Category Archives: Diabetes

Pancreatic Cancer Spreads

Pancreatic cancer is one of several types of cancer that has been linked to the genes primarily associated—and named for—breast cancer. As with breast cancer, however, genetic susceptibility is only a small part of the picture. Because the pancreas is where insulin is produced, pancreatic cancer is associated with diabetes, and diabetic people are more likely to develop cancer, as are people with other diseases of the pancreas. That means obesity and other risk factors for diabetes are also risk factors for pancreatic cancer.

It is also one of the cancers to which smokers are particularly vulnerable, and the vulnerability lasts a long time, taking years or even decades after quitting to return to non-smoker risk levels. Cutting back on red meat is suggested for cutting risk, but the evidence for a connection is unclear.

As with many forms of cancer, pancreatic cancer ordinarily has no obvious symptoms in the early stages. However, pancreatic cancer can lead to the appearance of jaundice. Other symptoms include poor appetite and weight loss, odd stools, or pain in the upper abdomen, though these are not as specific. Moreover, while diabetes is a risk factor for pancreatic cancer, it can also be caused by it. That means the sudden onset of type 2 diabetes can be an indication that pancreatic cancer screening is in order, particularly in patients with no real risk factors for diabetes, those with a family history of pancreatic or breast cancer, or African-American patients.

Even with an early diagnosis, however, pancreatic cancer has a relatively low survival rate, around one in three, largely because it is such an aggressive form off cancer. Recently this month, researchers found that a gene called TRIM29, which is involved in a substantial majority of cases of pancreatic cancer, affects the way tumor cells grow. The pancreatic cancer variant of the gene also alters the structure of the tumor cells in such a way that they have an easier time moving around and spreading through the organs of the body.

Because it is so deadly even in the early stages, prevention is more important that screening for pancreatic cancer. The means quitting smoking, exercise, and a healthy diet that includes fruits and vegetables.

Metabolic Syndrome And Diabetes

"Metabolic syndrome" is a medical term referring to a confluence of symptoms that may not always cause distress themselves but that do indicate poor health and a dangerously high risk of other, serious problems later on. The syndrome occurs when someone is obese and has high blood pressure, high blood glucose, or a poor cholesterol profile. In particular, "central obesity," when fat is carried in the abdomen, is a diagnostic criterion. Elevated blood glucose itself indicates a diabetes precursor called insulin resistance. The relevant factors of the cholesterol profile ae triglycerides—high in metabolic syndrome—and HDL cholesterol, low in patients with the condition.

There is strong evidence of a genetic component to the risk of metabolic syndrome, meaning someone with a family history of the condition or of any of the diseases for which it is a risk factor should be careful, but there are a number of risk factors that can be controlled. Diet and exercise are factors; people who eat poorly—foods high in sugar or fat—and a sedentary lifestyle raise the risk of the condition the latter in women especially. People with certain medical conditions, such as polycystic ovarian syndrome or sleep apnea, are especially prone to metabolic syndrome as well.

Because of the insulin connection, people with metabolic syndrome are likely to get type 2 diabetes. Many people with metabolic syndrome have what is called insulin resistance, wherein the body produces insulin normally but the cells are unable to respond to it properly, leading to elevated blood glucose levels. This is a factor in the diagnosis of metabolic syndrome, but it is also a factor in the diagnosis of diabetes, the symptoms of which result from too much glucose in the blood. People with metabolic syndrome are also prone to getting heart disease.

The most common recommendation for people who have or are at risk of metabolic syndrome is to loose weight and exercise more—to address the causative factors of obesity and high blood pressure. It is particularly important for older people and people with a hereditary risk of the condition. A recent study found that eating a healthy breakfast can help avoid cravings for high fat foods later in the day, and help ward off metabolic syndrome.

Diabetes And Fitness

Good news for people who lead active lives: it’s one of the best and most effective ways to avoid type 2 diabetes. Unlike type 1, type 2 diabetes isn’t congenital; instead, it happens during a person’s life. Risk factors for type 2 diabetes include inactivity and eating too many sugary foods, and in people who get diabetes, these factors can also affect the severity. Exercise, in particular, is considered the most effective treatment for diabetes. Patients who are taking medication are urged to add exercise as well to boost its effectiveness. Studies show that people who exercise get three times the benefit from diabetes medication as more sedentary people.

