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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Mexico Taxes Soda to Combat Obesity

popA food earthquake just hit south of the border. Mexico has successfully passed legislation placing an 8 percent sales tax on sugary soft drinks in response to their obesity epidemic. This is a significant public policy threat to the revenues of industrial beverage companies like Pepsi and Coca-Cola. It also raises public policy questions for the U.S. as it struggles with its own national epidemic of obesity and diabetes.

Health care costs expand with waistlines

Mexico and the United States are two of the world’s fattest countries. In the U.S. 31.8 percent of adults are classified as obese. In Mexico, it is 32.8 percent.

Heightened obesity levels increase human suffering. Obesity is linked to type 2 diabetes, coronary heart disease, stroke, hypertension and arthritis. Today, 25 million Americans have type 2 diabetes. 27 million have chronic heart disease. 68 million have hypertension and 50 million have arthritis.

Heightened obesity levels also place a heavy cost burden upon our national economy and family budgets. In the U.S., the cost of treating obesity-related diseases is $48 billion. The Harvard School of Public Health estimates that the added costs of lost work days, increased medical insurance rates and lost wages results in a $190 billion cost impact upon our national economy.

Increased sodas sales drive obesity rates higher

The consumption of just one can of soda is not going to make a person obese or cause diabetes. It is the volume of soda being consumed by Americans and Mexicans that is threatening human health. According to the national Soft Drink Association, the average adult in the U.S. consumes 600 12-ounce servings of soda per year. Mexico is the world’s largest consumer of soft drinks. The average Mexican drinks a stunning 46 gallons of soda per year! Coca-Cola’s own estimates are that the average Mexican consumes 650 cans of soda per year.

Research points to increased soda consumption driving obesity rates higher in both Mexico and the United States. The rate of increased soda consumption and the increase in obesity rates have risen together.

Soda plus junk food are threatening our children’s health

Soda and fast food companies view their products as benign to human health because a “calorie is a calorie.” Research say this is not the case. A National Health and Nutrition Examination Survey found that top sources of energy for 2 to 18-year-olds were grain desserts, pizza and sugar sweetened beverages. This study went on to identify that half of the “empty calories” in our children’s diet comes from just six foods: soda, fruit drinks, dairy desserts, grain desserts, pizza and whole milk. Illogically, government policy continues to support the food industry’s promotion of increased junk food and soda consumption by our sons and daughters that over the long term will increase their exposure to obesity-related diseases.

Marketing, advertising and volume price incentives drive obesity rates higher

I attended a national marketing conference where the Coca-Cola company’s confused ethics were brought to my attention. At this conference, a Coca-Cola marketing manager presented his success in growing Diet Coke sales through a promotional campaign focused upon the erosion of polar bear habitat due to climate change. This Diet Coke marketing campaign was a Hollywood-quality media outreach that successfully engaged youth and the millennial generation on their heightened focus of environmental issues. Proudly, this marketing manager reported that this campaign drove the sale of Diet Coke to record results. This case study left me with these impressions:

  • Polar bears gained needed publicity on their loss of habitat
  • Nothing really happened that enhanced the survival rate of polar bears
  • The Coca-Cola company grew their revenues
  • A marketing team may have gotten a financial raise
  • The health risk to U.S. citizens, especially our children, from drinking “empty calories” was increased

Will Mexico’s sales tax on soda reduce obesity?

The public policy question of Mexico’s 8 percent tax on soda is whether it will result in reduced sugar consumption, resulting in the reduction of obesity. Raising the price of a product through a tax will reduce its purchase if these three key conditions are met:

  1. Consumer incomes do not increase to levels that economically compensate for the demand suppressing tax
  2. There are viable and cost-attractive product substitutes to the product being taxed
  3. The product tax is significantly high enough to create a new “cultural norm” away from purchasing the taxed product

The challenge for Mexico is that soda fills a consumer void in clean water supplies. Soda has also become a cultural norm promoted by millions of dollars in annual advertising that links soda to the aspirations and values of consumers. And the income of Mexicans are increasing and this income increase can blunt or eliminate the demand-suppressing impacts of a tax upon soda.

