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Posts Tagged ‘diabetes’

It was heartening to spy through the mist from our friends Susan and Jean-Michel’s bathroom window in Strasbourg (AlsaceLorraine in NE France) a sea of allotments stretching a hundred yards to the elevated road on the horizon.

Dotted with little sheds and pockets of green (but no sign of anyone working–well it’s winter!)–they at least were proof that vegetables are grown in this part of France.

Heartening in both senses–good news and good for the heart–after several veg-free meals eaten over a weekend in the restaurants of this ancient regional capital.

Meat is big here–the displays of it in butchers’ windows are impressive.

And often it seems little else on the plate.

True there is the chou (white cabbage)in the ubiquitous choucroute (sauerkraut) but that is not a fresh vegetable and it’s true there are potatoes but they are not an option for me.

Even white fish is served with sauerkraut here!

Vous allez manger bien la-bas! [You’ll eat well there!] we were assured enthusiastically by our friend and neighbor, Thierry, an amateur [fan] of good food when he heard we were heading to Strasbourg for the weekend.

Heavy–yes but bee-an!

At a reception in the celebrated Wine Cave Historique des Hospices de Strasbourgthe guide casually mentioned that there is more cadiovasular disease and Type 2 diabetes in this region than any other in France!

In a cave underneath the hospital of Strasbourg great casks of local wine are stored--including the oldest cask of drinkable wine in the world--so they say!

Our host in Strasbourg, Jean-Michel–(who by the way cooked me a delicious omelette for lunch on Saturday!)–said this part of France had the lowest life expectancy.

Cause and effect?

QED!

But it made me think how difficult it is to change ingrained habits….

The people of Alsace are clearly proud of their cuisine.

It reflects centuries of tradition and daily consumption, deeply connected with the customs and rural way of life autrefois (in times gone by).

But “in times gone by” the people (peasants) worked hard all day in the fields and the food they ate in this northern climate stoked their boilers.

Times have changed–but not the way of eating it seems.

Come to think of it a couple of days hard digging at the allotment would take care of at least two plates of choucroute–and there’d be some vegetables to see for the effort too!!

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It was the lead story Wednesday morning on BBC Radio 4’s The Today Programme and headlined in the British broadsheet newspapers.

 

A devastating new report says diabetics in Britain are dying far too early due to poor management of their condition.

This includes not receiving basic diabetic health checks on the NHS,  unhealthy lifestyles and not properly understanding how to take prescribed medication.

The new report urges better education and support for people with diabetes.

Teaching people how to  manage their condition (including exercising and improving one’s diet) reduces the risk of complications.

Education is vital–not just for people with diabetes, but also for friends and loved ones, if they are to provide the necessary support.

 For example,  persuading loved ones to recognise that they are at risk may be problematical:
Fit as a fiddle me–maybe a bit overweight; got to get exercising and cut out the extra chips–going to start tomorrow, honest! Don’t worry about me.
Denial is an easy option and with Type 2 diabetes–not just for the diabetic, but for family and friends–as there are seldom obvious signs and symptoms early on.
With no family history of the condition, for instance, why would you go for a blood test when you feel more or less “on form”?  Why put yourself through the stress?
Well, an estimated 800,000 (!!) Brits have diabetes but DON’T KNOW IT!
You could be one of them.
A simple blood test will tell.
None of this is easy on one’s own.
Family and friends can play a vital role.

I was lucky–I was diagnosed with Type 2, inadvertently one could say, thanks to a friend.

An old schoolmate convinced me to have a blood test for prostate cancer, after he’d been diagnosed with it.

My blood test was clear for cancer–but it turned up higher than normal glucose (sugar) levels in my blood. A second test six months later confirmed the diagnosis of Type 2 diabetes.

In a way I was doubly lucky.

My mother had Type 1 diabetes (injecting) for 30  years; I knew from watching her struggle that I had to take my own predicament seriously.

The support of friends and family is important.

In a recent interview for Diabetes UK‘s Balance Magazine I was asked :

What would you do if you were head of NHS Diabetes Services for a day?

I’d have a day for the partners of people with diabetes. There’s a lot of ignorance around and more people need to learn about the condition.

