USA: Insulin Resistance May Lead to Kidney Disease in the Elderly, says Study

WASHINGTON DC / US News & World Report / Health / March 8, 2012

Those with metabolic syndrome more likely to see rapid renal-function decline, researchers say

Elderly people with metabolic syndrome are at increased risk for chronic kidney disease, and insulin resistance may be the central hub that links metabolic syndrome and kidney-function decline, according to a new study.

People are diagnosed with metabolic syndrome when they have at least three risk factors for diabetes and heart disease, including: high blood pressure, high blood-sugar (glucose) levels, high triglycerides (fat in the blood), low levels of "good" (HDL) cholesterol and too much abdominal fat.

The study included 1,456 people, aged 65 and older, in Taiwan who were followed for an average of more than three years. The findings will appear in the Journal of Clinical Endocrinology & Metabolism.

"Our study found that metabolic syndrome predicts both the prevalence and incidence of chronic kidney disease in people aged 65 years or older," the lead investigator, Dr. Chung-Jen Yen, of National Taiwan University in Taipei, said in a journal news release.

"We also found that rapid decline in renal function is more likely found in individuals with insulin resistance and high blood-sugar levels," Yen added.

The findings suggest "that people can safeguard their kidneys when they take care of their blood glucose levels and lose weight," Yen said. "Further studies are needed to assess the impact of treating metabolic syndrome and insulin resistance on renal outcomes in the elderly population."

More information

The American Academy of Family Physicians has more aboutmetabolic syndrome.

Copyright © 2012 HealthDay.

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USA: Treating Insulin Overdose

NEW YORK, NY / WebMD / Treating Diabetes / January 24, 2012


Diabetes, Insulin Overdose, and Other Complications

WebMD Medical Reference

By Matthew Hoffman, MD

Reviewed By Brunilda Nazario, MD

Cold sweats, trembling hands, intense anxiety, a general sense of confusion -- no, it's not the night before final exams. These are the signs of low blood sugar or hypoglycemia. They can also be the signs of an insulin overdose, a potentially dangerous complication with diabetes.

Hypoglycemia happens to many people with diabetes. And it can sometimes be serious. Thankfully, most episodes related to insulin are avoidable if you stick with a few simple rules. WebMD takes a look at how to handle the problem of insulin overdose. Read on to learn about how to prevent it and how to treat it.

When Insulin Works too Well

Insulin stimulates the cells of the body to absorb sugar (glucose) out of the blood. It also inhibits the production of glucose by the liver. In type 1 diabetes, the body does not make insulin. In type 2 diabetes, the body is resistant to the insulin the body does make, and with time the pancreas may make less insulin. 

All people with type 1 diabetes need to take insulin injections. Many people with type 2 diabetes -- those whose blood sugar can't be controlled with oral medication, diet, and exercise -- take insulin injections.

There are several ways you can get too much insulin in your system and have a drop in your blood sugar:

• You inject too much insulin because you have difficulty reading the syringes or vials or are unfamiliar with a new product.
• You inject the right amount of insulin but the wrong type. For instance, you normally take 30 units of long-acting and 10 units of short-acting insulin. Injecting 30 units of short acting insulin is an easy mistake to make.
• You inject insulin, but then didn't eat. Insulin injections should be timed with meals. Blood sugar rises after meals, but without eating, insulin lowers blood sugar levels to a potentially dangerous level.
• You inject the right amount of insulin but inject it into an arm or leg just before exercise. Physical activity affects insulin absorption: Don't inject in an area affected by the exercise.

Symptoms of an Insulin Overdose

It doesn't matter how it happens. An insulin overdose always has the same effect: low blood sugar levels, or hypoglycemia. Symptoms of hypoglycemia include:

• Anxiety
• Confusion
• Extreme hunger
• Fatigue
• Irritability
• Sweating or clammy skin
• Trembling hands

If sugar levels continue to fall during an insulin overdose, serious complications -- seizures and unconsciousness -- can occur.

Low blood sugar is defined as less than 70 mg/dL. Hypoglycemia is defined as a low blood sugar that leads to symptoms. Some people with poorly controlled diabetes can experience the symptoms of "low" blood sugar at normal blood sugar levels (70 to 120 mg/dL).

On the other hand, some people with diabetes won't experience these symptoms even at low sugar levels. For unclear reasons, some people have few warning signs when their blood sugars drop. This unawareness of low sugar is more common in people with type 1 diabetes.

Being unaware of low sugar levels means you're at higher risk for insulin problems. You may not have a warning that you sugar is low until you become too confused to correct the situation or become unconscious. Family and friends need to know what to do if the situation becomes serious.

What to Do During an Insulin Overdose

The first thing is to not panic if you have an insulin overdose. In most cases, an insulin overdose can be treated at home. Follow these steps as long as you're conscious and able to do so:

• Check your sugar.
• Drink one-half cup of regular soda or sweetened fruit juice and eat a hard candy or glucose paste, tablets, or gel. If you skipped a meal, eat something now. Fifteen to twenty grams of carbohydrates should raise your blood glucose level.
• Rest. Get off your feet and take a break.
• Recheck your blood sugar after 15 or 20 minutes. If its still low, take another 15-20 grams of a quick-acting sugar and eat something if you can.
• Observe. Pay attention to how you feel for the next few hours.
• If you still have symptoms, check your sugar again an hour after eating. Keep snacking if sugar is low.
• If your sugar level stays low after two hours, or if your symptoms aren't improving, seek medical help.

Don't worry about pushing your sugar too high if it's only for a short time. One high level won't hurt you, but a very low sugar can.

If you're unconscious or too confused or are having seizures, your loved ones will have to take control. They should know how to do the following:

• If you lose consciousness, they should call 911 immediately.
• They should inject you with glucagon, an insulin antidote. If you are prone to low blood sugar, ask your doctor if you should have glucagon on hand at home.
• If you're alert enough to follow instructions, they should give you sweet juice to drink. If your symptoms don't steadily improve over the next hour, they should call 911.

How to Prevent an Insulin Overdose

You can avoid an insulin overdose if you do the following:

• Eat something at every mealtime. Even if you're not hungry, have some bread, a glass of skim milk, or a small serving of fruit. Never skip meals!
• Be prepared. Expect that you'll experience insulin complications at some point. Pack hard candies in your bag, and your spouse's. Keep some in the car, and in your travel bag, as well.
• Make sure friends and family know your usual signs and symptoms of hypoglycemia. If low blood sugar levels make you too confused, those around you will need to take action.