Public policy that can reduce obesity

The current U.S. public policy of increasing consumer awareness of the health risks tied to high levels of soda consumption is at best slowing the rate of soda consumption. Encouragingly, at least half of U.S. moms say they are reducing their family’s consumption of soda.

Cigarette regulations provide an example of public policy that will meaningfully reduce soda consumption levels and its human health impacts. The public policy tools used to reduce the rate of cigarette consumption were:

  • Significantly higher product taxes
  • Advertising restrictions, especially toward children
  • Very visible and frank package labeling that links consumption to adverse health risks
  • Regulation of adult consumption behaviors
  • Sales prohibition to minors

Applying similar rules and regulations to soda sales will reshape the current cultural norm of soda drink dispensers that offer unlimited refills and “super size me” portions. Without this level of public policy, it is highly unlikely that the U.S. will achieve affordable health care insurance or significant reductions in the human suffering created from the marketing of obesity-linked diets.

Bill Roth is an economist and the Founder of Earth 2017. He coaches business owners and leaders on proven best practices in pricing, marketing and operations that make money and create a positive difference. His book, The Secret Green Sauce, profiles business case studies of pioneering best practices that are proven to win customers and grow product revenues. Follow him on Twitter: @earth2017

[image credit: Vox Efx: Flickr cc]


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The Magi and The Sleeping Star Offers A New Type of Diabetes Management

The Magi and The Sleeping Star is a Kickstarter campaign with a cause. In this fantasy adventure game by Game Equals Life, your hero will battle against ancient kings and robots, as well as a very real-word problem, type 1 diabetes.

Developer Adam Grantham is a game designer who has lived with type 1 diabetes for over 19 years. He’s always wanted to make a game that will help people better understand the disease, which is how he thought up the idea for The Magi and The Sleeping Star. If the game is funded, not only will it help people to learn about diabetes, but kids who have been newly diagnosed will finally have a hero to look up to.

“The Magi and The Sleeping Star is unlike any health game before,” explains Grantham on the Kickstarter page. “Rather than coming from the realms of medical research and academia, it comes straight from the game industry. I knew from the beginning that if the game wasn’t fun, it wasn’t going to be teaching anyone anything. So we designed a core game that was strong enough to stand alone as an exciting, evocative adventure.”

He goes on to discuss one of the game’s core mechanics, blood sugar balance. In order to be able to access all of your hero’s abilities, players will need to manage blood sugar levels. According to Grantham, the game isn’t about diabetes, instead it’s about a hero’s journey and that hero just happens to have the disease.

If you want to help bring The Magi and The Sleeping Star to life, check out the game’s Kickstarter campaign.

Leah B. Jackson is an Associate Editor at IGN. Feel free to follow her/send tips on Twitter and MyIGN.

Another Angle on Childhood Obesity — Empower the Child …

We know the statistics. Childhood obesity has become a national public health challenge, with rates of childhood obesity doubling in the past 30 years. (1) According to the Centers for Disease Control and Prevention, in 2010 approximately 1/3 of children were obese or overweight. (2) A study released by the American Heart Association just this month found 5 percent of American teenagers were severely obese.

With a national focus on childhood obesity this month, teaching children to manage their weight and eat consciously should play a significant role in empowering children to prevent obesity. Children are capable of learning about food, nutrition and movement. The American Academy of Pediatrics has found that children are starting to eat more vegetables and move. While these results are encouraging, significant gains are still needed to combat this national health crisis.

Having sent my own child off to school recently, I realize that access to the right food prevents children from making poor food choices, but empowering children with the tools and knowledge to make healthy decisions is a life skill that can be taught. Children can learn to budget calories, sugar and fat. We just need to teach them.

