Home BP monitors as good as surgery ones

Adapted from Hodgkinson JA et al. Accuracy of blood pressure monitors owned by patients with hypertension (ACCU-RATE study): a cross sectional, observational study in central England. Br J Gen Pract. 2020 June 2

More and more of us are checking our own blood pressure and telling our GPs what the result is over the phone or via skype. Home monitoring has been increasing in the last ten years and has greatly accelerated with the Covid pandemic making avoiding face to face consultations a virtue.

Blood pressure checks are done to diagnose and monitor hypertension but are also a matter of routine for contraceptive pill checks, hormone replacement therapy checks, and diabetes checks.

This study was conducted on just under seven thousand general practice patients in the Midlands of England.

Those who used home blood pressure monitors had them tested against a reference monitor and those who were not within 3 mm Hg were considered to have failed. This is a pretty strict test. The cuffs were also assessed.

In all 76% of the monitors passed on the monitors and cuffs. 86% passed the monitor tests. The monitors that failed mainly tended to over estimate the blood pressure.

In general monitors that have been validated (should say so on the monitor) were more accurate than those that were not. Monitors that cost more than £10 were more accurate than those over £10. Monitors that were under four years old were more accurate than those that were older.

The authors say that BP monitors are very likely to be accurate if they have been validated and are over 4 years old.

BMJ: Low carbing for six months can put type two diabetes into remission without adverse effects.

Adapted from Efficacy and safety of low and very low carb diets for type two diabetes remission. Systemic review and meta-analysis by Goldenber JZ et al. BMJ 2021;372:m4743

My comment: Now, we all know this, but there still is a great deal of resistance to the idea that cutting out sugar and especially starch from your diet, can put type two diabetes into remission. Lately there has been a lot more emphasis that very low calorie diets are good for diabetes remission, but let’s face it, starving yourself is no fun at all, and eventually, even if you do manage to keep to a very low calorie diet for many months, you need to do something to maintain that remission, rather than yo-yo back into diabetes. This is why I was pleased to see this report in the BMJ.

This study looked at randomised controlled trials that evaluated low carb diets for at least 12 weeks in adults with type two diabetes. Their definition was less than 130 g of carb a day or 26% of the diet from carbohydrates. A very low carb diet was defined as less than 50g of carb a day or 10% of dietary carbs a day.

They wanted to see if remission was achieved. This was deemed to be a HbA1c of less than 6.5% or a fasting blood sugar of less than 7.0 mmol/L with or without the use of diabetes medication. They also looked at weight loss, HbAIc, fasting glucose and adverse events.

Compared to control diets, low carb diets produced remission at six months in 57% versus 31% in the control diets.

The population studied were 1,357 people aged 47 to 67 years of age and most were overweight or obese. 23 studies were looked at and 14 of these included patients who were on insulin. There was very little in the way of adverse consequences.

High intensity interval training is great for type one diabetics

Adapted from HIIT provides multiple advantages in patients with type 1 diabetes. Diabetes in Control May 23 2020 by George McConnell Pharm D candidate. LECOM School of Pharmacy.

Lifestyle changes are hard. Many type one diabetics lead sedentary lives. They have a big fear of hypoglycaemia from exercise. Another complaint is that they don’t have enough time. High intensity interval training has been gaining popularity over the last few years due to its low time commitment. HIIT improves vascular function without the reductions in blood sugar that are often associated with moderate intensity exercise.

One study looked at what happened at home. Eleven type 1s completed six weeks of HIIT at home. A session was one minute of HIIT followed by one minute of rest. The goal was to get to 80% or more of their predicted maximum heart rate from the formula 220- age. The exercise component was two thirty second body weight exercises with no rest in between. There were 18 exercises and 9 suggested pairings but the participants were allowed to choose what they did of these exercises. They were to exercise on three days of the week, starting at six minutes and building up by two sessions every two weeks. They had heart rate monitors that could be downloaded so they and the researchers could see their results. They were to exercise only when their blood sugar was between 7 and 14 mmol/L.(126-252mg/dL). Blood sugars, insulin and ingested carbohydrates were measured.

