Category: General

Blogging About Diabetes

Emma11 Comments

Medical News Today summed up ten of the best diabetes blogs. Sadly, we weren’t one of them (there’s no justice in this world), but they did make some great suggestions that I want to check out.

Why blog about diabetes? When I was first diagnosed, there were few opportunities to meet other people with diabetes. Weirdly enough, I grew up in a tiny town (population sub 2,500), and five of us were diagnosed with type 1 in a short space of time. I did have other diabetics around me, and my mum ended up developing a close friendship with the mother of one of them.

That said, though – we didn’t have that much information at our fingertips and in those days, the GP, the consultant and the diabetic nurse were autocratic figures. No-one challenged them or the recommendations they made.

Fast forward thirty-odd years and millions of people share their experiences of living with diabetes, types 1 and 2. Obviously, we don’t all have medical qualifications, and can’t and shouldn’t offer medical advice but we can tell stories about what has worked for us.

We can share our experiences of how we exercise, what we eat, what we do to prepare for holidays – it’s all about how we live as well as we can with the ol’ sugar curse! Online friendships and communities can’t replace real-life meetings and connections, but they do go some way to making you feel less alone with your diabetes.

So, here are some of Medical News Today’s best blogs about diabetes that I’m going to be investigating…

Bitter-Sweet – Karen Graffeo was diagnosed at the age of eleven and remembers daily insulin injections, a strict exchange diet and sugar monitoring involving urine and glass test tubes. (Me too!)

She started Bitter Sweet in 2008, tagline “life with diabetes isn’t all that bad”.

The College Diabetes Network sounds useful for anyone (or the parents of anyone) about to go off to college/university. It can be scary for both prospects, and the site provides the tools and resources that can help people with diabetes live well as students. Categories include clinics, student rights, job opportunities, dining hall eating, relationships and more.

The FitBlog is run by husband and wife team, Tobias and Christel Oerum. Christel has type 1 diabetes, and the site is for people to find out more about exercising safely and efficiently when you have diabetes.

 

 

 

 

 

 

Are you doing what matters most to you?

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mum and dad

This amusing article was spotted by psychologist Ron Friedman. Are you spending your time on what really matters?

 

The Tail End
This is one of the most compelling articles I’ve read in a while. It’s a simple concept, yet chances are, it will change the way that you view life (and perhaps even improve your relationship with your parents).

Ron Friedman

 

Study Finds Some Type 1s DO Produce Insulin

Emma3 Comments

Free stock photo of health, medical, medicine, prickAn article in Medical New Today caught our eye this week – research recently found that people with type 1 diabetes produced some insulin.

Yeah, yeah, I thought, it’s the newbies again. But apparently not. The Uppsala University in Sweden’s researchers found that nearly half of patients who’d had the condition for more than ten years did produce insulin.

Type 1 diabetes is routinely described as a condition where the body doesn’t make insulin. The researchers found that the insulin-producing patients had higher levels of immune cells that produce a protein called interleukin-35 (IL-35). This is believed to suppress the immune system and reduce inflammation in the body.

The findings were reported by the study’s co-author, Dr Daniel Epses, in Diabetes Care.

Type 1 diabetes happens when the immune system mistakenly attacks insulin-producing cells or beta cells in the pancreas.

This was believed to lead to a complete loss of insulin production in type 1 diabetics, but studies in recent years have shown that some patients still have functioning beta cells.

Dr Epses and his colleagues wanted to work out if there are any immunological mechanisms that could explain why some type 1 diabetics still produce small amounts of insulin.

The study looked at 113 patients aged 18 and over. All of them had been living with diabetes for at least ten years.

Researchers measured the levels of C-peptide in the blood – an indicator of insulin production. They also measured circulating cytokine levels, including IL-35. Cytokines are proteins that are secreted by the immune cells and they play a major role in cell signalling.

The team found that almost half the patients were C-peptide positive – in other words, they had some level of insulin production. The results also showed that patients who were C-peptide positive had significantly higher levels of IL-35 in their blood, compared with the patients who were C-peptide negative (the ones who had lost all insulin production).

Previous research has indicated that IL-35 can suppress auto-immune disease. It is possible that in some type 1 diabetics, the protein prevents the immune system from attacking and destroying beta cells.

Dr Epses and his colleagues, who are based at the Department of Medical Cell Biology at Uppsala University, couldn’t determine if C-peptide positive patients had higher IL-35 levels at type 1 diabetes diagnosis, or whether levels of the protein increased over time because of a reduced immune system attack on insulin-producing beta cells.

More study is needed to gain an understanding of how IL-35 might relate to insulin production. The researchers believe, however, that their findings show the potential of IL-35 as a treatment for type 1 diabetes. As the findings also show that almost half of patients with type 1 diabetes produce some insulin, the team thinks it might be possible to encourage regeneration of their remaining beta cells and so boost insulin production.

 

 

Diabetes Week

Emma4 Comments

Oops! We forgot to do anything to mark Diabetes Week in the UK (it finishes today), a bit remiss seeing as we’re a blog all about diabetes.

