Beat it

Beat it

Auberle to run drop-in service center Downtown for youths leaving foster care

September 15, 2015 12:00 AM

By Molly Born / Pittsburgh Post-Gazette
The Allegheny County Department of Human Services has selected social services agency Auberle to run a drop-in center for young adults who are homeless or transitioning from foster care to independent living.
The “412 Youth Zone” is set to open in December on two floors of the Wood Street Commons building in Downtown Pittsburgh. JoAnn Hannah, manager for the human services transitions program, said the department’s independent living service grant, which receives state and federal funding, paid for the one-year, $2 million contract with the McKeesport nonprofit.
County officials said the project is the culmination of a department-commissioned study that estimated about 240 unaccompanied youths — homeless young adults between the ages of 18-24 — live in Allegheny County and work already underway by human services staff to help young adults move from foster care to independent living.
Kathy McCauley, the consultant who compiled the study, suggested a full-time drop-in center among her recommendations. The county chose Auberle from among eight plans it received after issuing a request for proposals for such a program in February.
“This population of young people has always been very important to Auberle,” John Lydon, the agency’s CEO, said in an interview. By creating a “one-stop shop,” he said, “we felt we could make a difference.”
Young adults ages 16 to 24 who are currently in, or recently left, the county’s foster care system are expected to be the facility’s primary users, Ms. Hannah said.
“I’m excited about the potential to serve as many young people as we possibly can,” she said. “… This has been a long time coming — and it has to be that way, and I understand that — but I’m really raring to go.”
The 13,000-square-foot center will include a common area that can fit 400 people and be adapted into smaller spaces; a fitness room; showers; a laundry facility and short-term child care. Visitors can work toward their GED with the full-time instructor on site, or earn a food handlers’ license in the full industrial kitchen, Ms. Hannah said. At least one registered nurse will be on site.
Thirty-five Auberle employees will work at the center, and the agency’s 27 partners will assign staff there on varying schedules, Mr. Lydon said.
Some of the center’s features started as suggestions from members of the human services youth advisory board, which includes young adults in the independent living program. Some of those young people named the facility and will play a role in its design. Construction is set to begin in the coming weeks.
About $400,000 of the grant — plus funds from the building’s owner — will pay for renovations, and $1.6 million will go toward running the center and the program of the same name.
Mr. Lydon said starting next month, Auberle will receive all referrals from the county for young people in this age group, discuss their goals and “connect them to services that will make their plan a success.” Before, other agencies or county staff did this.

Molly Born:, 412-263-1944 or on Twitter @molly_born. Mary Niederberger contributed.

Minneapolis woman goes from foster care to Harvard Law School

SEPTEMBER 20, 2015 — 11:50AM

Gail Rosenblum@GROSENBLUM
Anoka County Judge Steve Askew has been retired for six years. He spends his summers at the lake with wife, Carol, a retired social worker. He enjoys his three grandsons and cares for his parents, now in their 90s.
And once in a while, the 70-year-old judge reflects on his 25 years on the bench and wonders — like many do with a front-row seat to human pain and potential — what happened to those who stood before him.
“Most of what you hear about past cases is those who have not done so well,” Askew said before correcting himself. “Actually, you mostly hear nothing at all about old cases, so I like to hope for the best.”
So he was deeply moved — and quite surprised — when an outpouring of gratitude and validation arrived recently in his inbox.
“Judge Askew,” the writer began. “This e-mail will likely seem to be quite out of the blue to you, and I don’t even really know where to start.”
Esther Mulder was 7 months old when she began her relationship with the Minnesota foster care system. An only child born in Florida, Mulder and her mother, who suffers from mental health challenges, moved here to be near relatives.
Soon after their arrival, Mulder began a back-and-forth shuttle from her mother’s apartment to respite care with a foster family in Coon Rapids who could offer her more stability.
“It was predictable there,” said 29-year-old Mulder, recalling a serene moment of normalcy when her foster mother washed her hair with cream rinse.
Still, Mulder struggled in school. When she mentioned her dream of college, a well-meaning social worker counseled her to “be realisti c.”
In sixth grade, Mulder was placed at St. Joseph’s Home for Children, where smaller classes got her back on track. “I began to understand math,” she said. “I was an avid reader. That changed what school was for me.”
Something else changed. In 1997, the middle-schooler appeared for the first time before an Anoka County judge who would review her care and living preferences twice annually as a ward of the state. Because the county valued consistency, Mulder was assigned to the same judge for seven years.
“I appeared before you as a juvenile in permanent foster care in Anoka County,” Mulder continued in her e-mail to Askew. “I don’t expect you to remember me, but I wanted to write to you to say thank you, all those years ago, for making the decisions that you did in my case.”
The judge did remember her.
“She was quiet, thoughtful and really made the most of the opportunities,” he said from his cabin. “She really did well in foster care. Her mother was a decent person, but had long-term issues. We did what we could to support her.”
One of his most gracious efforts, she said, was to remind the wounded teenager to not “cast away lightly” her relationship with her mother.
Found her focus
By the time she entered Blaine High School, Mulder, who was again living in foster care, had shed self-doubt about college and was supremely focused.
She played viola in the orchestra, joined the swimming and diving teams, beat all the boys in her gym class in push-ups and became passionate about English and social studies.
She worked full-time at a Dairy Queen and began her college countdown by taking college tours.
“I knew I had to get good grades — and scholarships,” she said.
Few knew that she was a ward of the state. “I didn’t want my teachers to know,” she said. “I knew they’d lower their expectations.”
Askew never lowered his. Twice a year, the judge and the teenager met in a small courtroom. He was, Mulder said, “a stable and fair presence.” When she was 18, he extended her ward-of-the-state status until she began college, “to make sure I wasn’t thrown into the world without any lifelines.”
Mulder attended Gustavus Adolphus College on a full-ride scholarship, majoring in political science. She graduated in 2008 with honors. She joined Teach for America and taught middle-school social studies and coached swimming for three years in Florida.
“Growing up,” she said, “prepared me well for doing difficult things.”
While she loved the public service nature of teaching at-risk children, she began to wonder if her skill set was a better fit for law. “I could serve the same community,” she said, “but in a different way.”
She took the LSAT and applied to Harvard Law School on a whim. When an admissions officer called her, she thought it was a joke. “I think I said some audacious things to the interviewer.”
Nonetheless, she was accepted, logging more than 2,000 hours of pro bono legal work during her law school studies.
A homecoming
When she graduated from Harvard in May 2014, she moved back to Minnesota to take a job with the Hennepin County public defender’s office.
“I love my clients,” Mulder said recently over coffee in downtown Minneapolis, not far from her office. “There are some heartbreaking stories. But I identify with underdogs. I was an underdog.”
She and her mother, who lives in a supervised living arrangement, talk on a regular basis. Mulder visits her mom every other Saturday.
Mulder plays in a community orchestra, swims, runs and travels.
This summer, one piece of unfinished business was tied up when Mulder approached a veteran public defender in her office. Bryan J. Leary once practiced law in Anoka County. Might he know how Mulder could contact the retired judge? Leary provided Mulder with Askew’s e-mail address.
The thoughtful judge and the passionate public defender plan to meet for coffee soon. They have a lot to talk about.
“You try and make the best decision you can at the moment,” Askew said. “There’s always a few that haunt you. If the calluses get too deep, you’re probably not doing a very good job.”
News of Mulder’s success “was a real uplifting moment on a sleepy summer afternoon,” he said. “It’s always good to hear that something went this well.”
But he insists that he was among many who saw great potential in the young woman.
“She did this because of who she is,” he said.
Then he laughed.
“She’s got spiffier credentials now than I do.”

