Beat it

Beat it

More diabetes cases diagnosed after Medicaid expansion


Reuters

U.S. states that expanded their Medicaid programs under the Affordable Care Act have seen larger increases in diabetes cases than states that didn’t expand their programs, a new study shows.
The findings suggest that expanding Medicaid, the government-run health insurance for the poor, allows people with diabetes to be diagnosed earlier than before, which may improve outcomes later on, the researchers say.
"This is important because diabetes is becoming more prevalent as the population gets older,” said Dr. Harvey Kaufman, lead author of the study and senior medical director at Quest Diagnostics, which funded the analysis.
In the early stages of the disease, people can make lifestyle changes and get care that helps delay complications, he added.
If left untreated, diabetes can lead to vision loss, kidney failure, nerve problems and amputations of the legs and feet, according to the U.S. Centers for Disease Control and Prevention. The agency says $176 billion is spent on diabetes and its complications each year.
Diabetes occurs when the body can't properly use or make enough of the hormone insulin to convert blood sugar into energy, according to the World Health Organization (WHO).
About one in nine adults has diabetes, according to the WHO. Type 2 diabetes accounts for the vast majority of cases and is linked to obesity and advanced age.
Kaufman and colleagues focused their research on the hemoglobin A1c test, which measures the average blood sugar level for the past two or three months.
Using Quest Diagnostics’ database of lab tests, which includes about 150 million patient encounters annually, they counted how many people had at least one blood sugar test that was negative before Medicaid expansion and positive afterwards.
In January 2014, 26 states expanded access to Medicaid and 24 did not.
Where more people got Medicaid, newly diagnosed diabetes cases among Medicaid recipients surged 23 percent, from 14,625 in the first six months of 2013 to 18,020 in the first six months of 2014. In states that didn't expand Medicaid, diagnosis increased just 0.4 percent.
People are considered diabetic when their A1c level is at least 6.5 percent. Where Medicaid was expanded, the average A1c levels of newly diagnosed diabetes patients was 7.96 percent, compared with 8.14 percent in non-expansion states.
"It was apparent in the non-expansion states that you are making diagnosis at a later stage when they are presenting at the hospital with complications," said Dr. Robert Ratner, chief scientific and medical officer of the American Diabetes Association.
"The earlier you catch the disease, the easier it is to treat, and the more responsive it is and the more stable it can be," said Ratner, who wasn't involved in the study.
While more women in the study had diabetes, the increase in diagnosis was steeper for men. Gains were also greater for older people, aged 50 to 64, than for individuals aged 19 to 49.
The study had some limitations, including its reliance only on records from blood sugar tests done by Quest Diagnostics and its lack of clinical information. It's also possible that some patients tested at Quest might have been diagnosed prior to the start of the study period.
Because it's only based on tests at Quest, "you don't know 100 percent if this was a new diagnosis, and not something the patient might have already known," said Dr. Benjamin Sommers, a health economist at Harvard University. "But the overall study design makes a lot of sense."
The number of newly diagnosed diabetes cases in the states where Medicaid expanded bodes well for the detection of other chronic health conditions which, like diabetes, may not immediately cause symptoms that are easy for patients to detect on their own, Sommers said.
"With the expanded coverage, you're not going to diagnose more broken bones because whether or not they have insurance, when somebody breaks a leg they are going to get an x-ray," said Sommers, who wasn't involved in the study. "These findings with diabetes may be the tip of the iceberg, and you can imagine similar outcomes for earlier detection of high blood pressure, or cancer, or mental illness."



FDA approves new treatment for diabetic retinopathy in patients with diabetic macular edema


For Immediate Release
March 25, 2015
Release
The U.S. Food and Drug Administration today expanded the approved use for Eylea (aflibercept) injection to treat diabetic retinopathy in patients with diabetic macular edema.
Diabetic retinopathy (DR) is the most common diabetic eye disease and is a leading cause of blindness in adults in the United States. According to the Centers for Disease Control and Prevention, diabetes (type 1 and type 2) affects more than 29 million people in the United States and is the leading cause of new blindness among people ages 20 to 74 years. In 2008, 33 percent of adults with diabetes aged 40 years or older had some form of DR. In some cases of DR with diabetic macular edema (DME), abnormal new blood vessels grow on the surface of the retina. Severe vision loss or blindness can occur if the new blood vessels break.
“Diabetes is a serious public health crisis, affecting more patients every year,” said Edward Cox, M.D., M.P.H, director of the Office of Antimicrobial Products in the FDA’s Center for Drug Evaluation and Research. “Today’s approval gives patients with diabetic retinopathy and diabetic macular edema another therapy to treat this vision-impairing complication.”
In February, the FDA approved Lucentis (ranibizumab injection) 0.3 mg to treat DR in patients with DME.
Eylea is administered by a physician as an injection into the eye once a month for the first five injections and then once every two months. It is intended to be used along with appropriate interventions to control blood sugar, blood pressure and cholesterol.
The safety and efficacy of Eylea to treat DR in patients with DME were evaluated in 679 participants in two clinical studies where participants were randomly assigned to receive Eylea or macular laser photocoagulation, a laser-based treatment used to burn small areas of the retina. At week 100, participants being treated with Eylea showed significant improvement in the severity of their DR, compared to patients who did not receive Eylea.
The most common side effects associated with Eylea include bleeding of the conjunctiva (the tissue that lines the inside of the eyelids and covers the white part of the eye); eye pain; cataracts; floaters; increased pressure inside the eye (increased intraocular pressure); and separation of the interior jelly of the eye from the retina (vitreous detachment). Serious adverse reactions include infection within the eye (endophthalmitis) and retinal detachments.
The FDA granted breakthrough therapy designation to Eylea for the treatment of DR with DME. The FDA can designate a drug a breakthrough therapy at the request of the sponsor if preliminary clinical evidence indicates the drug may demonstrate a substantial improvement over available therapies for patients with serious or life-threatening conditions. The FDA also reviewed the new use for Eylea under the agency’s priority review program, which provides for an expedited review of drugs that demonstrate the potential to be a significant improvement in safety or effectiveness in the treatment of a serious condition.
The FDA previously approved Eylea to treat wet (neovascular) age-related macular degeneration, a condition in which abnormal blood vessels grow and leak fluid into the macula. Eylea is also approved to treat DME and macular edema secondary to retinal vein occlusions, both of which cause fluid to leak into the macula resulting in blurred vision.
Eylea is marketed by Tarrytown, N.Y.-based Regeneron Pharmaceuticals Inc. Lucentis is marketed by South San Francisco, California-based Genentech, a subsidiary of Roche Pharmaceuticals.

