Health for life

I dont keep track of all the designated days for things... and in fact, often, various organizations just randomly make up a day, out of the blue, whenever they want to promote something... (Not necessarily a bad thing, really.)

So, apparently, today is Type 2 Diabetes Alert Day. 

The American Diabetes Association wants to create awareness of the risks a person might have for developing Type 2 Diabetes... by having them answer some basic, simplistic questions. Yeah, pretty basic and simplistic:

• Are you old?
• Are you a man or a woman (because apparently men are more screwed than women)?
• Do you have high blood pressure?
• Did you have gestational diabetes (which should be a big DUH, right)?
• Did you have a mother or father with Type 2 Diabetes (another big DUH)?
• Are you a fat, couch potato? 

Dear American Diabetes Association,  

When I was diagnosed with Type 2 Diabetes, the first thing I did (like any other person newly diagnosed), was to go visit your site. I studied it quite a bit... and gleaned some buzz words like "tight control," and goals of keeping my blood glucose under 180 mg/dL.  

Then I thought to myself... wait a minute? 180 mg/dL is awful close to 200 mg/dL. That sounds... quite dangerous and irresponsible. That cant be right...  

So I googled, more, and more... and even the American Association of Clinical Endocrinologists suggests keeping blood glucose levels under 140 mg/dL, and perably, as close to normal as possible. 

I understand blood glucose goals are individual, and should be consulted with ones doctor, ADA... (Some of us have other illnesses and hurdles that might make tighter blood glucose control difficult.) But you are giving people a very risky, and low MINIMUM hurdle to shoot for, without much other guidance!! WHY???? Please excuse me if I dont immediately reject the theories that you have deep conflicts of interests with big pharmaceutical representatives lining your pockets.  

Now, dear ADA... you claim you dont embrace any particular diet, but say we should ALL just eat healthy as healthy should be considered for ANY person without diabetes, without further explanations... Honestly, ADA, shame on you. We all know thats just veiled talk for telling people they ought to eat a diet made up of 60% carbohydrates, rich in fruit, starchy grains, and vegetables. (Yes, a world in which corn is good for your health.) It sounds charming, and wise... But even to my mind, back then, that was just hogwash. Normal people dont have a BUSTED pancreas... If this were the case, then hey! Everyone, throw your glucose meters, oral medications, and your insulin away. 

So through more research of my own, I found out I could eat following the guidance of my glucose meter, instead. The way it SHOULD be. Oh, imagine that...?! I should eat meals, and use my glucose meter to TEST those meals, to see if they exceed 140 mg/dL! And OMG, instead of just eating whatever because its "healthy..." Wow, what a concept! Im sorry, but oatmeal, for my diabetes, is NOT healthy. Hope Warshaw might lie -- but my glucose meter NEVER will.

Dont get me wrong, ADA... some people DO need meds, as their poor pancreases are too pooped out... But why the hell should I put the BURDEN of my care and how well I do, on just meds and insulin? Requiring more and more meds as time goes on, and more and more insulin... and then, oh no... developing complications I could have delayed, or reduced a risk for? I would be just accelerating the damage, and pancreatic beta cell failure, by willingly keeping myself at 180 mg/dL goals all the time.. when I could help it.

Its not easy, ADA... but why should we lie to people and make them believe it is? You know whats harder? DIALYSIS. NEUROPATHY. AMPUTATIONS.  

Then I thought to myself... "Hey? Who the hell are the American Diabetes Association, anyway? Theyre not even endocrinologists! What THE fructose!"  

Yeah, thats right...  Just a bunch of six figured salaried talking heads for big pharma sponsored researchers.

So, in essence, American Diabetes Association... here is my success story: I went and read your site, and then I did the opposite. 

"Well, my husband is a board certified endocrinologist, and he told me that whenever a Type 2 patient is good, and gets their numbers normalized, that he removes the Type 2 Diabetes diagnosis, and changes it to a Metabolic Syndrome diagnosis, instead, to help them out." -- Misinformed Mrs. Know-It-All.