Gail Rosenblum writes two to three columns a week on people, social issues, trends, and the complexities of human relationships. 612-673-7350 @grosenblum

High protein diets improve blood sugar control in diabetics, do not affect kidneys

By: Emily Lunardo

A recent study, published in the journal Diabetologia, found high protein diets improve blood sugar control in diabetics without negatively affecting the kidneys. Previous research has shown positive and negative effects of a high protein diet for diabetics. For the latest findings, researchers used two high-protein diets with the same amount of calories, but one with animal-based protein and the other with plant-based protein. Researchers wanted to compare the effects the diets had on metabolism function and liver fat.
For the research 37 patients – both male and female – with type-2 diabetes either received the high protein diet with animal-based protein or a high protein diet with plant-based protein. Participants consumed these diets for the course of six weeks. Prior to the start of the diet, and once again at the end, various tests were administered to measure parameters.
Both groups saw improvements in their liver enzymes and liver fat was reduced as well. Insulin resistance only improved in the group which ate the animal protein diet, but the plant protein group had a significant reduction in plasma creatinine – this means their kidney function improved. The animal protein group did not see improvements in their kidney function.
Authors of the study concluded, “In diabetic subjects, the six-week high-protein diet leads to an improvement in glucose metabolism and decrease in liver fat independently from the protein source. The high-protein diet has no adverse effects on kidney parameters, moreover the kidney function actually improved in the plant protein group.”
The authors suggest larger studies need to be conducted in order to further prove their findings.