Other Insulin Complications

Most other insulin complications are due to not taking enough insulin. Not enough insulin can result in extremely high blood sugars, causing one of two urgent medical conditions:

• Diabetic ketoacidosis (DKA). Excessive urination in response to high sugar causes severe dehydration. At the same time, without enough insulin to allow sugar absorption, the body's cells act as if they are starving.
• Hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Blood sugars can reach greater than 1,000 in HHNS. Similar to DKA, HHNS causes profound dehydration and can be life-threatening.

Once they occur, these insulin complications require hospitalization for treatment.

WebMD Medical Reference

SOURCES:

American Diabetes Association: "About Insulin and Other Drugs."

American Diabetes Association: "Hypoglycemia."

American Diabetes Association: "Ketoacidosis."

American Diabetes Association: "Hyperosmolar hyperglycemic nonketotic syndrome."

The DCCT Research Group. American Journal of Medicine, 1991; vol 90: pp 450-459.

Meneilly G. Diabetes, 1994; vol 43: pp 403-410.

Levy C. Diabetes Care, 1998; vol 21: pp 1330-1338.

Korzon-Burakowska A. Diabetes Care, 1998; vol 21: pp 283-290.

Familydoctor.org: "Diabetes: Why You Need Insulin and How to Use It."

Reviewed by Brunilda Nazario, MD on September 12, 2011

© 2011 WebMD, LLC. All rights reserved.

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UK: Diabetes report reveals 24,000 avoidable deaths a year

LONDON, England / The Guardian / Society / Health / December 14, 2011

Audit gives 'incredibly alarming' estimate of deaths due to inadequate healthcare or failure to manage condition properly


By Denis Campbell, health correspondent

A woman using a diabetes test kit. 

Photograph: Jeffrey Hamilton/Getty Images

Up to 24,000 people with diabetes are dying avoidably each year because they do not receive the right healthcare or do not manage their condition properly, a government-commissioned report has revealed.

The "incredibly alarming" figure is the first estimate of the number of patients who die early because a failure to have health checks, take drugs at the right time and maintain a healthy lifestyle increased their risk of dangerously high or low blood sugar, heart failure or kidney problems.

While three-quarters of the 24,000 deaths are among the over-65s, younger patients are most at risk. Two young people aged 15 to 34 in England are believed to die every week as a result.

While young women aged 15 to 34 have a 1 in 3,300 chance of dying, the risk to a woman of that age with type 1 diabetes is one in 360 (nine times higher), and with type 2 one in 520 (six times higher) . Young men the same age are at a similarly higher risk: one in 360 for type 1 and one in 430 for type 2, about four times higher than the average death risk of one in 1,530.

Dr Bob Young, a consultant diabetologist who led the audit, said the grim statistics gave the first "reliable measure of the huge impact of diabetes on early death. Many of these early deaths could be prevented". Because the number of people with diabetes was increasing, the toll would increase, unless there was action to improve the situation, he added.

Paul Burstow, the care services minister, said: "The audit has revealed shocking variation in care with devastating consequences for the lives of those with diabetes. This snapshot of NHS diabetes care reveals an unacceptable death toll, a death toll that can be cut by delivering the right care at the right time. Armed with the results of this audit, I expect the NHS to learn from the best."

An expansion of Telehealth, which lets patients use technology to monitor their condition while at home and so avoid regular trips to hospital or to see their GP, would help diabetics manage their condition better, as would greater integration of health and social care services, Burstow added.

Barbara Young, the chief executive of Diabetes UK, said the figures were "incredibly alarming as there is no reason why people with diabetes cannot live long and healthy lives if they receive the right care and support to manage their conditions."

While self-management was important, half of those with type 2 diabetes and more than two-thirds of those with type 1 did not get the care they needed, she said.

© 2011 Guardian News and Media Limited

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FRANCE: Scandal Over Mediator, a French Weight-Loss Drug, Prompts Calls for Wide Changes

PARIS, France / Herald-Tribune.com / Health / December 12, 2011

By Scott Sayare

PARIS — In 33 years on pharmacy shelves here, the diabetes drug Mediator was prescribed to an estimated five million French patients, many of them diabetics, many others hoping simply to lose weight. When French authorities ordered the drug off the market in 2009, alerted to possible cardiovascular risks, there were 300,000 active prescriptions.

Mediator and its enigmatic French manufacturer, Laboratoires Servier, a privately held company with a troubled past, find themselves at the center of France’s largest public-health scandal in at least a decade. Health officials estimate that as many as 2,000 people died, with thousands more hospitalized, victims of cardiac valve damage and pulmonary hypertension apparently linked to the drug.

Politicians and the press have pilloried Servier, charging that it concealed the dangers of Mediator for decades and insisting that the company has a wider history of disregarding health concerns about its products. Many have noted that two Servier weight-loss products, both closely related to Mediator, were at the center of the fen-phen scandal of the late 1990s in the United States.

In France, government investigators have accused Servier of licensing Mediator as a diabetes drug to avoid scrutiny, but urging doctors to prescribe the pills as a diet aid to bolster sales — a practice that greatly expanded the pool of those potentially harmed by the drug. Magistrates are investigating the company on charges of consumer fraud and manslaughter, and a public prosecutor has charged Servier with defrauding the French health care system. Trials are expected next year.

There are broader implications, as well. Drug makers have long viewed France’s pharmaceutical oversight apparatus as being relatively permissive, in particular as compared with the United States Food and Drug Administration, which industry and some patient groups criticize as overly cautious. French political leaders say that the Mediator scandal has exposed the failings of the country’s regulatory system, which they have described as rife with conflicts of interest and marked by a distinct apathy toward questions of public health.

The head of the French regulatory body, known by its acronym Afssaps, resigned this year, and French senators approved a package of reforms in October.

“We want there to be a ‘before’ and ‘after’ as regards Mediator in our country,” said Health Minister Xavier Bertrand, addressing the Senate. Getty Images

Servier says it did nothing wrong and has insisted that the discovery of the dangers of the drug, also known as benfluorex, depended in part upon recent advances in echocardiography.