Diet can also make a difference. A diet high in legumes, vegetables such as peas, beans, and lentils, for example, reduces levels of a protein known as glycated hemoglobin. High glycated hemoglobin levels are associated with type 2 diabetes—indeed, doctors regard an excess of glycated hemoglobin as a diagnostic indicator of diabetes. As with exercise, legumes provide a benefit to diabetics as well. Eating legumes has been found to reduce the risk of heart disease in people with diabetes—fiber provides similar benefits to a lesser degree.

In addition to diet and exercise, other things that prevent diabetes are melatonin and oddly, whole-body vibration. Brief, daily whole-body vibration of people with conditions typically regarded as precursors to type 2 diabetes may help keep glucose levels under control. Vibration was tested on laboratory animals , and found to work on juveniles, but was not as effective in full grown specimen. Nonetheless, researchers hold out hope that applications can be found that will be beneficial to human beings.

Melatonin is a sleep hormone produced by the brain, and melatonin supplements are often used as a sleep aid. A study has found that people with lower concentrations of melatonin in the blood are more prone to developing type 2 diabetes. The study found that people with insufficient melatonin have more than twice the diabetes risk. The mechanism is not entirely clear. However, melatonin can help prevent or reduce weight gain, and being overweight has been associated with risk of diabetes.

Blue Light Special

Type 2 diabetes develops during the course of a person’s lifetime. It is the type that used to be called "adult-onset diabetes," though that term was dropped as more and more children started developing the disease. It differs from type 1, however, in that type 1 diabetes is an autoimmune disease present from a very young age. Symptoms of type 2 diabetes include being thirsty unusually often and wounds that heal notably slowly, as well as increased appetite and fatigue.

A consequence of the differences between the types of diabetes is that type 2 diabetes is preventable. It generally strikes smokers and people who are overweight, sedentary, or both. In addition, chronically elevated blood sugar often progresses to diabetes. It is particularly important for people to take preventative measures if hey carry fat in the abdomen as opposed to other parts of the body, if they are over 45, or if they have a family history of type 2 diabetes. Prevention means losing weight, getting active, quitting smoking, and adding more fruits, vegetables, and whole grains to the diet.

Another possible preventative measure is to get sunshine. Recent research suggests that vitamin D, which is create in the human body in response to sunlight, does not have any effect on diabetes. However, sunlight does seem to be beneficial in other ways, researchers said. In addition ti making vitamin D, sunlight triggers the release of nitric oxide in the skin, which has a beneficial effect on diabetes. In fact, a topical cream that includes nitric oxide was found to have a similar effect.

In another study, a blue light was found to enhance the effectiveness and precision of certain diabetes medications. In fact, the medication is activated or deactivated by the light, making it easier to calibrate dosage. Although diabetes medication is necessary to prevent blood sugar levels from getting too high, there is a risk of the medication working too well, causing blood sugar to be dangerously low. New patients are particularly prone to this problem. With the light-activated medication, there would be more tolerance in dosing, since the drug could be activated only when and to the extent needed.

Magical Metformin?

The drug metformin is given to patients who have type 2 diabetes, but until recently, no one knew exactly how it worked. What they did know was that it doesn’t affect blood sugar directly, instead helping insulin in the body to work properly. That is, metformin does nothing to directly lower blood glucose. Rather, it interacts with insulin in a way that means the insulin gets used properly, and the insulin, restored to full function as long as the drug is effective, lowers glucose levels, as it is supposed to do. Now researchers have discovered the mechanism by which metformin performs this feat. The drug works in the liver, where it suppresses fatty tissue.

Nonalcoholic fatty liver disease—which occurs, as the name suggests, when fat deposits collect in the liver other than as a result of alcohol consumption—is generally caused by obesity, and has been implicated in the development of type 2 diabetes. The damaged liver is less efficient at using insulin to regulate blood sugar levels. Metformin attacks these fatty deposits, eroding them and letting the liver better do its job.

In the wake of this discovery, researchers are taking a closer look at what other tricks metformin might be able to perform. In one study, metformin had a beneficial effect on the weights of obese children who ate healthy diets and followed an exercise plan. While diet and exercise played a large role. the metformin helped enhance the effectiveness of these interventions. Metformin is given to children over age ten with type 2 diabetes, but is not officially used for non-diabetic children. The study confirmed what doctors prescribing metformin off-label had already recognized, that the drug helps children lose weight, though the study found the effect was small in the long term.

Another line of investigation did not pan out at all. A research team in the Netherlands gave metformin to heart attack survivors who were not diabetic. People who have the specific sort of myocardial infarction the test subjects had experienced often develop heart dysfunction. The researchers thought metformin might have properties that could prevent this dysfunction. Sadly, in the study, patients who were taking metformin fared no better than those who were not. However, metformin is still being studied to see what else it may be able to do.