The FDA, an agency within the U.S. Department of Health and Human Services, promotes and protects the public health by, among other things, assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.

Repeated Use of Antibiotics May Raise Diabetes Risk


by Agata Blaszczak-Boxe, 

People who have taken certain antibiotics repeatedly may be at an increased risk of type 2 diabetes , according to a new study.
Researchers found that people in the study who had ever been prescribed two or more courses of specific types of antibiotics were more likely to be diagnosed with type 2 diabetes  than people who had never been prescribed these antibiotics, or had taken just one course. The antibiotics in the study came from one of four categories: penicillins, cephalosporins, quinolones and macrolides.
The study "raises a red flag about the overuse of antibiotics, and it should make us much more concerned about this overuse," said Dr. Raphael Kellman, a New York City internist who was not involved in the study. "We should certainly be more judicious, more cautious when we use antibiotics."



Even interrupting sitting time may improve health in type 2 diabetes


BY JANICE NEUMANN

 (Reuters Health) - - People with Type 2 diabetes could trim down and improve their metabolic health by replacing long periods of sitting with periodic standing, taking the stairs or even just changing the television station manually, a new study suggests.
“It is important to stress that physical activity incorporates all different forms of movement and that people do not have to participate in structured exercise to be sufficiently active,” said Catherine Falconer, who led the study.
“Whatever you can do to increase the amount of physical activity you do and reduce the length of time sitting will have an impact on your diabetes and general health,” she wrote in an email.
Previous research has shown that increasing physical activity can help people with type 2 diabetes better handle their weight, glucose and lipid levels, Falconer and her team point out in Medicine and Science in Sports and Exercise. But people with diabetes may have a particularly hard time staying active.
“Type 2 diabetes is commonly associated with an obesogenic lifestyle, including low levels of physical activity. For some people with type 2 diabetes, mobility issues may prevent them from achieving sufficient physical activity, but for others it may be a result of behavior and environmental factors,” Falconer said.
Studies have also shown that people may have trouble increasing their activity level enough to actually improve their health and that long periods of just sitting may be particularly harmful.
So the researchers decided to examine the potential effect of replacing long periods of sedentary behavior with short interrupted periods, light exercise and moderate-to-vigorous physical activity.
They looked at data on 519 adults with type 2 diabetes from a larger 2006-2008 study. The participants included in the new analysis wore accelerometers on their waists to measure their activity levels and also gave fasting blood samples to check their cholesterol, triglyceride, insulin and glucose levels.
Researchers found the participants spent 65 percent of the waking day sedentary and 45 percent of that time was spent in long blocks of 30 minutes or more being inactive. The study team then used a statistical analysis technique to compare what might be the effects of replacing 30 minutes of one behavior with 30 minutes of another.
With just some interruptions in 30-minute sedentary blocks, the weight and waist circumference of subjects went down slightly, and fell even more when light or moderate-to-vigorous physical activity was swapped-in for the sedentary time.
When the researchers analyzed how much the adults’ metabolic health could improve with the different levels of activity, they found that HDL (“good”) cholesterol rose with light physical exercise, though not with more vigorous exercise.
“I think the message that we don’t even have to push for the moderate-to-vigorous physical activity, that breaking up your sitting time has demonstrable benefits is actually pretty compelling,” said Dr. Eddie Phillips, who founded and directs the Joslin Diabetes Center’s Institute of Lifestyle Medicine in Boston, Massachusetts.
Phillips pointed out in a phone conversation with Reuters Health that the 2008 Physical Activity Guidelines for Americans suggested 150 minutes of moderate-intensity aerobic and “while there’s been an uptick . . . the majority of Americans don’t get that.”
“It is a valid criticism to say we have not convinced the public to walk more appreciably, and those recommendations will remain, but if we can now recommend to patients that, ‘Gees, if you just get up out of your chair when the commercial comes on or drink more water and have to go to the bathroom,’ even that is enough to break up the prolonged sedentary bouts they describe in the research,” said Phillips, who was not involved in the study.
Phillips said he made physical exercise a part of his regular discussions with diabetic patients, suggesting they increase their activity by even small increments.
“The discussion is usually about, ‘Could you walk a little more, a little faster, a little more frequently. From there I would start asking what you like to do . . . get outside, be involved in a competition, do ballroom dancing?” he said. “The exact type of exercise is actually not that important and more to do with what you find enjoyable.”
SOURCE: bit.ly/1Bcq2zd Medicine and Science in Sports and Exercise, online March 6, 2015.