“I don’t see at what point Mediator could have been caught sooner,” said Lucy Vincent, a spokeswoman for Servier.

The withdrawal of Mediator from the market in 2009 — it was then available in France, Luxembourg and Portugal — caused little stir. Only the following year, with the publication of a book titled “Mediator 150 mg: How Many Dead?” did the news media and government officials take serious note.

“I realized they were withdrawing the drug on the sly,” said the book’s author, Dr. Irène Frachon, a pulmonologist. Servier and the health authorities made little effort to alert former patients, she said, like “a car manufacturer who sees there’s a defect in the brakes of its car, and who corrects the defect in its production line but doesn’t warn the people who have the car.”

In 2007, Dr. Frachon was among the first to identify the apparent risks of Mediator. Her book prompted lawsuits, public outcry and a government inquiry.

In January 2011, the interministerial commission leading the inquiry charged that Servier had deceived health authorities and patients in order to keep Mediator on the market.

But in their report, investigators also wrote that health officials had ignored a series of warning signs beginning a decade before. They additionally found that regulatory decisions taken by the Afssaps, the drug licensing agency, were in fact a “co-production,” reached in “cooperation” with drug makers.

At the Afssaps, voting members of the approval committee have long served simultaneously as consultants or employees of the pharmaceutical firms they are meant to regulate, officials acknowledge. And while members are expected to declare conflicts of interest, there are no penalties for not doing so. Consultants or employees from various companies, including Servier, remain active participants even now, according to Ms. Vincent, the Servier spokeswoman.

In America Food and Drug Administration restrictions on conflicts of interest are more rigorous, French and American health officials say. Failure to report a conflict of interest is a crime.

“It’s a matter of culture,” said Dr. Gérard Bapt, a cardiologist and a member of Parliament who has worked on the Mediator case. French health professionals and public officials often dismiss conflicts of interest as irrelevant, he said.


Dr. Gérard Bapt speaks in the National Assembly

Dr. Frachon agreed, attributing that attitude to a certain sense of pride. “We’re the nation of the Enlightenment,” the logic goes, she said, “and we don’t have to take moral lessons from anyone.”

Additionally, in the United States, the specter of class-action lawsuits imposes a higher level of precaution on the part of drug makers, Dr. Bapt suggested.

French law provides for no equivalent legal actions. The fen-phen scandal, which prompted two Servier drugs to be pulled from the market after being linked to severe heart damage, brought a huge class-action settlement and thousands of separate claims in the United States. Wyeth, which had licensed the drugs for the American market, set aside more than $20 billion to pay patient damages. In France, lawsuits connected to the same drugs — have seen a payout of no more than 2 million euros (about $2.7 million), Dr. Bapt said.

The recently approved legal changes, known as the “post-Mediator” rules and partly inspired by the American Physician Payments Sunshine Act, will not create the possibility of class-action suits here. But the reforms, to take effect in the spring, would put in place sanctions for Afssaps committee members who fail to declare conflicts of interest. Interactions between doctors and drug companies are to be more strictly limited, as well.

While they publicly hail the changes, however, some in the pharmaceutical industry insist that the outrage over Mediator cannot be fully explained by the revelations in the case so far. Rather, they say, the public appears shocked by the moral complexities of drug development — by the realization that all medications involve the weighing of benefits and risks, and that even the most honorable evaluators make mistakes.

“There is no public knowledge or acknowledgment of what medicines really are, their limits,” said Ms. Vincent of Servier. “They want to believe in the miracle.”

“Mediator was a drug like any other drug, with its advantages, because it certainly had its advantages, and unfortunately this major disadvantage, which came to light very late,” she continued. “That’s the tragedy of the story.”

Muriel Rousset, 45, began taking Mediator to lose weight shortly after the birth of her second son, in 1998. In 2006, she underwent open-heart surgery to replace two damaged heart valves; she continued to take Mediator, not knowing the drug may have caused her heart problem.

In an interview, she recalled hearing French health officials explain last year that “all medicines are dangerous.”

Muriel : «Je vis avec cette épée de Damoclès»

“Well, wait,” Ms. Rousset said. “For me, as a citizen, I don’t know that medicines are dangerous. A medicine is made to save a life, to bring health, to make things better. And not to kill us.”

Copyright © 2011 HeraldTribune.com

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JAPAN: It takes a sugar to catch a sugar

WAKO, Saitama / Riken Advanced Science Institute / December 2, 2011

A single sugar molecule plays an outsized role in helping a glucose-transporting protein respond promptly to insulin signals

After every meal, the hormone insulin is released into the bloodstream, issuing instructions to target cells to begin taking up excess sugar. In some situations, however, cells stop responding to these signals; and this insulin-resistant state is associated with onset of type 2 diabetes. 

Unexpected findings from Tadashi Suzuki’s group at the RIKEN Advanced Science Institute in Wako have now revealed how a cellular malfunction may contribute to this insulin resistance.

Suzuki and postdoctoral fellow Yoshimi Haga had originally sought to develop imaging strategies to track localization of proteins modified with carbohydrate groups in a process known as glycosylation. They tested their method with the glucose-transporter protein GLUT4 and developed a mutant version of the protein that lacks a glycosylation site, but the results led their study in a new direction. 

“We accidentally found that behavior of our N57Q mutant and the wild-type protein was quite different,” says Suzuki. “It was a completely serendipitous finding.”

Insulin-responsive cells typically maintain reservoirs of GLUT4 in bubble-like vesicles within the cytoplasm; insulin signals induce the transport of GLUT 4 to the cell surface, where it begins pumping glucose into the cell. The N57Q mutant, on the other hand, was largely unresponsive to insulin (Fig. 1). Suzuki and colleagues determined that, instead of gathering within storage vesicles, this protein tended to accumulate either at the cell surface or within ‘recycling vesicles’ that continually shuttle to and away from the plasma membrane.

The N57Q mutant retains normal glucose-transporting capabilities, suggesting that this modification acts primarily as a trafficking signal rather than influencing protein function. Accordingly, the researchers observed the same insulin-insensitive behavior when they used a chemical treatment to alter the glycosylation of normal GLUT4. 