The woman was very angry at me. How dare I suggest Type 2 Diabetes has no cure. And furthermore, I could go get a gastric bypass surgery, if I wanted. That, for certain, was also a cure. This, of course, was followed by a few "You people will never be like us; you need to stop comparing yourselves to us... You keep trying to act like we are the same, or have it worse than us, or that your disease is just as bad as ours" type of comments. I cant say that I blame her entirely for her misinformed, self righteous attitude. (Okay, I know she was being kind of a bitch. Im just trying to be nice, here.)

This is the every day bread of Type 2 Diabetes awareness. Raising Type 2 Diabetes awareness is not easy. In fact, its one of the most painful things Ive ever had to do in my life. My husband certainly doesnt understand it, sees a redundant theme in it, and wonders why I dont just get out of it... since its obvious I cant change the world. Ive gone to bed crying, on more than a few nights.

The comment above, is of course, ridiculous. If there is a board certified endocrinologist out there, doing this, he needs to have his license revoked. Simple as that. He is doing NO ONE any favors. He is hurting his patients a lot more than he knows. I understand that insurance companies love judging us -- hey why not, the media has done a great job of misinforming the world, and insurance companies get their news just like the rest of us, and want to use that to safeguard their old, mighty dollar -- but the value of a small defense against an insurance company does NOT outweigh the psychological harm and denial you feed into a person by acting like their diagnosis doesnt exist. Would these people dream of telling someone who had AIDS "If youre good, and your labs come back good, Ill change your diagnosis to HIV positive, instead?" Yeah, I dont think so! (Its not entirely a perfect analogy, but you get the idea...)

But people dont GET the permanence of Type 2 Diabetes. Whats worse is that, while we preach day and night that this is an epidemic of epic proportions, our medical establishment does not act like it! (Oh, lots of people are acting like it, dont get me wrong... but its, mostly, the people who want to scam us, and take advantage of us...) If this is such a serious threat, why isnt the American Medical Association, and the American Association of Clinical Endocrinologists, making it a priority to get doctors educated, and prepared, for diagnosing, and empowering patients? Why are they not working hard to give patients the weapons to fight back, and effectively not feel themselves the hopeless victims of this disease? (I know someone out there will claim that they are... but the proof, or lack of proof, is in the pudding, folks.)

• Patients are out there, going undiagnosed, not because they dont regularly see a doctor (though some, undeniably dont...), but because doctors dont know how to recognize the signs of diabetes, or are UNWILLING to mark down a "diabetes diagnosis" in a patient record, thanks to insurance company scheming. More and more Type 2 Diabetes patients are being diagnosed by other medical professionals, such as gynecologists, urologists, dentists, and eye doctors. Often, a patient even gets misdiagnosed based on ridiculously old knowledge, like assuming that an adult could not be a Type 1 Diabetic, instead, leaving the patient vulnerable to Diabetic Ketoacidosis, and Diabetic Coma.  
• Most doctors, especially Primary Care Physicians (or Family Doctors), get a MINIMAL amount of diabetes education in medical school, and NO extended diabetes education throughout their careers. Diabetes information, care, and knowledge is growing about as fast as technological advances are... why should doctors remain in the dark, if we, as patients, cant afford to do so? Some doctors are going by on 20, and 30 years of OLD diabetes education! As a consequence, when a diabetic patient gets diagnosed, thanks to this lack of knowledge and insurance company scheming, patients get denied access to specialists, denied access to certified diabetes educators, denied access to dietitians, denied access to insulin, etc. Doctors, ROUTINELY, give NO information or direction to a newly diagnosed Type 2 Diabetes patient, leaving them vulnerable to whatever might be out there, on the internet. There is something vastly wrong with an insurance company that denies access to a dietitian, or certified diabetes educator, but is happy to approve gastric bypass surgery. In other scenarios, doctors give patients extreme misinformation, such as "STOP eating ALL fruit because they are high in carbs." Ummm, hello, not all fruit is made the same... We need to learn to MANAGE food, not put the fear of God in people.   
• The medical establishment is allowing itself to be ruled by the treatment guidelines of the American Diabetes Association -- an Association with clear conflicts of interest, per a recent study done by the Mount Sinai School of Medicine, and which has been SLOW AS MOLASSES in embracing the future of diabetes tight control, and management. Whats worse, they have GREATLY contributed to diagnoses getting delayed and delayed. This is WRONG and unacceptable. Doctors and Endocrinologists need to be educating the ADA, and not the other way around! 
• Instead, more and more "doctors" and "medical professionals" are taking advantage of the serious need for diabetes patient education, as a door to write books, push supplements, spread their own pseudoscience, and MAKE MONEY. 