So, to make up for our tardiness, here are some interesting facts about diabetes…

  • The earliest known written record that referred to diabetes is thought to be 1,500 BCE – an Egyptian papyrus report that mentioned frequent urination as a symptom.
  • The symptoms (thirst, weight loss, peeing too much) were recognised for more than 1,200 years before the disease got a name.
  • It was the Greek physician Aretaeus (30-90CE) who was credited with coming up with the name diabainein, meaning ‘a siphon’. This refers to the excessive urination associated with the condition. Diabetes was first recorded in the Middle Ages, the Greek word ‘mellitus’ meaning honey, later added.
  • Early tests for diabetes meant doctors drinking people’s urine to see if it was sweet… Or they watched to see if the urine attracted ants or flies.
  • The writer of this piece remembers urine testing in the good ol’ days before blood testing was available.
  • Dr. Priscilla White led treatment for diabetes in pregnancy. When she joined the practice of Dr. Elliott P. Joslin in 1924, the foetal success rate was 54 percent. By the time she retired in 1974 1974, the foetal success rate was 90 percent.
  • Type 1 and type 2 diabetes were officially differentiated in 1936. The difference had been noted in the 18th Century when a physician spotted that some people suffered from a more chronic condition than others who died in less than five weeks after the onset of symptoms.

And finally – in 1916, Dr. Frederick M. Allen developed hospital treatment that restricted the diet of diabetes patients to whisky mixed with black coffee or clear soup for non-drinkers. Patients were given this mixture every few hours until sugar disappeared from the urine (usually within five days). They then had to follow a very strict low-carbohydrate diet. This programme had the best treatment outcome for its time…

Swings and roundabouts, huh?

To celebrate Diabetes Week, here’s my latest low-carb pudding idea. Take about 200g Greek yoghurt, mix with a rounded teaspoon of cocoa powder, a heaped teaspoon of granulated sweetener and there you have it – chocolate cream!

Add raspberries or strawberries for extra sweetness/goodness. About 5g carbs per serving without fruit.

 

 

Eric Barker: How to make friends as an adult

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friendship gibran

 Originally posted in Welcome to the Barking Up The Wrong Tree weekly update for February 19th, 2017.

This Is How To Make Friends As An Adult: 5 Secrets Backed By Research

Click here to read the post on the blog or keep scrolling to read in-email.

When you were a kid it was a lot easier. In college you almost had to be trying not to make friends. But then you’re an adult. You get busy with work. Your friends get busy with work. People get married. Have kids. And pretty soon being “close” means a text message twice a year.

You’re not alone… Or, actually, the whole point of this is you really may be alone. But you’re not alone in being alone. These days we’re all alone together. In 1985 most people said they had 3 close friends. In 2004 the most common number was zero.

Via Social: Why Our Brains Are Wired to Connect:

In a survey given in 1985, people were asked to list their friends in response to the question “Over the last six months, who are the people with whom you discussed matters important to you?” The most common number of friends listed was three; 59 percent of respondents listed three or more friends fitting this description. The same survey was given again in 2004. This time the most common number of friends was zero. And only 37 percent of respondents listed three or more friends. Back in 1985, only 10 percent indicated that they had zero confidants. In 2004, this number skyrocketed to 25 percent. One out of every four of us is walking around with no one to share our lives with.
Friends are important. Nobody would dispute that. But I doubt you know how very important they are.

So let’s see just how critical friends can be — and the scientifically backed ways to get more of them in your life…

Loneliness Is A Killer

When people are dying, what do they regret the most? Coming in at #4 is: “I wish I had stayed in touch with my friends.”

And neglecting your friends can make those deathbed regrets come a lot sooner than you’d like. When I spoke to Carlin Flora, author of Friendfluence: The Surprising Ways Friends Make Us Who We Are, she told me:

Julianne Holt-Lunstad did a meta-analysis of social support and health outcomes and found that not having enough friends or having a weak social circle is the same risk factor as smoking 15 cigarettes a day.
Maybe your grandparents lived to 100 and you take good care of yourself. You’re healthy. But if you want those years to be full of smiles, you need to invest in friendship. 70% of your happiness comes from relationships.

Via The 100 Simple Secrets of Happy People:

Contrary to the belief that happiness is hard to explain, or that it depends on having great wealth, researchers have identified the core factors in a happy life. The primary components are number of friends, closeness of friends, closeness of family, and relationships with co-workers and neighbors. Together these features explain about 70 percent of personal happiness. – Murray and Peacock 1996
The Grant Study at Harvard has followed a group of men for their entire lives. The guy who led the study for a few decades, George Vaillant, was asked, “What have you learned from the Grant Study men?” Vaillant’s response?

That the only thing that really matters in life are your relationships to other people.
So friendships are really really really important. But maybe you’re not worried. Maybe you have lots of friends. Guess what?

In seven years, half of your close friends won’t be close to you anymore.