Reversing Type 1 Diabetes

Type 1 diabetes is a disease in which the pancreas does not produce enough of the hormone insulin to meet the needs of the body. Unlike type 2 diabetes, which develops when the body doesn’t respond to insulin properly as a result of excess abdominal fat, type 1 diabetes is an inherited autoimmune disease, in which the immune system treats the pancreas as a foreign body and attacks it.

As with most autoimmune diseases, type 1 diabetes has been on the rise in recent decades. It is normally diagnosed in children, and is a life-long condition. Symptoms include frequent urination and thirst, weight loss, extreme hunger, and fatigue. Type 1 diabetes used to be known as insulin-dependent diabetes, because patients had to carefully measure insulin levels, and inject themselves periodically. Modern medical technology has made it possible for people to use automatic insulin pumps to monitor their insulin levels and administer appropriate doses when it is necessary to do so.

Now a newer treatment may become available that could the condition entirely. Experiments with laboratory animals have found a way to protect the cells that produce insulin from the overactive immune system. The immune system doesn’t attack the protected cells, and so they are able to produce the needed insulin. The procedure has not yet been tried in humans, but the receptor involved works in similar ways in humans and mice, and so the researchers think the treatment might work in humans as well. They say it only works in the early stages of the disease, however.

Another suggested treatment involves using immune-suppressing drugs to stop the immune system from attacking the pancreas. After that, the immune system itself is rebooted, with new cells that are less hostile to the pancreas. The doctor who devised this approach is hoping that by rebooting the immune system the pancreatic cells can be kept safe. This treatment has been tested, in adults, and has proven successful for those patients. This is the first study to find a treatment that is effective even in patients who have had the disease for a long time. Ordinarily, the later type 1 diabetes is caught, the less well it responds to treatment.

Diabetes And Statins

Life is full of trade-offs. One alarming one is that statins, drugs intended to lower unhealthy cholesterol levels and boost healthy cholesterol, thereby reducing the risk of heart disease, seem to raise the risk of type 2 diabetes. Obesity is associated with both high cholesterol and diabetes, but the drug itself seems to raise diabetes risk. In some studies, the risk of diabetes went up as much as 32 percent due to statin use, even as heart disease fell 44 percent. In part because of the obesity link, this side effect is a danger to the 13 million people expected to be on statins, some of the most widely prescribed medications in the world, during their lifetimes. Fortunately, researchers think they may have come up with a way to minimize this effect.

Statin drugs have come under fire recently for perceived over-prescription. Given the consistently high effectiveness of the drugs—lowering heart attack and stroke risk as much as 40 percent—and particularly given the side effects, there is some concern that people are being given statin prescriptions as a one-size-fits-all quick fix when they may be better served by some other approach. The side effects, though rare, can be dangerous or even fatal. In addition to type 2 diabetes, statin users can suffer memory loss, liver damage, and muscle weakness. In some cases, statins can lead to a potentially fatal condition of severe muscle pain, liver damage, and kidney failure called rhabdomyolysis. In light of these dangers, some experts are wary of prescribing these drugs to patients who do not have a high risk of heart disease. Patients who have not had a heart attack, or who do not already have high cholesterol, are unlikely to see enough benefit from statin drugs to offset these risks.

However, at least for diabetes, the risk may be easily manageable. The effect of statin drugs involves an immune response, which is how they achieve their cholesterol-lowering feats. However, another effect of this immune response is to target the pancreas and lower insulin levels, leading to elevated blood sugar. The immediate recommendation is a second drug, called glyburide, which protects the pancreas from this immune response, and helps maintain the production of the needed amount of insulin. The researchers say further investigation of the immune response is needed to find ways to prevent or counteract other side effects.

Surgery For Weight Loss

Bariatic surgery is an often controversial procedure to help people lose weight. It is often derided as an "easy way out," but the fact is weight loss is difficult, the human body is deigned so that weight is much more easily gained than lost, and most diets usually don’t work for most people. If anything, patients who have weight loss surgery need to put more effort and thought into how and what they eat than dieters typically, do. The various kinds of bariatric surgery reduce stomach capacity in various ways, which make these restrictions easier, but also make them mandatory.

On of the most common types of weight loss surgery is called Roux-en-Y. The intestine is rerouted in a Y shape around most of the stomach and attached to a small pouch. This limits patients to the capacity of that pouch. Other types of surgery used miniaturized instruments inserted through a small incision to place an adjustable band around the stomach, making it smaller that way.

