Big breakfast may be best for diabetes patients

(HealthDay)—A hearty breakfast that includes protein and fat may actually help people with type 2 diabetes better control both their hunger and their blood sugar levels.

Patients who ate a big breakfast for three months experienced lower (glucose) levels, and nearly one-third were able to reduce the amount of diabetic medication they took, according to an Israeli study that was scheduled for presentation Wednesday at the European Association for the Study of Diabetes annual meeting in Barcelona.

“The changes were very dramatic,” said Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center in New York City. “I’m impressed with these findings,” added Zonszein, who was not involved with the study. “We should see if they can be reproduced.”

The researchers based their new study on previous investigations that found that people who regularly eat breakfast tend to have a lower (BMI) than those who skip the meal. BMI is a measurement that takes into account height and weight. Breakfast eaters also enjoy lower and are able to use more efficiently.

The trial randomly assigned 59 people with to either a big or small breakfast group.

The big breakfast contained about one-third of the daily that the would have, while the small breakfast contained only 12.5 percent of their total daily energy intake. The big breakfast also contained a higher percentage of protein and fat.

Doctors found that after 13 weeks, blood sugar levels and blood pressure dropped dramatically in people who ate a big breakfast every day. Those who ate a big breakfast enjoyed blood sugar level reductions three times greater than those who ate a small breakfast, and reductions that were four times greater.


About one-third of the people eating a big breakfast ended up cutting back on the daily they needed to take. By comparison, about 17 percent of the small breakfast group had to increase their medication prescriptions during the course of the trial.

The people eating a big breakfast also found themselves less hungry later in the day.

“As the study progressed, we found that hunger scores increased significantly in the small breakfast group while satiety scores increased in the big breakfast group,” study co-author Dr. Hadas Rabinovitz, of the Hebrew University of Jerusalem, said in a news release from the association. “In addition, the big breakfast group reported a reduced urge to eat and a less preoccupation with food, while the small breakfast group had increased preoccupation with food and a greater urge to eat over time.”

Rabinovitz speculated that a big breakfast rich in protein causes suppression of ghrelin, which is known as the “hunger hormone.”

The protein in the also likely helped control the patients’ blood sugar levels, said Vandana Sheth, a certified diabetes instructor and registered dietitian in Los Angeles and a spokeswoman for the Academy of Nutrition and Dietetics.

“We know when you eat carbohydrates, they can elevate blood sugar within 15 minutes to an hour,” Sheth said. “Protein takes longer to convert into glucose, as long as three hours, and not all of it goes to glucose. Some of it is used to repair muscle, for example. So it’s not a direct effect—100 percent of the carbs you eat convert to glucose, while only a portion of protein you eat converts to glucose.”

Zonszein said he has concerns about the study. For example, he said both the size and the length of the trial were insufficient, and he questioned why so many participants left before its conclusion.

However, he said the results were impressive enough that he might try the dietary strategy out in his own practice.

“It’s a virtually benign manipulation of the meal pattern,” Zonszein said. “I want to give it to my nutritionist to see what she thinks, and we may end up using it with several of our patients.”

The data and conclusions of research presented at medical meetings should be viewed as preliminary until published in a peer-reviewed journal.

More information: For more information on a diabetic diet, visit the U.S. National Library of Medicine.


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Biomarker that can predict diabetes risk identified

Scientists have identified a biomarker that can predict diabetes risk up to 10 years before onset of the disease.

Researchers at the Vanderbilt Heart and Vascular Institute and Massachusetts General Hospital in US conducted a study of 188 individuals who developed type 2 diabetes

mellitus and 188 individuals without diabetes who were followed for 12 years.

“From the baseline blood samples, we identified a novel biomarker, 2-aminoadipic acid (2-AAA), that was higher in people who went on to develop diabetes than in those who did not,” said Thomas J Wang, director of the Division of Cardiology at Vanderbilt.

“That information was above and beyond knowing their blood sugar at baseline, knowing whether they were obese, or had other characteristics that put them at risk,” Wang said.

Individuals who had 2-AAA concentrations in the top quartile had up to a fourfold risk of developing diabetes during the 12-year follow-up period compared with people in the lowest quartile.