Via Friendfluence: The Surprising Ways Friends Make Us Who We Are:

A study by a Dutch sociologist who tracked about a thousand people of all ages found that on average, we lose half of our close network members every seven years. To think that half of the people currently on your “most dialed” list will fade out of your life in less than a decade is frightening indeed.
Ouch. Scared yet? I am.

(To learn an FBI behavior expert’s tips for getting people to like you, click here.)

So what do we do? (No, going back to college is not the answer.) How do we make new friends as adults?

1) The New Starts With The Old

The first step to making new friends is… don’t. Instead, reconnect with old friends:

These findings suggest that dormant relationships – often overlooked or underutilized – can be a valuable source of knowledge and social capital.
Doing this is easy, it’s not scary, they’re people you already have history with, and it doesn’t take a lot of time or work to get to know them. Go to Facebook or LinkedIn for ideas and then send some texts. Boom. You already have more friends.

If you’re going to be strategic, who should your prioritize? You probably met a disproportionate number of your friends through just a handful of people. Those are your “superconnectors.”

Rekindle those relationships. And then ask them if there’s anyone you should meet. Next time you get together, see if that new person can come along. Not. Hard. At. All.

(To learn how to deal with a narcissist, click here.)

But maybe this feels a little awkward. Maybe your friendship muscles have atrophied. Maybe you weren’t great at making friends in the first place. So what really makes people “click”?

2) Listen, Seek Similarity, and Celebrate

Clicking with people is a lot less about you and a lot more about focusing on them. Don’t be interesting. Be interested. And what are the best ways to do that?

Listen, Seek Similarity, and Celebrate.

Studies show being likable can be as easy as listening to people and asking them to tell you more.

And mountains of research show similarity is critical. So when they mention something you have in common, point it out.

Finally, celebrate the positive. When someone talks about the good things in their life, be enthusiastic and encouraging.

Via The Myths of Happiness:

The surprising finding is that the closest, most intimate, and most trusting relationships appear to be distinguished not by how the partners respond to each other’s disappointments, losses, and reversals but how they react to good news.
(To learn more about how to be someone people love to talk to, click here.)

Alright, your superconnectors are making introductions and you’re clicking. But how do you get close to these new people? We’ve all met people we thought were cool… but just didn’t know how to take it to the next level and go from acquaintance to friend. It’s simple, but not necessarily easy…

3) Be Vulnerable

Open up a bit. Don’t go full TMI, but make yourself a little bit vulnerable. Nobody becomes besties by only discussing the weather.

Close friends are what leads to personal discussions. But personal discussions are also what leads to close friends.

Via Click: The Magic of Instant Connections:

Allowing yourself to be vulnerable helps the other person to trust you, precisely because you are putting yourself at emotional, psychological, or physical risk. Other people tend to react by being more open and vulnerable themselves. The fact that both of you are letting down your guard helps to lay the groundwork for a faster, closer personal connection.
Close friends have a good “if-then profile” of each other. Once you have an idea of “if” someone was in situation X, “then” they would display behavior Y, that means you’re really starting to understand them. And this leads to good friendships:

People who had more knowledge of their friend’s if-then profile of triggers had better relationships. They had less conflict with the friend and less frustration with the relationship.
How many close friends do you need? If we go by the science, you want to aim for at least five.

Via Finding Flow: The Psychology of Engagement with Everyday Life:

National surveys find that when someone claims to have five or more friends with whom they can discuss important problems, they are 60 percent more likely to say that they are ‘very happy.’
(To learn the lazy way to an awesome life, click here.)

So you have new friends. Awesome. Now how do you not screw this up?

4) Don’t Be A Stranger

First and foremost: make the time. What’s the most common thing friends fight about? Time commitments.

Via Friendfluence: The Surprising Ways Friends Make Us Who We Are:

Daniel Hruschka reviewed studies on the causes of conflict in friendship and found that the most common friendship fights boil down to time commitments. Spending time with someone is a sure indicator that you value him; no one likes to feel undervalued.
You need to keep in touch. (Remember: not keeping in touch is how you got into this problem in the first place.)

If you want to stay close friends with someone, how often do you need to check in? Research says at least every two weeks.

(To learn the four rituals neuroscience says will make you happy, click here.)

So even if you need to set a reminder on your calendar, check in every two weeks. But, actually, there’s a better way to make sure you don’t forget…

5) Start A Group

Denmark has the happiest people in the world. (I’m guessing Hamlet was an exception.) Why are Danes so happy? One reason is that 92% of them are members of some kind of social group.

Via Engineering Happiness: A New Approach for Building a Joyful Life:

The sociologist Ruut Veenhoven and his team have collected happiness data from ninety-one countries, representing two-thirds of the world’s population. He has concluded that Denmark is home to the happiest people in the world, with Switzerland close behind… Interestingly enough, one of the more detailed points of the research found that 92 percent of the people in Denmark are members of some sort of group, ranging from sports to cultural interests. To avoid loneliness, we must seek active social lives, maintain friendships, and enjoy stable relationships.
And what’s the best way to make sure you’re in a group? Start one. That makes it a lot easier to stay in touch and a lot easier to manage those big 5 friendships with 20% of the effort.

