular testing.

“In part it comes from the primary care doctors and nurses. Broader public awareness and education is also needed,” he added.

One diabetes sufferer told Medical News Today that if it was not for her awareness of the risk of diabetic eye disease, the quick actions of her endocrinologist and regular eye tests, she may have lost all vision.

‘If it wasn’t for regular eye exams, I would have gone blind’

Suzanne Gardner was diagnosed with type 1 diabetes at the age of 7.

In 1999, Suzanne began experiencing problems with her vision, such as seeing blurred colors and the inability to see details. She said she was previously made aware of the risk of vision loss due to her diabetes.

“In fact, vision loss was something that was of great concern to people who had diabetes,” she added.

“However, 41 years ago, the technology for diabetes was not as advanced as it is today. We had no means of testing blood glucose at home. So diabetes couldn’t be as well controlled as it is today with home glucose monitoring machines and insulin pumps.”

Suzanne visited an ophthalmologist who diagnosed her with diabetic retinopathy. Within 2 years of diagnosis, Suzanne was deemed legally blind.

“Despite a series of operations, my doctors could only save partial vision in one of my eyes,” she said.

However, despite this devastating outcome, Suzanne says that if it was not for regular eye examinations, she may have lost all vision:

“As soon as my endocrinologist saw signs of diabetic eye disease, we all took it very seriously.

She sent me to see a specialist who deals specifically with the retina. If it had not been for the constant visits and immediate attention of my retina specialist, I would have gone completely blind.”

‘It’s important for people to know about vision loss risk’

In spite of her vision loss, Suzanne has made a successful career for herself in the form of art.

“I was devastated by my vision loss. I couldn’t work and couldn’t drive. All of a sudden, everything about how I defined myself had changed,” she told Medical News Today.

“When a friend suggested I start painting, it was the last thing on my mind. But when I picked up the brush, it helped me through a very dark time in my life after my diagnosis, and I decided that I wanted to begin creating artwork for a living.”

Soon after the discovery of her love of art, she became a professional artist and was selling her artwork online and at shows.

“My limited eyesight gave me a new appreciation for vivid colors and focused my work on what I could accomplish, despite vision loss,” she said.

“I have learned to rely on my memory and use strong magnifying glasses since it is difficult for me to see details. I also use bright contrasting colors, which are easier for me to distinguish.”

Not only is Suzanne’s success as an artist a personal achievement, but she also hopes her work inspires other diabetes sufferers to look after their vision.

“It’s important for people to know about the risk of vision loss from diabetes. It’s my mission to use art as a way to remind people that their sight is worth protecting.

Because of my experience, it’s important to me that my paintings make a statement. I hope people see my art, hear my story and are inspired to prioritize their vision.”

Reducing the risk of diabetic eye disease

There is no doubt that by having annual retina eye exams, the risk of vision loss as a result of diabetes could be significantly reduced. But what does a dilated examination involve?

During the test, eye drops are put into a patient’s eye. These drops cause the pupils to open, allowing the doctor to clearly assess all structures of the eye, including the retina, to determine whether there is any damage or early signs of disease.

“Ophthalmologists, optometrists and retina specialists are able to conduct these exams and can direct patients to the appropriate specialists if there are findings,” explained Dr. Awh.

As well as regular dilated eye exams, the NEI says that diabetes sufferers can also reduce their risk of diabetic eye disease though good control of blood sugar, blood pressure and cholesterol levels.

To find information about how diabetes can cause vision loss, the retina eye exam and to find a retina specialist in your area, you can visit Diabetes Eye Check, a part of the American Society of Retina Specialists (ASRS).

Written by Honor Whiteman

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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Coke and Pepsi Face Diabetes Backlash

Photo: Getty Images

Mayor Bloomberg’s thwarted soda ban hasn’t been forgotten. Coke and Pepsi are facing a new health-related challenge as doctors increasingly link their sugary beverages to debilitating illness, according to a critical new report by Wall Street bank Credit Suisse and research from Georgetown University, made available exclusively to Adweek.

Diabetes has supplanted obesity as the biggest threat to any brand hocking sugary beverages, according to Credit Suisse’s research. “We found that 90 percent of doctors in the United States, U.K. and Asia are convinced that excessive sugar consumption causes Type 2 diabetes,” said Stefano Natella, head of Global Equity Research at Credit Suisse. About 43 percent of added sugars in our diets come from sweetened beverages, per the report.

Put another way, the American Medical Association recommends that women have no more than 6 teaspoons of sugar a day; a 12-ounce can of soda contains 8-10 teaspoons.

Until now, major soda brands have insisted that  soda—at about 150 calories a can—can be part of a healthy lifestyle for people who avoid overeating and stay active. Marketing efforts, such as Coke’s recent pro-heath ad “Live Like Grandpa Did,” focus on preventing obesity.

But when it comes to brand attitudes, consumers worry more about diabetes than they do about obesity, and many hold Coke and Pepsi responsible. A study by Georgetown University conducted last week showed that after people saw a sugary soda ad with a pro-exercise, anti-obesity message, almost all of them had a positive attitude toward the products’ parent brand. But when the ad was modified to be anti-diabetes, participants’ reactions became 37 percent more negative toward the parent brand, said researcher Ishani Banerji.

“People are not willing to punish the brand for obesity, which seems like a lifestyle problem. But diabetes is considered a disease, and many consumers see the parent brand as contributing to it,” even if the brand claims otherwise, said Kurt Carlson, a Georgetown marketing professor who oversaw the study.

Not surprisingly, Coke and Pepsi are careful to skip around the D-word in their health-related marketing. Instead, they emphasize that they are ramping up their no-sugar and low-sugar offerings and encourage fitness. “We offer a diverse portfolio of beverage choices to meet a range of consumer needs,” said a Pepsi rep. Coke is helping build 100 fitness centers in U.S. schools to promote physical activity, said a Coca-Cola rep. Both companies declined to say if they will address diabetes concerns in future marketing.

As the debate over sugar and diabetes intensifies, consumption of non-diet drinks will suffer, predicts the Credit Suisse report. Coke and Pepsi will certainly shift their messages and product development, said Tom Bernthal, CEO of brand consultancy Kelton Global. 

Ty Montague, co-founder of creative consultancy co: collective, said the pressure is on the beverage giants to “create stuff people want more than the core [high-sugar] soda products.”

Indeed, Pepsi launched a cola in Australia last year that replaces a third of the sugar with stevia, a natural, no-calorie sweetener. In June, Coke introduced its own low-sugar stevia product, Coca-Cola Life, in Argentina.

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