For diabetics, middle ground is a livable option



By Rosemary Boggs

Pasta doesn't make you fat. It's how much pasta you eat that makes you fat.
-- Giada De Laurentiis,chef and cookbook author

I love the quotation above because it reminds me of how I've tried to come to terms with my eating habits. Having one cookie isn't the worst thing, but having the whole bag can be.
Like a petulant child, I really resent having to watch what I eat and drink. If someone tries to tell me that a food is forbidden or a no-no, they've basically, in my mind, just challenged me to eat it.
I am a diabetic. Thousands and thousands of people are diabetic. I struggle with my eating and I know that I truly am not alone in this.
Thousands and thousands of people have heart disease, cancer and an array of other health issues and diseases that can be affected by our eating habits.
When I was first diagnosed, I had this fear that if I ate one candy bar or cookie I could quickly slip downhill and die. It was a matter of life and death.
And really, it still is.
But as time has gone by, I've let my guard down and lapsed back into a couple of old habits. I don't always do what's best for me.
It's like Paul said in Romans 7:15: "For I do not understand my own actions. I do not practice or accomplish what I wish, but I do the very thing that I loathe."
And, like they sang in Disney's Beauty and the Beast, "it's a tale as old as time." But at least I am more aware of what I'm doing, which is a start.
WAKE UP
I received a copy of the book 21 Things You Need to Know About Diabetes and Your Heart and decided to read it. It's by Jill Weisenberger, a registered dietitian who has a practice in Virginia.
Her goal is to teach and encourage diabetics to care for their hearts. After reading the book I see she's on the right track. Sadly, much of the content is stuff we may already know but don't practice.
She begins by explaining the term "heart disease," or cardiovascular disease. These are catchalls used to describe several diseases of the heart or blood vessels. And she says that people with diabetes are at double the risk of having these diseases.
So what is the diabetes-heart connection?
Blood vessel damage throughout the body occurs more frequently, at an earlier age and with greater severity in people with diabetes. People with diabetes tend to have problems with blood vessel dilation and a greater likelihood of forming clots that obstruct blood flow. Research also links insulin resistance to heart disease as well as high blood pressure, excessive blood cholesterol and high triglyceride levels.
Good lifestyle habits can help put us in control of our lives. And medical management of risk factors and health problems greatly improves our chances of leading a full life without the worst effects of heart disease, which often culminate in having a heart attack.
So what are the symptoms of a heart attack?
The author says they vary from person to person. Common signs include chest pain or discomfort, upper body discomfort and shortness of breath. Less common signs include nausea, breaking out in a cold sweat, feeling unusually tired for no apparent reason, and sudden dizziness or feeling lightheaded.
Diabetic nerve damage or neuropathy may cause symptoms to be milder or even mask them. The main thing is to get to the hospital immediately if you think you are having a heart attack.
TAKE CHARGE
She asserts that monitoring our blood glucose is empowering, but many of us just don't do it regularly. If we can approach it with the right attitude, self-monitoring our blood glucose can put us in charge. And by using the results effectively we can work to control our diabetes and health.
The book has no actual list of 21 things to do, but there are 21 chapters full of solid advice and information that will benefit many. There are several chapters about eating and how changing our habits in a few small ways can make a big difference.
Weisenberger says that moderate weight loss can improve insulin resistance. She's talking 5 percent to 10 percent of our body weight. And losing just 10 pounds can be effective in controlling high blood pressure.
There is no magic plan, food or pills that will melt fat from our bodies. And we don't need to follow long lists of restrictive dietary rules and/or give up our favorite foods entirely.
We mainly need to understand, the author says, that any diet that helps us lose weight does so because we consume fewer calories than our body burns. And that does not necessarily mean we have to drastically cut calories to lose weight.
What it does mean is that we need to change our diets to consume fewer calories, increase our physical activity or, preferably, both.
Our best diet will be one that we can live with long term. It should include foods we enjoy in reasonable quantities and not restrict the foods we need for optimal health.
Weight loss cannot be the only goal though, Weisenberger says. Our best diet should balance enjoyment and good health.
I second that!
For more information, go to Diabetes.org the website of the American Diabetes Association.
Email me at:

rboggs@arkansasonline.com

Statins increase risk of diabetes by almost 50 per cent, study finds


Research on 9,000 men has found those taking statins are 47 per cent more likely to develop diabetes - but critics say the study fails to take proper account of the reasons

