Scottish Diabetes Survey 2016: are we winning or losing the diabetes struggle?

In Scotland 5.4% of the population is registered as having diabetes. 10.6% have type one and 88.3% have type two. 1.1% have other types such as Maturity Onset Diabetes in the Young.

In type ones 37.3% are overweight and a further 26% are obese. So 36.7% are of normal weight. In type twos 31.6% were overweight and 55.6% were obese. So only 12.8% were normal weight.

The annual HbA1c was done in over 90% of diabetics in both groups. 24.5% of type ones and 58.6% of type twos met the target of less than 58 mmol/mol which is equivalent to 7.5%.

Over 84.9% of both groups had their blood pressure measured that year and 45% of type ones and 32.7% of type twos met the target of less than 130 mmHg systolic.

Cholesterol levels were done in 86.4% of patients and this met the target of less than 5 mmol/l in 69.1% of type ones and 78.4% of type twos.

22.9% of type ones were current smokers compared to 17.2% of type twos.

Eye screening was undertaken in 85.4% of diabetics that year. 59.1% had had their feet checked and the score recorded.

When it comes to end stage disease in type ones, 3.5% had had a heart attack, 2.6% had had coronary revascularisation, 1.4% had end stage renal failure and 1.1% had had a major limb amputation.

In type twos, 9.7% had had a heart attack, 7.5% had had revascularisation, 0.6% had end stage renal failure and 0.7% had had a major amputation.

Overall 10.8 of the diabetic population use insulin pumps.

My comments: It can be seen from the data that screening is  doing very well. We have an average number of people with diabetes and the distribution between types one and two has not changed. Smoking is an issue in only about 20% of diabetics which probably compares favourably with social norms.

We have lost the battle of the bulge. Only 12.8% of type twos are of normal weight. Type ones are more like the “norm” for Scotland with just over a third being of normal weight.

Blood sugar control is very poor particularly in type ones with about three quarters of them with blood sugars over 7.5%. 

When it comes to complications, type twos are much more likely to get cardiac problems whereas type ones are more likely to get renal failure and amputations. 

 

Imagine NOT having diabetes…

a picture of a blood testing machine on The Diabetes Diet
This will be my blood sugar levels from now on. All the time. Yes sirree.

When you’ve lived with diabetes as long as I have, it’s almost impossible to imagine what life is like without that constant round of tests, injections and mild anxiety around food as you eat something and hope it doesn’t result in postprandial blood sugar levels that are too high or too low.

Today, I read about people’s experiences of research or new procedures they’d taken part in. One woman wore the artificial pancreas when she was pregnant. Giving it back afterwards was, she said, “like losing a limb”. Another person received islet stem cells transplant because he couldn’t recognise hypo symptoms and was able to come off insulin altogether, although he did have to go back on small amounts four months later.

So, Emma B, I said to myself, say you woke up tomorrow without type 1 diabetes what would be the best thing about it. And is there anything you would miss?

Energy

The main point that would strike me would be the energy. Imagine living with levels of energy that remain more or less constant. To the non-diabetics out there, please make the most of it this on my behalf. You have no idea how brilliant it is. I get days here and there when the energy is constant, and blimey you could put me in charge of Brexit and I’d sort it out… But some of those other days are tedious. Tiredness makes you grumpy and makes every task far more difficult, meaning you have to invest in willpower (a finite thing) for trivial rubbish.

It’s hard to over-estimate the impact that one single thing would make. Perhaps I’d turn into an extrovert. Tiredness often makes conversation an effort. Or I’d enter a full marathon instead of a half. My freelance copywriting business might take off because I’d be able to do far more work every day AND I’d be an excellent net-worker and pitcher, thanks to the whirling fizz running through my veins.

Injection-free meals

I’d also relish sitting down to meals without having to do blood tests and injections first. Oh the bliss of pulling up a plate without eyeballing its contents and doing all the calculations in your head—right, so that’s about 15g of carbs (I think), my blood sugar is a little raised so I need to factor that in, but I’m going for a walk afterwards so include 30 minutes of exercise, maybe allow for an hour because I’m going up that big hill… etc., etc.

I might never go near a doctor’s surgery again. A silly thing, I know, but we sugar shunners spend a lot of time in hospital waiting rooms, often wondering why the magazine collection is so rubbish and why all the posters on the wall are so out of date. There’s the clinics, the retinal screening and all the other appointments associated with diabetes. Not going along to any of them ever again would be a joy.

My abdomen would say an almighty big ‘thank-you’ for not getting stabbed seven or eight times a day. Granted, the needles we have these days are tiny (I use a 4mm version), but occasionally I hit a nerve and it HURTS. Ditto my fingers. As one of our regular readers said, doctors can always tell the folks who are conscientious about blood tests as they were the ones with tiny black marks all over their finger tips.

Pizza and chips anyone?

Would I dive into plates of chips, 15-inch pizzas and cakes and sweets? Probably not. I’m used to eating in a certain way, and I believe it’s healthy for most people, not just those with diabetes. I do eat chocolate and pizza from time to time because life’s too short to eat low-carb all the time.