Adherence was 95% and pulse targets were achieved. Glucose levels remained the same during and one hour after exercise. Carbs were ingested in 6% of the sessions. Insulin was needed after only 3 of the 188 sessions. There was no severe hypoglycaemic episodes. After six weeks there was a mean decrease of 13% in their daily short acting insulin doses. There were no significant changes to the mean blood glucose concentration or to BMI.

Home exercise means that there is no commute or gym fees. It was a bit sad that there was no weight loss despite the strict adherence to the regime by these motivated participants.

The top three barriers to exercise in type 1s are given as lack of time 91%, fear of hypos 27%, and a lack of motivation 18%, so these quick, high intensity exercise sessions can provide a solution to these barriers. It is convenient, quick, requires no equipment, does not adversely affect blood sugar levels and can increase motivation to exercise. It only took 60 minutes a week overall.

Practice pearls:

HIIT at home is quick and does not need gym attendance.

HIIT is good for busy people taking an hour a week.

HIIT reduces short acting insulin doses.

HIIT does not cause significant hypos, but blood sugar levels should still be checked.

HIIT sadly does not cause weight loss.

Scott Sam N et al. A multidisciplinary evaluation of a virtually supervised home based high intensity interval training intervention in people with type one diabetes. Diabetes Care. ADA. 1 Dec 2019.

Cancer is now the top cause of death if you have diabetes.

Adapted from Cancer replaces heart disease and stroke as leading cause of death in people with diabetes. Pearson-Stuttard J et al. Lancet Diabetes Endocrinol 4 Feb 2021 and Six adiposity markers predict incidence and mortality for 24 cancers. Parra-Soto S et al BMC Med 11 Jan 2021

People with type one and two diabetes have been told for decades that cardiovascular disease in the form of heart attacks and strokes are the most likely way that the Grim Reaper is likely to call on them. New research however shows that cancer is now the leading cause of death.

The study was conducted by Imperial College London. Between 2001 and 2018 the cardiovascular causes have been superceded by cancer as the main diagnosis causing death in a total of nearly 314 thousand people.

Also, the death rates are a third less than previously, so diabetics were living longer, and dying of cancer instead of cardiovascular disease. Other causes that were still fatal included dementia, liver disease and respiratory disease. These were more common in the diabetic population compared to the non diabetic population.

People with diabetes still tended to die at earlier ages than the general population, but the gap is narrowing. Dementia and liver disease were twice as high compared to the general population for instance.

The lead author Dr Jonathan Pearson-Stuttard said, ” Improvements in risk factors such as smoking and blood pressure, along with improvements in medical treatments have contributed to large falls in deaths from heart disease and stroke. The improvements have been even greater in those with diabetes. This has resulted in vascular conditions accounting for around 25 percent of all deaths in those with diabetes compared to 45 per cent 20 years ago.”

” In contrast improvements in cancer death rates have been much more modest, with improvements in those with diabetes lagging behind the general population. Added to this, the UK lags behind the EU in terms of cancer survival rates.”

The authors want people to know that if they have diabetes they have higher rates of cancer, dementia and liver disease compared to the general population.

If you are overweight the cancers that you are more likely to get, in no particular order, are:

Stomach, oesophageal, gallbladder, liver, kidney, pancreas, bladder, colorectal, endometrial, uterine, breast, lymphatic, and non-Hodgkin lymphoma.

My comment: Although this is not the most cheerful of posts, the good news is that diabetics are living long enough to die of diseases of older age such as cancer and dementia.