By Laura Donnelly, Health Editor

Statins prescribed to guard against heart attacks and strokes could increase the risk of diabetes by almost 50 per cent, a major trial suggests.
A six-year study from Finland on almost 9,000 men found that those prescribed the cholesterol-lowering drugs were far more likely to suffer from poor blood sugar control, and signs of diabetes.
Researchers found that after results were adjusted for age, body mass index, family history of diabetes, and smoking, alcohol and exercise habits, those on statins were 46 per cent more likely to develop diabetes.
However, some experts criticised the research, as it was not a randomised controlled trial.
Those being prescribed statins were already likely to have a higher risk of diabetes, they said, given that both conditions are linked to lifestyle.
The study led by Professor Markku Laakso, Institute of Clinical Medicine, University of Eastern Finland and Kuopio University Hospital, Finland, tracked 8,749 men aged between 45 and 73 for six years.
None had been diagnosed as diabetic at the start of the trial, and just over 2,100 of the participants were on statins.
By the end of the trial, 625 men were diagnosed with diabetes, the research published in Diabetologia, the journal of the European Association for the Study of Diabetes, found.
The risk of diabetes rose in line with the dose of the statins prescribed, the study found.
Researchers said the drugs appeared to alter insulin sensitivity, and reduce secretion of the hormone, triggering diabetes.
Previous studies have suggested a small increased risk of diabetes from statins.
Researchers said the new findings suggested such risks may have been previously underestimated, and said the size of the study, and way it was carried out meant its conclusions were likely to be reliable.
Last July, health watchdogs recommended that statins should be offered to around 17 million people – anyone estimated to have a 10 per cent chance of developing heart disease within a decade.
Experts said up to 50,000 lives a year could be saved if the guidelines are followed.
The controversial guidance triggered heated arguments about the benefits and risks of the drugs, and criticism that insufficent trial data has been published about their side-effects.
Dr Aseem Malhotra, Honorary Consultant Cardiologist, Frimley Park Hospital, who has criticised the guidance, said: “This study confirms that statins directly increase the risk of developing diabetes.”
He said GPs should ensure patients were properly informed about the risks and benefits from the drugs before they decided whether to take them.
But some scientists criticised the new research, and said the apparent increase in the risk of diabetes in those prescribed statins may not have been caused by the drugs.
Prof Stephen Evans, Professor of Pharmacoepidemiology at the London School of Hygiene & Tropical Medicine said: “The users of statins were generally at higher risk of heart disease and differed in a number of ways, probably including several ways that were not measured,” pointing out that the study did not track the diets of those involved.
Prof Keith Frayn, Emeritus Professor of Human Metabolism at the University of Oxford, pointed out that the 46 per cent increase measured the relative rise in risk.
Overall, 11 per cent of those taking a statin developed diabetes, compared with 6 per cent of those not taking the drug, with differences reduced further when confounding factors were taken into account, he said.
Professor Peter Weissberg, medical director at the British Heart Foundation, said: “This study showed that it was patients taking a high dose statin who were most at risk of developing type 2 diabetes and, importantly, many of the patients who developed diabetes already had risk factors for diabetes at the start of the study. This suggests that statins may act by unmasking a pre-existing tendency to diabetes.”

“It is important that people taking statins because of existing cardiovascular disease should continue to take them as the benefits will outweigh the risks.” 

Sanofi diabetes drug awaits imminent EU green light


BY BEN HIRSCHLER

(Reuters) - Sanofi's new Toujeo diabetes drug is on track to receive a potential green light from European regulators this week, building on a U.S. regulatory approval awarded on Wednesday.
Toujeo is a more potent follow-up to the French drugmaker's top-selling Lantus insulin product, which accounts for a fifth of group sales, and the new drug is pivotal to Sanofi's diabetes business as Lantus faces loss of patent protection.
A committee of experts at the European Medicines Agency is considering whether to recommend Toujeo at a regular monthly meeting in London, according to the agency's website. Decisions from such meetings are normally announced around midday on Fridays.
 Assuming Toujeo gets a positive opinion, it is likely to be formally approved by the European Commission a couple of months later, allowing Sanofi to launch in its chosen first European markets of Germany and Britain.
The U.S. approval for Toujeo disappointed some Sanofi investors because the wording on the drug's label failed to spell out the benefits of Toujeo over Lantus.
In Europe, however, the labeling rules are different and Sanofi may be able to make more claims for Toujeo.
Pascale Witz, Sanofi's executive vice president of global divisions, said she was confident doctors would recognize the benefits of using Toujeo, even if this was not spelt out on the U.S. label, because clinical studies about the drug had been published in major journals.
Toujeo has the same active ingredient as Lantus, called insulin glargine, but at three times the concentration and with a design to release the insulin more gradually.
The medicine provides similar blood glucose control as Lantus with lower rates of hypoglycemia, a potentially dangerous drop in blood sugar.
Witz declined to comment on the price of Toujeo but said "pricing will not be a barrier to access".
Even with a competitive price, investors fear Sanofi may struggle to switch sufficient patients from Lantus to Toujeo. Many analysts see a modest switch rate of only around 20 percent, although Witz said that figure was too low.
"That's a pessimistic view. We think it's going to be more than that," she said on the sidelines of an Economist pharmaceuticals conference in London.

