Gestational diabetics seven times more likely to get type two diabetes

From RCGP Brian McMillan et al

Reducing risk of type 2 diabetes after gestational diabetes: a qualitative study to explore the potential of technology in primary care.

April 2018

Although women who have experienced gestational diabetes have are seven times more likely to develop type two diabetes than other pregnant women, there is as yet no formal testing arrangement in primary care.

These women may benefit from annual Hbaic and ongoing dietary and advice on weight management.

If these women have a HbA1c of more than 42 they can become eligible for the National Diabetes Prevention Programme. Otherwise not.

Women in this situation were interviewed and told researchers that they would welcome advice regarding diet and the help of other women in the same situation. They said they would value technology to give them the information to enable personalised self management.

Diabetes awareness mama: managing mood changes in your type 1 child

This article is from the mother of a type one son who has recently started school. She discusses ways to help other parents of children in the same situation in her blog.

https://diabetesawarenessmama.com/2017/07/05/managing-mood-changes/

Managing mood changes
July 5, 2017
Hannah Foreman-Wenneker
Today I would like to open the doors on what goes on behind the scenes of a T1D child. What do they feel that we parents cannot see? What do they want to tell us but are too young to possess the vocabulary or verbalise their emotions? These, and many more questions, often race through my mind. Taking on the full time job of a pancreas isn’t just about calculating carbohydrates, night time blood tests or insulin pump therapy; it is equally as important to understand the side effects this disease has on your child’s brain and subsequently, personality.
It all starts with the physiology of diabetes. I will never be able to fully appreciate what our son physically and mentally feels when he experiences a hypo or hyper, I can only describe to you what I have been told. According to the experts: diabetics, when a child is having a hypo they feel weak, dizzy, confused and shaky. This fantastic 3 minute video of four woman describing how they physically feel and mentally react during a hypo is well worth your time.
It is quite common for a T1D to suffer from ‘hypo-unawareness‘, particularly in young children who are naturally less aware of their body and how it functions. Hypo-unawareness is physically dangerous, but it is also a mental battle for the patient and for those who care for them. When our son Noah, is feeling these symptoms his insulin pump will give me a warning alarm (caveat: there is a 20 minute, give or take, communication delay between his body and the pump) and I can treat the hypo for its physical effects.

There is no medical treatment for the mental effects of a hypo. In our experience, Noah morphs from an adorable kitten to a roaring lion in a nano-second. He goes from “Mummy I love you to the universe and back” to a vein-popping, red faced animal screaming inaudible words that make no sense anyway. Unlike typical child-like tantrums (which he naturally has too, yey! these appear as is if from nowhere.

Sometimes his behaviour is quicker to burst forth than the pump’s warning alarm and we can tell he is having a hypo simply from his monumental meltdown over inconsequential nothingness. Even though I know his diabetes is just ‘having a conversation with me’, I confess, I sometimes feel embarrassed when we are out in public. There are occasions when I have been in the supermarket or walking down the street and Noah’s diabetes wants to have another ‘chat’ with me. Millions of parents know the look you get from strangers on the street; you know the one, it appears that you cannot control your own child. I get those same looks but sometimes I just want to scream ‘you have no idea what he battles with inside!‘

Noah can also become confused during a hypo and he finds it difficult to concentrate. Whilst these are less fiery side-effects they cause me more long-term concern than the tantrum-style behaviour. I know the meltdowns will become easier as he gets older but he has already started school and now I find myself wondering how hypos will affect him in the future. How will Noah cope with T1D together with his education? Will it impact his academic ability? How can we help him now to learn to overcome these issues down the line?
According to this scholarly article we are already using the best possible therapy to support Noah’s mood and behaviour. ‘Continuous subcutaneous insulin infusion’ or insulin pump therapy has been very effective in reducing the frequency of hypos in T1Ds and the results show improved mood and behaviour changes in young children. So is that all that we have at hand to help? My answer to this is: I don’t think so.

Whilst it is notoriously difficult to measure neurological impact of T1D and, from what I can gather, is something that experts vary in opinion on, frequently the following cognitive elements are reported to be affected by T1D: intelligence (general ability), attention, processing speed, memory, and executive skills. I am not a scientist and I haven’t done any research into this, I am also only two years in as a T1D carer but my firm belief today is that all of these cognitive domains can also be greatly influenced by the parents, teachers, siblings, social circles, mentors and extended family etc. who surround the child.
And what about hypers? Someone once described to me that a hyper is like having a massive hangover, but without the nausea part. The patient is very thirsty, has severe headaches and lethargy. It isn’t rocket science to realise that these are not attributable feelings to a productive day at school or work.

