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Environmental Determinants Of Type 2 Diabetes

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Potential For The Prevention Of Type 2 Diabetes

Potential for the prevention of type 2 diabetes British Medical Bulletin, Volume 60, Issue 1, 1 November 2001, Pages 183199, Johan Eriksson, Jaana Lindstrm, Jaakko Tuomilehto; Potential for the prevention of type 2 diabetes, British Medical Bulletin, Volume 60, Issue 1, 1 November 2001, Pages 183199, Need for prevention and prevention strategies Type 2 diabetes is one of the most rapidly increasing chronic diseases in the world. The need for its primary prevention has been increasingly emphasised, although only during the past 1015 years 1 6 . The main justifications of prevention of type 2 diabetes are the possible prevention or postponement of complications related to type 2 diabetes in order to reduce both human suffering and the socio-economic burden on the community. It has been repeatedly shown that both symptomatic and asymptomatic diabetic patients have an increased prevalence of both macrovascular and microvascular complications by the time the disease is first diagnosed 7 9 . A Swedish study showed that 77% of all costs for the care of type 2 diabetes were due to its complications, mostly cardiovascular 10 . Also, in people with impaired glucose tolerance (IGT), both mor Continue reading >>

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Popular Questions

  1. DaveManCan

    Ok my profile says type 1 but I am type 2. Every time I try and change it in my profile I get an error.
    I just started Metformin. Wow... I can not believe how sick I get. I am not talking stomach, diahrea, nausea, etc. I am talking death's door sick. I feel horrible inside like something is seriously wrong. Like the chemistry in my body just got dramatically altered.
    Anyone else have a similar experience?
    Thank you,
    Dave

  2. hlzpiano

    Metformin is known to cause gastric distress. I am of the firm belief that you shouldn't have to take any medication that makes you that sick especially when there are effective alternatives. I would personally stop taking the Metformin. Ask your doctor to prescribe a small dose of a sulfonylurea drug such as glyburide, glipizide, or glimepiride. These are cheap and effective drugs for lowering your blood sugar. Another alternative might be to watch your carb intake and test, test, test. Testing is important to see if these alternative measures get you the blood sugar control that you need.

  3. t1wayne

    As Helene noted, there are many T2 oral meds that can help with BG control; but they ALL have some side effect(s). Your first step should be to talk to the doc about how severe your GI issues are with the met. Here's a quick rundown on the alternative meds Helene alluded to, by class:
    Biguanides - this is the met, and some other brands. They've been around the longest, are considered the safest, and the primary side effect is GI distress. They don't start working right away - it takes a few weeks. They work by inhibiting stored glucose release by the liver, and help with insulin sensitivity a bit.
    Sulfonylureas (id'd by Helene) - these are the next most common oral T2 med; they stimulate the pancreatic beta cells to produce more insulin for longer periods of time, and they begin working immediately. Side effects include hypoglycemia, weight gain, nausea and skin rash. Because they push the pancreatic beta cells to produce more insulin, they hasten the progression to pancreatic beta cell decline.
    Meglitinides (Prandin, Starlix) - these also stimulate the release of more insulin for longer periods of time, and begin working quickly. Side effects include hypoglycemia, weight gain, nausea, back pain and headache. And they can hasten pancreatic beta cell impairment.
    Dipeptidy Peptidase - 4 (DPP-4) inhibitors (Onglyza, Januvia, Tradjenta) - These also stimulate the release of more insuln for longer, like the sulfonylureas and meglitinides, but they also inhibit the release of stored glucose from the liver, like biguanides. Side effects include upper respiratory tract infection, sore throat, headache, and inflammation of the pancreas.
    Thiazolidinediones (avandia, actos) - sort of the reversal of biguanides, these improve sensitivity to insulin and inhibit the release of stored glucose from the liver (the functional emphasis is reversed). Side effects include heart problems, stroke and liver disease.
    Alpha-glucosidase inhibitors (precose, glyset) - these work by slowing the digestion of some starches and sugars (giving your pancreas time to react to meals, and slowing the pace at which your BG spikes). Side effects are reminiscent of biguanides - stomach pain, gas and diarrhea.
    ALL of these oral meds are based on the presumption that you are controlling your carb intake and getting regular exercise; so Helene's reference to that deserves some more stress. With respect to testing... the point is to test with purpose. Keep a log of everything you eat (including grams of carbs) as well as your meter readings immediately before, plus one and two hours after meals. this will give you an idea of how quickly/slowly your system is responding to the meals you are eating, and from that, you can modify your meals to get better control of your BG.
    Good luck!
    w.