 

According to the 2005 CDC report, National Diabetes Fact Sheet (US Centers for Disease Control and Prevention):

"About one in every 400 to 600 children and adolescents has type 1 diabetes."

Thats a lot of children.

To answer the question I posed in my title, a group of researchers in the UK conducted a meta-analysis (a study of studies) of five observational studies that investigated the effect of vitamin D supplementation on the risk of developing type 1 diabetes.¹ Their findings were reported last week in the online edition of the Archives of Disease in Childhood:

"Meta-analysis of data ... showed that the risk of type 1 diabetes was significantly reduced in infants who were supplemented with vitamin D compared to those who were not supplemented."

And ...

"There was also some evidence of a dose-response effect, with those using higher amounts of vitamin D being at lower risk of developing type 1 diabetes."

Unlike the more common type 2 diabetes, type 1 is an auto-immune disease. It develops when the bodys immune system destroys pancreatic beta cells. Beta cells produce the hormone insulin which regulates blood glucose. Without insulin, diabetes results.

Both pancreatic beta cells and immune system cells carry receptors for vitamin D. Future research may shed light on how the vitamin operates among these cells.
________
¹ Vitamin D Supplementation in Early Childhood and Risk of Type 1 Diabetes: a Systematic Review and Meta-analysis

News summary, BBC:
Vitamin D Cuts Risk of Diabetes

New research shows that a Mediterranean-style diet and diets low in available carbohydrates can offer protection against type 2 diabetes. The study is published in Diabetologia, the journal of the European Association for the Study of Diabetes (EASD), and is by Dr Carlo La Vecchia, Mario Negri Institute of Pharmacological Research, Milan, Italy, and colleagues.

The authors studied patients from Greece who are part of the ongoing European Prospective Investigation into Cancer and nutrition (EPIC), led by Dr. Antonia Trichopoulou, from the University of Athens. From a total of 22,295 participants, actively followed up for just over 11 years, 2,330 cases of type 2 diabetes were recorded. To assess dietary habits, all participants completed a questionnaire, and the researchers constructed a 10-point Mediterranean diet score (MDS) and a similar scale to measure the available carbohydrate (or glycaemic load [GL]) of the diet.

People with an MDS of over 6 were 12% less likely to develop diabetes than those with the lowest MDS of 3 or under. Patients with the highest available carbohydrate in their diet were 21% more likely to develop diabetes than those with the lowest. A high MDS combined with low available carbohydrate reduced the chances of developing diabetes by 20% as compared with a diet low in MDS and high in GL.

The authors say: "The role of the Mediterranean diet in weight control is still controversial, and in most studies from Mediterranean countries the adherence to the Mediterranean diet was unrelated to overweight. This suggests that the protection of the Mediterranean diet against diabetes is not through weight control, but through several dietary characteristics of the Mediterranean diet. However, this issue is difficult to address in cohort studies because of the lack of information on weight changes during follow-up that are rarely recorded."

They point out that a particular feature of the Mediterranean diet is the use of extra virgin olive oil which leads to a high ratio of monounsaturated to saturated fatty acids. But again research here has been conflicting. One review of dietary fat and diabetes suggests that replacing saturated and trans fats with unsaturated fats has beneficial effects on insulin sensitivity and is likely to reduce the risk of type 2 diabetes. However, in a randomised trial of high-cardiovascular-risk individuals who were assigned to the Mediterranean diet supplemented with either free extra virgin olive oil or nuts and were compared with individuals on a low-fat diet (comparison group), there was no difference in diabetes occurrence between the two variants of the Mediterranean diet when compared with the comparison group.

