All About Diabetes

Will Cross became the first American with diabetes to reach the summit of Mt. Everest. Cross has proven that even people with diabetes can conquer the world’s highest mountain.

Before Cross, a 49-year-old Austrian man, Geri Winkler, became the first type 1 diabetic to scale the world’s highest peak earlier in May. Nevertheless, Cross was happy to have conquered Everest on his second attempt.

Climbing Everest poses brutal challenges for the”ordinary” climber, more so for persons with diabetes like Cross and Winkler, who both have type 1 diabetes, which requires regular intake of insulin.Aside from hypoglycemia or low blood sugar episodes that could put their lives in danger, they are also more susceptible – to frostbite, bacteria and dehydration. Medical experts say Cross’s achievement would have been impossible fifty years ago. But with new and better ways to monitor blood sugars and improved delivery systems for insulin, even diabetics can now scale the “top of the world.”

Methods of delivering insulin have progressed from needle injections to insulin pumps. Even insulin has improved, and Cross used a form of insulin called rapid-acting insulin in his Everest expedition. Aside from an insulin pump, Cross also brought along a product called Flexpen – a prefilled injection device – to give him the most control of his insulin.

Besides scaling Everest, Cross was also the first American and the first person with diabetes in the world to walk to the North and South Poles and to climb the highest peak on each continent, an odyssey known as the NovoLog Peaks and Poles Challenge.

For people with diabetes, checking blood sugar everyday is important. It is part of the routine they must do to keep their diabetes under control. And because it is routinely done, checking their blood sugar becomes automatic. Sometimes, diabetics get so used to the idea that they are not bothered by the regular needle pricks at all. But for some, they get tired of the daily process and lose interest in doing it altogether. And before they know it, the worst happens, and complications set in.

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Many research studies have demonstrated that not getting enough sleep affects the body’s ability to manage blood sugar levels and appetite, increasing the risk of obesity and diabetes. (more…)

Researchers from the Joslin Diabetes Center have identified insulin resistance in the liver as a key factor that causes metabolic syndrome and one of its associated conditions, atherosclerosis.

Not only do the findings provide an understanding of how metabolic syndrome occurs, but it also pinpoint a target for treatment of the condition. “This is one of the first true insights into the role of the liver in the metabolic syndrome and provides guidance for future therapies,” said senior study investigator Dr. C. Ronald Kahn, an internationally recognized researcher in diabetes and metabolism.

Study investigators add that the findings indicate that metabolic syndrome is not merely a collection of abnormalities that should be considered and treated independently, rather, it is a group of closely linked disturbances in glucose and cholesterol metabolism that stem from a defect in insulin signaling in the liver.

Obesity, glucose intolerance, hypertension, low levels of “good” cholesterol, and high levels of triglycerides — all of which are related to insulin resistance — make up the medical problems that identifies metabolic syndrome. Together, these abnormalities are associated with an increased risk of atherosclerosis — the buildup of plaque in the coronary arteries that often results to heart attack and stroke.

Joslin Diabetes Center is the world’s largest diabetes clinic, diabetes research center and provider of diabetes education.

She proudly walked the stage and graciously accepted the medal that symbolized her triumph over a disease that cripples many, who are not as lucky as her. Could it just be luck that Lola Dolores Fabian, 72, has triumphed over diabetes for more than 30 years now?

Lola Dolores is one of the three awardees of the Diabetes Achievement Award gold medal for having survived diabetes for more than 30 years without major complications of the disease. Every year, the organizers of the Diabetes Awareness Week award diabetics who have survived diabetes without major complications for more than 10 to 30 years.

Complete Faith in Doctors
Having diabetes came not as a surprise to Lola Dolores, because she says that the disease indeed runs in the family.One of her siblings, and her mother, also has diabetes. Even her husband had diabetes, and had been amputated a foot because of diabetes. Now, four of her eight children also have diabetes.

Lola Dolores was diagnosed with diabetes in 1976. She did not feel any of the usual symptoms of diabetes before the diagnosis. Not until she experienced breathing difficulties after a laborious activity did she find out that she had diabetes. Since then, she has been religiously seeing doctors for her disease, even when she was still in Cebu, and until she moved to Davao. Now that she’s living in Fort Bonifacio in Taguig, she regularly goes to the Fort Bonifacio Medical Center, where she has been going for consultations for four years now.

Her blurry vision is what she regularly sees a doctor for these days. However, she says, it is not a major thing to worry about.”Medyo blurred lang (It’s just a little blurry),” says Lola Dolores. She adds that the doctor even said that her eyes do not need to be operated on.