(Reporting by Ben Hirschler)

Got Diabetes? There's an App for That


U.S. health researchers said they are targeting millions of smartphone users with Apple Inc's new software tool, hoping to collect an unprecedented amount of data on major diseases by tracking their behaviours via iPhone.
The ResearchKit software tool, an open source platform, allows researchers to design applications that use built-in sensors on the iPhone along with data from other wearable devices to gather real-time health data. Scientists from Stanford University School of Medicine and Weill Cornell Medical College are among the first to offer apps for diseases like diabetes and heart disease.
For example, Massachusetts General Hospital's GlucoSuccess app allows diabetics to participate in a research study that gives feedback on how their diet and exercise patterns impact daily glucose readings. It asks volunteers whether they have taken all of their medications or inspected their feet.
"It's very hard in practise for people to carry out all the recommendations and stick with them over time," said Dr. Stanley Shaw, co-director of the Center for Assessment Technology and Continuous Health at Massachusetts General.
Other apps released on Monday involve studies on asthma, breast cancer and Parkinson's disease. For volunteers, the apps are designed to help people with chronic disease follow through with important health behaviours.
For researchers, the data improves upon the many pages of survey questions study volunteers had to fill out, often based on their recollection of what they ate in the prior week or how many minutes they put in at the gym. Shaw said the fact that Apple made ResearchKit open source will allow "a whole host of medical researchers" to develop apps for their own research projects.
"We view this as the opening salvo," he said.
The MyHeart Counts app will collect data about physical activity and cardiac risk factors for Stanford scientists studying heart disease. It allows users to complete tasks, such as performing a six-minute walk if they are able, and answer surveys from their iPhone, and provide them with an assessment of their heart health and information on how to improve it.
The app can tap into data gathered by other wearable gadgets such as Jawbone or Fitbit, but it can also be used with the iPhone, as long as people remember to keep their phones turned on, said Dr. Euan Ashley, chair of Stanford's biomedical data science initiative.
Dr. Francis Collins, director of the National Institutes of Health, sees mobile health playing a major role in the president's $215 million precision medicine initiative. He anticipates tech companies will use large patient studies as a "test bed for a lot of the technologies they are developing."
"The Googles and the Apples and the Qualcomms are certainly paying close attention to the potential of this," Collins said in a recent interview with Reuters.
Researchers say ResearchKit simplifies their recruiting work. Volunteers can decide how much data to share directly with the research institutions. "The data does not go to Apple," Ashley said. Dr. Eric Schadt, a genomics professor at the Icahn School of Medicine at New York's Mount Sinai, used the platform to develop an asthma app along with Weill Cornell Medical College and LifeMap Solutions, a subsidiary of BioTime .

The fact that researchers can recruit, consent and enroll participants remotely should produce study sample sizes that are "orders of magnitude" greater than in the past at a fraction of the cost, Schadt said.

Diabetes-friendly carbs



The Leader-Post February 28, 2015

Eating right and being active take on a whole new meaning for those with diabetes.
Because the disease comes in more than one form, anyone can develop the chronic disease.
Kristal Dickie, community dietitian with the File Hills Qu'Appelle Tribal Council, said when it comes to food everything is OK - in moderation.
Part of her job is to help teach diabetes management to those living with the disease.
"Diabetes, because it's a chronic disease, is managed individually," said Dickie.
This enables the person with the disease the opportunity to take control of it whether through diet and exercise or medication or a combination of both.
"The biggest message we give people is, 'All foods fit and it's a balancing act, so you have to balance the foods that you are eating with your activity level and the medications that you are taking to be able to achieve normal or close to normal blood sugars,' " said Dickie. Although nothing is forbidden, diabetics are advised to choose foods that are higher in nutritional value.
"You need to look for things that are going to be providing good things to your body like vitamins, minerals and fibre," said Dickie. "When it comes to diabetics specifically, you need to be aware of the carbohydrate content of foods because carbohydrate is the component that breaks down into sugar and will cause your blood sugars to elevate."
Dickie said bannock is a carbohydrate and can be incorporated into a person's diet.
"We don't encourage people to cut out carbohydrates because your body runs on sugar," she said. "So you need to have some carbohydrate in your diet, but it's a balance. So absolutely you can include bannock and any carbohydrate food." Dickie said diabetics must always be aware of what other foods are being consumed with the carbohydrate, what medications are utilized and the level of physical activity involved.
She said there are also healthier options such as having baked bannock over fried.
kbenjoe@leaderpost.com
Kristal Dickie's light baked bannock
5 cups flour
3 tbsp. baking powder
½ cup vegetable oil
2 ½ cups oatmeal
¼ cup skim milk powder
2 ½ cups water
Step 1: Mix together flour, oatmeal, baking powder and powdered milk
Step 2: Add the vegetable oil
Step 3: Add water and stir until evenly blended.
Step 4: Bake

Other bannock recipes can be found at www.for.gov.bc.ca/rsi/fnb/BannockAwareness.pdf.