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Social Determinants Of Type 2 Diabetes And Health In The United States

Diabetes Mellitus affects approximately 25.6 million individuals or 11.3% of those over age 20. It is the sixth leading cause of death in the United States[1]. Diabetes places the individual at risk for serious long term complications including blindness, cardiovascular disease, end stage renal disease, hypertension, stroke, neuropathy, lower limb amputations, and premature death[1]. Estimated annual healthcare cost in 2012 for diabetes and its resulting complications was $245 billion[2]. Given the considerable differences internationally in methods of allocating health care resources, systems of funding and/or paying for care, and cultural attitudes to health and health care, the purpose of this review of the literature is to examine current understanding of the social determinants affecting diabetes and health in the United States, and to make recommendations for future research. Historically, research and resulting clinical approaches focusing on the individual have led to improvement in self-management outcomes and reduction of cardiovascular risk factors; however, these short-term improvements have not been maintained over time. Researchers more recently have recognized the n Continue reading >>

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  1. gypsytech

    I had insulin treated gestational diabetes in the 90's with 2 pregnancies. Since then I have been diagnosed as having reactive hypoglycemia. Somehow I have found myself pregnant again in my mid 40's, after the sheer shock I am now extremely excited however due to my past pregnancies and the reactive hypoglycemia I had to have the 3 hour glucose tolerance test done at 9 weeks pregnant. My results fasting 89 1 hour: 188 (fail) 2 hour: 148 and 3 hour: 49 (failed/crashed) I am off to a diabetes clinic this coming Thurs but am of course curious and full of questions.
    To my knowledge to be diagnosed with gestational diabetes you must fail 2 parts of the test with high numbers? I can't find anything about failing with one high number and one low number.
    As of today, I still feel off, lack of concentration, extremely tired even though I've been "grazing" high protein food since the test last wednesday. Should I be concerned?
    Everything I have read concerning gestational diabetes states it happens in the later part of the second trimester. Does this possibly mean that my results are not due to pregnancy and I might be pre diabetic?

    I understand that I will only have a true diagnosis after my appointment with the diabetic center but if anyone has any info on any of my questions that might lead me towards more knowledge on the subject I would be extremely greatful

  2. susanm9006

    First of all, congrats on your pregnancy, what an unexpected blessing. As far as diabetes, since you have had reactive hypoglycemia for some time I suspect that you have been pre-diabetic, or early diabetic for a while. In diabetes progression, carb intolerance leading to high post meal numbers is the first place where the disease shows up. You go high after a meal, then second stage insulin production kicks in and you go low, but your fasting level remains low and A1C remains within range because your lows are helping reduce your overall average. Eventually your pancreas starts slowing down and it takes longer post meal to go back to fasting levels and your overall average goes up.

    Reducing your carb intake, testing yourself about an hour after eating so you know how what you are eating affects your blood glucose and increasing your exercise routine will help keep your numbers more even.