“These results clearly suggest that there must be a mechanism that detects subtle differences in glycan structure on this protein to sort it into specific GLUT4 vesicles,” says Suzuki.

Several studies have found evidence that GLUT4 may be subject to altered glycosylation in a subset of patients with type 2 diabetes; and, these new findings provide a potential explanation for how malfunctions in this protein modification process could contribute to pathology. 

As a next step, Suzuki hopes to uncover more details about how this transport pathway intersects with the insulin response. 

“We believe that glycan-recognition molecules known as lectins should be involved in this process,” he says, “and we will try to identify these lectins and other players involved in the fine-tuning of intracellular trafficking of GLUT4.”

The corresponding author for this highlight is based at the Glycometabolome Team, RIKEN Advanced Science Institute.

© ResearchSEA 2005 - 2010
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INDIA: Festival cheer rings diabetes alarm for Indians

NEW DELHI / Reuters / Health / Lifestyle / October 12, 2011

By David Lalmalsawma

It's festival season in India, with the celebrations providing a perfect opportunity for family outings, late-night parties and customary feasting on sweets.

But health experts warn that the festivities, coupled with genetic predisposition and lifestyle changes brought about by the increasing prosperity of the middle class, is contributing to the country being called the world's "diabetes capital," with the highest number of diabetics in any nation.

Kashmiri people buy pastries and spices ahead of Eid al-Fitr festival

in Srinagar September 20, 2009.  Credit: Reuters/Danish Ismail

The string of festivals, starting with Durga Puja and Dussehra and ending with Diwali, take place in accordance with the Hindu calendar and the dates change every year. The first two were on Oct 6 and Diwali falls on Oct 26 this year.

"For the next one month or so, it is all either festivals or outings," says Anoop Misra, chairman at New Delhi's Fortis-C-DOC, Center of Excellence for Diabetes, Metabolic Diseases and Endocrinology.

"During this time, the rate of obesity goes up, sugar control of established diabetics goes down and those who are predisposed to develop diabetes also show diabetes."

Festivals in India are synonymous with eating and gifting sweets, and most food and confectionery shops are decked with an assortment of goodies in colorful wrappings meant for traditional presents.

Two all-time favorites are rasgullas, a soft, spongy ball made from cottage cheese, and the conch-shaped samdesh, made from jaggery. A popular holiday treat is milk-based kaju barfi.

But experts warn the festival fun -- and, not least, the culture of sweet-eating that peaks then -- can help trigger long-term health problems, with diabetes only the start.

The disease is characterized by high levels of sugar in the blood and can lead to more serious complications such as heart disease and stroke, damage to the kidneys or nerves, and blindness.

But the culture of consuming sweets is hard to shake off, especially during festivals.

"Everybody (in India) has a sweet tooth, including me," said Ramachandran, a man in his 50s polishing off a plate of sweets at a New Delhi restaurant.

"(Diabetes) is not because of sweets. It's because people are too lazy (to exercise)," he added.

MIDDLE CLASS DISEASE?

The majority of those with diabetes have Type 2, which is linked to obesity and lack of exercise. India, with 62.4 million cases, has the world's highest number of diabetics.

Misra said numbers are rising at an alarming rate because of a newly rich middle class that increasingly consumes junk food while adopting more sedentary lifestyles.

"Their awareness about healthy eating is very low," he said.

Recent studies have shown the numbers of diabetics is also rising fast in villages, where people are traditionally more active and have not previously been exposed to fast food restaurants and refined snacks.

Nutritionist Uma Gupta attributes it to increasing stress and people adopting city culture, among other causes.

A recent study commissioned by the Indian Council for Medical Research found that in the last one year, the number of diabetics in India increased by 11.6 million, while another 77.2 million are pre-diabetics -- a precursor to Type 2 diabetes where a person's blood sugar levels are higher than normal.

Experts warn that the country's health infrastructure could soon be unable to deal with the burden.

"(Diabetes) is a forerunner of multiple diseases including heart disease and cancer ... I don't think our present health system can counter this pressure," Misra said.

The situation is made worse by a tendency for people to wait until they have a real health problem before doing anything, said Gupta.

"Take measures now, improve your lifestyle. Otherwise, hospitals will not have space for you, doctors will not have time to treat you," she added.

"Treatment should start from your plate itself."

(Editing by Elaine Lies)

Source: Thomsun Reuters
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CANADA: Average Canadian eats 26 tsp of sugar a day

TORONTO, Ontario / The Globe and Mail / Health News / September 21, 2011

Sweet heavens:
Statscan finds average Canadian eats 26 tsp of sugar a day

Carly Weeks
Globe and Mail Update

Getty Images/iStockphoto

Canadians eat a lot of sugar. Or do we?

A new report released Wednesday by Statistics Canada has, for the first time, offered a comprehensive snapshot of how much sugar Canadians consume each day. On average, people across the country down the equivalent of 26 teaspoons of sugar a day, which accounts for about 21 per cent of all calories consumed.

While that includes sugar from fruit, milk and other natural sources, Statistics Canada reported that 35 per cent of all sugar consumed comes from products sweetened by the manufacturer, such as pop, fruit juice and candy.

Added sugar raises concern for dietitians and other health experts, because whereas natural sources of sugar provide other important nutrients and vitamins, items such as pop and candy are “empty calories” that can contribute to weight gain and obesity.

The top sources of sugar consumed by Canadians include milk, fruit, pop, candy, fruit juice and vegetables, according to the report.

But for all the information it provides, the report also exposes problems in understanding how much sugar is coming from natural or artificial sources, as well as a lack of consensus on how much is too much.

The report was compiled using data from the 2004 Canadian Community Health Survey, which asked more than 35,100 people about everything they had consumed in the previous 24 hours.

Researchers were unable to distinguish between calories derived from natural and non-natural sources of sugar, a significant flaw that hampers the ability to assess accurately whether Canadians are consuming too much sugar from unhealthy sources.

Researchers used the foods and beverages reported by survey participants to simply estimate the amounts and types of sugar they were consuming from natural and artificial sources.

From their estimates, they concluded that more than one-third of sugar consumed by Canadians comes from pop, desserts, cereal and similar products containing added sugar. Consumption of products containing added sugar accounted for 17 per cent of sugar consumption among those aged 1 to 3, but rose to more than 40 per cent among those aged 14 to 18, with teenage boys getting nearly half of their sugar from artificial sources. Among seniors, consumption of products with added sugar decreased to 25 per cent of total sugar intake.