Global Diabetes Rates Are Rising as Obesity Spreads

Still, there were some questions about the data. The drug did not reduce the risk of heart attacks over all by a statistically significant amount, and it actually seemed to raise the risk of stroke, though not by a statistically significant amount.
So how did it reduce deaths from cardiovascular causes? One way, not necessarily expected, was by reducing deaths from heart failure, a condition in which the heart cannot pump enough blood.
Lilly and Boehringer announced last month that the drug had decreased cardiovascular problems among trial participants. But the data was not revealed until Thursday, when it was presented in Stockholm at the annual meeting of the European Association for the Study of Diabetes and alsopublished by The New England Journal of Medicine.
Tim Anderson, pharmaceutical analyst at Sanford C. Bernstein & Company, tripled his estimate of Jardiance sales in 2020 to $2.7 billion. Sales of two other drugs in the same class, known as SGLT2 inhibitors, might also increase even though there is no data yet showing that they decrease cardiovascular risk.
Those drugs are Invokana from Johnson & Johnson and Farxiga from AstraZeneca. The findings could hurt sales of some other types of diabetes drugs, including the Merck blockbuster Januvia.
Lilly’s shares rose nearly 7 percent Thursday, to $89.98. Boehringer is privately held.
The Food and Drug Administration approves diabetes drugs if they reduce blood sugar levels. It does not require that the drugs be shown to reduce the risks of the complications of high blood sugar, such as heart attacks, even though that is the real goal of treatment.
“The F.D.A. has given diabetes drugs a bye,” said Dr. David M. Nathan, director of the diabetes center at Massachusetts General Hospital. That is because some studies started decades ago suggested that controlling blood sugar did lower the risk of certain complications, like blindness and kidney disease.
But whether the drugs reduce heart attacks and other cardiovascular problems has been less clear. There was some evidence of benefit in the very long run shown in those early studies. But there have also been counterexamples, including one trial several years ago in which more intensive glucose control raised the risk of death.
In 2007, an analysis by Dr. Nissen suggested that the widely used diabetes drug Avandia increased the risk of heart attacks. While the finding was disputed, the F.D.A. began requiring developers of new diabetes drugs to conduct large trials to rule out the possibility that their drugs increased cardiovascular risk.
Several of those large studies have now been conducted, including one for Merck’s Januvia, and the drugs have generally been found not to raise cardiovascular risk. But they did not decrease the risks, either — until this trial with Jardiance.
The study, paid for by Lilly and Boehringer, involved 7,000 people with Type 2 diabetes who already had cardiovascular disease, so they were at very high risk of heart attacks and strokes. They were randomly assigned to get either Jardiance, which is known generically as empagliflozin, or a placebo. The patients were allowed to take other diabetes drugs as well.
After a median follow-up of about three years, about 10.5 percent of those getting Jardiance had suffered a heart attack or a stroke, or had died from cardiovascular causes, compared with 12.1 percent of those getting a placebo. That works out to about a 14 percent relative reduction in risk.
About 3.7 percent of those getting the drug died from cardiovascular causes compared with 5.9 percent of those taking the placebo pill, a relative risk reduction of 38 percent. There was also a 32 percent reduction of risk of death from all causes and a reduction of 35 percent for hospitalization for heart failure.
The authors of the study do not think Jardiance’s effect comes from its ability to reduce blood sugar, but perhaps from its ability to reduceblood pressure, weight and arterial stiffness.
Dr. Bernard Zinman, director of the diabetes center at Mount Sinai Hospital in Toronto and the principal investigator in the trial, said the results were particularly impressive because most of the patients were already taking statins and blood pressure drugs to reduce their cardiovascular risks. Dr. Zinman has been a consultant to Lilly and Boehringer.
Still, he and other experts stopped short of saying that Jardiance should now be the treatment of choice, though that might be looked at by committees that write guidelines. Most important, some experts said, the results of the study might not apply to the majority of people with Type 2 diabetes, who have a far lower risk of cardiovascular problems than the people in the trial.
Jardiance and other SGLT2 inhibitors, which work by causing sugar to be excreted in urine, have side effects like increased urinary tract and genital infections. Recently, the F.D.A. expressed concerns that one or all of those drugs might cause bone fractures and a dangerousacid buildup in the blood. In the Jardiance trial, however, those problems were not seen.
Jardiance, a daily pill, costs about $350 a month, according to the website GoodRx.
The results could bolster support for the F.D.A.’s policy of requiring large cardiovascular studies that aim to rule out risks for new diabetes drugs. Critics say these costly trials are unnecessary and deter companies from developing drugs for the 29 million Americans with diabetes.
One critic, Dr. Robert E. Ratner, chief scientific and medical officer for the American Diabetes Association, said he was not dissuaded. He said companies wanting to prove that their drugs reduce heart risk “have an intrinsic motive for pursuing such studies, and they will occur on their own without F.D.A. mandate.”

But Dr. Ratner said it was unfair and wasteful to single out diabetes for studies just to prove the absence of risk, without any initial reason to be concerned. He said that to date, 138,000 patients had been enrolled in such trials at a cost of at least $2 billion.

Jardiance, a Diabetes Drug, Cut Cardiovascular Deaths by 38%, Study Says


For the first time, a widely used modern diabetesdrug has been shown to reduce deaths from cardiovascular disease, a long-sought goal of treatment, researchers announced on Thursday.
In a clinical trial, the drug — Jardiance, sold jointly by Eli Lilly and Boehringer Ingelheim — reduced the overall risk of having a heart attack or stroke, or of dying from cardiovascular causes, by 14 percent. Looking only at cardiovascular deaths, the reduction was 38 percent.
“There are very few therapies we have in cardiovascular medicine that have ever shown a one-third reduction in the risk of cardiovascular death,” said Dr. Steven E. Nissen, chairman of cardiovascular medicine at the Cleveland Clinic, who was not involved in the study.

Because cardiovascular disease is the leading cause of death for people with diabetes, he said, reducing that rate “by 38 percent is a landmark result.”