  3. t1wayne

    Hi @gypsytech -
    As @Susanm9006 alluded... T2 is a progressive disease. You have it because you have the genetic markers for it, otherwise you wouldn't get it. And "Gestational" Diabetes (GD) is nothing more (or less) than T2 diabetes. T2's biochemical cause is insensitivity to insulin at the cellular level... meaning that your body's cells, which use insulin to transfer glucose from your blood into themselves for fuel, don't react to it properly. This results in the over-production of insulin to compensate for the insensitivity to it, which then leads to weight gain and hunger (it's more complex than that, but that's the gist of it). Eventually, the pancreas can't keep up with the extra insulin need, and BG levels rise above "normal".
    During pregnancy, women who are suffering from insulin insensitivity, but not yet diagnosed as D (Diabetic) because they haven't reached elevated BG levels, are pushed "over the line" diagnostically because of the extra stress on their hormonal systems from the pregnancy (insulin is a hormone, controlled by the same system that controls reproductive functions). But most such women return to "normal" after the child is delivered. BUT... the docs should have told you that you were at much higher risk for T2 than women that don't develop gestational diabetes; the historically cited rate of T2 in women that had GD is 60%.. though there are studies suggesting both higher and lower rates. Also... studies of women that had GD show much higher rates (in the 80+% range) for elevated BG and glucose intolerance after pregnancy, but before diagnosis as T2.
    As for the diagnostic criteria for GD... the simple fact of the matter is that you are suffering from the condition(s) known as "glucose intolerance", "insulin insensitvity", and "reactive hypoglycemia"... all of which "precede" the diagnosis of T2. The diagnostic criteria are set to under-diagnose both T2 and GD. Non-D BG ranges from 90 to 120 mg/dl. So with #'s like 89 fasting (too low, though so slight as to be immaterial), 188 (68 too high - way too high), 148 (28 too high-significant) and 49 (significantly too low by 41), you are clearly suffering from non-control of your BG. The pregnancy will only make this worsen, since you've been suffering from it before becoming pregnant. That said... you can get it - and keep it - controlled. I'm not trying to be harsh, if it sounds that way.. just trying to stress the importance of taking charge of your BG manually, since your body is no longer doing it automatically for you.
    The short answer to your end question is... yes, you're "pre-diabetic"... which is exactly the same as being "a little bit pregnant" (sorry, I couldn't resist... ). BUT.. you also have GD - because GD is nothing but "pre-diabetic" that "goes away" after the pregnancy - for a little while. Docs need to be more emphatic about this with pregnant women dx'd with GD. Remember the 60% cite for women that had GD and go on to T2? That's so low because 10% of them die before they get dx'd.... The best approach for you to take is to begin living like a T2 - limit carb intake (carbs increase BG), get regular activity in (exercise improves insulin sensitivity), and during this pregnancy, you're likely to be using insulin again. Talk all this over with the doc.
    Good luck, congratulations on your latest family addition, and stay focused - you CAN do this!!

    w.

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Genetic And Environmental Determinants Of Type 2 Diabetes In Chinese Singaporeans Pereira, Mark A. University Of Minnesota Twin Cities, Minneapolis, Mn, United States

Genetic and Environmental Determinants of Type 2 Diabetes in Chinese Singaporeans Southeast Asian populations have high rates of type 2 diabetes (T2D) despite low rates of obesity. This """"""""Southeast Asian Paradox"""""""" has caused an extremely high public health and economic burden. While Southeast Asian-specific lower thresholds for defining obesity, set by the World Health Organization, underscore the particular susceptibility of these ethnic groups to T2D, the underlying biological and environmental causes for the excess diabetes in these populations are unknown. To date, genome-wide association studies of T2D have been completed in European populations, with none in other ethnic groups. These recent genetic findings only add to a """"""""Southeast Asian Paradox"""""""" of T2D because several of the risk alleles found in Europeans have relatively low frequencies in the Asians. Our main aim is the identification of genetic susceptibility factors for T2D in Chinese living in Singapore, where there is a high prevalence of T2D. The study samples are derived from the ongoing Singapore Chinese Health Study, a population-based prospective cohort of 63,257 adult men and women ass Continue reading >>

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Popular Questions

  1. KarinB

    What is the best sort of cream for a Diabetic (T1) to use on their feet to keep them soft and moisturised? I have searched the internet and there is a lot of controversy over what to use.
    Also, whilst on the subject of feet, does anyone use a JML Shower Feet? As we only have a shower so our feet don't have the chance to soak in a bath I thought this may be a good idea, not only for my diabetic son, but also for all of us to use (or shouldn't we share?).

  2. izzzi

    I think those JML Shower Feet gadgets are the worst things to use in a shower.
    They could trap more bad things all over your feet. ( yak )
    Aqueous Cream BP is very good and not expensive.
    Roy.

  3. witan

    It's true that showers are one of the worst things for your feet - there is a great tendency to overlook them.
    Most important is to physically wash them, if you can't balance on one leg sit down in the shower and do it. Then there is the drying, too many people just let them air-dry, then some bits, especially between the toes won't dry before you put your socks or shoes on, if you are in a hard-water area there will be a build up of calcium salts which may cause other problems too. A water softener will probably help.
    So dry thoroughly and use a cream, any simple cream will do, but not too greasy or oily or your foot may start sliding around in your shoes and that can feel quite uncomfortable. Fancy expensive creams aren't necessary unless you are treating another problem, they simply doubly ensure they are dry and add a fine protective layer.
    like every thing in life you only get out what you put in, so if you want to care for your feet well you'll need to soak them a couple of times a week, a large washing up bowl is all you'll need. what to add to the water - I've used anything from TCP (diluted as instructions) when treating fungal nail infections and cracked skin to Epsom Salts which I'm trying now and are a great low cost way of softening your skin and may have BP reducing advantages too.

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