Men consumed more sugar from those food categories than women, regardless of age, the report said.

However, researchers were unable to say how many calories the average Canadian consumes in products that have had sugar added.

Another significant issue is that no clear guidelines exist for the right amount of sugar consumption. Health Canada has no maximum targets or guidelines advising Canadians how much of their diet should come from food with added sugar.

The Institute of Medicine of the National Academies, an influential, independent U.S. organization that advises governments on health policy, says added sugars should account for no more than 25 per cent of a person’s daily calories. But the World Health Organization states that the number should be much lower, at 10 per cent.

Rosie Schwartz, a Toronto-based dietitian, author and advocate on a variety of nutrition issues, says the lack of consensus or guidance is one of the factors creating confusion among consumers about how much sugar is healthy. Many people don’t know what the daily limit should be, or that many foods that seem healthy, such as fruit juice or flavoured yogurt, could contain added sugar.

Compounding these problems is the fact nutrition labels often make it challenging to tell whether a product contains added sugar, she said.

“That can make it very difficult for people,” Ms. Schwartz said. “I would like to see more clear labelling.”

The Canadian Sugar Institute, an industry group, said the results of the Statistics Canada report demonstrate that Canadians are not consuming unhealthy amounts of sugar and will help “dispel considerable misinformation regarding Canadian consumption patterns.”

But Ms. Schwartz said that while the report doesn’t provide all the answers about sugar intake in Canada, it does highlight the fact that many people are consuming excessive amounts.

For instance, pop accounted for 14 per cent of total sugar intake, candy for 10 per cent and fruit juice for 9 per cent among those aged 9 to 18. Milk made up 14 per cent of calories and fruit 10.6 per cent.

Among adults, pop accounted for 13 per cent of sugar intake, milk 10 per cent, fruit juice 7.6 per cent and candy 5 per cent.

“I think that we need to reduce… sugar consumption,” Ms. Schwartz said. “Too much sugar does have health consequences.”

© Copyright 2011 The Globe and Mail Inc.
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USA: Heart Risks May Hasten Mental Decline

NEW YORK, NY / The New York Times / Research / Health / August 9, 2011


VITAL SIGNS
By Nicholas Bakalar


Cardiovascular risk factors in middle age are associated with brain deterioration and a decline in mental function later in life, a new report has found.


In a study published online last week in Neurology, scientists at the University of California, Davis, examined 1,352 men and women, ages 45 to 63, and recorded the group’s rates of hypertension, diabetes, smoking, high cholesterol, obesity and other risks.

The researchers also performed brain scans of the participants and administered several widely used tests of mental ability. No subject had symptoms of dementia at the start of the study.

In follow-up examinations 7 to 13 years later, the researchers found that high blood pressure at the start of the study was associated with an increased appearance of white areas on the scan, a sign of brain deterioration.

Midlife diabetes was associated with a greater annual increase in the size of the brain’s temporal horn, a marker of Alzheimer’s disease, in later years. And those with an increased waist-to-hip ratio had a significant decrease in total brain volume over time.
Obese people and those with hypertension eventually performed more poorly on tests of memory and mental skills, even after controlling for baseline cognitive performance, the researchers found.


© 2011 The New York Times Company
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INDIA: Diabetes takes hold of Bangalore's senior citizens

BANGALORE, Karnataka / Deccan Chronicle / Channels / August 1, 2011

Diabetes is the most common health problem among the state’s silver citizens, according to the findings of a three-year study of senior citizens in the State. Cardiac-related and nephrology problems follow. Dr Sunil Rao, general manager of the Columbia Asia Referral Hospital, Yeshwanthpur, who led the study, says emotional stress is a major trigger of diabetes.

“With the current fast-paced lifestyle and urbanisation, many senior citizens are compelled to lead lonely lives because their children have either settled abroad for professional reasons, or even if they are here, they don’t have the time to look into the small problems of their parents. This often leads to a lot of emotional stress, which is known to be a trigger for diabetes and cardiac problems.” he said. The early symptoms of these diseases are not identified early because there is no one to spot the problem and start treatment, he added.

Dr Rao said that while sedentary lifestyle and changes in dietary habits are known to be trigger factors for diabetes and cardiac complications, emotional stress that stems from loneliness and lack of family support adds to the problem. He believes this explains why arthritis and orthopaedic diseases, generally associated with old age, are less frequently seen in senior citizens, and instead psychosomatic diseases top the list of the most common diseases.

To emphasise the need for psychological support to the elderly, Columbia Asia Referral Hospital organised a parent-child walkathon, ‘Pledge for Health’ on Sunday.

Some 5,000 people took a pledge to ensure that the elderly lead a healthy life.

Copyright © 2011 Deccan Chronicle
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AUSTRALIA: Diabetes can be a silent killer

MARYBOROUGH, Queensland / Frazer Coast Chronicle  / Health / Life & Style / July 6, 2011

Miranda Cashin

IN AUSTRALIA, it is estimated that 1.7 million people are diabetic but half don’t know it yet. Diabetes Australia says 275 Australians are diagnosed with diabetes every day. It is Australia’s fastest-growing chronic illness and it is estimated that by 2015, the number of diabetics will reach 4.6 million.

There are two types of diabetes: Type 1 and Type 2, with Type 2 accounting for 90% of cases.

The condition occurs where blood glucose levels become too high because the body doesn’t produce enough insulin or can’t use insulin properly.

Type 1 diabetes results from a complete lack of insulin caused by the body destroying its own insulin-producing cells in the pancreas.

It’s an autoimmune condition, not caused by lifestyle factors.

Suffers have daily injections of insulin to function.

Jock Fraser is careful of what he eats to manage his diabetes. Barry Leddicoat

Type 2 diabetes is the most common type and is dramatically on the increase.

It is a result of low levels of insulin or when the body cannot sufficiently use it.

Being overweight or obese increases risk of developing this type of diabetes.

The lack of obvious symptoms can mean the disease goes undetected for a long time.

But while no overt symptoms are present, the disease can be picked up through a blood test.