Study Finds Link Between Diabetes, Napping

Research doesn’t prove cause and effect
The researchers say their findings suggest excessive sleepiness and long napping during the day may be a warning signal of Type 2 diabetes

STOCKHOLM—Daytime drowsiness and taking long naps during the day was associated with an increased prevalence of Type 2 diabetes, according to a review of past studies.
Researchers at the University of Tokyo reviewed 10 studies including a total of more than 260,000 individuals, looking for links between daytime sleepiness or napping and the risk of Type 2 diabetes.
The doctors found that those who felt very sleepy during the day had a 56% higher risk of being diabetic than those who didn’t, while those who took naps of 60 minutes or more had a 46% higher risk of having the condition than those who took no or smaller naps.
The study, to be presented at the European Association for the Study of Diabetes conference in Stockholm on Friday, shows an association between the two conditions but doesn’t prove cause and effect. Still, researchers say their findings suggest excessive sleepiness and long napping during the day may be a warning signal of Type 2 diabetes.
People who experience these conditions should see a doctor to have their symptoms evaluated, said Dr. Tomohide Yamada, a researcher at the department of diabetes and metabolic diseases at the University of Tokyo in Japan.
Dr. Yamada noted the possibility of reverse causality, meaning people who are already suffering from bad health may be more inclined to feel sleepy or take longer daytime naps.
The analysis showed there was no adverse link between short naps of about 40 minutes a day and Type 2 diabetes. Previous studies have found beneficial health effects of taking naps of 30 minutes or less a day including increased alertness and improved motor skills.
Diabetes is a condition where the body is unable to effectively break down blood sugar. It affects 387 million people world-wide and can lead to heart disease, kidney failure, blindness and death. Type 2 diabetes is the most common form and happens when the body becomes desensitized to insulin, a naturally occurring hormone that metabolizes sugar.

Authors of the study said excessive sleepiness or daytime napping could have several explanations, including nighttime sleep disturbances such as obstructive sleep apnea, a disorder with one or more pauses in breathing or shallow breaths while sleeping. People suffering from major depression are also more likely to experience bouts of sleepiness or excessive naps. Previous studies have linked both sleep apnea and depression with increased risk of diabetes.

Study Warns that Diabetics Who Smoke Are At A Much Higher Risk For Other health Problems, Including Heart Disease

A fascinating new study says that diabetics who smoke might benefit far greater from quitting smoking than a smoker who is otherwise healthy. The study says that diabetics who smoke have been shown to be at a higher risk for heart disease and other cardiovascular complications.
In fact, the study authors say: “Active smoking is associated with significantly increased risks of total mortality and cardiovascular events among diabetic patients, while smoking cessation was associated with reduced risks compared to current smoking. The findings provide strong evidence for the recommendation of quitting smoking among diabetic patients.”
But it might not be that smoking is necessarily worse for smokers than it is for otherwise healthy adults.
For example, UCSD chief of the division of global health, Dr. Wael Al-Delaimy, comments that part of the problem might have something to do with the care diabetes patients get.

In an e-mail, Al-Delaimy told Reuters: “The physician caring for the diabetes patient might be focusing on cardiovascular risk factors or diabetes complications and diet and weight control while neglecting smoking as another important risk factor.”
Indeed, a diabetic generally has far more immediate health concerns than the habit of smoking, particularly if they are not showing any symptoms of complications. But a person without diabetes who is a smoker might simply get advice from their doctor to quit smoking to improve health.
Al-Delaimy also notes, “If you are a patient suffering from diabetes and smoking cigarettes, or if you know a family member, friend or anyone else who is diabetic and smoking, there is still opportunity to substantially decrease further complications and suffering or even early death by quitting smoking.”

New study about diabetes

Tania Rogers

Christian Hicks lost 40 pounds a few years ago. He stays in shape rollerblading five days a week. He said, "Found myself winded and out of breath and said I am out of shape time to start hitting it now and do something about it."
Christian believes his lifestyle change kept his health from spiraling out of control. "My motto is persistence and patience and you'll get there."
But according to new research, 50 percent of adults have diabetes or pre-diabetes due to diet and inactivity. The study was released by the Journal of the American Medical Association. Endocrinologist Dr. William Kaye says now is the time to take action. "We need to focus on stopping the pre-diabetics going into the diabetes population."
Many of us spend several hours a day sitting at our desks and not moving and in order to improve our health, experts say it's important to exercise, it's as easy as lacing up your shoes and taking a stroll. Dr. Kaye said, "Even if it's before work or after work or half an hour, four times a week, that's considered to be an efficient exercise." He says limit eating junk foods. "The sodas, the candy, the cakes. we live in an environment of abundance of bad options." And watch your weight. "You don't have to become skinny to get the effect of diet, all you have to do is lose five percent your body weight or 10 percent depending on the degree of obesity."
But most of all, Dr. Kaye says keep moving. A way of life Christian hopes to continue. Christian said, "I see a lot of people trying to exercise out here and getting back into shape, hopefully they will keep it up."

Can cabbage help control diabetes?