In our house, we budget sugar by creating our own system of sugar finance. The children are allowed so many “sugar dollars” per day and have learned to use addition and subtraction to decide if they can eat that second cupcake or lollipop. They think about the number of sugary drinks they may have had and they count their servings of fruits and vegetables. They actually treat the whole system like a game and are determined to win everyday by banking their sugar dollars for real money at the end of the week. They are, by the way, 5 years and 4 years of age, respectively.

I have seen many great initiatives trying to bring the concept of nutrition into the schools. Vending machines with healthy foods, improved food service, and community gardens are becoming a part of our children’s schools. While this is encouraging, I still do not see a national curriculum on nutrition that teaches children to budget and measure food, calories and sugar on a daily basis. We need a curriculum that empowers the child. Sugar dollars may be a start, but we need more creative tools to help kids help themselves.

In developing such a curriculum, children will also learn the more intangible lessons of self control, discipline and respect for one’s body. These are skills that will determine success later in life. Short term, self gratification does not lead to success of any kind. Strategic thinking, planning and impulse control will. Having observed my own children and many others, these are early learning lessons. They should begin in preschool and advanced through elementary education.

While we work on food deserts, movement and genetically modified food, lets include the child at the center of the childhood obesity concept. As a mom, pediatrician, integrative health expert and living healthy naturally M.D., I know that children can do this. They can beat the obesity crisis if we can create the right curriculum. We need to empower the child.

References:

1. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity and trends in body mass index among US children and adolescents, 1999-2010. Journal of the American Medical Association 2012;307(5):483-490.

2. National Center for Health Statistics. Health, United States, 2011: With Special Features on Socioeconomic Status and Health. Hyattsville, MD; U.S. Department of Health and Human Services; 2012.

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Type 2 Diabetes? Hypertension? Get Tested for Sleep Apnea!

If you suffer from Type 2 diabetes or hypertension, you should be evaluated for obstructive sleep apnea (OSA) by a physician who is board-certified in sleep medicine. This is a recommendation recently issued for the first time by the American Academy of Sleep Medicine (AASM). This new guideline could have a significant impact on diagnostic procedures for tens of millions of adults in the United States. Type 2 diabetes and hypertension are all-too-common conditions among U.S. adults, and their numbers are rising alarmingly. More than 25 million people in the U.S. have diabetes, and approximately 90-95 percent of these are cases of Type 2 diabetes. Hypertension — high blood pressure — affects a third of American adults, roughly 67 million people.

OSA frequently is found in people with Type 2 diabetes and with cardiovascular conditions, including hypertension. Estimates vary, but it is believed that approximately half of patients with high blood pressure also have OSA. The overlap may be even higher with Type 2 diabetes, with a majority of these patients also suffering from the sleep disorder.

There is an enormous body of research to suggest that people who suffer from OSA are at significantly increased risk for diabetes and hypertension, and vice versa. The relationships of OSA to diabetes and hypertension are complicated and appear to be multi-directional. All three conditions share risk factors, particularly obesity. In addition to exploring the consequences of shared risk factors, scientists are also investigating other biological connections between sleep apnea, hypertension and Type 2 diabetes. We don’t know all of the connections between these three health issues, but we do know that in the cases of both Type 2 diabetes and hypertension, the presence of OSA is extremely common and can complicate treatment if left unattended. OSA, like many sleep disorders, continues to be seriously under diagnosed. Those with undiagnosed sleep apnea are at particular risk for complications of diabetes and hypertension.

