Hypoglycemia is the clinical syndrome that results from low blood sugar. The symptoms of hypoglycemia can vary from person to person, as can the severity. Classically, hypoglycemia is diagnosed by a low blood sugar with symptoms that resolve when the sugar level returns to the normal range.
While patients who do not have any metabolic problems can complain of symptoms suggestive of low blood sugar, true hypoglycemia usually occurs in patients being treated for diabetes (type 1 and type 2). Patients with pre-diabetes who have insulin resistance can also have low blood sugars on occasion if their high circulating insulin levels are further challenged by a prolonged period of fasting. There are other rare causes for hypoglycemia, such as insulin producing tumors (insulinomas) and certain medications. These uncommon causes of hypoglycemia will not be discussed in this article, which will primarily focus on the hypoglycemia occurring with diabetes mellitus and its treatment.
Despite our advances in the treatment of diabetes, hypoglycemic episodes are often the limiting factor in achieving optimal blood sugar control. In large scale studies looking at tight control in both type 1 and type 2 diabetes, low blood sugars occurred more often in the patients who were managed most intensively. This is important for patients and physicians to recognize, especially as the goal for treating patients with diabetes become tighter blood sugar control.
Monday 28 November 2011
Wednesday 23 November 2011
INFLAMATION AND DIABETES
High levels of glucose autooxidize-that is, start a chain reaction that produces large amounts of free radicals and "advanced glycation products," both of which damage the body. Free radicals stimulate inflammatory responses and, in this way, people with diabetes develop high levels of inflammation. This situation has been well documented in several studies that have found sharp elevations of CRP (C-reactive protein) and interleukin-6 in people with diabetes. Because of the ability of inflammatory cytokines to stimulate one another, people with diabetes typically have a strong undercurrent of inflammation, which increases the risk of other diseases, such as heart disease.
Nutrients That Can Help
Many supplements can lessen the inflammation in diabetes, but in this case, supplements can be like bailing water in a sinking boat. It is essential that the underlying diet be corrected.
That said, a key objective of supplementation should be to lower glucose levels and improve insulin function, which should in turn reduce inflammation.
A lack of chromium results in diabetes-like symptoms. Not surprising, therefore, supplements of chromium have been shown to improve insulin function and lower glucose levels.
Vitamins E and C improve glucose tolerance and have the added benefit of lowering levels of CRP and interleukin-6. The effect of these vitamins on easing diabetic complications may be greater than their glucose-lowering properties.
The omega-3 fatty acids forms the building blocks of many of the body's natural anti-inflammatory compounds. Fish oil supplements, which are typically produced from salmon oil, are especially rich in eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Although both fatty acids are essential for health, EPA plays a more important role in the body's defenses against inflammation.
Fish oils actually help rebuild articular (joint) cartilage. Bruce Caterson, Ph.D., of Cardiff University, Wales, led a team of molecular biologists who discovered specifically why fish oils reduce inflammation and inhibit the breakdown of cartilage, one of the characteristics of osteoarthritis.
Nutrients That Can Help
Many supplements can lessen the inflammation in diabetes, but in this case, supplements can be like bailing water in a sinking boat. It is essential that the underlying diet be corrected.
That said, a key objective of supplementation should be to lower glucose levels and improve insulin function, which should in turn reduce inflammation.
A lack of chromium results in diabetes-like symptoms. Not surprising, therefore, supplements of chromium have been shown to improve insulin function and lower glucose levels.
Vitamins E and C improve glucose tolerance and have the added benefit of lowering levels of CRP and interleukin-6. The effect of these vitamins on easing diabetic complications may be greater than their glucose-lowering properties.
The omega-3 fatty acids forms the building blocks of many of the body's natural anti-inflammatory compounds. Fish oil supplements, which are typically produced from salmon oil, are especially rich in eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Although both fatty acids are essential for health, EPA plays a more important role in the body's defenses against inflammation.