Regarding GL, the authors say: "High GL diet leads to rapid rises in blood glucose and insulin levels. The chronically increased insulin demand may eventually result in pancreatic β cell failure and, as a consequence, impaired glucose tolerance and increased insulin resistance, which is a predictor of diabetes. A high dietary GL has also been unfavourably related to glycaemic control in individuals with diabetes."

They conclude: "A low GL diet that also adequately adheres to the principles of the traditional Mediterranean diet may reduce the incidence of type 2 diabetes.

A group of researchers in Spain recently performed a meta-analysis, or a systematic review, of 29 studies that investigated metformins effectiveness when compared to other oral medications, insulin, or dietary changes.

They found metformin used as a single therapy was the best first-line treatment for controlling blood glucose long-term, especially for overweight patients.

Metformin (Brand name: Glucophage) was approved by the FDA for use in type 2 diabetes in December, 1994. A generic form became available in January 2002.

________
For a summary of the study:
Diabetes drug controls blood glucose, cardiac risk

For the study itself:
Published in The Cochrane Library, July 2005 (abstract only, subscription required for full article)
Metformin monotherapy for type 2 diabetes mellitus

"I do what I have to do, so that I can do what I want to do."

Life is not a simple exercise for me. While it just seems to come naturally to some, its just not so, for me. Having a positive state of mind is a continuous choice I have to make, and it is a continuous decision to stop self destructive thoughts in their tracks, and choose to believe the positive mantras that might seem cheesy, or ludicrous to me.

I dont really know why I am like this... and I could psycho-analyze it to death, but Im not sure how helpful that would be. Im pretty sure that some of the hurdles Ive faced (especially in my childhood) have helped me develop a somewhat dim view of the world. Things like childhood obesity, a grim personal appearance (thanks to undiagnosed PCOS), constant exhaustion and mood swings (thanks to undiagnosed Hypothyroidism), uninvested parents and a lack of personal development, etc.

I felt so alone most of my childhood, and so inadequate, that I spent it trying to pursue instant gratification. In my teen years, eating and TV became my sole companions and comforts, while my family was mostly off in their own world. Its still like this today, you know. I dont get social phone calls from family, nor so much as a card on a birthday, or a holiday... and quite frankly, I dont remember the last time I got anything at all in the mail, from them, or even a social phone call. You can see why a child would try to drown itself with love in the form of whatever one came across -- be it food, or TV, or what have you. Pick your poison.

When one is swimming in loneliness, illness induced mood swings, life induced anxiety, and self loathing... it is extremely hard to have self control of any kind. Whether it be with your rigerator, or with your checkbook, or whatever brings you immediate release. Whats worse is that when you dont have deadlines or commitments of any kind, you can put off desperately needed changes, for as long as possible and tell yourself that tomorrow, you will start; but when someone tells you that you have NO choice, that its the hour zero and you need to buckle down, or else... your life turns into a shiny, red button. Do not press the shiny red button, they say... You must guard yourself to never press the shiny red button. Everyones anticipating, and policing you. Everyone knows.

History Eraser Button

This is what life is like for many of my fellow type 2 diabetics, right now... A shiny red button. Its easy to understand how one gets to that kind of place, and ever soooo hard to help someone get out of that place, see the light, and understand that although life may be smacking us with its behind (like the announcer guy on this Ren and Stimpy video), that we have a choice. We indeed have a choice, and our lives dont automatically go down the drain... Our destinies are not planned for us. We MAKE our own futures; we write them today.

Every November is sort of bittersweet, for me.  In one way, I am very excited -- the unity, love and compassion of many, just pours over in our communities.  It is a huge opportunity to spread a bright blue beacon of awareness across the world. Its almost like Christmas time... Diabetes style.

