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World Diabetes Day

World Diabetes Day

World Diabetes Day

Tuesday November 14th is World Diabetes Day. The International Diabetes Federation (IDF) defines diabetes as follows:
“Diabetes is a chronic disease that occurs when the pancreas is no longer able to make insulin, or when the body cannot make good use of the insulin it produces. Insulin is a hormone made by the pancreas, that acts like a key to let glucose from the food we eat pass from the blood stream into the cells in the body to produce energy. All carbohydrate foods are broken down into glucose in the blood. Insulin helps glucose get into the cells.
Not being able to produce insulin or use it effectively leads to raised glucose levels in the blood (known as hyperglycaemia). Over the long-term high glucose levels are associated with damage to the body and failure of various organs and tissues.”
Note the mention of the word “glucose” five times and the acknowledgment that all carbohydrate foods are broken down into glucose.
The different types
The IDF definition describes the two types of diabetes – type 1 diabetes is the type where the body is no longer able to make insulin and type 2 diabetes is the type where the body cannot make good use of the insulin it produces.
We used to call type 1 diabetes (T1D) “juvenile diabetes”, as it only used to occur in young people. The typical age of onset was during teenage years – some children developed type 1 younger and a few in their early 20s, but it was largely a teenage condition. If you hadn’t developed T1D by the time of your 21st birthday, you were highly unlikely to do so.
Type 2 diabetes (T2D) used to b Continue reading

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Why Sleep Is Important With Diabetes

Why Sleep Is Important With Diabetes

People with diabetes hear constantly to exercise, eat right, and check blood sugars. Doctors rarely mention the importance of sleep, but good sleep is among the best diabetes medicines.
A paper from Penn State University found that the risk of death from stroke and heart disease was significantly higher in people who get less than six hours of sleep a night. Researcher Julio Fernandez-Mendoza, PhD, said, short sleep “multiplies the risk of poor outcomes in people with CVD [cardiovascular disease] or stroke.” Heart disease and stroke are the leading causes of diabetes-related deaths.
“We have to look beyond sleep apnea,” said Dr. Fernandez-Mendoza. “Most of these patients without sleep apnea but with coronary vascular disease or stroke complain of poor sleep or chronic insomnia. We know now that when such objective short sleep is present their long-term prognosis is much worse.”
Obstructive sleep apnea (OSA) has been known for years to increase risk of Type 2 diabetes, heart disease, and early death. In sleep apnea, people stop breathing repeatedly while asleep, because their airways are blocked by relaxing throat muscles. They wake up to clear their throat so they can breathe and then fall back asleep, over and over, usually without being aware of it. Penn State researchers found that people with OSA had three times the risk of Type 2 diabetes and four times the risk of high blood pressure (hypertension.)
According to the American Sleep Association, “animal studies show that sleep is necessary for survival.” The immune system, our bodies’ repair system, is Continue reading

Type 1 diabetes cured in mice using gene therapy

Type 1 diabetes cured in mice using gene therapy

Researchers from the University of Texas Health Science Center in San Antonio have found a way to cure type 1 diabetes in mice. It is hoped that the novel technique - which boosts insulin secretion in the pancreas - will reach human clinical trials in the next 3 years.
Study co-author Dr. Bruno Doiron, Ph.D., of the Division of Diabetes, and colleagues recently reported their findings in the journal Current Pharmaceutical Biotechnology.
Type 1 diabetes is estimated to affect around 1.25 million children and adults in the United States. Onset of the condition is most common in childhood, but it can arise at any age.
In type 1 diabetes, the immune system destroys the insulin-producing beta cells of the pancreas. Insulin is the hormone that regulates blood glucose levels. As a result, blood glucose levels become too high.
There is currently no cure for type 1 diabetes; the condition is managed through diet and insulin therapy. However, in recent years, researchers have investigated replacing beta cells as a means of eradicating type 1 diabetes once and for all.
Dr. Doiron and colleagues have taken a different approach with their new study. The team reveals how they used a method called gene transfer to coax other pancreatic cells into producing insulin.
Using this technique, the researchers have managed to cure type 1 diabetes in mice, bringing us one step closer to curing the condition in humans.
Gene transfer method led to long-term insulin secretion in mice
The gene transfer technique - called Cellular Networking, Integration and Processing - involves introducing specific g Continue reading

Invokana: Diabetes Drug Gets Black Box Warning for Amputation Risks

Invokana: Diabetes Drug Gets Black Box Warning for Amputation Risks

Invokana (canagliflozin), an SGLT-2 drug for use in type 2 diabetes and off-label in those with type 1 diabetes has been required by the FDA to carry the prominent boxed warning due to a higher risk for leg and foot amputations.
This new requirement is a result of two clinical trials whose data revealed these elevated risks. Canagliflozin is the drug present in the marketed products: Invokana, Invokamet, and Invokamet XR.
The clinical trials called CANVAS (Canagliflozin Cardiovascular Assessment Study) and CANVAS-R (A Study of the Effects of Canagliflozin on Renal Endpoints in Adult Participants With Type 2 Diabetes Mellitus) revealed that leg and foot amputations happened about twice as often in those taking canagliflozin compared to those taking a placebo.
Over the span of a year the amputation risk for CANVAS trial patients was equal to 5.9 out of every 1,000 patients taking canagliflozin and 2.8 out of every 1,000 patients taking a placebo.
Over the span of a year the amputation risk for CANVAS-R trial patients was equal to 7.5 out of every 1,000 patients taking canagliflozin and 4.2 out of every 1,000 patients taking a placebo.
Most common was toe and middle the foot amputations but below and above the knee leg amputations were also observed. Some patients needed multiple amputations, “some involving both limbs.”
This warning is in addition to last year’s FDA strengthened warning to users of canagliflozin for an increased risk of acute kidney injury and in 2015 the strengthened “warning for canagliflozin related to the increased risk of bone fractures,”
Sympt Continue reading

Studies Show Diabetes Drug Invokana Increases Amputation Risk

Studies Show Diabetes Drug Invokana Increases Amputation Risk

People with diabetes who take a class of drugs known as sodium–glucose cotransporter 2 (SGLT2) inhibitors will now need to weigh benefits against risks after studies showed the medications significantly reduce heart problems in subjects, but, surprisingly, also increase the risk of amputation.
The results of the studies on the Johnson & Johnson drug canagliflozin, marketed under the name Invokana, confirm cardiovascular benefits not only for that particular medication, but also for others in its class. Those same results, however, call into question whether other drugs in the class also contribute to increased amputation.
“Drugs to treat diabetes have been undergoing a positive transformation in the last three or four years,” says Dr. Bruce Neal, lead investigator in the study and professor of medicine for University of New South Wales Sydney, and senior director, the George Institute for Global Health in Sydney, Australia. “It used to be we would test diabetes drugs to see if they lowered glucose levels and did not cause heart problems. Now, we test drugs and expect to see them not only lower glucose but improve cardiovascular health. It’s been extraordinary. But, now we might be finding out that there are glitches along the way.”
Neal led a team of six other academic researchers combining data from two studies, the first a clinical trial before the drug was approved by the Food and Drug Administration in 2013 and the second a post-marketing study designed to detect any cardiovascular risks from the drug. Such studies are a recent requirement of the FDA to ensu Continue reading

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