The Sleep Heart Health Study is a long-term, ongoing, population-based investigation of the health consequences of sleep-disordered breathing on cardiovascular health. This research has revealed a strong association between the disordered breathing that is a symptom of sleep apnea and hypertension. The results are striking, in particular because they indicate the risks of OSA to high blood pressure are not limited to traditional high-risk groups such as the obese, men and older adults. Instead, the study has found elevated risk for high blood pressure among middle-aged and older adults, men and women, people who are overweight and those who are normal weight. Other recent research has also demonstrated the relationship between OSA and high blood pressure:

  • The risk of hypertension appears to increase with the severity of obstructive sleep apnea. Researchers at the University of Wisconsin School of Medicine analyzed data on sleep and blood pressure for 709 adults over a four-year period. They found the risk of hypertension increased with the frequency of apnea episodes per hour of sleep. Those with 15 or more apnea episodes per hour were at three times the risk for hypertension as those without sleep apnea.
  • Severe OSA has also been strongly linked to resistant hypertension. Resistant hypertension is a form of high blood pressure that does not respond to medication. When a group of men and women with resistant hypertension were tested for obstructive sleep apnea, researchers found 83 percent had the sleep disorder.

Attempting to treat high blood pressure through medications or other therapies without also addressing the possible presence of OSA may undermine the success of treatment.

The same likely is true for Type 2 diabetes. Research has established links between obstructive sleep apnea and diabetes, which have been described as “interacting epidemics.” Studies indicate that OSA may disrupt normal glucose metabolism and increase insulin resistance, which is the underlying biological mechanism of Type 2 diabetes:

  • Researchers at the University of Chicago found the presence of OSA in patients with Type 2 diabetes was linked to a decline in glucose control. Compared to diabetes patients without obstructive sleep apnea, those with mild, moderate and severe sleep apnea demonstrated poorer glucose control. As severity of OSA increased, glucose control in these patients deteriorated significantly.
  • Obesity is an important risk factor for both obstructive sleep apnea and Type 2 diabetes. But research indicates that a relationship between the two conditions may exist independent of obesity. Researchers at Pennsylvania State University found an association between insulin resistance and sleep apnea in a group of non-obese middle-aged men.

There’s some good news behind this AASM recommendation as well. In both hypertension and Type 2 diabetes patients with OSA, treatment for sleep apnea can not only improve the sleep disorder, but also help improve the other conditions as well. Research shows that effectively treating OSA can lead to improvements in hypertension and Type 2 diabetes:

  • Regular use of continuous positive airway pressure (CPAP), the most common treatment for OSA, appears to play a role in lowering glucose levels, according to new research from the University of Chicago’s Sleep, Metabolism and Health Center. Patients with both sleep apnea and Type 2 diabetes who used CPAP continuously for one week lowered both their daily average glucose levels and their morning glucose levels. (Morning spikes in glucose levels are common among those with Type 2 diabetes.)
  • CPAP also can help reduce both nocturnal and daytime blood pressure in patients with obstructive sleep apnea. A single night of CPAP use resulted in a reduction of nighttime systolic blood pressure, and 2 months of sustained CPAP lowered daytime systolic blood pressure as well. Other research has shown that 12 weeks of CPAP therapy resulted in lowered daily blood pressure values.

This recommendation by the AASM makes a great deal of sense, based on the abundance of evidence we have linking these conditions and the complications we know can arise when sleep apnea is left untreated. Now it is up to patients and doctors to follow through and make sure these evaluations take place, with qualified physicians. If you are one of the millions who suffer from either Type 2 diabetes or hypertension, your can improve your health and lower your risks if you are properly evaluated for obstructive sleep apnea.

Sweet Dreams,
Michael J. Breus, PhD
The Sleep Doctor®
The Sleep Doctor’s Diet Plan: Lose Weight Through Better Sleep
Everything you do, you do better with a good night’s sleep™
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Forgotten Dimension of Diabetes Revealed in DAWN2 Study

Would you be surprised to know family members of people with diabetes share similar emotional difficulties as their loved ones? Many health care providers don’t acknowledge the self-blame and anxieties that keep diabetes patients away for years? Enough people report positive experiences with diabetes that it’s leading to a new field of research?