In another way, Diabetes Awareness Month is very frustrating to me... because it is, in many ways, National Recrimination Month.  I can conspiracy-theory-spin this all the way to the bank, but I wont... Instead, Ill just share a few simple truths with you:

1. Type 2 Diabetes Awareness, largely focuses on telling people that their Diabetes is preventable, and that 80-90% of the cases could have been avoided.  Now, Im curious... did anyone send you a survey, or knock on your door asking you how you got your diabetes? Did they ask you what medications you take, what other illnesses you have, or come over and take blood samples from you? No? Oh. Well... Thats because when people are throwing that statistic around, they are usually mentioning either of these two studies... (Most people, or organizations, WONT EVEN REFERENCE THEM. I had to dig DEEP just to find these two.)
• Diet, Lifestyle, and the Risk of Type 2 Diabetes Mellitus in Women: Frank B. Hu, M.D., JoAnn E. Manson, M.D., Meir J. Stampfer, M.D., Graham Colditz, M.D., Simin Liu, M.D., Caren G. Solomon, M.D., and Walter C. Willett, M.D. N Engl J Med 2001; 345:790-797. September 13, 2001. http://www.nejm.org/doi/full/10.1056/NEJMoa010492#t=articleDiscussion
• Lifestyle Factors and Risk for New-Onset Diabetes: A Population-Based Cohort Study. Jared P. Reis, PhD; Catherine M. Loria, PhD; Paul D. Sorlie, PhD; Yikyung Park, PhD; Albert Hollenbeck, PhD; and Arthur Schatzkin, MD, PhD†. http://www.annals.org/content/155/5/292.abstract 

Now... whats wrong with using this to badger people with diabetes? Well, for starters, these types of studies are OBSERVATIONAL studies.  Meaning a.) they rely largely on demographic data from participants, and not on laboratory studied, measured, clinical data,  b.) they make assumptions on what a healthy diet means, b.) they rely on anecdotal testimony on what participants may claim are their risk markers for a family history, c.) they do not account for racial, or ethnic risk markers, d.) they use limited populations of people that may or may not represent the overall population, in certain circumstances (like ALL nurses, which their occupation already may put STRESS as a HUGE factor in diagnosis.), e.) they dont tell how many of the total participants in the studies were actually overweight or obese, regardless of diabetes development, f.) they control for common things, like metabolic syndrome, but not for other critical factors, such as different illnesses, medications, pollution, toxins, etc., g.) They assume things like high triglycerides, high cholesterol, and high blood pressure, are ALL preventable things (completely ignoring their genetic components), and whats worse... h.) These studies assume that because the rest of the people were able to, somehow, avoid getting Type 2 Diabetes... that those people who did get it, should have been able to avoid it, too! I think that its very evident that we are all UNIQUE, as our fingerprints, and that unless we were able to magically step back in time, and redirect those people who got Type 2 diabetes, we will never truly be able to tell if they could have prevented their illness just by comparing them to other strangers! Thats like saying I could have avoided getting late to work, like Jenny did, without taking into account a.) my car breaking down, b.) people having an accident and blocking the main roadways, c.) tornado warnings being issued, etc., etc. These studies tell you NOTHING about these people other than many of them have a poor diet, like MOST Americans do.  Yet MOST Americans will NOT develop Diabetes.  These studies will NOT tell you anything about the chemistry inside these peoples bodies, or even WHY they might be overeating, or addicted to nicotine, or alcohol.  As discussed in my About Diabetes post, Type 2 Diabetes is a HELL of a lot more complicated than these simplistic studies.  