Regardless of the technique used, the health benefits are many. People with type 2 diabetes, for example, normally need insulin and medications the rest of their lives. However, obese people with type 2 diabetes—of which obesity is a major cause—show marked improvement, and in a study some were able to stop this maintenance treatment or diabetes entirely. Other studies found that obese people who underwent bariatric surgery successfully halved their heart attack risk. People on whom the weight loss operation had been performed had a 40 percent lower mortality rate and 50 percent fewer heart attacks than obese people who had not had surgery.

All this however, is not without a price. People who receive the surgery still need to follow a restrictive diet. In fact, it becomes more important, as failing to stick to the diet can result in not merely failing to lose weight, but in medical complications. Furthermore, the restrictive diet can mean nutritional deficiencies if people don’t carefully plan meals and take necessary supplements. There are also some signs that at least some procedures can make bones more brittle. While many patients find that the benefits more than compensate for the risks, it is still important for someone considering surgery for obesity to discuss both with a health care provider.

Screening For Gesational Diabetes

Changes brought about by pregnancy have a significant impact on the way the body functions. Things that are altered include the shape and relative position of internal organs, hormone levels, the ways certain neurotransmitters function, and the kinds and amounts of certain chemicals in the bloodstream. One of these changes is the formation of the placenta, which produces hormones that can interfere with insulin receptors, leading to gestational diabetes.

Gestational diabetes occurs in about one in every ten pregnancies. It generally goes away after the pregnancy, though it does raise the risk of type 2 diabetes. However, gestational diabetes itself creates several risks during the pregnancy and for the fetus. People with gestational diabetes are more likely to suffer stillbirth or experience pre-term labor. Gestational diabetes is a risk factor for pre-eclampsia, and people with the condition often require Cesarian delivery.

Usually, diabetes only occurs late in the pregnancy, and presents with few or no symptoms. That’s why it is important for people who are pregnant to get screened for diabetes, which is in many cases the only way for the condition to be diagnosed. In fact, recommendations released yesterday called for screening to be done at 24 weeks in all pregnancies, or even earlier—early signs can sometimes be found by screening at just 13 weeks in.

Screening is particularly important for people with known risk factors. People who are overweight, who have high blood pressure, or who have a family history of type 2 diabetes need to be on the lookout. Being over 25 is also a risk factor. People who have had gestational diabetes in a previous pregnancy are particularly likely to get it again; people who have had a stillbirth or delivered a baby over nine pounds may have had undiagnosed diabetes and should also be alert.

However, anyone who gets pregnant is at some risk of diabetes. There are steps that can reduce that risk. Losing weight—never during the pregnancy, but leading up to it if it’s planned—can help. Risk is higher for people who become pregnant while 20 percent or more above ideal body weight. Moderate exercise and healthy eating habits can help protect against diabetes before or during pregnancy.

Blood Sugar And Memory

Diabetes and Alzheimer’s disease are so closely linked—in causes, in risk factors, even in some of their effects and symptoms—that Alzheimer’s has been referred to as "type 3 diabetes." Uncontrolled diabetes is very closely associated with a heightened risk of developing vascular dementia resulting from poor blood flow to the brain, in old age. Worse, some researchers suspect there’s a cycle, with diabetes and dementia each making the other worse.

Moreover, new research suggests that you don’t have to have diabetes, or even a diabetes precursor, such as glucose intolerance, for your memory to be affected. A recent study found that simple high blood sugar is enough to affect subjects’ performance on a standard laboratory memory test. The subjects all had blood sugar near the top of the normal range, well below the level that is the standard for a diagnosis of diabetes. In addition to the memory test, brain MRI scans showed that the area of the brain responsible for memory was lower in people with high blood sugar levels.

"These results suggest that even for people within the normal range of blood sugar, lowering their blood sugar levels could be a promising strategy for preventing memory problems and cognitive decline as they age," said Dr. Agnes Floël, the author of the study, in a statement. "Strategies such as lowering calorie intake and increasing physical activity should be tested."

In addition to keeping blood sugar levels under control, there are several things you can do to help maintain and improve your memory. For one thing, in addition to physical activity, make sure to keep up mental activity. Don’t let yourself stagnate alone; things like crossword puzzles, spending time with friends or in group activities, or learning a language or a musical instrument can all help keep your mind sharp. You’re never too old to take a class or learn a craft. Keeping your space organized will help organize your brain, and make it easier to remember things in general. Preventing dementia won’t just give you a longer life, but also a richer one; it means having not just more years, but better years.