Jovina cooks Greek: Chicken with Tzaziki

Chicken Tenders

4 servings

Ingredients

1/2 cup plain Greek yogurt

1 tablespoon extra virgin olive oil, plus extra for the grill pan 

1/2 tablespoon fresh lemon juice 

1/2 teaspoon dried oregano 

1/4 teaspoon coriander 

1/4 teaspoon paprika 

1 clove garlic, minced

Kosher salt and freshly ground black pepper

1 pound chicken tenders, about 8

Directions

Mix the yogurt, oil, lemon juice, oregano, coriander, paprika, garlic, 1/4 teaspoon salt, and 1/4 teaspoon pepper in a medium bowl until fully blended. Add the chicken and mix to coat. Cover and refrigerate for 2 to 4 hours.

Now make your cucumber sauce, Tzaziki and put it in the fridge as well.

When you are about one hour before your meal take out the chicken mini fillets and allow to reach room temperature, about 30 minutes, then fry in olive oil till cooked. They can be kept warm in the oven.

Cucumber Sauce

Ingredients

1 cup plain Greek yogurt

1 peeled and seeded cucumber, finely diced 

1 1/2 tablespoons freshly squeezed lemon juice 

1 tablespoon chopped fresh dill or 1 teaspoon dried

1 clove garlic, grated

¼ cup feta cheese

Kosher salt

Directions

Combine the yogurt, cucumber, lemon juice, dill, garlic, feta cheese, and 1/4 teaspoon salt in a medium bowl. Chill, covered, for at least 30 minutes to let the flavors blend.

Serve the Tzaziki with your cooked chicken.

Noise worsens blood sugars

From Diabetes in Control

Noise Exposure Leads to Hyperglycemia

Aug 15, 2020 Editor: Steve Freed, R.PH., CDE
Author: Sameen Khan, Pharm.D. Candidate, USF College of Pharmacy 

Stress hormones triggered by noise exposure affect insulin secretion and sensitivity, leading to increased hyperglycemia risk. 

Studies have reported an association between exposure to high noise levels and the activation of stress hormones such as cortisol, which reduces pancreatic insulin secretion and decreases insulin sensitivity throughout the body, leading to increased risk of developing type 2 diabetes. This association is alarming for those with occupations that cause high levels of loud noise exposure regularly. Concerns have been validated by researchers; for example, in a 2011 cross-sectional study, which linked noise-induced hearing loss with impaired fasting glucose levels. Also, the 2014 U.S. national survey associated elevated body mass indexes (BMI) with patients that self-reported occupational noise exposure.

A 2012 retrospective cohort study investigated the incidence of hyperglycemia in machinery and equipment manufacturing workers exposed to increased noise levels over one year. Researchers recruited study participants from four job sites, excluding those with a history of diabetes or who were unable to follow up with researchers after one year, culminating in 905 total study participants. A health examination was performed at the commencement of the study, which required that participants undergo an overnight fast so that baseline fasting plasma glucose levels could be determined. Noise exposure levels were determined through a walkthrough survey that utilized a personal noise dosimeter to report sound levels in decibels from the working hours of 08:00 to 17:00, excluding 12:00 to 13:00. An eight-hour time-weighted average (TWA) was then calculated. Participants were then classified into “high” (≥ 85 decibels), “medium” (70-85 decibels), and “low” (<70 decibels) exposure groups. The study’s primary endpoints were diagnosis of prediabetes, initiation of hypoglycemic medication, or end of the one-year study period.

Demographics between the exposure groups varied considerably. Those in high occupational noise exposure jobs were mostly male and had lower educational levels than those in the low-exposure groups. Only 23.25% of those in the high exposure group had an education level of greater than 12 years, while 82.4% of those in the low exposure group did.  Smoking was more common as sound exposure increased. The high-exposure group had the highest incidence of smoking and reported 38.9% as smokers, the medium-exposure group had 28.6% smokers, and of the low-exposure group, only 15.9% were smokers. Statistical analysis utilizing the Cox proportional hazard regression model found that participants exposed to high levels of noise defined in the study as ≥ 85 decibels were at significantly higher risk of developing hyperglycemia than their low (<70 decibels) noise exposure counterparts. The high exposure group had a 1.80 risk ratio for developing hyperglycemia, reported with a 95% confidence interval (1.04-3.10) compared to the low exposure group.  