“The caveat with these new biomarkers is that they require further evaluation in other populations and further work to determine how this information might be used

clinically,” Wang said.

The researchers also conducted laboratory studies to understand why this biomarker is elevated so well in advance of the onset of diabetes.

They found that giving 2-AAA to mice alters the way they metabolise glucose. These molecules seem to influence the function of the pancreas, which is responsible for making insulin, the hormone that tells the body to take up blood sugar.

“2-AAA appears to be more than a passive marker. It actually seems to play a role in glucose metabolism,” Wang said.

“It is still a bit early to understand the biological implications of that role, but these experimental data are intriguing in that this molecule could be contributing in some manner to the development of the disease itself,” he added.

… contd.




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Study: High blood sugar, but not necessarily diabetes, raises dementia risk

Diabetes has been linked to diabetes before, but a new study suggests people with high blood sugar who don’t even have the disease still seem to face an added risk for Alzheimer’s

Researchers say the new study’s findings suggests a novel way to try to prevent Alzheimer’s disease is by keeping blood sugar, or glucose, at a healthy level.

Alzheimer’s is by far the most common form of dementia. An estimated In the 5.2 million people have Alzheimer’s or some other form of dementia in the U.S., and that number is expected to climb to 13.8 million by 2050, according to the Alzheimer’s Association.

The new study tracked blood sugar over time in people with and without diabetes to see how it affects their risk for the mind-destroying neurological disease.

The results challenge current thinking by showing that it’s not just the high glucose levels of diabetes that are a concern, said the study’s leader, Dr. Paul Crane of the University of Washington in Seattle.

“The most interesting finding was that every incrementally higher glucose level was associated with a higher risk of dementia in people who did not have diabetes,” Crane said in a statement.

“It’s a nice, clean pattern” – risk rises as blood sugar does, added Dallas Anderson, a scientist at the National Institute on Aging, the federal agency that paid for the study. “This is part of a larger picture” and adds evidence that exercising and controlling blood pressure, blood sugar and cholesterol are a viable way to delay or prevent dementia, he said.

Because so many attempts to develop effective drugs have failed, “It looks like, at the moment, sort of our best bet,” Anderson said. “We have to do something. If we just do nothing and wait around till there’s some kind of cocktail of pills, we could be waiting a long time.”

People who have diabetes don’t make enough insulin, or their bodies don’t use insulin well, to turn food into energy. That causes sugar in the blood to rise, which can damage the kidneys and other organs – possibly the brain, researchers say.

The new study, published in Thursday’s New England Journal of Medicine, just tracked people and did not test whether lowering someone’s blood sugar would help treat or prevent dementia. That would have to be tested in a new study, and people should not seek blood-sugar tests they wouldn’t normally get otherwise, Crane said.

“We don’t know from a study like this whether bringing down the glucose level will prevent or somehow modify dementia,” but it’s always a good idea to avoid developing diabetes, he said.

Crane did say that trying to eat less sugar — or foods with a lower glycemic index — may not help everyone.

“Your body turns your food into glucose, so your blood sugar levels depend not only on what you eat but also on your individual metabolism: how your body handles your food,” he said in a statement. Walking and physical activity could help, he added.

The study involved 2,067 people 65 and older in the Group Health Cooperative, a Seattle-area health care system. At the start, 232 participants had diabetes; the rest did not. They each had at least five blood-sugar tests within a few years of starting the study and more after it was underway. Researchers averaged these levels over time to even out spikes and dips from testing at various times of day or before or after a meal.

Participants were given standard tests for thinking skills every two years and asked about smoking, exercise and other things that affect dementia risk.

After nearly seven years of follow-up, 524, or one quarter of them, had developed dementia – mostly Alzheimer’s disease. Among participants who started out without diabetes, those with higher glucose levels over the previous five years had an 18 percent greater risk of developing dementia than those with lower glucose levels.

Among participants with diabetes at the outset, those with higher blood sugar were 40 percent more likely to develop dementia than diabetics at the lower end of the glucose spectrum.

The effect of blood sugar on dementia risk was seen even when researchers took into account whether participants had the apoE4 gene, which raises the risk for Alzheimer’s.

At least for diabetics, the results suggest that good blood-sugar control is important for cognition, Crane said.