And now for the things I would miss… wait for it…

Nothing? Diabetes doesn’t need to be dreadful. A sensible low-carb eating plan and a bit of exercise can work wonders. And it’s not the worst chronic health condition you can have, but honestly, truly and seriously I do not think there are any type 1s out there who wouldn’t say “goodbye” to diabetes without a backward glance.

 

PS – Do you remember my post about stockpiling insulin in case of a no-deal Brexit? There’s a post on Diabetes UK with the latest information here.

Diet doctor: Naan Bread

Naan bread is one of the things many of us miss when having a curry. While meat and vegetable curries lend themselves very easily to low carb eating, you can’t say the same for Naan Bread.  So it’s great to see a recipe for this first published in diet doctor and which came to my attention from our reader Shirley Yates who has her own low carb cooking blog.

 

Low Carb Naan Bread!
Published on June 21, 2017
Two pieces is only 3 net carbs!
Ingredients

¾ cup coconut flour
2 tablespoons ground psyllium husk powder
½ teaspoon baking powder
1 teaspoon salt
6¾ tablespoons melted coconut oil
2 cups boiling water
coconut oil, for frying
sea salt
Garlic butter

3½ oz. butter
1 – 2 garlic cloves, minced
Instructions
Mix all dry ingredients in a bowl. Add oil and then boiling water and stir thoroughly.
Allow to rise for five minutes. The dough will turn firm fairly quickly, but stay flexible. It should resemble the consistency of Play-Doh. If you find it’s too runny then add more psyllium husk until it feels right. The amount needed may vary depending on what brand of husk or coconut flour you use.
Divide into 6 or 8 pieces and form into balls that you flatten with your hands directly on parchment paper or on the kitchen counter.
Fry rounds in coconut oil over medium heat until the Naan turn a nice golden color.
Heat the oven to 140°F (70°C) and keep the bread warm while you make more.
Melt the butter and stir in the freshly squeezed garlic. Apply the melted butter on the bread pieces using a brush and sprinkle flaked salt on top.
Pour the rest of the garlic butter in a bowl and dip pieces of bread in it.
Recipe taken from The Diet doctor: https://www.dietdoctor.com/recipes/low-carb

When do you stop getting benefits from exercise?

From Danielle Baron’s article in International Medical News 10 August 18

As with many different health interventions, there is a sweet spot between doing enough of it and doing too much of it. Too little, and it is not effective. Too much and you could cause unexpected negative repercussions.  The subject of exercise has been investigated regarding its effect on mental health.

Over 1.2 million USA citizens were asked about their exercise habits and their mental wellbeing between 2011 and 2015 by researchers at the Centers for Disease Control and Prevention.

All exercise types improved mental health but popular team sports were particularly effective in boosting mental health. The optimal duration of exercise was between 30 and 60 minutes a session, three to five times a week.

Sessions of longer than 90 minutes or done more than 23 times a month however, were related to WORSE mental health.

The authors conclude that blanket advice on exercise could be improved by being more specific about the types, durations and frequencies that were more likely to improve mental health and that further studies could be helpful.

Chekroud SR et al. Association between physical exercise and mental health in 1.2 million individuals in the USA between 2011 and 2015: a cross sectional study. Lancet Psychiatry. Published online 8 August 2018. doi: 10.1016/S2215-0366(18)30227-X

My comments: Oh dear! Well, I’ve got the duration right at 40 minutes but I hate team sports (because I’m useless at hand to eye or foot coordination) and I aim to exercise every day, which these researchers considered “excessive”.  Maybe the team sports were more beneficial because of the socialisation aspect as well as the physical aspect. Maybe less than 23 times a month made it something to look forward to and a dopamine hit , “I’ve achieved that” rather than a black mark ” I failed to do my exercise session”   as I tend to think about it. I can see the downsides of exercise addiction reflected in this piece of research. 

High dose Vitamin D improves cardiovascular health markers

Adapted from UK Medical News 17 July 2018

Several different health measures, all which improve your cardiovascular outcomes, have been found to result from high dose vitamin D supplementation. You are likely to need to take at least 4,000 iu a day though, depending on how much extra sunshine you are exposed to regularly.

A meta-analysis of 81 randomised controlled trials looked at almost one thousand patients randomised to taking supplements or to a control group who did not. The active and control groups were both roughly 5,000 each.  The durations of the trials varied but averaged out at ten months. The doses ranged from 400 iu a day to 12,000 iu a day. The average taken was 3,000 iu a day.

The outcomes were related to the blood level of vitamin D achieved. Levels had to be over 86 nmol/L to get benefits. You need to take over 4,000 iu a day to get vitamin D concentrations of 100 nmol/L or more.  My comment:This does mean that the minimum levels advised by the Scottish Chief Medical Officer last year are way too low to see the benefits discussed here.

So what extra benefits do you see?

lower systolic and diastolic blood pressure.

lower high sensitivity C reactive protein.

lower serum parathyroid hormone.

lower triglycerides.

lower total cholesterol.

lower low density lipoprotein.

high density lipoprotein increased.