Awareness that high levels of noise exposure are a risk factor for hyperglycemia is an essential step in combatting it, particularly for those for whom it is unavoidable due to it being a byproduct of their occupation. Hearing-protective devices are critical in reducing the risk of developing hyperglycemia, which could lead to a chronic condition such as type 2 diabetes. This study‘s greatest strength was in the retrospective cohort design, which provided information based on a longitudinal follow-up of workers exposed to various noise levels. However, it did have limited knowledge of noise exposure that workers may have had outside of work, and was limited to one year. Additionally, researchers only measured the pre-prandial blood glucose levels. They did not measure postprandial levels, and these levels were only taken at the beginning and end of the study. The study would have benefited by having more measurements to correlate noise exposure to blood glucose levels strongly. For this reason, researchers recommend using animal models to study the impact of noise on hyperglycemia further. 

Practice Pearls: 

  • Noise levels greater than or equal to 85 decibels are highly correlated with an increased incidence of hyperglycemia. 
  • Those in jobs with high noise level exposure are likely to be males, smokers, and have a lower education status than those in jobs with reduced noise exposure. 
  • Hearing protective devices may be used to help protect against the development of diabetes. 

Chang, Ta-Yuan, et al. Occupational Noise Exposure and Its Association with Incident Hyperglycemia Retrospective Cohort Study. Nature, 22 May 2020, doi:10.2139/ssrn.3284860. 

Sameen Khan, Pharm.D. Candidate, USF College of Pharmacy

Medscape: Next generation insulins

Adapted from Medscape interview with Ulrik Pedersen-Bjergaard MD

Dr Pedersen-Bjergaard is based in Denmark.

Once weekly insulins are under development and are at the pre-clinical study level. These are expected to be a lot more convenient. Novonordisk’s is at the most advanced stage. They are basal insulins that cause no change in the HbA1Cs or body weight when used in type two diabetics. (Who still produce some insulin in their pancreatic beta cells). The new insulin called Icodec has been trialled against Glargine / Lantus and it is equally safe.

Blue tooth technology has been developed that will tell you how many units of insulin you injected and when you injected it, via an integrated pen unit. The unit will have automated titration recommendations via your blood sugar meter. This will give improved glucose readings and HbA1Cs.

Ultra rapid insulins are being developed. These reduce the one and two hour blood sugar spikes after meals but have not been optimised for pump use yet.

Insulin Degludec shows reduced hypos compared to Glargine/Lantus in type ones.

Jovina cooks: Sea bass, stuffed tomatoes and sweet potato cakes.

To assemble the meal you will need to start with the sweet potato cakes.

olive oil cooking spray

one large egg

half teaspoon salt

1/4 teaspoon black pepper

1 teaspoon honey

some fresh or dried thyme

1/4 cup minced spring onions

1/4 cup or 1oz of almond flour

2 sweet potatoes

Microwave your sweet potatoes for approximately 7 minutes (depends on your oven and size of potatoes)

Pre-heat your oven to 400 degrees F.

Line a rimmed baking sheet with parchment paper or a silicone sheet and spray with oil.

In a medium bowl whisk the egg, salt, pepper, honey, spring onions and thyme.

Add the ground almonds and cooked and mashed sweet potato.

Mix well.

Form six patties and flatten on the baking sheet with your hand or a rolling pin or spatula.

spray with oil and bake for 15 minutes.

Then turn, spray with oil again and bake for another 10 minutes.

Now make your Sweetcorn Creamy Stuffed Tomatoes.

4 medium sized tomatoes

2 cups of sweetcorn either tinned or cut from 4 fresh ears.

4 tablespoons mayonnaise

3 tablespoons minced spring onions

salt and black pepper

1 cup grated cheddar cheese

1 tablespoon fresh parsley

pre-heat oven to 400 F

cut the top off the tomatoes, remove the seeds and pulp with a spoon.

turn upside down and dry on kitchen towel

Combine the corn with the remaining ingredients

Fill the tomatoes with the mixture and bake for 15-20 minutes till the cheese bubbles.