And the good news is that because Type 2 diabetes is linked to lifestyle factors, it is entirely preventable and treatable through lifestyle changes such as keeping a healthy weight, a healthy diet and regular exercise.

Sunshine Coast resident Jock Fraser was lucky to be diagnosed with Type 2 diabetes 22 years ago.

He was unaware anything was wrong until it was picked up in a free public screening in New Zealand.

A diagnosis of chronic illness can be stressful but Jock said it had spurred him to make a few changes he should have made anyway.

“I made a few lifestyle changes, watched my diet and increased my exercise. Just basic things we all should do anyway,” he said.

Now, 22 years on, Jock keeps his diabetes in check through a combination of lifestyle choices and medication.

He eats a diet low in sugar, salt and fat, as well as going for a 30-minute walk daily.

He also attends a local diabetes support group on the fourth Friday of the month in Caloundra.

The group educates sufferers and provides a friendly environment where diabetics can connect with others, swap tips and tricks, and receive emotional support.

Next week is Diabetes Awareness Week.

Blue Care Caloundra Allied health assistant Shelly McBride said it was surprising how little people knew about diabetes.

To learn more, take the test on the Diabetes Australia (Queensland) website at www.diabetesqueensland or speak to your local doctor.

FACTS ABOUT DIABETES
• Diabetes is a condition where blood glucose levels become too high because the body doesn’t produce enough insulin
• It is Australia’s fastest- growing chronic disease
• It is estimated that 1.7 million people in Australia have diabetes, with about half of those not aware they have the condition.
• It is estimated that by 2015, the number of people with diabetes will reach 4.6 million
• More than 8000 people on the Sunshine Coast are registered diabetes sufferers
• It is entirely treatable

For support or information visit: Caloundra Blue Care Diabetes Support Group 5438 5000; Diabetes Australia Queensland 1300 136 588 or ww.diabetesqueensland.org.au; Australian Diabetes Council at http://www.australiandiabetescouncil.com/

© The Maryborough Hervey Bay Newspaper Company Pty Ltd 2011

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Credit: Reports and photographs are property of owners of intellectual rights.
Seniors World Chronicle, a not-for-profit, serves to chronicle and widen their reach.

QATAR: Diabetes - No longer the preserve of the rich?

DOHA, Qatar / Al Jazeera / Inside Story / June 29, 2011

A new study has revealed that diabetes is far more widespread than previously thought

A new study has revealed that diabetes is far more widespread than previously thought. Nearly 350 million adults around the world have the disease, doubling the rate of 30 years ago.


Researchers from Imperial College London and Harvard University analysed data from more than 2.5 million adults across the world. They found that the number of people with Type 2 diabetes, which is linked to obesity and lifestyle, is no longer limited to rich countries.

It is now a global problem, and fast becoming the biggest cost for many health care systems.

Why is diabetes on the rise? Can it be avoided?

Inside Story, with presenter Shiulie Ghosh, discusses with Dr Michael Hall, the former chairman and current vice-president of Diabetes UK; Lorenzo Piemonte, of the International Diabetes Federation in Rome and a diabetes patient; and Dr Khalid bin Jabor Al Thani, the former under-secretary of Qatar's ministry of health in Doha.

This episode of Inside Story aired from June 26, 2011.

Source: Al Jazeera

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Credit: Reports and photographs are property of owners of intellectual rights.
Seniors World Chronicle, a not-for-profit, serves to chronicle and widen their reach.

USA: Research shows promise in reversing Type 1 diabetes

LOS ANGELES, California / Los Angeles Times / Health / June 25, 2011

Experiments in a small number of people show that an inexpensive vaccine normally used against tuberculosis may stop the immune system from attacking pancreas cells.

 

The findings contradict an essential paradigm of diabetes therapy  that once the insulin-secreting beta cells of the pancreas have been destroyed, they are gone forever. (Kirk McKoy / Los Angeles Times)

By Thomas H. Maugh II, Los Angeles Times

Preliminary experiments in a handful of people suggest that it might be possible to reverse Type 1 diabetes using an inexpensive vaccine to stop the immune system from attacking cells in the pancreas.

Research in mice had already shown that the tuberculosis vaccine called BCG, prevents T cells from destroying insulin-secreting cells, allowing the pancreas to regenerate and begin producing insulin again, curing the disease.

Now tests with very low doses of the vaccine in humans show transient increases in insulin production, researchers will report Sunday at a San Diego meeting of the American Diabetes Assn.

The Massachusetts General Hospital team is now gearing up to use higher doses of the vaccine in larger numbers of people in an effort to increase and prolong the response.

The findings contradict an essential paradigm of diabetes therapy — that once the insulin-secreting beta cells of the pancreas have been destroyed, they are gone forever. Because of that belief, most research today focuses on using vaccines to prevent the cells' destruction in the first place, or on using beta cell transplants to replace the destroyed cells.

The new findings, however, hint that even in patients with long-standing diabetes, the body retains the potential to restore pancreas function if clinicians can only block the parts of the immune system that are killing the beta cells.

The results are "fascinating and very promising," said immunology expert Dr. Eva Mezey, director of the adult stem-cell unit at the National Institute of Dental and Craniofacial Research. But Mezey noted that the results had been achieved in only a small number of patients and that they suggest the vaccinations would have to be repeated regularly.

The key player in the diabetes study is a protein of the immune system called tumor necrosis factor, or TNF. Studies by others have shown that if you increase levels of TNF in the blood, it will block other parts of the immune system that attack the body, especially the pancreas.

To raise TNF levels, Dr. Denise Faustman of Massachusetts General Hospital and her colleagues have been working with the BCG vaccine, known formally as Bacille Calmette-Guerin. BCG has been used for more than 80 years in relatively low doses to stimulate immunity against tuberculosis. More recently, it has been used in much higher doses to treat bladder cancer.

Faustman first reported her findings in mice in a 2001 paper in the Journal of Clinical Investigation, but scientists reviewing her findings for that journal were so skeptical that she was not allowed to refer to "regeneration" of the pancreas in the paper. Instead, she was told to say "restoration of insulin secretion by return of blood sugar to normal."

In 2003, she published a report in the journal Science in which she was able to use the word "regeneration," but that finding was met by an "explosion of skepticism," she said. Nonetheless, by 2007, "six international labs had duplicated the mouse experiments," she said. "We needed to move forward into humans."