Fish oils actually help rebuild articular (joint) cartilage. Bruce Caterson, Ph.D., of Cardiff University, Wales, led a team of molecular biologists who discovered specifically why fish oils reduce inflammation and inhibit the breakdown of cartilage, one of the characteristics of osteoarthritis.
Wednesday 16 November 2011
DIABETES AT RISK
Researchers don't fully understand why some children develop type 2 diabetes and others don't, even if they have similar risk factors. It's clear that certain factors increase the risk, however, including:
* Weight. Being overweight is a primary risk factor for type 2 diabetes in children. The more fatty tissue a child has, the more resistant his or her cells become to insulin. However, weight isn't the only factor in developing type 2 diabetes. Some children with type 2 diabetes are normal weight.
* Inactivity. The less active your child is, the greater his or her risk of type 2 diabetes. Physical activity helps your child control his or her weight, uses glucose as energy, and makes your child's cells more responsive to insulin.
* Family history. The risk of type 2 diabetes significantly increases if a parent or sibling has type 2 diabetes — but it's difficult to tell if this is related to lifestyle, genetics or both.
* Race. Although it's unclear why, children of certain races — especially blacks, Hispanics, Native Americans, Asian-Americans, and Pacific Islanders — are more likely to develop type 2 diabetes.
* Sex. Type 2 diabetes is more common in girls than in boys during childhood.
* Weight. Being overweight is a primary risk factor for type 2 diabetes in children. The more fatty tissue a child has, the more resistant his or her cells become to insulin. However, weight isn't the only factor in developing type 2 diabetes. Some children with type 2 diabetes are normal weight.
* Inactivity. The less active your child is, the greater his or her risk of type 2 diabetes. Physical activity helps your child control his or her weight, uses glucose as energy, and makes your child's cells more responsive to insulin.
* Family history. The risk of type 2 diabetes significantly increases if a parent or sibling has type 2 diabetes — but it's difficult to tell if this is related to lifestyle, genetics or both.
* Race. Although it's unclear why, children of certain races — especially blacks, Hispanics, Native Americans, Asian-Americans, and Pacific Islanders — are more likely to develop type 2 diabetes.
* Sex. Type 2 diabetes is more common in girls than in boys during childhood.
Thursday 10 November 2011
EFFECTS OF DIABETES
* More than 11 million women in the US have diabetes.
* Women in minority racial and ethnic groups are the hardest hit by type 2 diabetes; the prevalence is two to four times higher among black, Hispanic, American Indian, and Asian-Pacific Islander women than among white women. Because minority populations are expected to grow at a faster rate than the U.S. population as a whole, the number of women in these groups who are diagnosed with diabetes will increase significantly in the coming years.
* Diabetes is a more common cause of coronary heart disease among women than men.
* Among people with diabetes, the prognosis of heart disease is worse for women than for men; women have poorer quality of life and lower survival rates than men do.
* The link between diabetes and obesity is striking. Nearly half (47%) the women with diabetes have a body mass index greater than 30 kg/m2 compared with 25% of all women.
Adolescent Years (10-17 Years)
* About 86,192 females younger than 20 years old have type 1 diabetes; 92% are white, 4% are black, and 4% are Hispanic or Asian American.
* Eating disorders may be higher among young women with type 1 diabetes than among young women in the general population.
* There is an apparent increase in the number of youth of all racial and ethnic groups being diagnosed with type 2 diabetes, and it appears to be more common among girls than boys.
* By age 20 years, 40%-60% of people with type 1 diabetes have evidence of retinopathy, or diabetic eye disease. Untreated retinopathy can lead to blindness. The risk for developing proliferative retinopathy—the most severe form—is higher for girls than for boys (in at least one study).
Reproductive Years (18-44 Years)
* An estimated 1.3 million women of reproductive age have diabetes; about 500,000 of them do not know they have the disease.
* Type 2 diabetes accounts for most diabetes cases during this life stage. Most women with type 1 diabetes were diagnosed during childhood or adolescence.
* Women of minority racial and ethnic groups are two to four times more likely than non-Hispanic white women to have type 2 diabetes.