She also relates that she had been operated on just once in her 30 years of being diabetic. In 2003, Lola Dolores had a gall bladder operation. Other than that and her blurry vision, she does not have any other major complication of diabetes. It was also only recently that she has been under insulin therapy. She’s been injecting insulin twice a day, in addition to her standard oral antidiabetes medications, for only two years now. This means that she has been able to have good control of her diabetes for most of the more than 30 years that she has had the disease.And it was only recently that she needed insulin to better control her blood sugar and diabetes.

No to Herbals
When asked what her secrets are to having stayed this long with diabetes without major complications, Lola Dolores quips, “Siguro dahil ang dami kong gamot (Maybe because I take a lot of medicines).” “I take about 6 tablets a day,” she says.When this writer remarked that she must have been very diligent in taking her medicines, Lola Dolores says that “Oo dapat, kase yun tang naman ang trabaho ko dito sa bahay. Mag-kontrol sa pagkain, mag-rest, at uminom ng gamot (Yes, I should, because that’s the only thing that I do here in the house. To control what I eat, take a rest, and take my medicines),” she enumerates.

Moreover, Lola Dolores firmly believes that regular check-up with a doctor and taking medicines prescribed only by her doctor is what kept her surviving diabetes. “So 30 years kong pagiging diabetic, hindi ako uminom ng mga herbal-herbal na yan (In my 30 years of being diabetic, I did not take any herbal medicines)” she stresses.

She says that she would only take whatever was prescribed by her doctor, and that she does not take anything without a doctor’s prescription. “Yang mga so TV na yan, maraming kung anu-anong herbal, hindi ako naniniwala dyan. (I don’t believe in the many herbal medicines I see on TV),” she says. Lola Dolores emphasizes that she only believes what her doctor says. “Kaya every week pumupunta ako sa doktor. Kung ano ang sinasabi ng doktor, sinusunod ko (That is why I go to the doctor every week. I follow whatever the doctor says).”

Not a Big Secret
Indeed, Lola Dolores’ secrets to winning over diabetes, are no big secrets at all. Every diabetic knows the importance of regular check-up and oral medications in controlling diabetes. However, it was Lola Dolores’ firm resolve and dedication to adhere to her diabetes treatment plan, that cuts her above the rest, and kept her winning over diabetes all these years.
Aside from religiously following her doctor’s orders and taking her medicines diligently, Lola Dolores also still watches what she eats and does a little exercise.

For Lola Dolores, being at the prime of her life does not stop her from taking care of herself. Even a small living space could not stop her from not moving around. She relates that she walks back and forth the whole length of the house as a form of exercise. Sometimes, she says, she stretches her limbs and flexes her feet even when she’s lying down on her bed. Her advice to her fellow diabetics is simple: “Always see a doctor for regular check-up and always take your medicines.”
Living with diabetes for more than 30 years is no small feat. Lola Dolores has proven that it was not just luck that kept her triumphant over diabetes. She has shown that having the right attitude towards diabetes and being proactive in her treatment, has made her worthy of being honored as a true Diabetes Achiever.

Carbohydrates present in bread and other bakery products, rice, root crops, cereals, fruits and vegetables contributes to 70 percent of the total dietary intake among Filipinos (2003 FNRI-DOST National Nutrition Survey). Carbohydrate foods may be classified as “available” or “unavailable”. Available carbohydrates are the easily digested food, e.g.white bread and rice, while the unavailable carbohydrates are the slowly digested food, e.g. high fiber foods like kamote and mongo. (more…)

Scientists at the Johns Hopkins University are testing mice and pigs for insulin encased in seaweed capsules and iron to help those with type 1 diabetes whose bodies have rejected their transplanted insulin-cells.

Two separate experiments were done to understand what happens to insulin-cells after they have been transplanted and why the transplants work for some people and not for others. In the first experiment, insulin was encapsulated with alginate, a substance derived from seaweed, and iron to be able to monitor the cells magnetically. The capsules where then implanted in diabetic mice and were found that the blood sugar levels of the mice returned to normal just after a week. Half of the mice that did not receive the seaweed transplants died.

Pigs underwent the same procedure, except that the capsules were now implanted in the liver instead in the pancreas as more blood vessels could help carry the insulin to the rest of the body. Researchers report that after three weeks, the capsules were still in place and were producing usable amounts of insulin.

The study was done in the hope that the capsules will reduce the need for anti-rejection drugs in people receiving transplants. Initially funded by the National Institutes of Health and the Howard Hughes Medical Institute, researchers are now working on a longer-term trial in pigs and are working with a private company to begin the process of seeking Food and Drug Administration approval.

Extracts from pumpkin could replace or reduce the need for insulin injections for diabetics, according to a study published in the journal Chemistry and Industry. Chinese scientists have discovered that pumpkin extracts promote regeneration of damaged pancreatic cells in type 1 diabetic rats, thereby boosting the rats’ levels of insulin-producing beta cells and insulin in the blood. “Pumpkin extract is potentially a very good product for pre-diabetic persons, as well as those who have already developed diabetes,” said research leader Tao Xia of the East China Normal University.