In the human trial, Faustman and her colleagues studied six patients who had been diagnosed with Type 1 diabetes for an average of 15 years. They were randomly selected to receive either two doses of BCG spaced four weeks apart or a placebo.

Careful examination of those receiving the vaccine showed a decline of T cells that normally attack the pancreas. It also revealed a temporary but statistically significant elevation of an insulin precursor called C-peptide, an indication that new insulin production was occurring.

"If this is reproducible and correct, it could be a phenomenal finding," said Dr. Robert R. Henry of UC San Diego, who chaired the scientific program at the meeting. It suggests that once the destructive immune response is controlled, the body has the capability to produce more insulin, he said.

One of the patients receiving a placebo also showed a similar elevation of C-peptide, but that patient coincidentally became infected by Epstein-Barr virus, which is known to induce production of TNF.

The concentrations of BCG that the team used were much lower than they would have liked, but were the highest the Food and Drug Administration would permit, Faustman said.

She said she is now negotiating with the agency to use higher levels, which should produce a more pronounced effect, and to enroll more people.

The research is funded by philanthropists, primarily the Iacocca Family Foundation.

thomas.maugh@latimes.com

Copyright © 2011, Los Angeles Times

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Credit: Reports and photographs are property of owners of intellectual rights.
Seniors World Chronicle, a not-for-profit, serves to chronicle and widen their reach.

USA: For Those With Diabetes, Older Drugs Are Often Best

NEW YORK / The New York Times / Health / May 28, 2011

Dr. Wendy L. Bennett of the Johns Hopkins University School of Medicine

said becoming educated was the most important thing a person

with diabetes could do to stem costs and avoid complications. 

Steve Ruark for The New York Times

By WALECIA KONRAD

WHEN it comes to prescription drugs, newer is not necessarily better. And that’s especially true when treating diabetes.

One in 10 Americans has Type 2 diabetes. If the trend continues, one in three will suffer from the disease by the year 2050, according to the federal Centers for Disease Control and Prevention.

Most Type 2 diabetes patients take one or more drugs to control blood sugar. They spent an estimated $12.5 billion on medication in 2007, twice the amount spent in 2001, according to a study by the University of Chicago. (That figure does not including drugs that diabetics are often prescribed for related health conditions, like high blood pressure and high cholesterol.)

Why the increase? More diagnosed patients, more drugs per patient and an onslaught of expensive new drugs, according to Dr. G. Caleb Alexander, assistant professor of medicine at the University of Chicago and lead author of the study. Since 1995, several new classes of diabetes medications have come on the market. Diabetes drugs are important to the pharmaceutical industry, more lucrative than drugs for many other chronic diseases, Dr. Alexander noted in an interview.

Simply put, many of these drugs help the body produce less glucose or more insulin, the hormone that shuttles glucose into cells for use as energy, or they increase the body’s sensitivity to its own insulin.

Patients and health care professionals have long hoped that as pharmaceutical companies found ways to help the body lower blood sugar, they would produce safer and more efficient alternatives to older medications. But a true breakthrough doesn’t seem to have happened yet.

A report released in March by the federal Agency for Healthcare Research and Quality and conducted by researchers at Johns Hopkins University reviewed data from 166 studies to evaluate the effectiveness and risks of various diabetes medicines. The researchers concluded that drugs that have been around for years are more effective at lowering blood sugar and often work with fewer side effects than the newest drugs. And because so many older drugs now are available as generics, they often cost just a fraction of the price of newer brand-name drugs.

Low-cost treatment is imperative to turning back the diabetes epidemic, said Dr. Wendy L. Bennett, assistant professor of medicine at Johns Hopkins University School of Medicine and the lead author of the A.H.R.Q. study. Experts estimate that only 25 percent of diabetic patients are getting the treatment they need, and expense is a big reason. Even well-insured patients may reel when confronted with the $6,000 a year it takes on average to manage the disease (not counting the costs of such complications as heart disease, stroke, and liver and kidney damage).

Becoming educated is the most important thing a person with diabetes can do to help stem the cost of medications as well as avoid complications, said Dr. Bennett. Here, three crucial things you should know.

Step 1: Fight diabetes with lifestyle changes.

Cost: Free or low cost.

If you are pre-diabetic or recently diagnosed, you may be able to dodge the expense of drug treatment with exercise and a better diet and by quitting smoking. None of this has to cost a fortune, and in any event healthier foods and, if necessary, a gym membership or other exercise program are well worth the investment. Even if you are taking medication, these lifestyle changes can help the medicine work better and longer.

For more information go to www.cdc.gov/diabetes and the Web site for the American Diabetes Association, http://www.diabetes.org/.

Step 2: If you need to begin taking a drug to control blood sugar, start with metformin, the most common and one of the least expensive diabetes drugs.

Cost: $36 for 100 pills (500 milligrams); usually taken twice a day. Prices may be even lower at Wal-Mart, Target and other discount pharmacies.

Metformin almost always works as a first-line drug, except for patients suffering from severe kidney disease, said Dr. Bennett. What’s more, metformin generally does not cause hypoglycemia, a common and dangerous side affect of many diabetes drugs.

It also does not seem to cause weight gain, as some other diabetes drugs do, said Dr. Bennett. “The last thing you want if you’ve been diagnosed with diabetes is additional weight,” she added.

A study published in Consumer Reports Health in February 2009 also found that older, less expensive diabetes drugs were just as effective as the new ones. Better yet, they have established safety records, while some newer diabetes drugs have been found to increase cardiovascular and other health risks.

“The expensive drugs are third- and fourth-line drugs,” said Dr. Marvin Lipman, chief medical adviser for Consumer Reports Health and a practicing endocrinologist in Westchester County, N.Y. “If you don’t get results with the less expensive drugs, you go to those. But you shouldn’t start there.”

Avoid: Certain newer diabetes drugs have been associated with heart failure and other risks.

Avandia, for example, has been linked to an increased risk of heart attacks. In September 2010, after years of debate, the Food and Drug Administration severely restricted Avandia’s availability, allowing it to be prescribed only to patients in a special program who had not responded to other drugs and were taking the medicine under a doctor’s strict supervision. This month the agency expanded those restrictions to include related drugs Avandamet and Avandaryl, which also contain rosiglitazone, the active agent in Avandia.