Below are highlights from my talk with Søren Skovlund, global director of patient research and engagement at Novo Nordisk and research director of the company’s DAWN2 (Diabetes Attitudes, Wishes and Needs) study. Above were some of the study’s surprising findings.

Novo Nordisk, the Danish pharmaceutical giant, is one of the world’s largest health care companies and manufacturers of insulin. Its 90-year history has been built on improving the everyday experience and care of people living with diabetes through its services as well as products.

The purpose of the DAWN studies (the first was conducted in 2001) is to help people with diabetes improve their self-management by looking at, and increasing understanding and awareness of, the unmet psycho-social needs of people with diabetes and caregivers. And subsequently, fostering initiatives, policy changes and education to help meet those needs.

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Over the weekend at the 73rd Scientific Conference of the American Diabetes Association (ADA), the company released results from their two-year long DAWN2 study.

As an advocate myself of emotional strength and support to self-manage diabetes, oddly, I see an increasing appetite for everything but — for quick and slick fixes.

We salivate over new technology and devices — meters with increasing bells, whistles and download capability, cool iPhone-like looking insulin pumps, greater functionality in mobile health devices, apps and games.

Yet just as in the Hans Christian Andersen tale “The Emperor’s New Clothes,” where no one in the kingdom told the emperor he wasn’t wearing any clothes but for one small child, few acknowledge the emotional component of managing diabetes. Why? It’s murky, messy, ill-defined and hard.

But study after study shows nearly half of the U.S. adult population with diabetes do not achieve the ADA’s recommendation of an A1C less than 7 percent and two-thirds of young people are not meeting their A1C target goal.

Study after study also shows that people do significantly better managing diabetes, and their quality of life improves, with support.

Do we need the best medicines and tools we can get to help us manage diabetes? Absolutely. My point is that you can have access to better medicines and tools and yet do little because you haven’t got the emotional strength, resilience and support to get up every day and manage this chronic condition; you may lack internal resources and/or family, friend, caregiver or peer-support.

Successful diabetes management in my book requires a “MUSE”: Meaningful reason to stay well, Understanding what diabetes is, Skills for lifestyle changes and Emotional strength/support, in addition to medicine and devices.

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Here follow highlights from my talk with Dr. Skovlund (pictured at left).

Key and surprising findings of DAWN2
RG: What are the key findings from both the original DAWN study in 2001 and the DAWN2 study?

Søren Skovlund: Both studies confirm the increased psychological burden that people with diabetes face and how significant that burden is in managing diabetes. Simply, you cannot deal with diabetes without also addressing how it affects your life.

We also learned the differences in perception health professionals and people with diabetes hold about what diabetes is and what the challenges are. And, I’m sure you won’t be surprised to know, there’s a communication gap between doctor and patient.

While health professionals report that they ask their patients regularly about how diabetes affects their life, few people with diabetes report that their care team asks them this question or involves them in any other ways, including planning their own treatment.

The good news, however, is we saw that the more people with diabetes feel that those helping them listen to them, the better they do with their diabetes.

One key finding in the first DAWN study that resonated particularly with clinical professionals was what keeps people with Type 2 diabetes from seeking and accepting treatment. Across all countries, fear and denial often keep people from seeking treatment for years. Then when offered treatment they often change doctors or delay.

RG: What other surprises were revealed in the new study?

SS: The fact that there’s a profound emotional burden on family members of a loved one with diabetes, yet so very little is known about it or done about it. We saw this for the first time in DAWN2 because we were evaluating spouses’ and other cohabitating adults’ experience on a larger scale.

DAWN2 shows us that this is an important aspect to address, particularly since this burden can be reduced.

Positive stories yield a new research field
On the positive side, we were surprised by the pocketful of positive, meaningful experiences a quarter to a third of people related about life with diabetes. We have thousands of hopeful, encouraging stories of meaning and inspiration.