Results showed that levels of blood sugar regulating hormones were increased by 36 percent and that the rats’ blood glucose levels were similar to those of non-diabetic rats at the end of the study. Findings also showed that the insulin-producing cells in the diabetic rats increased by 59 percent, compared to 21 percent before being fed with the pumpkin extract.The antioxidant effects of the pumpkin also suggested its pancreas-preserving effects.

However, researchers said that insulin injections would probably still be needed, but using the extract would greatly reduce the amount of insulin that would be needed. David Bender of the Royal Free and University College Medical School in London said that the research is an exciting breakthrough since pumpkin extracts could be developed into something that can be taken orally. He suggested however that more studies should be done before pumpkin extract could be considered as a treatment for — or for the prevention of — diabetes.

The protective effect of pumpkin is attributed to antioxidants and D-chiroinositol, a molecule that mediates insulin sensitivity.

Capsules of insulin produced in genetically modified plants could restore the body’s ability to produce insulin and help insulin-dependent (type 1) diabetes patients, according to biomedical researchers from the University of Central Florida.

The research team initially used genetically engineered tobacco plants with the insulin gene and then administered freeze-dried plant cells to diabetic mice as a powder for eight weeks. Results showed that the diabetic mice had normal blood and urine sugar levels, and that their cells were producing normal levels of insulin at the end of the study.

Professor Henry Daniell, who led the research team, has since proposed using lettuce instead of tobacco for producing the insulin because lettuce can be produced cheaply and to avoid the negative stigma associated with tobacco. Daniell and his team say that results of their study indicate that insulin capsules could someday be used to prevent diabetes before symptoms appear and treat the disease in later stages.

Insulin is typically given through shots for the hormone to go straight into the bloodstream. In the researchers’ proposed method, plant cell walls made of cellulose initially prevent insulin from degrading.When the plant cells that contain insulin reach the intestine, cell walls will slowly be broken down by bacteria living in it, gradually releasing insulin into the bloodstream.

Insulin produced from lettuce would be delivered as powder in capsules to patients because the dosage must be controlled carefully. If successful in their trials with people, the impact of the research could affect millions of diabetics worldwide and would greatly reduce the cost of treatment.

The United States’ National Institutes of Health provided $2 million to fund the study. Findings of the study were reported in the journal Plant Biotechnology.

To further understand the rational application and use of insulin among people with diabetes, Endure Medical, Inc. brought Dr. Michael Villa, chief of the Section of Diabetes, Endocrinology and Metabolism at St. Luke’s Medical Center, to Iloilo.

Dr. Villa’s three separate lectures—one for patients with diabetes from major hospitals in Iloilo, another for resident physicians of St. Paul Hospital in Iloilo City, and the last one for consultants and residents from major Iloilo hospitals—all delved on the vital role of insulin in diabetes management.

The first event of the day was a lay forum dedicated for the better understanding of diabetes, its complications, and current treatment strategies. Held at the Ayala Hall of the Center for Professional Values and Development in Iloilo City, the forum’s participants included nurses and elderly citizens from the diabetic group of St. Paul’s Hospital, Iloilo Doctors Hospital, and the West Visayas State University Hospital, among others.

“What’s important to us is that if you are diabetic, your blood sugar should be controlled,” said Dr. Villa. He also emphasized that between hyperglycemia and hypoglycemia, though both are considered easy to treat among doctors, the latter poses a greater danger since severe hypoglycemia can cause coma. “It is therefore important that you always eat and not miss a meal and always check your blood sugar,” he advised.

The lay forum was immediately followed with a scientific session for residents and nurses of St. Paul’s Hospital. Receiving a warm welcome from Dr. Henry Gonzales, chair of the Department of Family Medicine, and the medical staff, Dr. Villa proceeded with a presentation focused on the in-hospital management of hyperglycemic and critically-ill patients, especially in the outcomes of tight glycemic control. “Insulin as a treatment has been a protective factor against hyperglycemia and increased free-fatty acids,” said Dr. Villa. He added that these are just two factors that affect morbidity and mortality among patients, especially in the intensive care unit (ICU) and in the neurology ICU.

The last session of the day is dedicated for lectures among consultants and residents from major hospitals in Iloilo. This time, Dr. Francis Pasaporte, president of the Philippine Association of Diabetes Educators, joined Dr. Villa and centered on the role of insulin in outpatient management. Dr. Villa, on the other hand, focused on the effective use of different insulin types inside the hospital .

Endure Medical Inc. hopes that through these informative lectures on the vital role of insulin in diabetes and glycemic control, patients and doctors alike will be more aggressive and less hesitant to prescribe and advocate the use of insulin.