For those without diabetes, “it may be that with the brain, every additional bit of blood sugar that you have is associated with higher risk,” he said. “It changes how we think about thresholds, how we think about what is normal, what is abnormal.”

Bitter truth: Diabetes rising at alarming rate in Kingdom

Diabetes in the Kingdom is growing at an alarming annual rate of 80 percent, with 150,000 new cases reported every year.
This was revealed at a gathering of medical experts in the fields of glandular and diabetes-related diseases.
The participants explored the findings of a scientific study conducted among 1,300 fasting diabetics in Saudi Arabia, Kuwait, UAE, Bahrain, Oman, Egypt, Lebanon, Indonesia, Bangladesh and Pakistan.
Dr. Salih Al-Jasir, consultant endocrinologist at King Abdulaziz Medical City’s National Guard Hospital, said countries across the world were spending $ 471 billion annually on diabetes patients. “The US alone spends nearly $ 230 billion compared to SR6 billion on diabetes-related cases in the Kingdom.”
The Head of Diabetes Center at the Ministry of Health, Dr. Mohammed Al-Harbi, said the incidence of diabetes in the Kingdom stood at 14.1 percent of the total population and that 28.9 percent of those infected were above the age of 30. These figures reveal that there were as many as 4 to 6 million diabetics in the Kingdom.
Research findings reveal that the Kingdom is ranked third globally in terms of the incidence of type one diabetes, especially among children, and that this type of diabetes has nothing to do with lifestyle, as many may be born with the disease, he said.
The ministry has decided to set up 28 diabetes centers Kingdomwide, of which 19 centers are already operational, he said.
Dr. Yusuf Salih, consultant of glandular diseases at the Health Affairs department at the National Guard, said that food consumption should, in fact, decrease with the advent of Ramadan and that the volume of work should increase. However, food consumption is found to increase four-fold compared to other months of the year and in the absence of any physical activity, people tend to put on weight.
Dr. Anwar Al-Jimah, another gland disease consultant, stressed the importance of having a pre-dawn meal.
“The later you have sahoor, the more beneficial for diabetics since they need to manage their blood sugar levels,” he said. He advised patients to avoid exercises during fasting hours, especially after Asr prayer, to avoid risks related to low blood sugar cases.

15 – minute walk after meals could help cut type 2 diabetes risk

A fifteen minute walk after each meal may help older people regulate blood sugar levels and could reduce their risk of developing type 2 diabetes, a new study has claimed.

The study by researchers at the George Washington University School of Public Health and Health Services (SPHHS), found that three short post-meal walks were as effective at reducing blood sugar over 24 hours as a 45-minute walk of the same easy-to-moderate pace.

Moreover, post-meal walking was significantly more effective than a sustained walk at lowering blood sugar for up to three hours following the evening meal.

Lead study author Loretta DiPietro, PhD, MPH, chair of the SPHHS Department of Exercise Science, said that these findings are good news for people in their 70s and 80s who may feel more capable of engaging in intermittent physical activity on a daily basis, especially if the short walks can be combined with running errands or walking the dog.

She said that the muscle contractions connected with short walks were immediately effective in blunting the potentially damaging elevations in post-meal blood sugar commonly observed in older people.

DiPietro and her colleagues recruited ten people age 60 and older who were otherwise healthy but at risk of developing type 2 diabetes due to higher-than-normal levels of fasting blood sugar and to insufficient levels of physical activity.

Participants completed three randomly-ordered exercise protocols spaced four weeks apart.

Each protocol comprised a 48-hour stay in a whole-room calorimeter, with the first day serving as a control period. On the second day, participants engaged in either post-meal walking for 15 minutes after each meal or 45 minutes of sustained walking performed at 10:30 in the morning or at 4:30 in the afternoon.

DiPietro said that the team observed that the most effective time to go for a post-meal walk was after the evening meal. The exaggerated rise in blood sugar after this meal—often the largest of the day—often lasts well into the night and early morning and this was curbed significantly as soon as the participants started to walk on the treadmill.

The study has been published in Diabetes Care.