Debjani Arora 
For a regular person cabbage might not be a top favourite. And there are valid reasons – it’s smelly, it’s unappealing and if not cooked right, can be very tasteless too. But if you are a diabetic or suffering from metabolic syndrome, then cabbage is that one vegetable that should be on your grocery list without fail. Yes, cabbage can do wonders to treat diabetes naturally, and probably get you off medications too (if you are lucky). Did you know okra or ladies finger can also help fight diabetes naturally?
It helps to lose weight: Cabbage is low in calories and high in fibre content, so it becomes an ideal vegetable to choose for diabetics. It is also low on glycemic index with a rank of 10 (anything below 55 is considered low). GI is an indicator of how fast the carbohydrates will raise the blood glucose levels in your blood. A food item with a high GI means it will raise the levels quickly as compared to food with low GI. So bring cabbage to your table as often as you can. Here is a sample diet plan for diabetes to control blood sugar levels.
Controls blood sugar: Cabbage also has a lot of antioxidant and antihyperglycemic properties that make it a medicine for diabetes. In a study done on rats in 2008, cabbage extracts fed to them for 60 days lowered blood sugar levels and also helped to control fluctuations and keep the readings in the safe range. Here are 10 home remedies for diabetes that really work.
Improves kidney functions: Since cabbage can help keep blood sugar level in control, it also helps to maintain the kidney functions. When a diabetic has extremely high blood sugar levels (over 600 mg/dl), the kidneys try to get rid of the extra blood sugar by eliminating it through urine. This leads to excessive loss of body fluids, resulting in dehydration. Dehydration causes the blood to become thicker and further increases the blood sugar levels which makes it difficult for the kidneys to rectify it. This is why diabetics are more prone to kidney failures. Here are five other reasons for kidney damage that you need to know.
How to eat it:
•           A simple way to include cabbage in your diet is to prepare the vegetable as a side dish at least thrice a week.
•           If you dislike the preparation, add cabbage to your dals and soups to reap its benefits.
•           Prepare cabbage juice by chopping the vegetable and blending it on a high speed.
•           Add boiled cabbage to your salads with a dash of salt and lemon.
Image source: Getty Images
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1: Kataya HA, Hamza AA. Red Cabbage (Brassica oleracea) Ameliorates Diabetic Nephropathy in Rats. Evid Based Complement Alternat Med. 2008 Sep;5(3):281-7.doi: 10.1093/ecam/nem029. PubMed PMID: 18830445; PubMed Central PMCID:PMC2529380.

Are diabetics being given diet advice that just makes their problems WORSE?

•           Each day, 400 people in Britain are given a diagnosis of type 2 diabetes
•           Research indicates weight loss may be incredibly effective
•           Yet many are not getting the lifestyle guidance they need
•           Encouraged to eat balanced diet 'applicable to the general population'
•           'Some carbs rapidly turn into glucose in your blood and should be avoided'


