Diabetes Management Guidelines

Source: American Diabetes Association. Standards of medical care in diabetes—2016.
Diabetes Care. 2016;39(suppl 1):S1-S106. Available here.
Refer to source document for full recommendations, including class of recommendation and level of evidence.
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Cardiovascular Disease (CVD) & Diabetes
Blood Pressure (Hypertension) Management & Treatment Targets
Screening
Measure BP at every patient visit
Confirm elevated BP at a separate visit
Treatment targets
Systolic (SBP) targets
<140 mm Hg
Lower target (<130) may be appropriate in certain individuals*
Diastolic (DBP) targets
<90 mm Hg
Lower target (<80) may be appropriate in certain individuals*
*Younger individuals, people with albuminuria, and/or individuals with hypertension and one or more additional ASCVD risk factor
Only if the lower target can be achieved without undue treatment burden
Treatment of High Blood Pressure
Individuals with BP >120/80 mm Hg
Lifestyle changes (See below)
Individuals with confirmed office BP >140/90 mm Hg
Prompt initiation and timely subsequent titration of pharmacologic therapy (see below) in addition to lifestyle changes
Older adults
Treating to <130/70 mm Hg is not recommended
SBP <130 has not been shown to improve CV outcomes
DBP <70 has been associated with increased mortality
Pregnant individuals
Targets of 110-129/65-79 are recommended to optimize long-term maternal health and minimize impaired fetal growth
Pharmacologic Therapy for High Blood Pressure
Regimen to include ACEI or ARB—but never in combination
If either ACEI or ARB Continue reading

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Do Endurance Sports Cause Diabetes?

Earlier this month, an article was published suggesting that endurance athletes may be more susceptible to diabetes. Since diabetes is usually associated with a sedentary lifestyle, in addition to a poor diet, this goes directly against what most people would expect. We were curious about the conclusions of the article so we decided to jump into our own database to see if InsideTracker’s endurance athletes suffer from the same fate.
So, the question was clear: do runners, cyclists, and triathletes have higher fasting blood glucose levels?
The article looked at a study of 10 endurance athletes that exercised for at least six hours per week. They were connected to a continuous glucose monitor for 6 days, which captured blood glucose levels the entire time, including in the fasted state. After analyzing the data, three out of the 10 athletes had fasting blood glucose levels in the prediabetic range (100-125 mg/dL). Prediabetes, as defined by the American Diabetes Association, is a precursor to diabetes and roughly 25% of prediabetics will develop diabetes after five years. The average fasting blood glucose in the study was about 96 mg/dL (5.34 mmol/L). While this is less than the cutoff for prediabetes of 100 mg/dL, it is still higher than expected.
Looking in our own database, we found an overwhelmingly clear trend between endurance exercise and fasting blood glucose levels. Endurance activity is associated with LOWER blood glucose levels. Here are a few comparisons:
for the non-science crowd, if the p value is less than .05, the value is statistically significant). Therefo Continue reading

7 Steps To Help Reverse Type-2 Diabetes So You Never Have To Take Insulin Or Medication Again

This article was republished with permission fromdrhyman.com.
What disease affects EVERY other American and one in four kids? Type 2 diabetes or pre-diabetes. Type 2 diabetes in America has tripled since the 1980s, and researchers estimate one in three Americans will have diabetes by mid-century. More than one-third of American adults are obese. [1]
And one in three Medicare dollars is spent on diabetes making it the biggest driver of our federal debt. Sadly, these numbers continue to increase. Overall, it’s not a pretty picture, and experts predict things will only become worse.
I use the term “diabesity” to describe the continuum of health problems ranging from mild insulin resistance and overweight to obesity and diabetes. Diabesity is the underlying cause of most heart disease, cancer, and premature death in the world.
Tragically, these conditions are also 100% preventable and reversible.
Most people believe diabetes is not reversible. That’s unfortunate considering its numerous complications including kidney failure, amputation, stroke, and dementia. I’ve also heard experts claim obesity is difficult to treat and maintaining long-term weight loss is almost impossible.
I wholeheartedly disagree. Science shows diabetes and obesity are preventable and reversible with aggressive utilize nutrition and lifestyle modifications.
It is caused by the 152 pounds of sugar and 146 pounds of flour a year eaten on average by every American – that is a toxic drug dose of diabetes causing food.
It is well known that massively obese patients can reverse their diabetes within Continue reading

Fasting diet could regenerate pancreas and reverse diabetes, researchers say

A fasting diet has the ability to regenerate the pancreas and could potentially reverse diabetes, researchers have found.
A US study, published in scientific journal Cell, tested a modified version of the fasting-mimicking diet (FMD) on both mice and human cells.
The findings showed cycles of the diet could regenerate pancreatic cells to restore insulin in type 1 diabetes patients and could also reverse both type 1 and 2 diabetes in mice.
The study's co-author, Dr Valter Longo from the University of Southern California, told the ABC the findings were "potentially very exciting" because they could lead to cures for both type 1 and type 2 diabetes.
Type 1 diabetes, unlike type 2, is an autoimmune condition for which there is no known cause or cure. In patients with type 1 diabetes, the pancreas stops producing insulin.
Dr Longo also said a FMD could also regenerate other organs because their research had shown similar effects for blood cells.
"They show that extreme diets with very specific compositions can trigger self repair and regeneration processes in the mouse and possibly humans," Dr Longo said.
Taking into account the challenges and side-effects of fasting in humans, Dr Longo and his team developed a modified low-calorie, low-protein and low-carbohydrate but high-fat four-day FMD.
The diet caused changes in the levels of specific growth factors, glucose, and ketone bodies and reduced the blood glucose on pre-diabetic patients.
Mice receiving the FMD showed improved glucose tolerance and insulin tolerance.
The pancreas helps to control blood sugar levels and restoring Continue reading

Reversing Type 2 Diabetes

Diagnosis of type 2 diabetes is on the rise along with its dire health prognosis and earlier death. The good news is it can be prevented and reversed. Diabetes has been cited as the most challenging health problem in the 21st century. Over 29 million people in the United States have diabetes.1 According to the U.S. Centers for Disease Control and Prevention (CDC), the prevalence of type 2 diabetes has more than tripled in the past 30 years, and if current trends continue unabated, one-fifth to one-third of all Americans will have diabetes by the year 2050.2,3
Excess weight promotes insulin resistance and is the chief risk factor for type 2 diabetes. Currently 68 percent of adults are overweight or obese.4,5 The number of people with this disease has been increasing steadily, largely due to the increasing numbers of overweight people in both the young and the old.
Diabetes severely damages one’s health and shortens life expectancy
More than 80 percent of adults with Type 2 diabetes die of heart attacks and stroke, and these deaths occur at a younger age compared to people without diabetes. Diabetes also ages the body more rapidly, causing harm to the kidney, nervous system and other body systems. Diabetes is the leading cause of kidney failure and blindness in older adults. Over seventy thousand amputations each year are performed due to complications of diabetes. Diabetes also increases cancer risk, especially colorectal cancer.1,6-8
Type 2 diabetes is a preventable, reversible lifestyle disease
The heavier you are, the greater the risk you will develop type 2 diabetes. W Continue reading