In Diabetes Care, a Push to Simplify

Alfrieda Goterch, 82, found it increasingly hard to manage four daily injections of insulin to control her diabetes, along with a cascade of other age-related problems she was experiencing. In frail health after two major surgeries and a hospitalization following a fall, Ms. Goterch also had a worsening case of glaucoma, and she had developed a wound on her foot.

Older diabetics often struggle to manage the disease, and with their numbers growing fast, diabetes experts are stepping up efforts to improve care. They are screening older patients for physical and mental problems, simplifying complex medication schedules, monitoring them between office visits and teaching them how to manage their disease.

[image]Sara Friedrich

In a study of the care of older diabetes patients including Alfrieda Goterch, left, her daughter Susan Friedrich, right, has weekly calls with a dietitian.

The efforts can be more time-consuming and expensive but often pay off by preventing problems that might have gone untreated and keeping blood-sugar levels under control.

More than a quarter of Americans 65 and older have Type 2 diabetes, according to the Centers for Disease Control and Prevention, and roughly another 50% have a condition known as prediabetes. By 2050, as many as 1 in 3 adults in the U.S. could have diabetes if current trends hold, compared with 1 in 10 now, the CDC says, citing the increased odds of developing Type 2 diabetes with age, population growth of minority groups at higher risk and people with diabetes living longer.

Older diabetics have higher rates of amputation, heart attack, visual impairment and kidney disease. They seek emergency care for blood-sugar crises at twice the rate of the general diabetes population.

But physicians often lack time to assess, educate and manage older patients. Last fall, a consensus panel convened by the American Diabetes Association and the American Geriatrics Society warned that while doctors know how to help middle-aged patients prevent and manage diabetes, far less is known about managing older adults. The panel recommended more individualized treatment, starting with categorizing older adults as healthy, complex or very complex and adjusting regimens accordingly.

Diabetes patients may be active and otherwise healthy, but “on the other end of the spectrum are very frail, sick older patients with other major health problems,” says panel member Jeffrey Halter, director of the geriatrics center at the University of Michigan in Ann Arbor. “If doctors are prescribing 10 medications, and a patient has a significant cognitive disorder, that is asking for a lot of trouble.”

At Joslin Diabetes Center in Boston, where Ms. Goterch receives care, staffers do initial patient screenings to assess health status and functional ability and offer coping strategies and advice. They may provide simpler medical devices and medication schedules to patients with vision or dexterity problems, and refer some to a memory clinic. Between visits, staffers follow up with regular phone calls. In a study published in the March issue of Diabetes Care, a group of patients at Joslin who received regular phone calls offering advice and strategies for diabetes issues had better blood-sugar control than a group that got equal attention but with whom staffers discussed only life events unrelated to diabetes.

“Considering the number of patients who are aging and how many more we are going to see, we have to look for the barriers this population encounters and what we can do to help them overcome them,” says lead author Medha Munshi, who served on the consensus panel and heads Joslin’s Geriatric Diabetes Clinic.

Ms. Goterch, a widow in Salem, N.H., was assessed at Joslin in July 2011, after her daughter Susan Friedrich, a financial adviser, became concerned that oral medications weren’t enough to manage her mother’s disease. Dr. Munshi put Ms. Goterch on a regimen of one insulin injection in the morning and oral medications at mealtimes. That enabled Ms. Goterch to undergo hip surgery in June 2012. In December, though, after a fall requiring two months of inpatient rehabilitation, doctors at the hospital put her on a regimen of four daily injections.

Ms. Goterch lives with her daughter, and the whole family pitches in to help. But after she returned home in February she found it hard to manage the injections during the day when everyone was at work. In March, a blister on her heel became a serious wound. And she had to use eye drops daily for her glaucoma.

At Ms. Goterch’s next visit to Joslin, Dr. Munshi was concerned about the excessive highs and lows in her blood sugar. The good news, Dr. Munshi said, was that she qualified to return to one injection a day, as part of a new study, called Simple. The study aims to determine if fewer injections of a longer-acting insulin can reduce dangerous episodes of hypoglycemia, or low blood sugar, in older patients.