* Reproductive-aged women with type 2 diabetes have fewer years of education, have lower income, and are less likely to be employed than women without diabetes.
* Estimates of the overall prevalence of gestational diabetes in the United States range from at least 2.5% to 4% of pregnancies that result in singleton live births, with higher percentages among some ethnic groups and older women. Most gestational diabetes occurs in women with risk factors for type 2 diabetes; they are unable to secrete sufficient insulin to overcome the increased insulin resistance that normally results as pregnancy proceeds.
* Gestational diabetes usually ends after the baby is born, but women with gestational diabetes have a 20%-50% chance of developing type 2 diabetes in the 5-10 years after childbirth.
* Children whose mothers had diabetes during their pregnancies have a greater likelihood of becoming obese during childhood and adolescence and of developing type 2 diabetes later in life.
Middle Years (45-64 Years)
* Approximately 3.8 million women aged 45-64 years have diabetes.
* Diabetes is a leading cause of death among middle-aged American women.
* Coronary heart disease is an important cause of illness among middle-aged women with diabetes; rates are three to seven times higher among women 45-64 years old with diabetes than among those without diabetes.
* In 2000, at least one in four women aged 45-64 years with diabetes had a low level of formal education, and one in three lived in a low-income household. Women with diabetes were more likely than women without diabetes to have a low socioeconomic status regardless of race, ethnicity, or living arrangements (marital status, size of household, and employment status).
Older Years (65 Years and Older)
* About 4.0 million women aged 65 years and older have diabetes; one-quarter of them do not know they have the disease. Most elderly women with diabetes have type 2 diabetes.
* Because women make up a greater proportion of the elderly population and women with diabetes live longer than their male counterparts, elderly women with diabetes outnumber elderly men with diabetes. Diabetes is one of the leading underlying causes of death among women aged 65 years and older.
* Being older and having diabetes accelerate the development of diabetic complications such as heart disease, stroke, kidney disease, and blindness. Elderly women with diabetes are at particularly high risk for coronary heart disease, visual problems, hyperglycemia or hypoglycemia, and depression.
* Women in minority racial and ethnic groups are the hardest hit by type 2 diabetes; the prevalence is two to four times higher among black, Hispanic, American Indian, and Asian-Pacific Islander women than among white women. Because minority populations are expected to grow at a faster rate than the U.S. population as a whole, the number of women in these groups who are diagnosed with diabetes will increase significantly in the coming years.
* Diabetes is a more common cause of coronary heart disease among women than men.
* Among people with diabetes, the prognosis of heart disease is worse for women than for men; women have poorer quality of life and lower survival rates than men do.
* The link between diabetes and obesity is striking. Nearly half (47%) the women with diabetes have a body mass index greater than 30 kg/m2 compared with 25% of all women.
Adolescent Years (10-17 Years)
* About 86,192 females younger than 20 years old have type 1 diabetes; 92% are white, 4% are black, and 4% are Hispanic or Asian American.
* Eating disorders may be higher among young women with type 1 diabetes than among young women in the general population.
* There is an apparent increase in the number of youth of all racial and ethnic groups being diagnosed with type 2 diabetes, and it appears to be more common among girls than boys.
* By age 20 years, 40%-60% of people with type 1 diabetes have evidence of retinopathy, or diabetic eye disease. Untreated retinopathy can lead to blindness. The risk for developing proliferative retinopathy—the most severe form—is higher for girls than for boys (in at least one study).
Reproductive Years (18-44 Years)
* An estimated 1.3 million women of reproductive age have diabetes; about 500,000 of them do not know they have the disease.
* Type 2 diabetes accounts for most diabetes cases during this life stage. Most women with type 1 diabetes were diagnosed during childhood or adolescence.
* Women of minority racial and ethnic groups are two to four times more likely than non-Hispanic white women to have type 2 diabetes.
* Reproductive-aged women with type 2 diabetes have fewer years of education, have lower income, and are less likely to be employed than women without diabetes.