A weekly lunch. A monthly sewing circle. A quarterly movie night. Whatever works. Friends bring friends and suddenly it’s not so hard to meet cool new people. And who does everyone have to thank for this? You.

And make the effort to keep that group solid for everyone. Many studies show older people are happier. What’s one of the reasons? They prune the jerks out of their social circles:

Other studies have discovered that as people age, they seek out situations that will lift their moods — for instance, pruning social circles of friends or acquaintances who might bring them down.
(To learn the 6 rituals ancient wisdom says will make you happy, click here.)

Alright, popular kid, we’ve learned a lot. Let’s round it up and find out how to keep your new friendships alive over the long haul…

Sum Up

Here’s how to make friends as an adult:

  • The new starts with the old: Touch base with old friends and leverage your superconnectors.
  • Listen, seek similarity and celebrate: Don’t be interesting. Be interested.
  • Be vulnerable: Open up a bit. Form an “if-then” profile.
  • Don’t be a stranger: Check in every two weeks, minimum.
  • Start a group: Things that are habits get done. So start a group habit.

What does Carlin Flora, author of Friendfluence, say is the number one tip for keeping friendships alive?

Reach out to your good friends and tell them how much they mean to you. It’s just not something we’re accustomed to doing. It’ll make you feel great, it’ll make them feel great and it will strengthen the bond between you. Be more giving to the friends you already have. People in romantic relationships always celebrate anniversaries, yet you might have a friend for 15 years and you’ve probably never gone out to dinner and raised a glass to that. We need to cherish our friendships more.
Okay, you’re done reading. Time to start doing. Reach out to a friend right now. Send them this post and let’em know you want to get together.

Listen to what they’ve been up to. Celebrate their good news. Offer to help them out with something.

After all, that’s what friends are for.

Please share this. (It’s a very friendly thing to do.) Thank you!

 

Thanks for reading!
Eric
PS: If a friend forwarded this to you, you can sign up to get the weekly email yourself here.

Heri: Understanding your biological clock

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Synchronizing with our biological clock

biological_clock_human
Biological Human Clock

The 24-hour light–dark cycle is a fundamental characteristic of Earth’s environment and profoundly influences the behaviour and physiology of animals and humans.

The illustration above highlight how hormone production and vital signs fluctuate during the day. This is called the circadian rhythm.

And it can be an important tool to help you schedule tasks and daily routine!

For example, cortisol production is at its highest in the morning. It lets us wake up, be alert and start our day. Cortisol then slowly decreases throughout the day. It’s at its lowest during the night to let us sleep and repair us physically and psychologically.

sleeplight2

Melatonin secretion starts when our retina senses less light, and will stop after sunrise. The inner retina is especially sensitive to the lack of blue light wavelengths. Studies show for example that blue light will increase our alertness, performance and positive mood during the day. On the other hand, blocking blue light 3 hours before sleep significantly improves sleep quality.

Besides light, circadian rhythm is also sensitive to temperature. Lower temperatures in the evening will decrease alertness, metabolism as well as heart rate.

Other factors include meal times, stress and exercise. Weight training at 8pm can delay optimal sleeping time by 2 to 4 hours.

It is important to understand this biological human clock. Review the illustration above and look how you can (re)schedule work, nutrition, exercise and sleep. Your body will respond better, and your performance can improve, as well as your overall mood, health and well-being.

For example, if you usually sleep around 10:30pm, it is a good idea to stay away from 7:30pm blue light emitting devices such as iPads, mobile phones, TVs and most light bulbs. Studies show that you don’t have to be an active user: just having them in your bedroom is enough to show an effect. Of course, using actively an iPad or computer screen will increase stimulation, as well as increased potential stress from important emails and notifications.

sun

Here are a few take-aways from the illustration and recent studies:

  • Optimal time to wake up is around 7 to 7:30am, when melatonin production stops
  • 8am or earlier is a good time for breakfast, for best ingestion of carbs.
  • Testosterone production is at its highest at 9am. A few will schedule their weight training for best results. But statistically, this is also a peak time for heart attacks or strokes. Adjust accordingly if you have hypertension or at risk for CVD.
  • Schedule your most important work between 10:00am and 11:30. This is where you are the most alert, good memory, and best ability to focus. Work in an area with plenty of blue natural light, as well as comfortable temperature. Lack of blue light such as working in a window-less office, or working in a cold environment will make you less productive and more frustrated.
  • Noon to 2:30pm is a dead time. Adrenal glandes and hormones are their lowest, and lunch digestion will drag you down. Have one cup of coffee (or better yet healthier coffee alternatives), and schedule light work, such as emails or follow-ups.
  • 2:30pm to 6pm is good for more active work. Go meet and talk to colleagues.
  • 5pm is the best time for cardiovascular activities. Your lungs will be most efficient around that time. Take your Garmin or Suunto GPS sports watch, and hit the road!
  • 6:30pm to 7:30pm is when your blood pressure and temperature are at their highest. Don’t be stuck in traffic or have a heated emotional argument at that time!
  • Avoid carbs at dinner. Pasta, rice, bread will be transformed quickly into fat if ingested in the evening. Salad with a bit of your favourite protein is a better choice.
  • Stay away blue light 3 hours before you sleep. Exposure to amber light can help on the other hand.
  • night

If you work in night shifts, the best investment is a portable blue light for work (such as this) as well as a pair of blue light blocking glasses when you are going to sleep, to minimize circadian rhythm disruption. However, asking to take day shifts instead is better for your health.