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In 1981  (30 years ago) The AJCN

The American Journal of Clinical Nutrition

published a paper by Canadian Dr.  David Jenkins  (University of Toronto), which was to have a profound effect on the ability of people living with diabetes to make better choices of what they eat on day to day basis.

It established the Glycemic Index a measure, on the scale of 1 to 100, ranking carbohydrates according to their effect on our blood glucose levels and thus their post-meal impact on a malfunctioning system.

It was followed by the Glycemic Load which is a measure of the impact of the glucose in a single portion of food.

Dr Jenkins is interviewed in the latest newsletter of GI news.

Dr Alan Barclay charts in the same news letter the progress made in studies of GI and GL since 1981 .

GI started a world-wide glucose revolution, he states, as it clearly showed that carbs didn’t affect our blood glucose levels the way we thought they did–freeing people with diabetes from overly restrictive diets.

Despite controversial beginnings, the GI is now widely recognized as a reliable, physiologically based classification of foods according to their postprandial glycemic effect.

I have found the GI and the GL essential guides to everyday eating. Though I now take a pill a day, I credit them with allowing me to control the condition for six years without medication. 

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“Myth versus Fact”

This simple piece from the Los Angeles Times, busting a few myths about diabetes, is worth posting on its own–in full.

Learning about Type 2 diabetes and the risk factors involved can help a person detect the disease early or know what he or she needs to do to minimize their risk. Type 2 diabetes, which used to be called adult-onset diabetes, is becoming more common, especially in children and young adults. Here are common myths associated with Type 2 diabetes:

1. Type 2 diabetes is not a serious disease. 

Because Type 2 diabetes tends to develop slowly over time, many people believe it is not a serious disease. According to the American Diabetes Assn., diabetes kills more people each year than AIDS and breast cancer combined. 

2. Only overweight people develop Type 2 diabetes. 

Though being overweight or obese is a risk factor, it is not the only one. There are other risk factors to consider, such as family history. If you have immediate family members who have developed Type 2 diabetes, you have a greater risk of developing it. 

Ethnicity also plays a role. African Americans, Hispanics and Native Americans are more likely to develop Type 2 diabetes than Caucasians. 

3. There’s only one dangerous kind of diabetes.

Not true. Diabetes refers to a group of diseases — all of which require serious attention — that have in common the body’s inability to properly convert glucose from food into energy, leading to a high level of sugar in the blood. The main types of diabetes include Type 1 (formerly known as juvenile-onset diabetes), Type 2 and gestational (which occurs only during pregnancy). Managing any type of diabetes requires balancing food, physical activity and, if needed, medications.

4. People with diabetes must eat a special diet.

A healthful diet for someone with diabetes is the same as a healthful diet for anyone else. A good meal plan is based on whole-grain foods, lean protein, vegetables and fruit. Such a diet is low in fat (particularly saturated and trans fats), salt and simple sugars. 

5. Only older people develop Type 2 diabetes. Type 2 diabetes used to be an adult disease, developing primarily in people over 40 who were overweight or obese. Sedentary lifestyles, combined with being overweight, have led to an increase in the diagnosis of Type 2 diabetes in children as young as 10. 

If you would like to learn more about diabetes, go to http://www.diabetes.org.

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Testing times…

Our friend Simon–who also has Type 2– emailed:

Why do you not do the early morning thing? (to start with my doc had me finger-pricking morning and evening)… I jot down the count every day, so could easily work out an average. Is that what one should do?
It’s a good question.
I have the hemoglobin A1C test every three months and occasionally the fasting plasma glucose test (FPG). 
Different doctors have different approaches for different patients–makes sense.

Jottings on the test I take every three months:-
The Hemoglobin A1C test measures your average blood sugar in the previous three months to see if it has stayed within a target range.[5-7]

This is an explanation of how the test works and for me is helpful in understanding why it is effective:-

“Your red blood cells contain hemoglobin, which allows cells to transport oxygen to tissues. As a cell ages, the hemoglobin becomes increasingly “glycated”, meaning that more glucose molecules stick to it.