I am SICK and TIRED of hearing this old line used to badger poor people who got a disease they DIDNT WANT.  NO ONE wants Diabetes.  NO ONE. While I cant say that there arent folks out there, in the world, who love food... or love to pig out, or drink, or smoke, for the sake of doing these things... I can tell you that that is HARDLY an excuse to say everyone else who developed a disease was EXACTLY LIKE THAT. Whats worse are the George Burns of the world who smoked till they were 100, and had NO PROBLEMS ever with lung cancer, or the Manuel Uribes of the world, who weigh in around 1,000 lbs, and have no high blood pressure, no high cholesterol, no triglycerides, and no diabetes. Healthy eating and exercising can benefit EVERYONE, and they are ways to help us EXTEND our chances for good, overall health, and have more energy for life... but they are not a passport to a disease free life.  I recall a next door neighbor, from my childhood... Jogged every day, very fit, and thin... Died at 42, from a sudden heart attack. No family history.  His dad, by contrast, smoked like a chimney ALL HIS LIFE and didnt die until well into his old age, when he actually presented complications. Diet and exercise will NOT 100% prevent anyone from getting Type 2 Diabetes, nor should it be presented that way.  Am I saying we should push the lottery of life? NO.  No way in hell.  But what I AM saying is that telling people they could have avoided giving themselves a disease is a.) Unhelpful, and b.) Not the complete picture of things, and probably, very untruthful.  
2. Awareness focuses on telling people THEY need to take action in getting tested, and finding out that they have this chronic condition. Now, dont get me wrong... I agree with this.  I agree that we need to take action, and we need to get a hold of our health... but I agree with it, mostly because doctors are NOT doing their part.  And this is where awareness fails.  Awareness should not rely on going around, scaring people, telling them they need to get tested. (Many people wont... they dont want to know... hey, its scary... I dont blame them!) Awareness should rely on empowering doctors, urging them to continuously educate themselves about Diabetes, and giving them the tools to help, and empower persons with Diabetes, in a welcoming, and nonjudgmental environment. If this is such a dangerous disease, why arent doctors being sent to more intensive training to learn, and deal with this condition? Why is my PCP so ignorant that she had to go get herself on the ADA website to find out information to "give me," on what to do?! I can do that myself, thank you very much! (And it sure as hell WONT be from the ADA site!) If this is such a dangerous disease, why is a fasting blood glucose, or even an OGTT for those at high risk, NOT part of an annual physical? Why do people need to know that they need that, in order to demand it? Why cant a doctor know? 
Whats worse is HOW a diabetes diagnosis just keeps getting delayed, and delayed because of old, and tacky, ADA guidelines. Patients are not given proper follow up testing, told they have "pre-diabetes," not told they need to make any changes, not erred to any certified diabetes educators, or registered dietitians, and not given tools to monitor their condition.  In short, they are told they have NOTHING to worry about.  To just lose some weight, and they will be fine.  Most of these people are ALREADY diabetic, and dont know it.  By the time the average person gets diagnosed with "Pre-Diabetes," theyve already reached a 40% loss in beta cell function. (http://diabetes.diabetesjournals.org/content/52/1/102.full) By the time they are diagnosed with Type 2, an 80% loss in beta cell function. (http://www.dlife.com/diabetes/type-2/diabetes-causes/garnero_0608)
3. Awareness focuses mainly on telling people with Type 2 Diabetes that they need to take care of themselves, and they need to test.  I couldnt agree more! *clap* *clap* This is the truest thing that anyone can say about Diabetes (of any type), really.  It might seem hard to imagine that I, or anyone else, would have a problem with this... what could possibly be wrong? Well, the problem is similar to telling your spouse they need to go do the grocery shopping (for the week), and giving them only $20 to do it with. Huh? Ill spell it out for you... :)  Insurance companies will NOT HELP people with Type 2 Diabetes; they are of the view, and the assumption that because most of us will not immediately die from high blood sugar, that we do not need to test as often. This means that if you have "Pre-Diabetes," you are likely to be given 0-1 test strips (a day!) to test with; if you have Type 2 (anywhere from 2-4), depending on what medications you use... with 1 generally used for those not on medications, and 4 being used for those on insulin.  If you are a newly diagnosed person with diabetes who does NOT know how their diet affects them, 1 strip isnt going to be of much help.  Much less 0. You have to know at least two parts of a mathematical equation, to be able to come up with a conclusion of some sort (ie, because my fasting blood glucose before a meal was X, and my postprandial was Y, then I know the amount of carbohydrates I had raised me Z glucose points.) But if you only have X, or Y, by themselves, that doesnt tell you much of anything.  