The best diet for optimal blood sugar control & health
Author: kaitiscotland
I am a Scottish doctor who is working to improve the outcomes for people who have diabetes using a low carb diet, and advanced insulin techniques when necessary. Professionally I provide expert witness reports in the clinical forensic and family medicine areas and I also provide complementary therapies. I enjoy cooking, cinema, reading, travel and cats.
Photo by u041fu0430u0432u0435u043b u0421u043eu0440u043eu043au0438u043d on Pexels.com
Adapted from BMJ 21 September 2024
Do you really need a gastroscopy? This is a very commonly performed and unpleasant procedure for the patient. Health Boards tend to have criteria to guide GPs as to referral. Despite this, pick up rates of serious pathology are low.
In the UK, 400,000 gastroscopy results were analysed. Only one in ten showed anything other than normal findings or minor pathology.
Only one in 100 gastroscopies showed malignancy.
In patients under 50, less than 1% had malignancy, regardless of symptoms.
Those most likely to have cancer were men, the over 50s, those who had problems swallowing, and those with weight loss.
Insulin is often prescribed for type two diabetes patients who need extra help with blood sugar control. Up until now, this has been injected once or twice a day. Patients are often reluctant to start insulin, however, due to concerns about the injections, dose adjustment and worries about hypoglycaemia. Once weekly insulin may be an attractive proposition for some patients.
Once weekly insulin has already been developed and has been shown to be no worse than insulin glargine or degludec. Due to potential hypoglycaemia, weekly insulin could be a problem, especially for type one patients. Nonetheless once weekly icodec has been approved for use in adults with diabetes in the Europe and Canada but it has been rejected in the US.
In trials of type two patients, once weekly insulin, used as a basal insulin, was popular with the patients, and the rates of severe hypoglycaemia were not different from those using other types of basal insulin.
Titrating up the dose in type two patients takes about 8 to 12 weeks, because the doses must be titrated cautiously. It is thought that people who are prone to experiencing ketoacidosis due to missed insulin doses, may have a lot to gain with a weekly schedule. Those who are aiming for looser blood sugar control, those with co-morbidities, and those whose insulin needs to be administered by a care giver also may benefit.
Neither insulin icodec or efsitora, the weekly insulins, are yet licenced for use in the UK at the current time. NICE will be examining the evidence and trying to determine what the place of weekly insulin should be in the NHS.
After having early invasive breast cancer, development of other cancers or a new breast cancer in the other side, over the next twenty years is only 2.1% more than in women who have not had breast cancers.
The risk of contralateral side cancer is comparatively raised in younger women. Radiotherapy tended to increase the risk of contralateral breast cancer and lung cancer. Endocrine therapy tended to increase the rate of uterine cancer but reduced contralateral breast cancers. Chemotherapy increased the rates of leukaemia.
Other cancers that occurred more often in the breast cancer survivors were soft tissue, head and neck, thyroid, oesophagus, kidney, bladder, skin melanoma, haematological, ovarian and stomach cancers. It is thought that part of the adjuvant treatments for breast cancer could contribute to this increased risk.
Researchers looked at the data of 475,000 women who had been diagnosed between 1993 and 2016. After 20 years, 14 out of 100 women will develop some other kind of cancer compared to 12 out of women without the previous breast cancer diagnosis. 6 out of 100 will develop contralateral breast cancer compared to 3 in 100 of the general population.
This study was done because cancer treatments have long been recognised as contributing to the development of second cancers.
Second primary cancer is known to be substantially higher if a woman has a family history of breast cancer or genetic variants such as BRCA1 and BRCA2. Genetic evaluation of each woman who develops breast cancer will hopefully lead to targeted follow up and treatment.
Gepotidacin is the first new antibiotic to be approved in the UK in 30 years.
It has a mechanism that makes it more difficult than usual for bacteria to develop resistance to it.
It is approved for females over the age of 12 and over the weight of 40 kg.
Its use will only be for uncomplicated urinary tract infections.
My comment: Urinary infections are indeed a misery. I’m delighted that another antibiotic has been found. Remember that D:Mannose can also be very effective for the prevention and treatment of UTIs.
We are often told that diet is the key to fat loss and that exercise doesn’t play much of a part in this.
However, a meta-analysis of 116 clinical studies shows that notable improvements in waist circumference and other measures of body fat only occurred when moderate or high intensity aerobic exercise was done for more than 150 minutes per week.
A reduction on one kilogram in body weight is roughly equivalent to a deficit of 8,000 calories. This is a lot more difficult to burn off than most people realise.
My comment: I easily meet the 150 minutes or more of exercise a week but this is mixed exercise and comprises of low impact aerobics, resistance training, stretching, and balance and co-ordination exercise. I’ll need to stick to diet myself.
Respiratory syncytial virus (RSV) is the most common cause of acute lower respiratory tract illness in infants. Two years ago, and international trial demonstrated that vaccinating pregnant women against RSV reduced the number of newborns admitted to hospital with lung infections.
A UK study has now confirmed the benefits. There was a 72 percent reduction in babies hospitalised due to the virus compared to babies whose mothers had not had the vaccine.
In another study of adults from New York, getting RSV badly enough to require admission, led to an increase in acute cardiac events. More than a third of the patients ended up having heart failure, atrial fibrillation, and myocardial infarction after RSV infection. Most events happened within the month following admission. Half of the events occurred in patients with no prior history of cardiac problems.
Vaccination against herpes zoster is very effective in preventing shingles and post herpetic neuralgia in older people.
In Korea, examination of results after vaccination also indicate that major cardiac events reduced by one third. The protective effect lasted eight years after vaccination.
In the UK, the vaccine has been rolled out over the last ten years or so, and people are called depending on their date of birth. If you get invited, it is well worth getting the vaccine.
Other research has shown that the vaccine prevents shingles entirely only for the first year after vaccination and after that shingles becomes increasingly common again till almost all immunity is lost at the ten year point. However, there is still a reduced rate of post herpetic neuralgia in those who have been vaccinated.
Booster doses of the vaccine have been shown to reactivate vaccination effectiveness but so far this is not being done routinely in the UK.
In my young days as an orthopaedic surgeon, used to see a lot of trauma from motorbike accidents and accidents to manual workers. Most fractures are now due to minor falls, and due to the high amount of osteoporosis in the population, these are usually at the hip, wrist, upper humerus and vertebral bodies.
Half a million or so fragility fractures occur in the UK every year. This number is expected to rise by 25% by 2034. 2% of women at the age of 50 have osteoporosis and this reaches 50% by the age of 80. One in four Britons will get an osteoporotic fracture in their lifetime.
The Reduce study found that the length of hospital stay could be reduced by early post operative mobilisation and multi-disciplinary meetings with less surgical focus.
Half of all people who have a hip fracture have had a previous fragility fracture. The first fracture would be a good time to intervene in order to prevent further fractures. Breaking bones, losing height and having curved spines, is not an inevitable part of aging. Half of osteoporotic fractures can be prevented.
Exercise and anti-osteoporotic medicines are the backbone of treatment. A diet of oily fish and not being too thin are helpful. Bone enhancing oestrogen is manufactured in peripheral fat after the menopause.
Bones and muscles respond to how much we use them. Muscles get bigger with activity and make falls less likely. Bones increase in density with strength training. Balance and posture are also important factors to improve. Inactivity for whatever reason creates a vicious circle where bones get progressively weaker.
All medical staff and carers of older people need to embrace preventative strategies to optimise bone health and encourage activity and strength training to reduce fractures.
Diabetes Diet 