When monitoring diabetes, doctors generally focus on a test called A1C, which measures average blood-sugar levels over two to three months, and may set goals for patients in the range of 6% to 8%. But for elderly patients, the focus is less on hitting those numbers than on getting “the best blood glucose numbers you can get without the risk of hypoglycemia,” Dr. Munshi says. Simpler medication regimens can improve quality of life and decrease the frequency of low blood-sugar episodes, she notes, and they also are associated with better A1C numbers.

As part of the study, Ms. Friedrich reports on her mother’s blood-sugar levels in regular weekly calls with Nora Saul, a Joslin diabetes educator and dietitian, and they discuss adjustments to her diet and medications that may be needed. Ms. Goterch, for her part, says she is grateful for the care at Joslin and says the simplified regimen is keeping her blood sugar under control.

Joslin, an affiliate of Harvard Medical School, contracts with clinics and hospitals to establish diabetes-care programs around the country. The geriatric clinic holds educational webinars for primary-care doctors.

Other groups are running patient classes at hospitals, clinics and pharmacies, with reimbursement by Medicare and most insurers. Programs accredited by the American Association of Diabetes Educators have grown from 72 in 2009 to 573 serving primarily patients over 65 at 1,480 sites. Leslie Kolb, the association’s director of accreditation and quality initiatives, says the programs helped reduce A1C levels among participants in 2012 to an average 7.15 from 8.37.

A program at Presbyterian College School of Pharmacy in Clinton, S.C., gets referrals from physicians who may lack time to educate older diabetes patients, says Kayce Shealy, an assistant professor who runs a wellness clinic at the school. “We can assess their needs, review their medications, make recommendations and send them back to the doctors, who have been very receptive,” she says.

Write to Laura Landro at laura.landro@wsj.com

Dangerous Diabetes preventable

Diabetes Mellitus is one of the major chronic diseases which can be prevented. The study was conducted to assess the carbohydrate intake of type 2 diabetic female patients of age from 45 to 50 years at diabetic clinic of Services Hospital, Lahore. The tools used for data collection were anthropometric measurements, biochemical analysis, clinical signs and dietary data. The findings of the study are; BMI of selected diabetic patients reflects that the majority patients (54 per cent) are overweight. HbA1C value of selected diabetic population is 9.0 per cent which indicated a high blood sugar level and poor management and control of diabetes. Multiple clinical signs and symptoms are present among diabetic patients. Hypertension is found to be the most common health problem in patients with type 2 diabetes. A strong family history and gestational diabetes history relates to the onset of type 2 diabetes. Majority patients have less than basal energy expenditure k-calorie intake. Majority patients have more than 3 meals with snacks in a day. An important finding is that carbohydrate intake of diabetic patients is 156g/day while requirement is for 200g/day. Fibre consumption is unsatisfactory in diabetic patients.



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The combination of blood sugar controlling strategies (diet, medications and exercise) is followed by only a small percentage of patients. Majority patients are complying with a prescribed diet plan. Reasons for non compliance are also observed. The diet plan provided to diabetic patients is unsatisfactory and based on improper distribution of k-calorie between carbohydrate, protein and fat. It is recommended that balanced diet with adequate kilo calories and proper distribution of carbohydrates should be provided to the diabetic patients to prevent many health problems.
AWARENESS is needed on the management of diabetes.
ENCOURAGE patients to lead a normal healthy life and assure them that it is a manageable problem.
WEIGHT MAINTENANCE should be achieved for a good glycemic control.
OBESITY is the major risk factor and weight maintenance should be part of school education.
FAMILY HISTORY is also a major contributing factor and people should be screened and encouraged to adopt a lifestyle to delay the onset of diabetes.
EDUCATION LEVEL is an important factor for the better management and treatment of diabetes.
INDIVIDUAL NUTRITIONAL COUNSELING and nutrition education with special reference to patient’s carbohydrate intake is needed for much better control of glycemic levels; individualizing patient’s own variables, i.e. sex, age, body weight parameters, cooking methods, eating patterns and their lifestyles.
PROPER MEAL SPACING should be introduced to the patients for the best glycemic goals to achieve.
FLEXIBILITY in eating patterns should be encouraged to the patients, by providing them more food choices of selection with the same (amount) grams of carbohydrates.
PROPER DISTRIBUTION OF CARBOHYDRATE regarding quantity and quality be encouraged. Such low-calorie recipes should be developed that focus on complex carbohydrates, high fiber and low to moderate fat, and modified diets that help to produce a low-glycemic load after a meal and ultimately beneficial for improving blood sugar levels.
Much attention is needed in the control of portion sizes by the use of measuring cups, and with the visual aids, rather than written documentations for majority of illiterate patients so that the focus on amount is achieved for all diabetic patients.
Household chores; a part of physical activity was also ignored by diabetic patients. Such types of physical activity should be encouraged for diabetic patients.
Diabetes is a lifelong problem and must be managed and controlled to avoid complications. Every diabetic clinic must have a qualified dietitian in the health care team.
This is an excerpt from the Ghazala Pervez Zaman-supervised thesis of the writer, a Punjab University MSc Food and Nutrition student.