And if you have nothing, youre pretty much going on exactly that... nothing. Almost every informational pamphlet out there, on Type 2 Diabetes, urges people to test before and after every meal, at rising, before going to bed, and before or during exercise, and at times of illness.  Now, do the math with me... how many strips does that add to? ... Yeah, a heck of a lot more than 1. Insurance companies claim that the costs of covering these strips is too much, yet... they do not factor in the costs of complications from poorly controlled blood glucose, nor do they seem to want to listen to how much money they could actually save if they actually taught people how to monitor their blood glucose and make meal decisions based on their numbers.
4. Awareness focuses on telling people they need to go talk to a Certified Diabetes Educator, Registered Dietitian, or Endocrinologist.  Yet, for a Type 2 Diabetic, insurance will SELDOM cover these specialists as they deem them unnecessary, and unjustifiable.  Diabetics are left to the care of very many ignorant PCPs, APs, and even RNs, or LNs, with their OWN ideas of what diabetes is.  Whats worse, is that NONE of these people seem to understand that Type 2 Diabetes is a progressive illness in which our bodies will not be able to metabolize carbohydrates properly... We are ALL different in our progression (and the damage in our systems), and telling a person to eat X amount of carbohydrates, at meal times, without instead... letting them learn what number is appropriate for them based on their glucose responses, their overall health feeling, and appropriate medication levels, is setting up MANY people for failure.  This is where the conspiracy theorist in many wakes up, because keeping people on so many carbohydrates with the excuse of "your brain will starve," keeps a lot of diabetics on MANY medications, some very dangerous, bringing about many unnecessary complications at an early period of progression.  Whats worse is that doctors not up to par with the latest in medical research will keep Type 2 Diabetics from access to insulin, sometimes until terrible, and unnecessary damage has occurred, from the complications of high blood glucose. Studies have shown that early insulin intervention is NECESSARY in Type 2 Diabetics. (http://clinical.diabetesjournals.org/content/27/2/60.full)  
5. Awareness focuses on telling Diabetics they need to keep their blood glucose numbers steady. Yet another gem of wisdom here.  I couldnt agree more, again, frankly... "But why is this so wrong, Liz? You must be off your rocker..."  The problem here is that Diabetes advisory organizations do NOT agree on blood glucose target goals, and often use poorly done studies (like the ACCORD study) to justify that diabetics (of all types, without respect to good health), stick to higher blood glucose numbers that can lead to complications later down the road.  Frankly, the American Diabetes Association is the ONLY organization recommending such high blood glucose goals as being at 180 or lower, 2 hours after a meal! Everyone else recommends around 140 mg/dL.  Why are we relying on these people, and not on the American Association of Clinical Endocrinologists, for example? I cant tell you the answer to that one... I can surmise they channel most of the research funding money, and think many of us cant do it. We cant and wont take care of ourselves, to better levels... Its too hard.  While some, may, indeed have health challenges keeping them from tighter goals, I do think those are personal decisions that need to be made with ones medical team, and not as general blanket goals espoused by guideline organizations.  Again, the conspiracy theorist in me, would tell you that because the ADA has a LOT of conflicts of interest with big pharma (and this was documented through a recent Mount Sinai research study), then they get some type of financial, monetary kick back from many of us being on pills.   (http://www.ama-assn.org/amednews/2011/10/24/prsc1025.htm) 
6. By far... what I dislike the most about Type 2 Diabetes, in regard to Diabetes Awareness  Month... is that they NEVER talk about finding a cure.  This hurts me deeply... because NO, diet and exercise wont make this thing go away, and for many of us... like my father... they are not even guarantees of having good control. My father lost his battle to Type 2 Diabetes on 05/05/2003. During the last few years of his life, he endured kidney failure (we dialysed him at home), blindness, neuropathy (both peripheral and autonomic), coronary heart disease, dementia, stroke, and gangrene. He passed away at the operating table, from respiratory failure, as he was awaiting surgery for a leg amputation.  His diabetes simply took a very brittle turn for the worst... Ive never known someone that took better care of themselves.... He was President of the Puerto Rican Olympic Cycling Federation and Skating Federations, as well as President of the Puerto Rican BMX Associations.  A coach, and a huge supporter of active youth, and athletics.  He got me my first BMX bike when I was just 5 years old. 