In case there is daylight savings, shift circadian times above so timing syncs with your local sunrise time.

References:

  • Antoine U Viola, Lynette M James, Luc JM Schlangen and Derk-Jan Dijk. Blue-enriched white light in the workplace improves self-reported alertness, performance and sleep quality. Scandinavian Journal of Work, Environment & Health.  Vol. 34, No. 4 (August 2008), pp. 297-306
  • Dijk D-J, Archer SN (2009) Light, Sleep, and Circadian Rhythms: Together Again. PLoS Biol 7(6): e1000145. doi:10.1371/journal.pbio.1000145

Learning and Diabetes: A vicious circle

kaitiscotland8 Comments

Learning and Diabetes

Rowan Hillsoncalculator

Practical Diabetes Nov/Dec 16

Only 32% of type one diabetics and 78% of type two diabetics are currently offered structural education in England. Even then, not all will attend. Will it have any positive long term effects for those who do? Many issues affect learning. This article discusses some of them.

Literacy and numeracy

In England in 2011, 15% of the population aged 16-65 had the learning that is expected of an eleven year old child. This is considered “functionally illiterate” by the National Literacy Trust.  Although they would not be able to pass an English GCE, they can read simple texts on familiar topics. More than 50,000 UK diabetics are at this basic level of reading ability.

Numeracy problems are higher with 24% of adults function at the same level as your average eleven year old. Testing diabetics shows that numeracy and literacy are linked and that blood sugar control is better in those with better numeracy and literacy. This is not surprising since so many tasks need these skills.

Weighing foods and estimating portion sizes

Addition

Converting between metric and imperial systems

Multiplying and dividing

Using decimals

Recognising and understanding fractions

Working with ratios, proportions and percentages

Readability

Arial 12 point font, upper and lower case, on white or off white backgrounds, using short words, short sentences and short paragraphs all improve readability.

Health Literacy

Health literacy includes reading, writing, numeracy, listening, speaking and understanding.

In the type two diabetes population, lower health literacy was significantly associated with less knowledge of diabetes, poorer glucose self- management, less exercise and more smoking.

In the USA people understood food labels better if they had higher income and education.  Overall 31% gave the wrong answer to food label questions. Many diabetics have problems with misinterpreting glucose meter readings, miscalculating carbohydrate intake and medication doses.

Lower scores were associated with being older, non-white, fewer years in education, lower income and lower literacy and numeracy scores.

When an internet based patient system was offered, those with limited health literacy were less likely to sign in and had more difficulty navigating the system.

Cognitive impairment

Alzheimer’s disease, vascular dementia and other cognitive impairments are more likely in diabetics particularly those with type two diabetes. A longer duration of diabetes and a younger age of onset were associated with cognitive impairment.

Hyperglycaemia

High blood sugars can cause poor concentration, tension, irritability, restlessness and agitation. In experiments, high blood sugar induced delayed information processing, poorer working memory, and impaired attention.

In five to eighteen year olds with new type one diabetes most neuropsychological tests showed considerable impairment.  One year post diagnosis, dominant hand reaction time was worse in those with poor glycaemic control.

Long term, type ones diagnosed before the age of 18 had five times the risk of cognitive impairment compared to their non- diabetic counterparts. Chronic hyperglycaemia increased the risk.

Hypoglycaemia

Most friends and relatives can recognise if someone well known to them has a low blood sugar, often faster than the individual. Cognitive performance drops at blood sugars of 2.6-3 in non- diabetic subjects.  In type one children, those who had recurrent severe hypoglycaemia had more impaired memory and learning.

Psychological issues

Both depression and anxiety can impair test performance. Both of these and other mental illnesses are more common in diabetics.

Sensory and motor problems

Visual impairment and deafness can make some learning methods difficult.

Conclusion

We all learn in different ways. A substantial proportion of the population has low literacy and numeracy. This impairs health literacy which impairs diabetes knowledge for self -care. Poor numeracy may worsen blood sugar control. Clearly written, easily readable information helps everyone. Having diabetes increases the risk of cognitive impairment both at diagnosis and long term. Both high and low blood sugars affect current ability to learn and may have long term adverse effects on cognition.

Before teaching diabetics it is worth having a think about any difficulties your patient could be having assimilating the learning. If so, how can you tailor your teaching to their needs?