Higher glucose levels in the blood mean higher glycated hemoglobin, which translates into a greater HbA1c reading.”

The level of glycated hemoglobin provides information on the average level of glucose in the body over a 90 to 120 day period.

[You don’t need to fast or prepare for an HbA1c test.]

The Food and Drug Administration (FDA) in the US, has cleared the first over-the-counter test that measures glycated hemoglobin in people with diabetes to help monitor how well they are managing their disease (glycemic control).

Whichever test you take, it’s clear that the most important thing is TO TEST.
Enrico Cagliero, MD, a diabetes researcher and assistant professor of medicine at Harvard Medical School, has recently noted that:
 “If you look at the nationwide data [in the US], it’s sobering–a lot of diabetic patients are missing essential checks.
People with diabetes should know that complications aren’t inevitable.
Unfortunately, we still see a lot of complications, and a lot of those could have been prevented. It’s absolutely essential to get into this preventive mode as soon as possible. It definitely pays down the road.”


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“Good afternoon Ladies and Gentlemen, this is train 127 to Waahshington–train 127 to Waahshington”

En route to Washington from NYC by Amtrak–a three hour journey.

We find the “Quiet Coach” (no loud voices–no cell phone use)–perfect.

Meredith starts to read the in-house magazine, which has a photo of Michelle Obama on the cover looking in radiant health. Her mission is to stem the rise in juvenile obesity.

The theme this month is Health and Wellness–no escape.

Inside Meredith finds a short article written by Dr. Francis Collins, the director of the NIH–the National Institutes of Health–entitled: “Change your life style and save your life”–no escape.

These days you can’t even take a trip in the “quiet coach”  without being exhorted to examine your lifestyle!

Dr.  Collins  writes that shortly before taking up his post, he took advantage of one of the programmes funded  by the NIH and had a DNA scan designed to look at the hereditory risks of disease.

To his surprise the scan revealed he had a risk of Type 2 diabetes.

“The strategy that caught my eye,” he writes, “was an NIH funded Diabetes Prevention Program which found the the combination of increased physical activity and modest weight loss is a highly effective way to lower the risk of Type 2 Diabetes. When trial participants–all with elevated levels of glucose–exercised 2.5 hours a week and lost 7% of their weight on avereage, many were protected from developing diabetes, with preventive benefits lasting at least a decade.”

He decided to act and started working out. In the first six months of his new routine he lost 25 pounds.

“I’ve never felt fitter, ” he says.

“Taking charge of your health by choosing the right foods and the right exercise programme is among the most important investments you can make in your future”–no escape!!

“Ladies and Gentlemen–15 minutes to New Carrolt’n– New Carrolt’n 15 minutes. Twenty-five minutes to Waahshington, 25 minutes to Waahshington–New Carrolt’n, Maryland is next”.

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Diabetes is in my family.

My mother, Molly–who’d be 96 today–died of a diabetes-related heart attack at 9 a.m. on December 2nd 1982, while dressing to go shopping. Perhaps a good way to go–but hard for the rest of us. She was 68.

She developed Type 1 diabetes in the early fifties–the result, we were told, of shock at the sudden death of her own mother at our home in north London. Molly was in her mid-thirties. Diabetes was in her family–her Uncle Harry had it.

Enough was known about the disease by then to allow her another thirty years of life–she would often cite  Drs. Banting and Best (http://nobelprize.org/educational/medicine/insulin/discovery-insulin.html ) as her saviours, for their ground breaking work on insulin (http://en.wikipedia.org/wiki/Insulin).

When she was pregnant with my youngest brother Jack, the doctors at St. Thomas’ Hospital over the Thames from the Houses of Parliament, were uncertain whether to allow the pregnancy to continue. They went ahead–praise the Lord!–and Jack Ellis (http://en.wikipedia.org/wiki/Jack_Ellis_%28actor%29) thrives to this day!

She injected insulin twice a day for the rest of her life without any song and dance. I was in awe.

From time to time she would have what she called a”reaction“.
http://www.emedicinehealth.com/wilderness_diabetic_reaction/article_em.htm

This usually happened as result of a low blood sugar level.