Now make the Sea Bass with Caper Sauce

one pound of sea bass cut into smaller portions

salt and pepper to taste

caper sauce

3 tablespoons lime juice

3 tablespoons avocado oil

2 teaspoons red wine vinegar

one spring onion minced

1 tablespoon of capers drained and chopped

1 de-seeded jalepeno pepper minced

one glove garlic

mix all of these sauce ingredients together.

fry the fish fillets for two minutes each side.

Then add the sauce ingredients and turn the heat down for 5 minutes

Serve immediately.

The fish is the most time critical of the components of this meal.

Enjoy.

Over 40s can benefit from red light therapy

Adapted from Shinhmar H et al. J Gerontol A Biol Sci Med Sci 29 Jun 2020

It sounds like a hoax, but staring at a deep red light for three minutes a day has been found by researchers to significantly improve declining eyesight in people aged over 40.

This is the first study of its kind in humans and it was conducted in the UK.

At around the age of 40, human retinal cells start degenerate increasingly rapidly and this causes visual deterioration.

It had already been discovered that retinal photoreceptors in animals improved if they were exposed to 670 nm deep red light.

For the study 24 people aged between 28 and 72 with no retinal disease were recruited. The gender balance was equal. The function of their rods and cones on the retina were tested. Then they were given a special pen torch which emitted the deep red light and they were told to use this for three minutes a day for two weeks.

The light had no effect in the under 40s but after this colour sensitivity improved by up to 20 per cent, particularly in the blue parts of the spectrum, which is particularly affected by ageing. Rod sensitivity also improves. This helps people to see in low levels of light.

Lead author Professor Glen Jeffrey said,” Our study shows that it is possible to significantly improve vision that has declined in aged individuals using simple brief exposures to light wavelengths that recharge the energy system that has declined in the retina cells, rather like re-charging a battery.”

My comment: I am very shortsighted and as a result of my eye shape I have very poor night vision. If these little torches were made available I would definitely use one.

Whole almond consumption is associated with improved dietary quality

Adapted from Dikariyanto V et al. Whole almond consumption is associated with better dietary quality and cardiovascular disease risk factors in the UK adult population. National Diet and Nutrition Survey 2008-2017. Eur J Nutr. 2020 May 16.

Almonds are known to be a highly nutritious food, but they must be imported and they are expensive. They require sunshine, water and pollination by bees. The UK imports them from California and Spain. Almond consumption is low in the UK.

As in all observational studies, association does not mean causation. People who eat a lot of almonds, like me, are probably more health conscious, may be avoiding wheat and other grains, may be on a low carb diet, and may be more affluent and may also be doing more exercise.

The researchers looked at 6802 people who completed at least three days of a four day food diary between 2008 and 2017.

7.1 % of the population reported eating almonds with an average consumption of five grams a day (a very small amount). This group reported eating higher intakes of protein, total and unsaturated fats, fibre and micronutrients including vitamin E, thiamine, riboflavin, folate, pantothenic acid, biotin, vitamin C, potassium, magnesium, phosphorus, iron, copper and zinc, manganese and selenium. They also had lower intakes of trans fats, total carbohydrate, sugar and sodium than non consumers.

Almond consumers had a slightly lower body mass index and waist circumference compared to non consumers. There was no blood pressure differences.

The actual differences were BMIs of 25.5 versus 26.3 and waist sizes of 88.0 cm versus 90.1.

The authors concluded that, “Encouraging snacking on nuts, including almonds, to replace snack foods high in saturated fatty acids, refined sugars and free sugars may contribute to the sum effect of a healthy dietary pattern on reduced risk of cardiovascular diseases”.

I eat a lot more than 5mg of almonds a day, usually in the form of low carb baking. We have lots of almond based recipes on this site. If you like eating the nuts, go ahead. They are often conveniently packed in small bags and are very handy if you are travelling. Bear in mind that they do tend to get stuck between your teeth so bring some dental tape with you too.