My father, near diagnosis.

My father, 10+ years after diagnosis

Widely-used fish oil supplements modestly increase amounts of a hormone that is associated with lower risk of diabetes and heart disease, according to a study accepted for publication in The Endocrine Societys Journal of Clinical Endocrinology & Metabolism (JCEM).

Fish oil supplements, also called omega 3 fatty acid capsules, raise levels of adiponectin in the bloodstream. Adiponectin is an important hormone that has beneficial effects on metabolic processes like glucose regulation and the modulation of inflammation. In long-term human studies, higher levels of adiponectin are associated with lower risks of type 2 diabetes and coronary heart disease.

"While prior animal studies found fish oil increased circulating adiponectin, whether similar effects apply in humans is not established," said the studys lead author, Jason Wu, PhD, of the Harvard School of Public Health. "By reviewing evidence from existing randomized clinical trials, we found that fish oil supplementation caused modest increases in adiponectin in the blood of humans."

The meta-analysis reviewed and analyzed results from 14 randomized, placebo-controlled clinical trials. In total, 682 subjects were treated with fish oil, and 641 were given placebos – most commonly olive and sunflower oils. In those taking fish oil, adiponectin levels increased by 0.37 ug/mL. The results also suggested the effect of fish oil on adiponectin differed substantially across the trials, suggesting that fish oil supplementation may have stronger influence on adiponectin in some populations and weaker effects in others.

This is the first study to pool data from previous trials to suggest that fish oil consumption increases adiponectin in humans. The findings quantify the potential impact of fish oil on adiponectin level, and highlight the need to further investigate populations that may particularly benefit from fish oil supplementation.

"Although higher levels of adiponectin in the bloodstream have been linked to lower risk of diabetes and coronary heart disease, whether fish oil influences glucose metabolism and development of type 2 diabetes remains unclear," said Wu. "However, results from our study suggest that higher intake of fish oil may moderately increase blood level of adiponectin, and these results support potential benefits of fish oil consumption on glucose control and fat cell metabolism."

Despite the uncertainty about the effectiveness of fish oil on cardiovascular and metabolic diseases, about 37 percent of adults and 31 percent of children nationwide use omega-3 supplements, according to the 2007 National Health Interview Survey from the National Institutes of Healths National Center for Complementary and Alternative Medicine (NCCAM).

One of my earlier posts (Think Twice Before Feeding Your Child Cows Milk) discussed the possibility that early ingestion of cows milk can increase the risk for type 1 diabetes.

Last month, an article in a journal of the American Chemical Society reviewed the literature for this association:

Relation of Time of Introduction of Cow Milk Protein to an Infant and Risk of Type-1 Diabetes Mellitus, Journal of Proteome Research, April, 2008

Its author, Marcia Goldfarb, described a set of conditions which could explain how pancreatic beta cells are destroyed - leading to type 1 diabetes - when cows milk products are fed to infants:

"The newborn intestine does not have complete "closure" and can pass food antigens. Beta Lactoglobulin could generate antibody to glycodelin undermining T cell regulation of beta cells."

Mechanism

1. Beta-lactoglobulin is a protein present in cows milk, but not human milk. "It has the largest concentration of any whey protein in bovine milk. (Goldfarb)" Glycodelin is a human protein that affects our immune system, regulating our T-cells.
   
   
2. The cow beta-lactoglobulin and the human glycodelin have similar structures, such that an infants body may generate antibodies not just for the foreign beta-lactoglobulin, but also for the endogenous glycodelin.
   
   
3. Type 1 diabetes is thought to be caused by autoimmune destruction of pancreatic beta cells by T-cells. Destruction of glycodelin (by the antibodies generated to destroy the foreign cows milk protein) may allow proliferation of these beta-cell-destroying T-cells.

In a small investigation, Goldfarb indeed found antibodies to beta-lactoglobulin in the serum of children with type 1 diabetes. Those she tested who did not have diabetes did not have these antibodies.
________