DAWN2 researchers are now analyzing and coding thousands of personal stories we collected from four continents to see where people find positive images and turning points in living with diabetes, and we’re very excited about this as a new area of research.

If we can understand how people climb up their mountain of challenges, then maybe we can use these stories therapeutically. So DAWN2 may help us not just look at the burden of diabetes but also how we meet its challenges. And now we have a rich database to offer the global community from which to establish a research field. One we hope may also contribute to other chronic diseases.

RG: How open are health care professionals to changing their behavior?

SS: From our first study to DAWN2, we see greater openness and readiness on the part of healthcare professionals to partner with their patients. There’s a marked positive shift toward valuing patient empowerment and recognizing that the person with diabetes is the expert on his condition just as the professional is an expert in providing support, coaching and knowledge.

We also see the need for people with Type 2 diabetes, particularly, to speak up and get more actively engaged. Many people with Type 2 can be symptom free for years, and since few are cared for by diabetes specialists, they tend not to see their condition as serious or ask questions. Yet while diabetes is clearly serious, with information, hope, reassurance from their doctors, and a team effort, people can live a good and full life with diabetes.

So we need to find effective ways to get people with diabetes engaged, sooner, and sensitize and equip health professionals to respond.

Next steps
RG: How will the results of DAWN2 be used?

SS: Our next steps are for the national DAWN2 committees to begin to define concrete initiatives relative to emotional support, education and patient involvement that will help improve glycemic control and treatment outcomes in all our participating countries.

Over this year and next, we’ll also be ensuring that the study results are available to scientific publications and then publicly so anyone can apply to the committee to research the data and learn more.

For my 41 years living with diabetes, the last 10 working in the field, I see all too often the emotional toll diabetes extracts. My first book, The ABCs Of Loving Yourself With Diabetes, was expressly written to help readers develop greater emotional strength and resilience to better manage their care.

If you are having difficulty managing your diabetes look for sources of support — family, friends, social media sites, a coach or counselor, and tell your health care team.

Note: In full disclosure, Novo Nordisk has not asked me to write this blog. Personally, I applaud their investment in bringing greater awareness to the psycho-social dimension of living with, and managing, diabetes.

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Riva’s new book, Diabetes Do’s How-To’s, is available in print and Kindle, along with her other books, 50 Diabetes Myths That Can Ruin Your Life and the 50 Diabetes Truths That Can Save It and The ABCs Of Loving Yourself With Diabetes. Riva speaks to patients and health care providers about flourishing with diabetes. Visit her website DiabetesStories.com.

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Answer to obesity problem: Prancercise [VIDEO] | The Daily Caller

Joanna Rohrback has the answer to solving America’s obesity epidemic — and it involves prancing around like a pony.

Her fitness routine, titled “Prancercise,” is a self-described “fitness revolution” that entails a dance/prance movement with ankle weights to make it a bit more rigorous. And it is taking the internet by storm.

The Prancercise website crashed Wednesday due to traffic overload.

If the idea seems looney to you, you’re not alone. But Rohrback says she doesn’t care.

People describe her as “spooky and goofy and weird and wacky,” she told The Daily Beast. “I say bring it on. I love it. Look at all the attention it’s getting me. If I wasn’t all those things, I wouldn’t be who I am.”

The practice of prancercising pre-dates the popular Zumba dance exercise classes. Rohrback developed it in 1989 when she was a social worker.

“I must have heard a really good song I liked on the radio,” Rohrback said to the Daily Beast. “I started moving in a rhythmic way, using ankle weights. And it just evolved.”

She made a video at the time, but because of technological limitations, tabled the idea — until it reemerged on YouTube.

Prancercising involves many different forms, including the “prancercise gallop” and the “prancercise box,” all based on horse jumps.

 

Take a look: 

 

Coming soon….The Daily Caller staff learns how to prancercise.

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Ivanka Trump Gives Birth – Tweet tweet!

Another famo has squeezed one out and has chosen to inform the world by Tweeting.