Step 3: Choose combination drugs from among inexpensive generics.

Cost: Glimepiride, $13 for 100 pills (1 milligram). Glipizide, $64 for 100 pills (5 milligrams).

Most diabetics will have to eventually take more than one drug to keep blood sugar under control. The good news here from the Johns Hopkins study is that inexpensive metformin is also quite effective in combination with other generics, such as glimepiride and glipizide.

“Most combinations worked equally well, so when you’re adding a drug, you could choose a generic to save costs,” said Dr. Bennett. She added, however, that some drugs used with metformin might increase the risk of side effects such as hypoglycemia or weight gain. Patients should discuss each drug’s pros and cons, as well as cost, with their doctors.

Avoid: Do not start with one of the more expensive drugs in combination with metformin. In some cases, patients ultimately may need a combination of both generics and the newer drugs, but this usually becomes appropriate only after a less expensive combination has been used for some time or if the patient isn’t responding to the less expensive combination, said Dr. Bennett.

© 2011 The New York Times Company

USA: Must-Know Facts About Type 2 Diabetes

. 
NEW YORK, NY / WebMD / WebMDHeartHealth / May 10, 2011

Type 2 Diabetes Overview

Slide Show: How To Stay Healthy

Type 2 diabetes, often called non-insulin dependent diabetes, is the most common form of diabetes, affecting 90% - 95% of the 21 million people with diabetes.

In this article, you'll learn the basics about type 2 diabetes, including symptoms and causes, as well as type 2 diabetes in children.

What Is Type 2 Diabetes?

Unlike people with type 1 diabetes, people with type 2 diabetes produce insulin; however, either their pancreas does not produce enough insulin or the body cannot use the insulin adequately. This is called insulin resistance. When there isn't enough insulin or the insulin is not used as it should be, glucose (sugar) can't get into the body's cells. When glucose builds up in the blood instead of going into cells, the body's cells are not able to function properly.

Photograph by courtesy of Optimal Health

Other problems associated with the buildup of glucose in the blood include:

* Dehydration. The buildup of sugar in the blood can cause an increase in urination. When the kidneys lose the glucose through the urine, a large amount of water is also lost, causing dehydration.

* Diabetic Coma (Hyperosmolar nonketotic diabetic coma) . When a person with type 2 diabetes becomes severely dehydrated and is not able to drink enough fluids to make up for the fluid losses, they may develop this life-threatening complication.

* Damage to the body. Over time, the high glucose levels in the blood may damage the nerves and small blood vessels of the eyes, kidneys, and heart and predispose a person to atherosclerosis (hardening) of the large arteries that can cause heart attack and stroke.

Type 2 Diabetes in Children

More and more children are being diagnosed with type 2 diabetes. Find out about type 2 diabetes symptoms in children, the diagnosis, and the treatment in WebMD's article on type 2 diabetes in childhood. If your child is at risk for childhood diabetes, it’s important to learn specific self-care tips to help prevent diabetes.

For more detail, see WebMD's article Type 2 Diabetes in Children.

Who Gets Type 2 Diabetes?

Anyone can get type 2 diabetes. However, those at highest risk for the disease are those who are obese or overweight, women who have had gestational diabetes, people with family members who have type 2 diabetes and people who have metabolic syndrome (a cluster of problems that include high cholesterol, high triglycerides, low good 'HDL' cholesterol and a high bad 'LDL' cholesterol, and high blood pressure). In addition, older people are more susceptible to developing the disease since aging makes the body less tolerant of sugars.

In addition, people who smoke, have inactive lifestyles, or have certain dietary patterns have an increased risk of developing type 2 diabetes.

What Causes Type 2 Diabetes?

Although it is more common than type 1 diabetes, the causes of type 2 diabetes are less well understood. It is likely caused by multiple factors and not a single problem.

Type 2 diabetes can run in families, but the exact nature of how it's inherited or the identity of a single genetic factor is not known.

For more detail, see WebMD's article Causes of Type 2 Diabetes.

What Are the Symptoms of Type 2 Diabetes?

The symptoms of type 2 diabetes vary from person to person but may include:

* Increased thirst. * Increased hunger (especially after eating).
* Dry mouth.
* Nausea and occasionally vomiting.
* Frequent urination.
* Fatigue (weak, tired feeling).
* Blurred vision.
* Numbness or tingling of the hands or feet.
* Frequent infections of the skin, urinary tract or vagina.

Rarely, a person may be diagnosed with type 2 diabetes after presenting to the hospital in a diabetic coma.

For more detail, see WebMD's article Type 2 Diabetes Symptoms.

How Is Type 2 Diabetes Diagnosed?

To diagnose type 2 diabetes, your health care provider will first check for abnormalities in your blood (high blood glucose level) during a random fasting blood test or through a screening test known as the 2 hour glucose tolerance test. In addition, he or she may look for glucose or ketone bodies in your urine.

Type 2 diabetes testing includes a fasting plasma glucose test or a casual plasma glucose test. You will also need to check your blood sugar levels regularly.

For more detail, see WebMD's article Diagnosis of Diabetes.

Complications Associated With Type 2 Diabetes

If your type 2 diabetes isn't well controlled, there are a number of serious or life-threatening problems you may experience, including:

* Retinopathy . People with type 2 diabetes may already have abnormalities in the eyes related to the development of diabetes. Over time more and more people who initially do not have eye problems related to the disease will develop some form of eye problem. It is important to control not only sugars but blood pressure and cholesterol to prevent progression of eye disease. Fortunately, the vision loss isn't significant in most.

* Kidney damage . The risk of kidney disease increases over time, meaning the longer you have diabetes the greater your risk. This complication carries significant risk of serious illness -- such as kidney failure and heart disease.

* Poor blood circulation and nerve damage. Damage to nerves and hardening of the arteries leads to decreased sensation and poor blood circulation in the feet. This can lead to increased infections and an increased risk of ulcers which heal poorly and can in turn significantly raises the risk of amputation. Damage to nerves may also lead to digestive problems, such as nausea, vomiting, and diarrhea.

For more detail, see WebMD's article Preventing Diabetes Complications.


© 2009 WebMD, LLC