The BBC has adult learning resources at http://www.bbc.co.uk/learning/adults/

 

 

Scotland ‘Should Take Lead Role in Type 1 Research’

Emma5 Comments

Catriona Morrice of the Juvenile Diabetes Research Foundation (JRDF) talked to the Scotsman this week about how Scotland could lead the field to cure type 1 diabetes.

The Foundation’s development manager cites bioscience expertise where Scottish institutions, scientists and charities are already working in support of this aim, but she believes Scotland’s role could be even bigger.

A child diagnosed at the age of five can need more than 19,000 insulin injections before his or her 18th birthday [incidentally, where does that put you? I’m in my 33rd year of diabetes] so there’s no doubt that a cure will be welcomed by us, if not by the insulin-production companies…

Greater Focus

Morrice says the JDRF wants the Scottish Government to encourage an even greater focus on type 1 diabetes research. Scotland has among the world’s highest rates of incidence, and the JDRF has invested nearly £4 million in projects at the Universities of Edinburgh and Glasgow.

Across the international JDRF network, Morrice says, the organisation is delivering ground-breaking work. There are three areas of work which are of particular importance – encapsulation, immunotherapy and medicinal foods. The encapsulation research being carried out in the US is looking at ways to implant insulin-producing cells in the body while protecting them from the immune system. The basic idea is that they are wrapped in a protective coating and can do the same job as the ones in a healthy pancreas.

Immunotherapy works to alter what the immune system does, retraining it to no longer attack cells such as the insulin-producing beta cells of the pancreas. In Boston, a research team is working on a technique which will ‘hijack’ red blood cells, attaching insulin fragments to them. These blood cells travel quickly through the body and don’t cause an immune response themselves, as the individual produces them.

Food as Medicine

Then, there are medicinal foods. JDRF-funded research in Australia has shown that types of bacteria in our gut can have an impact on overall health. This has opened up debate about food could be used as medicine, helping to treat or prevent type 1 diabetes without harmful drugs.

But Scotland has something almost every other country doesn’t, Morrice adds – a database of people with type 1 diabetes that allows collaboration with families affected by type 1 diabetes who want to join clinical trials. Called the Scottish Care Information – Diabetes Collaboration, Morrice says it’s a vital resource for research scientists and the Foundation’s “overwhelming wish” is for Scotland to take the lead role in type 1 diabetes research.

 

The Raw Food Diet for Cats – an Update

Emma8 Comments
Feeding your cat a raw food diet might improve their energy levels. On the other hand…

Warning: this blog contains some details squeamish readers might find unpleasant…

A couple of weeks I blogged about my cat’s diet. Slightly off-topic I admit, but knowing how fond the internet is of cats, I thought regular readers might forgive me.

I’ve been experimenting with feeding my podgy puss a raw food diet to a) slim him down, and b) improve his health, specifically his digestion. My cat is sick after eating a lot. The general household rule is that whoever discovers the pile of puke wherever it lurks clears it up. My husband sometimes claims he only spotted it just before he left for work. Hmm…

The raw food diet for cats is rather like the low-carb diet we propose for people with diabetes. Admittedly, it doesn’t include mayonnaise, cheese or double cream and other such goodies, but it’s made up of unprocessed food and is very low in carbohydrates because it doesn’t include kibble, a product bulked up with grains.

Hard to Resist

Experts warn that patience and persistence are necessary for the transition. As Sandra, a reader of this blog commented, it’s a bit harder to be persistent when you’re at home with your cat all day. My moggie has trained me very well. He knows I’m a soft touch. A little pitiful meowing, or staring pointedly at the cupboard where the cat food is kept is hard to resist.

I can’t interest him in raw bones at all. I bought a box of them from Asda and even chopped them up for him. (Little aside, if you want to feel like a proper carnivore, cut bones up.) Nothing doing.

He refused to touch liver too, apart from the first time I put it down. Again, I’ve read that cats are very fussy about the freshness of meat. Liver goes off so fast, I think it would need to be fresh out of the animal for him to eat it. Years ago, my dad used to shoot rabbits, and he’d give them to the farm cats. He’d take the back legs and rip them apart down the middle, and the cats would dive into them with tremendous enthusiasm. You don’t get fresher than that, but it’s not something that is practical for me to do. I’m not keen on the idea either!

Eating too Fast

I’ve had the most success with raw mince and fresh, diced beef. As the diced meat is a bit harder to eat quickly, I prefer giving that than mince. The raw diet hasn’t stopped my cat throwing up, and he often throws up if he eats too fast. What’s worse? Clearing up regurgitated raw meat or cat food? Hard to tell.

What I have noticed is that I think he isn’t whining as much. The constant whinging for food I had put down to hunger because of poor quality nutrition and/or his bulimic tendencies seems to have eased off a bit. Is he more energetic? I don’t know. Freddie is an old-ish cat, as he is coming up for ten years old this year. He still sleeps a lot, but he also goes outside and jumps up and down on everything.

(Hygiene freaks look away now—yes, everything including the kitchen units and the dining table.)