Diabetes experts emphasize need for 'patient-centric' care

Experts at a symposium in Istanbul have suggested a more patient-centric course of treatment for diabetes, stressing that medication alone cannot limit the growing number of people affected by the condition every year.
Diabetes has emerged as one of the leading killers in the Middle East and Africa (MENA) region.
“Caregivers must know that they can no longer adhere to a ‘one-size-fits-all’ approach and that treatment must be more patient-specific,” a panel of experts told diabetes specialists gathered from across the region to discuss the latest advances in the field.
The Ras Al-Khaima-based company, Julphar Diabetes, organized the three-day symposium.
Abdulrazzaq Ali Al-Madani, CEO of Dubai Hospital, stated that the disease affects over 20 percent of the population in Kuwait, Saudi Arabia, Qatar and Bahrain. The United Arab Emirates, which had the fourth highest diabetes rate in the Gulf region until recently, has managed to lower diabetes rates through a set of aggressive measures that include raising awareness and using mobile clinics to treat people in remote areas.
More than 371 million people are currently diagnosed with diabetes worldwide. Half of those afflicted with the disease are still unaware of their condition.
In the MENA region, rapid development and urbanization are among the main factors that have contributed to a spurt in diabetes in recent decades.
Calling for a more personal approach to managing diabetes, Riyadh-based diabetes expert Aus Alzaid advised doctors to take each case individually and prescribe medication dosages according to the age and nature of the patient. “Forcing an elderly person to undergo intensive treatment to bring down prolonged blood sugar levels to their ideal increases the risk of hypoglycemia (dangerously low blood sugar levels). The limited long-term benefits of ideal blood sugar levels in this type of patient can be counterproductive,” he said.
The panel of speakers also cautioned against aggressive medication that frequently results in patients suffering from hypoglycemia. In rare cases, this can lead to seizures and death in the absence of immediate action.
Alzaid said school teachers and staff could be trained to deal with seizures in children, especially in view of the increasing number of youngsters affected by the disease. Schools should not discriminate against children with diabetes, he said.
In the UAE, according to Al-Madani, there is a law that gives children with type 1 diabetes special rights owing to their special needs, which include the need to use the bathroom more frequently or to take a break for insulin administration.
“Children diagnosed with diabetes can and should lead a normal life with the support of their parents,” said Alzaid. “Parents should not treat diabetic children as special.”
Experts have said that reducing obesity and implementing lifestyle changes alone cannot eradicate diabetes. Genetic makeup and other unidentified factors are also determining factors of the likelihood of contracting the disease.
Type 1 diabetes cannot be prevented, as scientists have not been able to determine it, nor can it be cured. It can only be managed or controlled by maintaining blood sugar levels, cholesterol and blood pressure. Alzaid stressed the fact that good management of diabetes does not only include maintaining blood sugar levels, but also maintaining normal blood pressure and LDL cholesterols level as low as possible.
Alzaid added that fasting is not advisable for people with type 1 diabetes. Those with type 2 diabetes should be cautious and follow their doctor’s recommendations. In the event of blood sugar levels dipping to dangerously low levels, it has been deemed permissible by Islamic scholars to break one’s fast.

Raleigh girl outruns diabetes

— Kelly Christ stood at the starting line at dawn, surrounded by thousands of other runners, stretching her legs for a 13-mile run – her third as a diabetic.

She checked her blood sugar: 192. Good.

She knew glucose would be waiting at the water stations if she needed it.