Manage your blood sugar levels with a large breakfast and a small dinner



Eating a bigger breakfast and a smaller dinner may help type 2 diabetics to better control their blood glucose.
Big breakfasts and small dinners might be a healthier way to eat for people with type 2 diabetes, according to a small new study.
Diabetics in the study who ate big breakfasts and small dinners had fewer episodes of high blood sugar than those who ate small breakfasts and large dinners, researchers found.
Blood sugar - also known as blood glucose - is controlled by the body's internal clock, with larger blood sugar peaks after evening meals, Dr. Daniela Jakubowicz told Reuters Health in an email.
People with type 2 diabetes often time their meals in opposition to their internal clock, said Jakubowicz, a researcher at Tel Aviv University's Wolfson Medical Center in Israel.
"They frequently skip breakfast while eating a high-calorie dinner," she said, adding that skipping breakfast is linked to obesity and poor blood sugar control.
The new study involved eight men and ten women with type 2 diabetes, ages 30 to 70, who were being treated with either the diabetes drug metformin and dietary advice or diet advice alone.
Read: Why you should keep taking your diabetes medication
Type 2 is the most common form of diabetes and is often linked to obesity. In type 2 diabetes, the body's cells are resistant to the hormone insulin, or the body doesn't make enough of it. Insulin gives blood sugar access to the body's cells to be used as fuel.
The participants were randomly assigned to follow a meal plan that consisted of either a 700-calorie breakfast and 200-calorie dinner or a 200-calorie breakfast and a 700-calorie dinner. Both diets included a 600-calorie lunch.
After following the assigned meal plans for six days at home, the participants spent a day at the clinic, where blood tests were taken. They repeated the experiment two weeks later with the other diet plan.
The study team found that post-meal glucose levels were 20 percent lower, and levels of insulin were 20 percent higher, when the participants consumed the large breakfasts and small dinners, according to the results in Diabetologia.
"Our study demonstrated that a large breakfast and reduced dinner is a beneficial alternative for the management of glucose balance during the day and should be considered as a therapeutic strategy in type 2 diabetes," Jakubowicz said.
Jakubowicz said longer studies are needed to see if the benefits would continue over time.
The new results support the advice to eat like a king at breakfast, a prince at lunch and a pauper at dinner, said Anna Taylor in an email to Reuters Health.
"Select your calories with care, however; what you eat, how you eat, and when you eat all play an important role in your nutrition as well as your health," said Taylor, a registered dietitian at the Cleveland Clinic in Ohio. She wasn't involved in the study.
She added that it's important for people to keep in mind that the study's participants took few medications and had no major complications.
The results might therefore not apply to other groups with diabetes, Taylor said.

She said that people with diabetes who take insulin should speak to their endocrinologists before experimenting with drastic dietary adjustments.

Chemistry professor publishes year-long diabetes research


by Eric Meyer 

State University of New York distinguished teaching professor of chemistry and chair of the chemistry department Wendy Pogozelski recently published a paper titled “Dietary carbohydrate restriction as the first approach in diabetes management: Critical review and evidence base.” Pogozelski has been working on the paper for a year and a half with co-author Richard Feinman from SUNY Downstate Medical Center and a number of other contributors.
This work has been part of an ongoing effort of Pogozelski’s to find topics more engaging to her students. Pogozelski explained that she understands that without some anchor to latch onto, it can become just one series of reaction after another.
“My whole original goal was just then to kind of make my classes interesting,” she said. “So I think that the issues that I’ve been able to bring into the classroom have really enhanced my teaching.”
While no students assisted in working on this particular paper, Pogozelski noted that students will have opportunities to work on other research in the future.
“I would like to get students more involved in this aspect of research,” she said.
After being diagnosed with adult onset type 1 diabetes in 2007 and receiving dietary advice that didn’t sound right for her, Pogozelski began looking into a diet better suited to her. As a biochemist, she wanted to understand the science behind various diets.
She began work on her paper with Feinman in 2013. Their findings were summarized in 12 points of evidence that supported a carbohydrate-restriction approach. According to Pogozelski, studies have shown that carbohydrate restriction can aide in the management of blood glucose levels for many with type 2 diabetes, reducing or nullifying the need for medication.
While this approach has been shown to be successful, there is no one size fits all approach to proper diet and diabetes management. “I really try not to give advice,” Pogozelski said. “My goal is to give people information that they can use to help them make their own decisions.”
The paper focuses on carbohydrate restriction as a way of combating diabetes––most significantly type 2. As of 2010, diabetes remains the seventh leading cause of death in the United States. As obesity rates have doubled over the past 20 years, so has the number of type 2 diabetics. The authors recommend that health agencies conduct hearings on a carbohydrate-restriction approach to treating diabetes.
The topic of nutrition can be addressed from a variety of viewpoints and falls directly in line with Geneseo’s focus on interdisciplinary topics.
“I really would like to be part of bringing these things into other classes or working with people in other disciplines to work on these initiatives,” Pogozelski said.

Pogozelski will be giving a TEDx Talk on April 4 on the topic “Changing Paradigms in Nutrition.” She will also be speaking during the all-college hour on April 8 about what research is saying about carbohydrates and fats, with more of a focus on connecting to a student audience.