For the last year, Noah experiences an (as yet) unresolved hyper every morning after his breakfast. His glucose levels soar, sometimes triple the amount of a non-T1D and try hard as we might, we haven’t yet fixed this ‘bug’ in his daily routine. Nevertheless, off he marches every morning to school, feeling like he drank himself under the table the night before. For now, I simply admire his strength but I worry about when he becomes a teenager, how will he find the will to keep concentrating on math, or history or grammar when he mentally becomes aware that he has a choice?
And speaking of teenagers, puberty is a notoriously challenging period for many diabetics, but I will leave this topic for another day, another year even. The underlying point here is that T1D presents enormous challenges both physically and mentally. Both require a bachelor degree level of understanding to deliver optimal short and long term care. Both take place behind the scenes and in front of a crowd but T1D is so massively misunderstood by many (including me before my son’s diagnosis) that raising awareness and understanding is a monumental challenge, but one that many can be proud to be passionate about.
#weneedacure

 

Polycystic ovary syndrome is linked to autism in offspring

Cambridge University Autism Research Centre has found that compared to women who do not have polycystic ovary syndrome, women who do have this have about double the risk of having a child with autism.  The risk was slightly higher in male children compared to female children.

Cherskov A et al. Polycystic ovary syndrome and autism: At test of the prenatal sex steroid theory. Transl Psychiatry. Aug 1 2018. doi:10.1038/s41398-018-01867.

The UK and US are the only western countries where life expectancy is falling

Researchers looked at 17 high income countries to evaluate trends in national mortality.

In the UK there has been a drop of a few months in life expectancy for both men and women over the age of 65. Degenerative diseases were the main cause such as respiratory disease, circulatory disease, Alzheimer’s disease, nervous system disease and mental disorders.

In the USA drug overdoses were responsible for the decline in life expectancy.

The study looked at mortality between 2014 and 2015. A sixty five year old in the UK at that time would have been born in 1950, after the start of the NHS.

We will need to wait to see if this trend will reverse or not.

British Medical Journal. UK life expectancy drops while other western countries improve. National Health Services. 2018 August 16.

Younger age at diagnosis predicts earlier death in type one diabetes (on standard treatment)

Researchers in Sweden have found that the earlier children are diagnosed with type one diabetes, the less their life expectancy is. Matters are worse for women than men. They think that adults diagnosed in childhood need increased input to deal with cardiovascular risk factors as they get older. Currently age of onset is ignored when it comes to stratifying risk.

Those diagnosed under the age of 10 had 4 times the hazard ratio for all cause mortality, over 7 times the risk of cardiovascular disease, 4 times the risk for non cardiovascular mortality,  over 11 times the risk of cardiovascular disease, 31 times the risk of having a myocardial infarction, over 6 times the risk for stroke, 13 times the risk of heart failure, but almost the same risk as controls for atrial fibrillation.

There is a better outlook for those diagnosed in their late twenties. The risk was almost 3 times the background rate for total mortality and the most prominent risk was again for cardiovascular mortality coming in at 6 times the background rate.

What this means is that if you are a girl diagnosed with type one under the age of ten, you may expect to live almost 18 years fewer than your classmates and if you are a boy, 14 years fewer.

My comment: More effort could also be given to youngsters on diagnosis achieving normal blood sugars by advising parents about the easiest ways to control blood sugars such as the adoption of a low carb diet and advanced insulin techniques. Although these statistics are shocking to see, it doesn’t have to be like this at all. Many diabetics have changed their life expectancy around and reverse some complications by adopting practices that improve glycaemic control and metabolic factors such as we describe on this site.

Rawshani A et al. Excess mortality and cardiovascular disease in young adults with type 1 diabetes in relation to age at onset: a nationwide, register-based cohort study. Lancet 2018;392:477-86;doi:10.1016/S0140-6736(18)31506-X

 

Public Health Collaboration Conference 2018: Achieving your optimal blood sugar target

Videos of the lectures given at the Public Health Collaboration conference 2018 which was held in May over the royal wedding weekend have now been released on You Tube.

You can see my talk, Achieving your optimal blood sugar target, as well as others, on the link below. There are a wide variety of lifestyle topics discussed. Happy viewing.

 

https://www.youtube.com/results?search_query=public+health+collaboration+conference+2018

Polycystic ovary syndrome has health consequences for the whole family

Parents and siblings of women with polycystic ovarian syndrome are more likely than non relatives to develop insulin resistance. The older relatives are, the more likely they are to develop type two diabetes.

Polycystic ovaries affects 4-19% of women of reproductive age. Type 2 diabetes is significantly higher among both the mothers and fathers of women with polycystic ovaries. Both are over twice as likely to be diabetic compared to matched controls.  Type two diabetes is more prevalent in the sisters and brothers of those with polycystic ovaries but was not statistically significant. Fasting insulin levels and insulin resistance were significantly higher in the mothers, fathers and sisters of women with polycystic ovaries.

My comment: Doctors tend to regard polycystic ovaries as a gynaecological condition, but this research indicates that it is a disease of insulin resistance and increased likelihood of type two diabetes in the whole family and does not just affect women, but men in the family as well. 

Yilmaz B et al. Diabetes mellitus and insulin resistance in mothers, fathers, sisters and brothers of women with polycystic ovary syndrome: a systematic review and meta-analysis. Fertil. Steril.2018 June 27 doi:10.1016/j.fertnsert.2018.04.024.PMID:29960703