So at the starting gun Sunday, she loped off into the early light in a pair of hot pink running shoes – confident she’d make it back.

“I train five days a week,” Kelly, 14, of Raleigh, said later. “It takes a lot of energy.”

The Tobacco Road Marathon regularly draws about 5,000 runners who compete for an $8,500 purse and a qualifying slot in the Boston Marathon. Most of them don’t have to worry about the chance of falling into a diabetic coma along the way.

Kelly, a runner since 2010, ran her first half-marathon only 13 days after being diagnosed with type 1 diabetes. Sunday counted as her third, and she also has finished a 5K obstacle course as a diabetic.

Type 1 diabetes, formerly known as juvenile diabetes, is far less common than type 2 diabetes. It is a chronic condition marked by a pancreas that cannot produce enough of the hormone insulin to allow sugar to get into cells and create energy. More than 3 million Americans live with type 1 diabetes, relying on insulin to manage it.

Kelly takes insulin at every meal. She pricks her finger 10 to 15 times a day to monitor blood sugar. Everything she does, especially exercise, impacts her glucose level, and her life is a constant balancing act. While she’s running and her endurance is stretched, she relies on her instincts. Once, she said, her blood sugar dropped to a low 57.

“I can feel it,” Kelly said. “I feel shaky in my legs.”

Most of the marathon course follows the American Tobacco Trail in western Wake County. Allscripts, a health-care software firm, is the main sponsor this year for the marathon, which has raised more than $200,000 in the past three years for charities including the Juvenile Diabetes Research Foundation, which works to cure, treat and prevent type 1 diabetes. Kelly knew another diabetic running in the race Sunday, just as dedicated as she is.

“They’re the single most driven people you’ll ever meet,” said Kathy Peterson, a spokeswoman for the foundation. “Kelly is by no means alone.”

Kelly felt nervous in 2011, when she was first diagnosed. But her mother runs marathons, including Sunday’s in Cary, and Kelly feels inspired.

Run on St. Patrick’s Day, the marathon had a light-hearted feel. Runners wore shamrock-shaped antennae and emerald-green tutus.

But as Kelly rounded the final bend with No. 1903 on her bib, and crossed the finish line at two hours and six minutes, she didn’t look like a leprechaun.

She looked like a survivor giving diabetes a knock on the chin.

Shaffer: (919) 829-4818

Diabetes: Tips to Avoid Diabetes Mellitus in Pregnant women

Gestational diabetes mellitus (GDM) is defined as the diabetes that occurs during pregnancy. It is one of the most common health problems faced by pregnant women and usually develops in the middle of the pregnancy, between the 24th and 28th weeks when hormones interfere with the mother’s ability to use insulin. As the pregnancy progresses, the insulin resistance worsens and blood sugar levels increase further.

There are many risks associated with diabetes during and after pregnancy for both the mother and child. The risk of Cesarean section, pre-eclampsia and perineal trauma is increased for the mother during pregnancy.

“Diabetes mellitus may be effectively managed by appropriate meal planning, increased physical activity and properly-instituted insulin treatment”, points Dr Rajiv Kovil, MBBS (Mumbai), Consultant Diabetologist.

Tips for controlling diabetes during pregnancy include:

•    Meals – cut down sweets, eats three small meals and one to three snacks a day, maintain proper mealtimes, and include balanced fiber intake in the form of fruits, vegetables and whole-grains.


•    Increased physical activity
– walking, swimming/aquaerobics, etc.


•    Monitor blood sugar level frequently
, doctors may ask to check the blood glucose more often than usual.

•    The blood sugar level should be below 95 mg/dl (5.3 mmol/l) on awakening, below 140 mg/dl (7.8 mmol/l) one hour after a meal and below 120 mg/dl (6.7 mmol/l) two hours after a meal.

•    Each time when checking the blood sugar level, keep a proper record of the results and present to the health care team for evaluation and modification of the treatment. If blood sugar levels are above targets, a perinatal diabetes management team may suggest ways to achieve targets.

•    Many may need extra insulin during pregnancy to reach their blood sugar target. Insulin is not harmful for the baby.
*Images courtesy: © Thinkstock photos/ Getty Images