There are more than three million people in this country living with type 2 diabetes and a further five million thought to be at risk of developing the disease. Diabetes UK has warned that the cost of treating patients 'could bankrupt the NHS'. In the second part of our series, we reveal the latest thinking on managing the complex condition.
When mother of three Sarah Gibbs was diagnosed with type 2 diabetes in May 2014, a nurse told her that her blood sugar levels were too high, gave her a prescription for medication to help reduce them - 'and that was it'.
Sarah, 42, from Newport, Gwent, went home, read about the complications she was likely to suffer if she couldn't control her blood sugar and panicked. 'I felt my life was finished,' she says.
Increasingly research indicates that the most effective way for people to hold type 2 diabetes in check is for them to lose weight by changing their diet and becoming more active
Each day, 400 people in Britain such as Sarah are given a diagnosis of type 2 diabetes - a disorder where blood sugar levels can become dangerously high unless they are managed effectively.
For the 3.3 million people in this country diagnosed with diabetes, working out how to lead your life with the condition can be bewildering and, as Sarah recognised, getting it wrong can have disastrous implications.
Two out of every three people diagnosed with type 2 diabetes do not manage to keep their blood glucose levels within healthy limits, according to statistics published by the charity Diabetes UK last month. It's as a direct result of this that 200,000 people every year develop severe diabetes-related complications: kidney and heart failure, nerve damage, blindness, heart attacks and strokes.
Yet how do you get that blood sugar control and why are so many people getting it wrong?
Medication can help, but increasingly research indicates that the most effective way for people to hold this disorder in check is for them to lose weight by changing their diet and becoming more active. Yet, as Sarah discovered, many are not getting the lifestyle guidance they need. The urgent need for this is underlined by new statistics from Public Health England showing that eight out of ten people with type 2 diabetes in England are both obese (ie with a BMI of 30 or more) and have unhealthy levels of inactivity.
Furthermore, there is evidence that, far from helping, the advice most frequently offered about diet may actually be making it harder for type 2 diabetics to keep their condition in check.
Type 2 diabetes normally occurs when fat clogs the liver, which regulates the supply of glucose to feed the body, and the pancreas, the tiny gland behind the stomach that produces the hormone insulin that takes glucose out of the blood stream and into cells.
But this fat can be eliminated, enabling normal insulin production to resume, by losing around 15 per cent of body weight (on average 2½ st). This means blood glucose levels return to normal immediately, an effect that lasts at least two years.
'We now know that once people with type 2 diabetes successfully lose weight and go below their personal fat threshold, the diabetes will disappear,' explains Professor Roy Taylor of Newcastle University.
'This knowledge is gold dust to many folk with type 2 diabetes. If I had the disorder, I would do this,' he says.
Guidelines from the National Institute for Health and Care Excellence (Nice), the NHS watchdog, recommend loss of up to 10 per cent of body weight. But the dietary advice on how to get there may do more harm than good, say some experts. According to Nice, anyone with type 2 diabetes should be encouraged to eat 'a healthy, balanced diet that's applicable to the general population' - in other words, meals containing a balance of protein, vegetables and, crucially, plenty of starchy carbohydrates including bread, rice and pasta.
However, some experts now insist that such a diet can actually contribute to type 2 diabetes.
'We know that type 2 diabetes develops when blood glucose rises above a certain level - and whether it's sugar, rice, bread or potatoes, these carbohydrates rapidly turn into glucose in your bloodstream and so should be avoided,' says Dr David Cavan, formerly a consultant physician at Bournemouth Diabetes and Endocrine Centre and now Director of Policy and Programmes at the International Diabetes Federation and author of Reverse Your Diabetes.
It's not just Nice which says type 2 diabetics can continue to eat carbo- hydrates or sugary foods. The charity Diabetes UK reassures visitors to its website ( that having diabetes 'doesn't mean you have to cut sugar out of your diet completely. We all enjoy eating sugary foods occasionally, and there's no problem including them as a treat in a healthy balanced diet'.
However, Dr Aseem Malhotra, consultant clinical associate to the Academy of Royal Colleges, last month challenged the charity to explain why it continues to recommend 'carbo- hydrates known to promote fat storage and hunger' to a group of people most of whom urgently need to lose weight.
He said: 'Given that type 2 diabetes is a condition related to an intolerance to metabolise carbohydrates, it is puzzling why Diabetes UK recommends as part of a "healthy balanced diet" the consumption of plenty of starchy carbohydrates and modest amounts of sugary food and drinks including cakes and biscuits.'
The best long-term intervention for type 2 diabetes, says Dr Cavan, is to restrict carbohydrates by cutting back on sugar and starch and replacing it with non-starchy (green) veg, with some fatty foods such as cheese and full-fat, unsweetened yogurt along with calorie-dense protein.
Nigel Fowler is a living testament of the benefits of this approach. Now 44, he was diagnosed with type 2 diabetes in November 2014 and his blood sugar levels were so high that he needed six injections of insulin a day. Even this didn't stop his blood glucose from swinging chaotically, yet he says: 'I got no advice on diet from the nurse who started me on the injections except that I should continue as normal.
Nigel Fowler, 44, he was diagnosed with type 2 diabetes but got no advice on diet
'In my case, that meant four Weetabix for breakfast, several sandwiches during the day and usually a Bakewell tart in the evening.'
Rather than advising him to change his diet, the nurse put the cake into the calculation to decide how much insulin he'd need.
'That effectively meant that I had to eat it - or I risked having a hypo (when blood sugar becomes dangerously low). It was like hitting my head with a hammer and then taking painkillers for the pain.'
In March this year, property manager Nigel, from Norden near Rochdale, read an article discussing new evidence of the health benefits of low-carb, high-fat diets and decided to reduce the amount of starchy and sugary food in his diet - cutting out bread and cakes and replacing his breakfast cereal with berries and double cream to fill him up for the morning.
'Wow! What a difference,' he says. He has lost a stone since March - but says the real difference is 'the calming of the yo-yo effect on my blood glucose. I've lost the bit of fat around my middle and just feel fitter and generally happier.'
It's an approach that's gaining in popularity. Around 280,000 people now swap tips on the online forum about controlling diabetes with a low-carbohydrate diet. Reading their stories led David Unwin, a Southport GP, to fundamentally change the way he approached diabetes with his patients.
Last year, the journal Diabetologia published a study of 19 patients with type 2 diabetes at Dr Unwin's surgery, who lost an average of 8.65kg (19lb) over seven months on a low-carb, high-fat diet, reducing their blood glucose levels by nearly a quarter.
Later this year, Dr Unwin is set to publish a further study of 69 patients with non-alcoholic fatty liver disease, a precursor of type 2 diabetes as well as heart disease, showing a 46 per cent improvement in liver blood tests, and therefore a reduced risk of high blood glucose levels after an average of 13 months on a low-carb high-fat diet.
Another alternative is a very low calorie diet (VLCD). This was tested in a ground-breaking study carried out by scientists at Newcastle University and published in 2011 in the journal, Diebetologia. All 11 patients in the study reversed type 2 diabetes after an eight-week diet of 600-calorie-per-day liquid sachets of soups and shakes containing essential vitamins and minerals.
As yet it's not available on the NHS, pending a five-year ongoing study, funded by Diabetes UK, to test whether people can undergo such a diet under the supervision of their GP safely and effectively. A key factor is that dieters must stop their diabetic medication before they begin the VLCD, because the combination of drugs and diet could cause their blood glucose levels to plummet to dangerously low levels.
Despite the clear importance of diet to type 2 diabetics, anyone who feels they need weight and lifestyle advice should ask for it - don't presume it will be offered. While some GPs and their specialist diabetes nurses are very good at discussing this with patients, Dr Unwin says others can feel that mentioning weight problems, even obesity, is too personal, even rude.
'Until fairly recently, I was typical of the conventional approach to managing a patient newly diagnosed with type 2 diabetes,' he says. 'I'd warn patients that if they couldn't control their blood sugar with diet, they would have to go on drugs. As to how to lose weight, that wasn't my field so I'd send them to a dietitian.
'Yet I believe a well-informed, motivated doctor can really help people to manage their weight and turn their lives round.'
Why NHS drugs may not work
When the condition cannot be controlled by lifestyle changes alone, the first drug someone with type 2 diabetes is normally offered is metformin. These tablets reduce the amount of glucose released by the liver and make the body's cells more sensitive to insulin.
Yet some people find the drug does not work or they cannot tolerate it, and they need additional or different medication to help keep their blood sugar stable.
There are some effective alternatives that prevent hypos (when blood sugar dips too low) and weight gain. Together, these measures improve diabetes control and the risk of long-term complications, says Tony Barnett, emeritus professor of medicine at the University of Birmingham and Heart of England NHS Foundation Trust.
The first drug someone with type 2 diabetes is normally offered is metformin
Recently published data found that the injectable drug liraglutide, which increases the amount of insulin produced by the body, can help people with type 2 diabetes to lose an average of 6 per cent of their body weight over 56 weeks - as well as controlling glucose levels and reducing the risk of hypos.
Yet guidelines from the National Institute for Health and Care Excellence still recommend older drugs such as sulphonylureas, repaglinide and pioglitazone - which can cause weight gain, hypos and other unpleasant side-effects.
'The cost of these older drugs is between £1 and £3 per month compared to £30 to £35 a month for the newer drugs,' says Professor Roger Gadsby of Warwick Medical School.
'If doctors prescribe the new drugs to every new diabetes patient, the drugs bill for diabetes could increase by around £250 million annually.'
DIY kit that got me back on track
A glucometer is a device you can use to check your blood sugar as often as you want. There are several types costing less than £20 available from chemists.
You test a small drop of blood obtained by pricking the skin with a lancet (sharp blade) and placing it on a disposable strip, which is then inserted into the meter.
Measuring blood sugar levels yourself is 'one of the key skills of successful diabetes management', according to the online diabetes community, It wasn't until she started to use a glucometer that Marie Nimmo, 50, a healthcare worker and mother of two from Galston, Ayrshire, was able to achieve healthy blood sugar levels and overcome her symptoms of fatigue and confusion.
Maria Nimmo bought a meter and testing strips and started to test her blood glucose
Diagnosed in April 2013, she felt 'rotten' - until three months after the diagnosis when she discovered the forum and found 'most members monitored the impact of high carbohydrate meals and activity on their glucose levels on a daily basis'.
She bought a meter and testing strips and started to test her blood glucose before and after meals. 'It gave me a clear idea of the impact of what I ate and different types of activity,' she says.
As a result, she cut down on bread, pasta, potatoes and rice, bought a second- hand exercise bike and lost 2 st (she's now 11 st and 5 ft 7 in).
'Most importantly, my blood glucose levels are normal. I'm not a saint - I'll have treats like everyone else. If I have two slices of cake, as I did for my 50th last week, I'll work off the excess glucose rather than becoming sweaty and irritable because my poor pancreas is having to work too hard,' she says.
Could standing up do more good than hitting the gym?
Dietary change is key to controlling or reversing type 2 diabetes - but it won't work for anyone who continues with a couch potato lifestyle.
And that includes people who exercise vigorously before flopping in front of the computer or TV.
A review of 47 studies, published in the Annals of Internal Medicine this year, revealed that sitting still for more than eight hours in a day raises the risk of type 2 diabetes by 90 per cent. And while there is some benefit in vigorous exercise, it's not enough to cancel out the risks of sitting down for hours on end.
'We need to do something when we're not exercising. We need to find excuses to stand up and move around,' says Dr Aviroop Biswas of the Toronto Rehabilitation Institute in Canada, who carried out the review.
He says take the stairs, not the lift; walk to the shops instead of driving; and carry groceries rather than using a trolley.