All benefits were numerically small but did reach statistical significance. Cardiovascular outcomes were not measured directly, only blood markers and blood pressure.

Mirhosseini N et al. Vitamin D Supplementation. Serum 25(OH)D Concentrations and cardiovascular disease risk factors: A systematic review and meta-analysis. Front Cardiovasc Med. 2018 July 12.

 

 

 

 

Yummy Lummy: Red hot chicken wings

These carry an Australian Government caution!

https://yummylummy.com/2018/01/06/super-hot-spicy-chicken-wings/#comments

Super hot and spicy chicken wings made with ground Queensland nuts, smoked almonds, iodised salt, black peppercorns, smoked paprika, dried mixed herbs, bird’s eye chillies, and chilli flakes.
• 8 Chicken wings
• 1 Handful Queensland nuts
• 1/2 Handful Smoked almonds
• 1 Tablespoon Iodised salt flakes
• 1 Tablespoon Whole black peppercorns
• 1 Tablespoon Smoked paprika
• 1 Tablespoon Dried mixed herbs
• 2 Dried bird’s eye chillies
• 1 Tablespoon Chilli flakes
• 2 Handfuls Shredded kale
• 1 Packet Coleslaw
• 1 Tablespoon French mustard
• 100 mL Pouring cream
1. In a coffee grinder, grind Queensland nuts, smoked almonds, iodised salt, black peppercorns, smoked paprika, dried mixed herbs, bird’s eye chillies, and chilli flakes.
2. Rub this into the skin of eight chicken wings.
3. Roast for 1 hour at 150 °C.

Metformin improves blood sugar and vascular health in type one children

 From Diabetes in Control: Metformin Improves Vascular Health in Children With Type 1 Diabetes
Nov 18, 2017
In individuals with type 1 diabetes (T1DM), cardiovascular disease (CVD) is a major issue and the primary cause of death.

Vascular changes can be detected years before progression to CVD. Targeting blood sugar regulation early in patients at high risk of developing T1DM and in those already diagnosed with T1DM, could potentially help reduce vascular dysfunction risk and even reverse changes already made in vascular function.

Past studies have shown that in adults with T1DM, metformin reduces HbA1c, BMI, and required insulin doses. It has also been suggested that metformin leads to reduced cardiovascular events and better blood sugar regulation in patients with type 2 diabetes. Studies conducted on children with T1DM suggest the same benefits. However, there is currently no research on how metformin affects vascular function in children with T1DM.
A double blind, randomized, placebo-controlled trial was conducted to evaluate the association between metformin and vascular health in children with T1DM over a 12-month period. The study included a total of 90 children from a Women’s and Children’s Hospital in South Australia.  Children were randomly divided into two groups to receive either the metformin intervention or the placebo intervention. Children who weighed 60kg or greater received 1gm of metformin twice daily and those who weighed less than 60kg received 500mg twice daily. Doses were then increased to the complete dose over a period of 2 to 6 weeks.
Follow-up was conducted at 3, 6, and 12 months from the start of the study. Vascular function was obtained at baseline and at every follow-up visit using the brachial artery ultrasound, HbA1C, insulin dose, and BMI were among some of the other outcomes measured.
Results show that vascular function defined by GTN improved over the 12-month period by 3.3% in the metformin intervention group regardless of HbA1c when compared to the placebo group (95% CI 0.3 to 6.3; P=0.03). GTN was found to be the highest in the metformin group at 3 months when compared to placebo. Children in the metformin group also experienced significant improvement (P=0.001) in HbA1c levels at 3 months (8.4%; 95% CI 8.0 to 8.8) (68mmol/mol; 95% CI 64 to 73) when compared to the placebo group (9.3%; 95% CI 9.0 to 9.7). At 12 months, the overall difference between HbA1c improvement between the two groups was lower but remained a significant 1.0% (95% CI 0.4 to 1.5) 10.9mmol/mol (95% CI 4.4 to 16.4), P=0.001. In addition, it was found that children in the metformin group had a decreased insulin dose requirement of 0.2 units/kg/day throughout the 12-month period compared to those in the placebo group (95% CI 0.1 to 0.3, P=0.001).
The following study determined that children with T1DM with above average BMIs and taking metformin saw a significant improvement in vascular smooth muscle function compared to those not taking metformin. The study suggested that in addition to vascular health, metformin also improved HbA1c levels and reduced total daily insulin dose. It was found that improvements in both vascular function and HbA1c were the highest at 3 months. This is most likely due to medication adherence being the highest around 3 months.
Practice Pearls:
In children with above average weight and who were diagnosed with type 1 diabetes, metformin provides a significant improvement in vascular smooth muscle function.
Metformin provides a significant improvement in HbA1c levels in children with type 1 diabetes.
In addition to vascular health and HbA1c benefits, metformin further aids in reducing daily insulin dose in children with type 1 diabetes.
Reference:
Anderson JJA, Couper JJ, Giles LC, et al. Effect of Metformin on vascular function in children with type 1 diabetes: A 12 month randomized controlled trial. 2017. J Clin Endocrinol Metab. 2017; 0: 1-16.