Half and Half

I’m not feeding him an entirely raw food diet. It is expensive, and as he isn’t eating a lot of the components that make up the ideal raw food diet for cats, I worry that he is missing out on certain nutrients, so I’ve kept in the kibble just to be on the safe side. I think asking my sister-in-law to feed him raw food while we are on holiday would be taking favour-asking too far.

As for his weight… ah. It’s either gone up or stayed the same. The last time he was at the vet’s (October), he weighed 6kg. We weighed him a few times after that and his weight went down to 5.7kg. Now, it’s 6kg again. Argh! I suspect he gets fed elsewhere. Freddie’s a bold boy. He happily wanders into other people’s houses. There are plenty of cats in my neighbourhood, so he’s probably helping himself to food. What can I do, apart from attaching a tag to his collar – “PLEASE DON’T FEED ME”?!

The raw food diet hasn’t achieved what I wanted it to do – better digestion and a lighter-weight cat. That said, I’ll probably keep up the half raw/half cat food diet. I don’t know if I’ve given it enough time to work. I should start weighing out what I’m giving him to make sure it isn’t too much.

Wish me luck!

 

 

 

 

 

Dr Claude Lardinois: New insights about cardiovascular disease

kaitiscotland1 Comment

This is a two part interview with Professor of Internal Medicine Dr Claude Lardinois given to Diabetes in Control. We learn new things from him that are not emphasised enough  in the medical community.

Continued smoking is THE factor that causes the most amputations in diabetics.

Feet should be examined EVERY time a diabetic sees a health care professional.

Diabetes = cardiovascular disease due to insulin resistance + high blood sugars

Apart from blood pressure and cholesterol, urinary albumin and genetic tests can help individualise the advice and treatment that is given to patients.

P E N T A D is a memory aid for doctors when they see a diabetic: protein in the urine, eyes, e, necklace, toes, A1C, document.

 

The Impact of Genetics in Cardiovascular Disease

Claude-K-LardinoisIn part 1 of this exclusive interview from AACE 2016, Dr. Claude Lardinois discusses amputations and SGLT-2s, and genetic risk factors for cardiovascular issues in diabetes patients.

 

I think smoking is a huge factor in amputations. In fact, I personally think that in my practice anyway, 90% of the patients that have amputations are the ones that continue to smoke.

Joy Pape: So, how do you teach your patients about foot care and preventing amputations?

Dr. Lardinois: We have a policy that you have to get your shoes and socks off immediately when you get in the room.So we inspect the feet every time we see the patients. When I have patients that are smokers, I look at their leg and I’m checking for sensory and that and I say, do you like your legs?

Well of course, Dr. Lardinois, I like my legs. Well if you keep smoking, you’re not going to have your legs. I say, do you know what a black and decker is? Well yeah. We might as well do a black and decker right now. Because that’s what’s going to end up happening if you keep smoking.

I’m amazed because I’ve actually had patients that have quit smoking. I just saw one of my patients not too long ago, and the nurse said your black and decker’s here today. She laughed, she said you got me to quit smoking, because you emphasized to me the importance of my legs.

Joy Pape: This could be very interesting. You might come up with some very interesting ways of getting people motivated to manage their diabetes better. Something else we were talking about earlier [was] about cardiovascular disease. Or just managing diabetes and the topic of genetics. Tell me more.

Dr. Lardinois: Let’s talk about diabetes and cardiovascular disease, because if you look at patients with diabetes and patients without diabetes, the only difference is one has an elevated blood sugar, the other does not.

So, intuitively, the thought process was, particularly from the ADA, is if you lower the glucose to normal, your heart disease will go away. Doesn’t happen. You still have heart disease, because it turns out it’s not the glucose, it’s that you have insulin resistance.

I’ve been accused by my colleagues that I’m really not an endocrinologist, I’m a cardiologist disguised as an endocrinologist, because I really don’t get too hung up about the blood sugar. I don’t have to have it 6.5 or 7. I tell my patients, you are going to die of heart disease.

So what are the factors that make the most difference in cardiovascular disease?

Blood pressure. I’m a very big believer in blood pressure control. Lower is better. Again, you have to be careful in some elderly patients.

But cholesterol is very important, measuring albumin in your urine is very important. So these are all factors, but even after we do that, we’re still evaluating people as a group, not as an individual. That’s where the genetics come in.

There are certain genetic tests that everybody should have done, whether you have diabetes or not. Some of those are Apo-E [tests].

Apo-E is a very important gene that really determines what type of nutritional recommendations you’re going to make for your patient. If you’re a 2-2 or a 2-3, or if you’re a 3-3 or a 3-4, it’s going to vary on what the nutritional recommendations are.

Another thing is, we always talk about alcohol as being good for you — modest alcohol consumption. If you’re an Apo-E 4 and 25% of the population has either 3-4 or 4-4, alcohol actually makes your cholesterol worse and it increases cancer, particularly breast cancer in women. Some of my colleagues say I’m not going to measure my Apo-E 4, because I like alcohol. You’re going to tell me I can’t drink anymore. But we have to explain to those patients that they really have to limit their alcohol to one drink a day. So that’s very important nutritional information, right from the start, that you would never get by just following the standard guidelines.