* Estimates of the overall prevalence of gestational diabetes in the United States range from at least 2.5% to 4% of pregnancies that result in singleton live births, with higher percentages among some ethnic groups and older women. Most gestational diabetes occurs in women with risk factors for type 2 diabetes; they are unable to secrete sufficient insulin to overcome the increased insulin resistance that normally results as pregnancy proceeds.
* Gestational diabetes usually ends after the baby is born, but women with gestational diabetes have a 20%-50% chance of developing type 2 diabetes in the 5-10 years after childbirth.
* Children whose mothers had diabetes during their pregnancies have a greater likelihood of becoming obese during childhood and adolescence and of developing type 2 diabetes later in life.
Middle Years (45-64 Years)
* Approximately 3.8 million women aged 45-64 years have diabetes.
* Diabetes is a leading cause of death among middle-aged American women.
* Coronary heart disease is an important cause of illness among middle-aged women with diabetes; rates are three to seven times higher among women 45-64 years old with diabetes than among those without diabetes.
* In 2000, at least one in four women aged 45-64 years with diabetes had a low level of formal education, and one in three lived in a low-income household. Women with diabetes were more likely than women without diabetes to have a low socioeconomic status regardless of race, ethnicity, or living arrangements (marital status, size of household, and employment status).
Older Years (65 Years and Older)
* About 4.0 million women aged 65 years and older have diabetes; one-quarter of them do not know they have the disease. Most elderly women with diabetes have type 2 diabetes.
* Because women make up a greater proportion of the elderly population and women with diabetes live longer than their male counterparts, elderly women with diabetes outnumber elderly men with diabetes. Diabetes is one of the leading underlying causes of death among women aged 65 years and older.
* Being older and having diabetes accelerate the development of diabetic complications such as heart disease, stroke, kidney disease, and blindness. Elderly women with diabetes are at particularly high risk for coronary heart disease, visual problems, hyperglycemia or hypoglycemia, and depression.
WOMEN DIABETES
Diabetes currently affects over 246 million people worldwide and over half of these people are women. Already considered an "epidemic," researchers expect these rates to increase to 380 million by 2025. In the US, almost 21 million children and adults have diabetes -- including 9.7 million women -- and almost one third of them do not know it. Diabetes can be especially hard on women. The burden of diabetes on women is unique, because the disease can affect both mothers and their unborn children. Diabetes can cause difficulties during pregnancy such as a miscarriage or a baby born with birth defects. Women with diabetes are also more likely to have a heart attack, and at a younger age, than women without diabetes.
Diabetes is the fifth-deadliest disease in the United States, and it has no cure. For women who do not currently have diabetes, pregnancy brings the risk of gestational diabetes. Gestational diabetes develops in 2% to 5% of all pregnancies but disappears when a pregnancy is over. Women who have had gestational diabetes or have given birth to a baby weighting more than 9 pounds are at an increased risk for developing type 2 diabetes later in life.
The prevalence of diabetes is at least 2-4 times higher among African American, Hispanic/Latino, American Indian, and Asian/Pacific Islander women than among white women. The risk for diabetes also increases with age. Because of the increasing lifespan of women and the rapid growth of minority populations, the number of women in the United States at high risk for diabetes and its complications is increasing. Because women are often influential in affecting behavior change in their own children and families, focusing prevention efforts on them is a good way to improve not only their health but also the health of those they love.
Diabetes is the fifth-deadliest disease in the United States, and it has no cure. For women who do not currently have diabetes, pregnancy brings the risk of gestational diabetes. Gestational diabetes develops in 2% to 5% of all pregnancies but disappears when a pregnancy is over. Women who have had gestational diabetes or have given birth to a baby weighting more than 9 pounds are at an increased risk for developing type 2 diabetes later in life.
The prevalence of diabetes is at least 2-4 times higher among African American, Hispanic/Latino, American Indian, and Asian/Pacific Islander women than among white women. The risk for diabetes also increases with age. Because of the increasing lifespan of women and the rapid growth of minority populations, the number of women in the United States at high risk for diabetes and its complications is increasing. Because women are often influential in affecting behavior change in their own children and families, focusing prevention efforts on them is a good way to improve not only their health but also the health of those they love.