Antibiotic Use Tied to Diabetes Risk


Danish researchers have found an association between the use of antibiotics and the development of Type 2 diabetes.
In 2012, the researchers identified 170,504 cases of Type 2 diabetes and matched them with 1,364,008 controls without diabetes. Then they used Danish government databases to check the participants’ antibiotic use over the previous 13 years.
Compared with having filled no prescription for antibiotics, those who filled two to four prescriptions had a 23 percent higher risk for diabetes, and those who filled five or more had a 53 percent higher risk.
The study, in The Journal of Clinical Endocrinology & Metabolism, acknowledges that reverse causation is a possibility — in other words, people who have diabetes or are at risk of developing the disease may take more antibiotics than others. Still, the risk was apparent up to 15 years before a diabetes diagnosis, which argues against this reverse causation.
The scientists suggest that antibiotics may disrupt the gut biota, causing changes in insulin sensitivity and glucose tolerance, which can lead to diabetes.

“In animal studies, antibiotic treatment has been shown to affect glucose and insulin metabolism,” said the lead author, Dr. Kristian Hallundbaek Mikkelsen of the Center for Diabetes Research at Gentofte Hospital in Copenhagen. “What we see in animals may be happening in people, and if so, then there are more good reasons to be strict about antibiotic prescription policy.”

Is the Paleo diet safe for diabetics?

By: Bel Marra Health | Diabetes, Healthy Eating | Monday, September 14, 2015 - 17:00 PM