Model, jewellery designer and TV personality (if being a judge on The Apprentice counts) and all round daughter of a squillionaire, Ivanka Trump announced the arrival of her firstborn on Sunday via the dubious public bullhorn of Twitter.

“We feel incredibly grateful and blessed. Thank you all for your support and well wishes!” ran the tweet.

Ivanka Trump - pregnant

Ivanka Trump - very pregnant

Trump converted to Judaism in 2009 in order to marry the baby’s father Jared Kushner who as owner of the New York Observer is no stranger to being sickeningly rich, himself.

When interviewed about the forthcoming child in Harper’s Bazaar in May this year Ivanka Trump told the magazine “We both said we wanted to wait one year and just enjoy being newlyweds. So we waited pretty much exactly that. Jared is ecstatic. She’ll be a daddy’s girl. I have a feeling they are going to gang up on me.”

[adsense]This as yet unnamed child makes Donald Trump a grandfather for the third time.

It must be strange being a famo. All those strangers reading your banal tweets and giving a shit. It’s destroyed the concept of celebrity as we know it. Famous people – back when they were stars – were either sophisticated, enigmatic or wild. They were urbane and had poise; they were shrouded in mystery; or they lived hedonistic lives of debauchery and big fat squelchy abandon. Finding out that Madonna ate popcorn for breakfast gave us an unparalleled insight into the life of the icon and it was something we could do too. Now Twitter is making it possible for us to infiltrate the lives of the famous. It is like leaving the backdoor open so we can peer in and see what celebrities are doing. They are like insects in a glass jar and we are removing the lid and peering in to watch them wriggle for us and they are inviting us to do so because without our attention, as celebrities, they die.

Twitter logo

Twitter: Follow me, like me, love me.

Nothing seems taboo when it comes to public bullhorning. Lily Allen tweeted about her miscarriage. Ashton Kutcher (who recently agreed to commit career suicide by replacing Charlie Sheen in Two and a Half Men) tweeted about Demi Moore “…My lovely wife through (sic) me a surprise party tonight with all of my friends. She’s the best and I love her so much.” Surely the gushy comments between a loved-up couple should be kept private. For all our sakes. If you want to proclaim unremitting love for your partner, do it discretely. That’s what makes it special. And proving that nothing is sacred, even the Dalai Lamar tweets.

Lily Allen

Lily Allen - tweeted about her miscarriage

I’m not vilifying Ivanka Trump for publicising her new arrival. I just find Twitter a bit distasteful. I liked the enigma of celebrity before Twitter came and made insects of them all.

If you would like to twitter on about Twitter or have a tweet about Ivanka Trump’s new bambino, take a moment to comment below:

 

Images: mix941fm.radio.com, usmagazine.com, petfinder.com, tweepi.com

Justin Bieber has egg on his face: Belieber army mobilises on Twitter

Having received the shocking news that Mariah Carey has been allowed to produce progeny, fairly successfully, it was somewhat of a relief to find out that Justin Bieber had been pelted with eggs during a performance in Sydney on Friday. I felt karma owed me a favour.

The harrowing eggy incident, at Acer Arena, prompted the usual glut of pathetic idle threats from Bieber fans, who are worryingly almost into their hundreds now.

A reconstruction of the events that led to Justin Bieber getting egg on his face

Justin Bieber takes one in the face for his fans

One such irked fan tweeted the following: “Dear person who threw eggs at @justinbieber in Sydney, you now have over #9millionbeliebers after you, be afraid! We go harder than hard!”

Now I’m no coward, but there ain’t nothing more terrifying (other than the idea of being the midwife at Carey’s recent evacuations) than being threatened by a bunch of hysterical, idiotic, generic nine-year-old girls, who have absolutely no hope in hell of ever finding out your identity.

Terrifying Beliebers gather their wepaons

Beliebers mobilise via Twitter in their war against face-eggers. Terrifying.