Monday 7 November 2011
CAUSES OF GESTATIONAL DIABETES
Researchers don't yet know exactly why some women develop gestational diabetes. To understand how gestational diabetes occurs, it can help to understand how pregnancy affects your body's normal processing of glucose.
Your body digests the food you eat to produce sugar (glucose) that enters your bloodstream. In response, your pancreas — a large gland behind your stomach — produces insulin. Insulin is a hormone that helps glucose move from your bloodstream into your body's cells, where it's used as energy.
During pregnancy, the placenta that connects your growing baby to your blood supply produces high levels of various other hormones. Almost all of them impair the action of insulin in your cells, raising your blood sugar. Modest elevation of blood sugar after meals is normal during pregnancy.
As your baby grows, the placenta produces more and more insulin-blocking hormones. In gestational diabetes, the placental hormones provoke a rise in blood sugar to a level that can affect the growth and welfare of your baby. Gestational diabetes usually develops during the last half of pregnancy — sometimes as early as the 20th week, but usually not until later.
Your body digests the food you eat to produce sugar (glucose) that enters your bloodstream. In response, your pancreas — a large gland behind your stomach — produces insulin. Insulin is a hormone that helps glucose move from your bloodstream into your body's cells, where it's used as energy.
During pregnancy, the placenta that connects your growing baby to your blood supply produces high levels of various other hormones. Almost all of them impair the action of insulin in your cells, raising your blood sugar. Modest elevation of blood sugar after meals is normal during pregnancy.
As your baby grows, the placenta produces more and more insulin-blocking hormones. In gestational diabetes, the placental hormones provoke a rise in blood sugar to a level that can affect the growth and welfare of your baby. Gestational diabetes usually develops during the last half of pregnancy — sometimes as early as the 20th week, but usually not until later.
Tuesday 1 November 2011
Vitamin C
Alpha-lipoic acid is a vitamin-like substance that is often described as "nature's perfect antioxidant". First of all, alpha-lipoic acid is a very small molecule that is efficiently absorbed and easily crosses cell membranes. Unlike vitamin E, which is primarily fat-soluble, and vitamin C, which is water-soluble, alpha-lipoic acid can quench either water- or fat-soluble free radicals both inside the cell and outside the intracellular spaces. Furthermore, alpha-lipoic acid extends the biochemical life of vitamin C and E as well as other antioxidants.
Alpha-lipoic acid is an approved drug in Germany for the treatment of diabetic neuropathy. In fact, it has been successfully used in Germany for more than 30 years. The beneficial effects of alpha-lipoic acid in diabetic neuropathy have been confirmed in several double-blind studies at a dosage of 300 to 600 mg daily.1,2 Although alpha-lipoic acid's primary effect in improving neuropathy is thought to be the result of its antioxidant effects, it has also been shown to lead to an improvement in blood sugar metabolism, improve blood flow to peripheral nerves, and actually stimulate the regeneration of nerve fibers. Its ability to improve blood sugar metabolism is a result of its effects on glucose metabolism and an ability to increase insulin sensitivity. Its importance in treating diabetic neuropathy cannot be overstated.
Alpha-lipoic acid is an approved drug in Germany for the treatment of diabetic neuropathy. In fact, it has been successfully used in Germany for more than 30 years. The beneficial effects of alpha-lipoic acid in diabetic neuropathy have been confirmed in several double-blind studies at a dosage of 300 to 600 mg daily.1,2 Although alpha-lipoic acid's primary effect in improving neuropathy is thought to be the result of its antioxidant effects, it has also been shown to lead to an improvement in blood sugar metabolism, improve blood flow to peripheral nerves, and actually stimulate the regeneration of nerve fibers. Its ability to improve blood sugar metabolism is a result of its effects on glucose metabolism and an ability to increase insulin sensitivity. Its importance in treating diabetic neuropathy cannot be overstated.
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