 Close to four million years ago cavemen roamed the planet and, while every aspect of life has evolved since then, scientists say their Paleo diet could be of benefit to diabetics today.
The Paleo diet has many names – some refer to it as the caveman diet; others call it stone-age diet or hunter-gatherer diet. Whatever the case, it is assumed the diet includes food available to humans prior to the establishment of agriculture. The Paleolithic period was about 2.5 million years ago; around the time humans first started using stone tools.
A caveman did not go hungry. Wild animal, fish, fruits, roots, nuts and eggs were part of the regular diet. Items such as grains, dairy products, salt, sugar and processed oils were not available since humans had not yet begun cultivating plants or domesticating animals.
Is the Paleo diet safe for diabetics?
Nutritional experts say that eating Paleo can remove foods from your diet that can disrupt your blood glucose the most. It can also help people lose weight. For starters, there are not a lot of carbohydrates involved in this diet. One of the benefits of the Paleo diet is that it provides foods that are satisfying and blood sugar balancing at the same time. This means that people feel full and experience fewer cravings. Type-2 diabetes happens when you eat too many carbohydrates/sugars and your body becomes desensitized to insulin. Since eating Paleo eliminates refined sugars, as well as grains that can spike your sugar, it is very effective for diabetics.
Diabetics are often treated with medications. Some increase the release of insulin, others slow down the release of glucose from the liver. There is also medication that suppresses appetite. For many people these remedies come with side effects, yet the Paleo diet does not.
Poor diet and exercise are two big contributors to diabetes, so it makes sense that some sort of diet would be part of the solution. Research has shown that the Paleo diet is more effective for diabetics than most low-fat diets, and can lead to greater fat loss and metabolic improvements. It can also lead to better improvement in blood pressure and kidney function than most other diets.

Effects of the Paleo diet on type-2 diabetics
 Nutritional experts who promote the Paleo diet believe that we are biologically adapted to consume pasture raised meat, fish, seafood, eggs, vegetables, fruits, etc. They do admit that there is one item missing from the diet and that’s calcium. For those who are interested in trying this diet, supplementing with calcium may be important.
What really stands out though, is the effects of the Paleo diet on diabetics. Evidence seems to suggest that this caveman menu is not only safe for those suffering from diabetes but is beneficial, especially for those who don’t respond well to traditional therapies.
A 2009 study reported in Cardiovascular Diabetology outlined the effects of the Paleo diet on type-2 diabetes.  The standard diabetes diet consists of carbohydrates. As mentioned above, the Paleolithic diet is based on lean meat, fish, fruits, vegetables and nuts. Over a three-month period participants consumed either a Paleo diet followed by a diabetes diet or the same two diets in the opposite order. The Paleo diet led to significantly lower blood pressure, weight, body mass index (BMI), triglyceride levels and waist circumference; while high-density lipoprotein values were higher. The study noted a number of improvements in cardiovascular risk factors as well, compared to people on the standard diabetes diet.
Earlier this year, a study was published in the Journal of Clinical Nutrition that focused on the effects of the Paleo diet on diabetics, especially those who suffer from type-2 diabetes. The authors of the study compared diabetics consuming a standard American diet with those consuming the Paleo diet. They measured blood pressure, urine electrolytes, insulin resistance as well as lipid levels. What they discovered was that the diabetics who were on the Paleo diet showed much greater improvements in both insulin control and lipid levels. This means that they had a better ratio of good cholesterol and fat to bad compared to the group on the standard American diet. They also realized the people that were on the Paleo diet experienced a significant improvement in insulin sensitivity, leading them to believe that even a very short time on a Paleo diet would be preferable to an American Diabetes Association diet for insulin control in those with type-2 diabetes.
Another research study published in the European Journal of Clinical Nutrition last April outlined similar results and in October, 2014, Lipids, Health and Disease showed that a Paleo diet improved cardiovascular risk factors which are linked to diabetes.
Is the Paleo diet right for you?
You can see through the Paleo diet and diabetes research that the life of the caveman can still have an influence on us today. The Paleo diet is rich in vitamins and minerals, unprocessed foods and foods that don’t trigger allergic reactions as much as the standard American diet does. People who suffer from diabetes just might benefit from improved glucose control, weight loss and better blood pressure on this diet. It is very important to note that people who have type-1 diabetes – who produce no insulin – would not be able to stop their medications and follow a Paleo diet. Not enough research has been conducted on the effects of the Paleo diet on people with type-1 diabetes.
Since each of us can have a different set of underlying health conditions, it is important to consult a doctor before starting any new diet. If, for example, you have kidney problems or are on certain medications, you may not be able to safely follow the Paleo diet. The caveman menu does include large amounts of “bulky” foods, so anyone with intestinal problems will not be able to handle it comfortably.
People who aren’t sure about making a complete commitment to the diet to manage their diabetes might want to think about including a few aspects into their diet, such as more berries and vegetables and fewer breads.
Paleo diet list for diabetics
 While on the surface you may think it doesn’t sound very extensive, the Paleo diet food list for diabetics does include a lot of variety. Here are some examples of what you can find on a Paleo menu.
•           Meat (beef, pork, lamb, rabbit, sheep, bison, wild boar)
•           Game Meat (Deer, pheasant, moose, elk, duck, wild turkey)
•           Poultry (Chicken, turkey, quail, goose)
•           Fish
•           Eggs (Chicken eggs, duck eggs, goose eggs, quail eggs)
•           Vegetables
•           Fruits
•           Nuts and seeds
•           Mushrooms
While on the Paleo diet you avoid dairy, grains, processed foods and sugars, starches, legumes and alcohol. Some people refer to this as “cleaner eating.”
The subject of Paleo diet and diabetes is getting more attention from nutritionists and dieticians. While it may not be the diet of choice for everyone, the mounting evidence of the effects of the Paleo diet on diabetics means more people are taking notice.
Close to 30 million Americans suffer from diabetes. The North American diet is high in fat and processed and preservative ridden foods. With diet being one of the biggest factors impacting diabetes, the Paleo diet is hard to ignore.

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