There’s other genetic markers. There’s actually a statin marker — a lot of controversy behind it. But I stand firm that there’s a certain gene that we have called KIF6, and if you don’t have the variant, the studies with two of the cholesterol drugs weren’t very compelling, that they lowered LDL, but they didn’t reduce heart disease. So I tell a lot, if you don’t know what your KIF6 variant is, which most doctors don’t (I know mine), you have to be very discretionary in which statin you prescribe.

Then there’s other genes that you could also look at. One is haptoglobin; haptoglobin is how we carry our oxygen around. It turns out that there’s three different haptoglobins, 1-1, 1-2, and 2-2. Well, patients with type 2 diabetes who have 2-2, have a 45 percent increased cardiovascular event rate.

So again, that’s why I think with cardiology, we have these studies, even if we aggressively treat their lipids, we still have this 30% residual. Well, I don’t think that residual is cholesterol. I think it’s haptoglobin, APO-E, maybe the statin that you’re prescribing; other factors, albumin in the urine.

I think albumin in the urine is a powerful risk factor for heart disease. But unfortunately the FDA doesn’t see it as a good primary endpoint. I think until they do that, and actually establish a primary endpoint for that, we will never get a valuable answer. There’s no question about albumin in the urine. People think it’s just the kidney, albumin in the urine is the kidney telling you, you have endothelial disease. That you are leaking albumin throughout your entire body. That albumin drives cardiovascular disease. Big time.

Joy Pape: So, do you refer your patients for genetic counseling? If this is the way you practice, how do you learn more about their profile?

Dr. Lardinois: Right now it’s been kind of challenging. The diabetes [practice] I was in, they were not all that receptive. Change is always hard to do. So I actually worked with two of my former medical students, who are now practicing physicians in Reno. There’s a concierge service. I helped them set-up a genetic thing, so if patients do want to come in, they pay cash now. It’s only $1000 for the genetic testing. You do a treadmill which is $1100, and that doesn’t tell me anything. I think treadmills are kind of useless. I went 16 minutes on the treadmill, and I’ve got heart disease. I went 16 minutes. Well they’d tell me I’m just fine. Well, I’d be dead now. That’s what happened to the guy on Meet the Press. He had a treadmill [test] and three days later he was dead. What was his name? I’ll think of it in a second. [ed. note: Tim Russert.] Right now, it’s been hard to get it implemented, and I’m moving to a different position in a different hospital and maybe I can get involved with a cardiologist and get this up and running. I do think there’s basic genetic testing that should be implemented in the management of everybody with any disease, and it’s not that expensive.

Joy Pape: So we talk about patient education and people making changes. Behavior change. So how did it work? How does it work if your patients find they have this certain gene and they need to cut down on their drinking? Have you had any experience with that?

Dr. Lardinois: Oh yeah, some of them aren’t really happy with that. But I say, I provide you a service. I’m not your mom or your dad and I provide you a service and I say based on this information, you should reduce your alcohol consumption to one drink a week.

Joy Pape: Is it effective?

Dr. Lardinois: In some people it is. I think 70% of patients will follow along with you, but I think 30% no matter what you do [won’t]. There’s patients that I say [to], I feel sorry, I feel bad today. They say why? You came in, I gave you these recommendations three months ago, you didn’t do any of them. Your A1C, your blood pressure, your cholesterol, your kidney test is all the same. I’m going to have to charge you $75 for this. We live in Nevada, you could go to a nice big buffet with your whole family for $75. So I feel kind of bad, I’m taking their money away because why did they even bother to come? They didn’t do anything.

Joy Pape: Well, I’m sure glad you came today. I think it’s obvious why you got this award that you’ll be getting tonight. So congratulations and thank you.

Dr. Lardinois: Just one other point I’d like to share that I think is important. One of the things I try to do is, I work with the VA to try to set up ways to get doctors to better manage their [patients’] diabetes. I actually came up with this thing called PENTAD. I published it in Archives of Family Medicine. It was very short. Just a little card, a pocket card. The P stood for Proteinuria, which would be albumin. The E stood for Eyes. Make sure you have your patients get their eye exam. N was necklace or bracelet. Make sure they have a bracelet. T was toes, check the toes. The A was A1C. And then you say well it’s PENTAD, you have the D, so what’s the D? I said that you Document in the chart that you did the PENTA. I was very successful. It worked very well. I was going through some old papers of mine and I came up and had a few of my PENTAD cards left that I did. I did camps for kids with diabetes for 18 years and I think Lilly or somebody nicely made these PENTAD cards, so we just gave them out to everybody.

Joy Pape: It’s great to have those memory tags, something to remember.

Dr. Lardinois: We actually had a stamp. We had a stamp at the VA where we just stamped the PENTAD in and you could just write it in. That improved compliance tremendously, because it’s a reminder.

Joy Pape: I know it’s something I’ll use. Thank you so much.

Read part 2.