Insulin Resistance Linked To Cholesterol Medications



Roughly 30 million Americans live with diabetes and if you are one of those people, then a new study regarding statins could be important.
Statins are cholesterol medication, yes, but the new study indicates that statins could introduce insulin resistance.
Dr. Ronald Goldberg, the director of the Lipid Disorder Clinic and associate director of the Diabetes Research Institute at the University of Miami, explains that the studies “show evidence that statins increased insulin resistance, and that the people who developed diabetes appeared to have less ability to respond to the insulin resistance by making more insulin.”
Obviously, this can be a problem.
Baylor College of Medicine professor, Dr. Alan Garber, also comments that statin users who have blood sugar levels that are beginning to creep up can probably stave off further development of type 2 diabetes through diet and exercise.
 The editor of the journal Diabetes, Obesity and Metabolism goes on to say, “The solution is lifestyle modification with diet and exercise. You should do that for high cholesterol, anyway. There’s no simple cure-all for all the risk factors in life. It’s clear that a single pill isn’t going to supplant individual self-management. Patients have to learn to take care of themselves.”
This suggests, then, that diabetics do not necessarily need to avoid statins, only that extra consideration should be taken when prescribing statins.
Former American Heart Association president and Professor of Medicine at University of Colorado School of Medicine, Dr. Robert Eckel, puts it this way: “It’s a good news-bad news scenario. Although there is convincing evidence that patients on statins are at increased risk of new-onset diabetes, the benefit accrued is reducing risks of heart attack, stroke, and fatal heart disease trumps the effects of being new onset diabetics

Vegetables suitable for Diabetics


•           Dr Hector Perera

It is very difficult to design a diet chart for diabetes patients. This is because all the fruits and vegetables are not good for them. There are many vegetables that may not seem starchy but they can spike your blood sugar levels. For example, potato is a vegetable that is easily identified as starchy. But could you ever guess that vegetables like beetroot or carrot cannot be a part of diet for diabetic patients? Eating the right kind of foods when suffering from diabetes can actually help you manage your condition. And the reverse of this statement is also true. Diabetics must avoid vegetables that have high sugar content. All root vegetables like carrots, turnips and even too many onions are forbidden in the diet for diabetes but not cooked, then they release the sugar slowly. However, there are set of vegetables that diabetics can feast upon without any apprehensions. These vegetables are included in the diet of diabetics because of their high fibre content. Also, the sugar content of these vegetables is not high that it will affect the blood sugar levels. Some vegetables like bitter gourd can actually help you manage your diabetes very well. Even the vegetables from the gourd family are very good foods for diabetes control. Here are some of the best vegetables for diabetics to enjoy in their meal.

Karawila
Bitter melon, or Goya or “Karawila” is commonly used for beneficial health reasons. Bitter melon is also referred to as bitter gourd, Karela, or Balsam Pear. The melon has an extremely bitter taste, but it is a helpful food. Bitter melon is commonly added to stir-fry, or may be enjoyed stuffed like stuffed “Malu miris”. It may also be added to the diet as a supplement. In order to receive the full health benefits, find and cook the melon regularly.
Bitter gourd thrives in hot and humid climates, so are commonly found in Asian countries like in Sri Lanka and also in South America.
Help lower dangerous cholesterol levels with bitter melon. Reducing cholesterol significantly reduces heart attack, heart disease, and stroke. The added benefit is that bitter melon is completely natural in working with the body to prevent these health risks. High cholesterol can only be diagnosed with a blood test.
This is a very important benefit for those who have Type II Diabetes. Carbohydrates turn to sugar, and bitter melon metabolizes the sugars. Faster metabolism of carbohydrates means that less fat is stored in the body which leads to weight loss, and healthy weight maintenance. Proper carbohydrate digestion also aids in muscle growth and development.

How does it work?
Bitter melon contains a chemical that acts like insulin to help reduce blood sugar levels. Insulin regular is used with a proper diet and exercise program to control high blood sugar in people with diabetes. Controlling high blood sugar helps prevent kidney damage, blindness, nerve problems, loss of limbs, and sexual function problems. Proper control of diabetes may also lessen your risk of a heart attack or stroke.

Fenugreek Leaves
The greens from the fenugreek plant are very useful in controlling diabetes. These mildly bitter greens help lower glucose level in the blood.
The healing properties of fenugreek are quite similar to cinnamon; due to its anti-diabetic elements, this spice is capable of controlling glucose metabolism. It also helps in preventing and treating of Type II diabetes.
Functioning in a similar manner to the well-known anti-diabetic medicine glibenclamide, this herb balances blood glucose homeostasis and reduces cellular insulin resistance. According to medical researchers, fenugreek lowers blood sugar levels of Type II diabetics by a huge percentage.
This herb, fenugreek, has a strong balancing effect on blood lipid levels and lowers the hazards of atherosclerosis. In case of diabetes, it has substantiated an outstanding ability to reduce LDL levels, triglycerides and cholesterol. One more important characteristic of this spice is its power to reduce platelet creation, which, in turn, lowers the chances of sudden blood clotting in your heart; the common consequences being strokes and massive heart attacks. Like most of the other spices, fenugreek too contains strong antioxidants. It is also beneficial in protecting other internally generated antioxidants from any kind of damage. It also shields the body against a variety of other chronic diseases.
Lady's Finger also called Okra
The gooey liquid that comes out when you cut okra helps regulate blood sugar. So, soak sliced okra in a glass of water and drink it early in the morning. Okra is very low in calories and dense with nutrients. It is high in fibre, vitamin A, C, and folate content.
It is also a good source of the B vitamins, vitamin K, calcium, potassium, iron, zinc, and traces of magnesium and manganese.
Okra is one of those few vegetables which have the highest content of phytonutrients and antioxidants such as beta-carotene, xanthin and lutein.


More Health Benefits

Okra is one of the best medicinal vegetable although it is not everyone’s favourite. You may like to try it if you knew about its immense health benefits:
Anaemia: Helps red blood cells production and prevent anaemia.
Anti-Cancer:  The high antioxidants in okra helps protect the immune system against harmful free radicals and prevent mutation of cells.