If she hadn’t got her insulin balance quite right–at a cocktail party perhaps (this was the fifties!), she’d start acting strangely, sometimes appearing to be the worse for drink. My father would delve into her handbag for the lump of sugar he knew was there and with some difficulty persuade her to swallow it.

At first it struck us ignorant kids as odd that a person whose body couldn’t absorb sugar normally would swallow some to save her from a coma or worse!

These “reactions” would occasionally occur in the middle of the night–a real danger. Miraculously my father always woke up in time to administer the sugar lump–though a couple of times I remember Ma being taken by ambulance to St. Thomas’ in a comatose state.

Witnessing first hand the damage diabetes could inflict, I needed no persuading to take it seriously when my diagnosis came a dozen years ago.

Ma set a great example. She was steadfast, brave and determined to enjoy life–despite her difficulties.

Molly

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I found this (http://www.diabetes.co.il/) yesterday.

It’s quick, fun and informative.

Excuse me while I get back to the kitchen…!

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I came across this comment today from Gerald Bernstein, MD, director of the diabetes management program at the Diabetes Institute at Beth Israel Medical Center in New York City, explaining why”belly fat” is bad:
“When those fat cells around the belly swamp the organs that play a key role in regulating blood sugar, that fat works to block the action of insulin, which is necessary to lower the blood sugar.
Insulin normally triggers the liver to take up extra blood glucose and store the energy for future use.
But when the liver is submerged in this fat tissue, insulin can’t get it to respond. As a result, blood sugar can accumulate in the bloodstream, where it can damage organs all over your body.”
It reminded me of what Jill Littrell, in a comment a few days ago, said–in scientific terms– about the link between this visceral fat that lies deep inside the abdomen, surrounding the abdominal organs– the liver, kidneys, the pancreas– and the development of Type Two diabetes.
I’m beginning to understand this better.
Whether you are young, middle or–more middle aged (!)–no fat is your friend.

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I like coincidence–the apparent chance conjunction of happenings.

Last night in a long comment on my blog, Jill Littrel, a  clinical psychologist at Georgia State University in Atlanta, talks about the root causes of Type Two Diabetes.

This morning’s Guardian newspaper carries an article (http://www.guardian.co.uk/society/2011/apr/13/obesity-surgery-treats-diabetes) about a study of people who have undergone surgery to remove excess body fat–and how this procedure has stopped the developement of the diabetes in a significant number of cases.

I am still digesting Jill’s piece (so to speak!), which is rich and written in scientific terms that are sometimes a little opaque for the layperson…. (I am going to ask Jill for a less technical version.)

The overall message is clear though: Type-two-ers have an insulin ‘delivery system’ that is faulty–the ‘goods’ (i.e. insulin) are not arriving where they are needed to do the job–to distribute glucose efficiently to the body’s cell system.

In the comment, she explains that there are a number of explanations.

One reason is the effect of excess fat round people’s middles on the body’s ability to self-regulate.

Which takes us to the article in The Guardian….

The theme here is getting rid of fat that is contributing to the breakdown of a healthy ‘delivery’ system.

According to the study, surgery to remove or reduce the fat can be effective in re-tuning the body and stopping the disease in its tracks.

It is easy to see the attraction of such a move.

Problem solved with a quick slice of the knife!

But doesn’t this conveniently sidestep the vexed question of why the person is overweight in the first place? Isn’t this just another ‘band-aid’ solution. How long will it take before the person puts it all back on?

For Jill Littrel the answer is to make lifestyle adjustments–e.g. more exercise, meditation to reduce stress, the use of certain spices like turmeric in cooking (I could add–a little cinnamon sprinkled on your breakfast choice!) which over time will help the body to readjust.

A British Department of Health spokesperson quoted in The Guardian agrees, saying in response to the findings of the study that surgery should only be considered as a last resort once weight-loss schemes and exercise programmes have been tried.

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Presidents John Adams and Thomas Jefferson both died on the same day (as far as we know, NOT of diabetes!)– July 4th, 1826 – 50 years to the day after they both signed of the Declaration of Independence.

I like coincidences!


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