Harder than hard?! LMFAO! These sociopathic midgets who aren’t even old enough to boast a pubic hair might grow up to regret this laughable behavior. Although the likelihood of that happening is dubious. They’ll never grow up.

Justin Bieber has lesbian hair

It’s not the first time that these satanic little inconsequential Bieber-obsessed micro-tarts have demonstrated their stupidity. It wasn’t so long ago they were issuing death threats (written in crayon) to some poor young girl that the irritating lesbian-haired child star was rumoured to be dating.

Issuing anonymous threats through Twitter? How very brave and mature of you.

I hope the US military are on stand by, in case any of these flat-chested diminutive morons carry out this sinister threat. You can have someone’s eye out with a peashooter I hear.

US Marines fresh from DNA testing Osama Bin Laden's corpse are on standby in case of a Belieber attack

Carefully share your thoughts on this latest episode of Justin Bieber’s fascinating life (so as not to upset those militant nine year olds) by leaving a comment.

Read about Bieber’s alleged assault charges; his award rival Esperanza Spalding attacked by his moron fans; his girlfriend Selena Gomez is also attacked by moron fans and how he vows not to derail like other teen stars. Damn.

images: joshywashington.wordpress.com; asiancorrespondent.com; blog.usnavyseals.com; idolator.com

Facebook and the rise of narcissism

From the words in the bible to the works of Salvador Dali, Narcissism has been a blight on individuals and society since the dawn of man. Narcissism is a mental disorder often caused by lack of attention when young, or a belief that the individual is more important then they actually are.

Musicians, actors and artists are the most likely cases and often choose that path because of the potential attention it brings them. It is considered a love of oneself; a desire to be seen as beautiful, interesting or important, but in truth is borne of insecurity and low self-esteem.

This is what we're waking up to most days. Narcissism is the staple of Facebook.

The modern age has created a new breed of narcissist, those who constantly sell themselves online through sites like Facebook, Twitter and MySpace, and a new study has made it quite clear who is leaning towards this social phenomenon.

They’re actually pretty easy to spot; they’ll be the ones telling you about every minute detail of their lives on a constant basis, from that ‘terrible hangover’ to ‘is soooooooo excited today’ right along to ‘met [insert celebrity name here]’ or pictures of the ever-changing hairdo. They want you to know all about themselves; they seek your approval and by being seen as someone garnering constant attention they somehow validate their existence.

Facebook has become the perfect breeding ground for narcissists; it’s the ideal medium for the lost and lonely to have a voice or a friend. And once they have a friend they never let go of the opportunity to bombard them with useless and trite information.

In a world that has become a well of information-overload do we really need to know who is in a relationship with whom? Apparently the narcissists think so.

The study was conducted by psychology professor Meghan M. Saculla of Flagler College and Western Kentucky University psychology professor W. Pitt Derryberry, with around 300 students as test subjects.

They found that subjects who used Facebook and MySpace as pure self-promotional tools in a bid to become more popular displayed narcissistic tendencies but also admitted the fact which excluded denial.

[adsense]The research, which was analyzed by Ars Technica, found that males actually led the way in that behavioural manner even though females were more likely to have more ‘friends’.

Another factor which may have contributed is demographics, with the study group containing disproportionately more females than males and groups coming from low income or non-city backgrounds.

Narcissism is treated as a personality disorder, especially when utter self absorption creates a magnified sense of self-worth and constant need for praise. However, the latest edition of the Diagnostic and Statistical Manual of Mental Disorder, (the definitive mental health document) will be omitting narcissism which will undoubtedly lead to a flurry of Facebook activity with people seeking validation and reassurance all over again.

Please share your thoughts on narcissism by leaving a comment.

Read about famous narcissists like Lady Gaga, Madonna, Jesse Ventura, Alain Robert and Katie Price (aka Jordan).

Images: piratesandrevolutionaries.blogspot.com, gravity7.com