Asthma:  The high antioxidants and vitamin C content make okra useful for reducing asthmatic attacks.

Bone Strength:  Folate in okra builds strong bones and density, preventing osteoporosis.

Cholesterol:  The soluble fibre helps to lower serum cholesterol, thus also reducing atherosclerosis and the risk of heart diseases.

Constipation:  The rich fibre and mucilaginous (slimy) content in okra pods help increase bulk, bind to toxins and ensure easy bowel movements with its natural laxative properties. Regularly eating okra also reduces the risk of colon cancer.

Diabetes:  It has insulin-like properties that help to reduce blood sugar level.

Gut flora:  The fibre helps improve the population of beneficial bacteria in the gut.
Immune Booster:  The high antioxidants and vitamin C content make okra a good immune booster food that reduce your catching the cough and cold.
Peptic Ulcers: The mucilaginous content provides a temporary coating to the digestive tract and stomach lining while healing the ulcers.
Pregnancy:  The rich folate content in okra can help decrease the incidence of neural tube defects in babies.
Skin Health:  With good bowel movements, skin health will improve. Helps reduce acne, psoriasis and other skin conditions.
Vision Health: Okra contains beta-carotenes (precursor of vitamin A), xanthin and lutein, all antioxidant properties that are helpful for vision health, preventing eye problems like cataract and glaucoma.

Bottle Gourd or “Labu”
 A glass of bottle gourd juice in the morning can help you manage your diabetes much better than taking insulin supplements. Lauki or gourd is one of the well-known vegetables in the market which has wonderful taste. Along with its tastes, it also has variety of health benefits.  There are different variety of gourds in the market with different names such as ghiya, bottle gourd, doodhi, calabash gourd etc. Apparently it is green in its outer surface with a waxy finish. Once you cut it from the middle, a soft spongy appearance that is white in colour will be found. Some people take out the outer surface of gourd and makes pieces of the inner portion.

Bottle gourd contains the 92% water and the remaining is easily digestible fibre. So it is the easily digestive food.  The glucose and sugar related compounds are nearly nil in the bottle gourd. So it the one of the food option for the diabetic patients. Bottle gourd helps to reduce the blood sugar levels. Take the bottle gourd in the daily diet or to make the habit of drinking the bottle gourd juice daily helps a lot to the diabetic patients. It helps reduce the inflammations in the liver and kidneys.

Not forgetting cauliflower and pumpkin also classed as healthy vegetable. With all this list some people must be wondering, to have a pint or two followed by a takeaway such as fish and chips or chicken and chips or hamburgers? Then comes the time for some fags, what do you say? Your comments are welcomed perera6@hotmail.co.uk

Dr Hector Perera

UAE, Saudi Arabia, Egypt among top 10 countries with high diabetes rates

  
JEDDAH — Despite the UAE, Saudi Arabia and Egypt being among the top 10 most prevalent countries for diabetes, the vast majority of those surveyed are still using white sugar as part of their daily diet, a Nielsen study commissioned by Splenda low calorie sweetener revealed.
Nielsen surveyed 400 diabetics from each of the three countries in order to gain insights into the attitudes of those who live with the condition and the caregivers who look after them. While some of the findings were encouraging, many believe that ‘living for today’ and ‘being carefree’ is preferable to changing their lifestyles.
White sugar was consumed at least once a day by more than half of those in Saudi Arabia & Egypt and by one third of those in UAE.
“We have made huge strides in making people aware of diabetes and made many lives more comfortable and the disease more manageable,” said Dr. Naseeb Al Shibli, General Surgery.  “But as this study shows, we also need to educate people’s minds on the dangers and consequences of ignoring it. Attitudes can be very difficult change but this report is an extremely valuable start. We know where to begin and we can target those who need the most advice.”
A separate report from Life Scan showed that the vast majority of diabetics were either unaware, ‘complacent’ or ‘half-hearted’ in their approach to managing the condition. Dr. Al Shibli believes that there is a long-standing cultural relationship between the Middle East and sugar which has led to a habit that is hard to break.
“Moving away from the traditional sugar-rich meals and sweet hot drinks would make a significant starting point. There are low calorie sugar alternatives which require no extra effort to prepare and are indistinguishable from sugar itself.”
The Nielsen findings further showed that while advice from doctors is the number one priority for managing the disease, family support provides the ongoing care that makes the greatest daily difference. Whether the diabetics were ‘complacent’, ‘half-hearted’ or ‘committed’ in managing their diabetes, the household’s mother was the primary caregiver across all three countries.
“Family members play an essential role in the well-being of their diabetic relatives and decision-making in their diet. It is vital that all of those care givers also receive the maximum support,” said Dr. Al Shibli.

“Every diabetes sufferer is an individual who needs unique care,” he added. “But there are certain criteria which we all need to monitor as starting points. We could be more prone to diabetes if we are over 40 years of age, have a family history of diabetes, are overweight, have a poor diet, smoke, do little exercise and have high blood pressure. These are some of the preliminary signs and if any of those match, it is always a good option to get screened for diabetes at your nearest clinic. Diabetes can’t be cured, but it can be managed to live a full life.” — SG