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Type 2 Diabetes Rate Declines – Except for Blacks and Hispanics

8 Oct

Over the past two decades, the occurrence of Type 2 diabetes in adults doubled. Now for the first time, according to new research from the Centers For Disease Control, the rate has leveled off – at least for some in the population.

type-2-diabetes-rates-down-websize

The CDC reports that the total number of people living with diabetes increased an average of 0.6 percent annually between 2008 and 2012, to the current 8.3% of adults. Do the math and that’s nearly 21 million people over age 18 with diabetes, in the U.S. alone.

But the rates at which new cases are accumulating have slowed in certain population groups in recent years, a fact also confirmed in a report in the Journal of the American Medical Association (JAMA). The CDC researchers said that the change may be due to another positive trend – the stabilization of obesity rates in the U.S.

“We are still seeing new and existing cases of diabetes going up, but the speed at which they are going up is leveling off,” said Ann Albright, director of the CDC’s Division of Diabetes Translation. “It gives us hope,” she says. “It’s important that we begin to slow down this runaway train.”

Unfortunately, the rate of type 2 diabetes continues to grow among blacks and Hispanics, the elderly, and those without a college education, according to the JAMA report. Those with a high school education or less were more than twice as likely to develop Type 2 diabetes than those who have completed college.

What’s being done to slow the growth of type 2 diabetes?

Figures from the CDC show that nearly 48 percent of non-Hispanic blacks and more than 42 percent of Hispanics are obese, making them more vulnerable to developing type 2 diabetes. The CDC has had great success with its National Diabetes Prevention Program, a lifestyle change program that can cut a person’s risk of type 2 diabetes in half. However, the continued increase in diabetes rates among blacks, Hispanics and people with less than a high school education, reflects the difficulty in reaching these parts of the population with programs like the NDPP.

Albright sad, “You have to begin to look at things like poverty level, access to diabetes prevention services, and making sure that these services are culturally appropriate and easy for people to access.”

Reaching the Hispanic population

The American Diabetes Association says that roughly 13 percent of U.S. Latinos have diabetes, but many of them are undiagnosed. At Alivio Medical center, on the east side of Indianapolis, great strides have been made in educating their Hispanic patients. There, Fridays and Saturdays are known as “diabetes days”, with a focus on diabetes diagnosis and treatment. According to Dr. Alfredo Lopez-Yunez, he’s seen “… an explosion of new diagnoses. We diagnose maybe 10 new patients a month, which is staggering in this relatively small practice. Even more concerning is that we’re diagnosing them at an earlier age.” Dr. Lopez-Yunez said that type 2 diabetes among Latinos in their 20s and 30s would have been unheard of ten or twenty years ago.

“Right now I’m diagnosing people with Type 2 diabetes in their 20s, and this disease is going to be with them forever,” he said. The result of undiagnosed or unmanaged diabetes may be runaway heart disease, kidney disease, an impact on eye health, neuropathies, foot ulcers, and many other health complications.

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A Question From India: Can Charcot Foot Be Cured?

6 Aug charcot foot diabetes

The PA Foot and Ankle Associates blog gets questions from all over the world about foot and ankle health. Today we received this one from Manohar in Bangalore City, India.

“Hello sir. This is Manohar from India, Bangalore City. My father is suffering with charcot joint disease and also a diabetic neuropathy. In the last month his leg is completely swelling. An orthopedic surgeon has suggested amputation. My question is how can it be cured?”

Thanks for your question, Manohar. The doctors at PA Foot and Ankle Associates, and particularly Dr. Thomas Rocchio, are one of the United States’ foremost experts on Charcot foot disorder.

Charcot foot disorder is a side effect of diabetes and is accompanied by diabetic peripheral neuropathy. Diabetes damages blood vessels, causing a decrease in blood flow to the feet. Poor circulation weakens bones, resulting in a disintegration of bones and joints in the foot and ankle. This puts the bones at high risk of fracture. Unfortunately, a diabetic who has nerve damage from DPN has a loss of sensation in their feet, and will be unaware of the bones fracturing. They continue to walk on the foot, causing the joints to eventually collapse and the foot to change shape, most notably to a rocker-bottom appearance. Sharp edges of bone may put pressure on the skin, creating the risk of chronic skin sores. It’s this end result – a combination of bone disintegration and trauma – which is known as Charcot foot disorder. It’s one of the most serious complications of diabetes.

charcot foot diagramcharcot foot disorder

Charcot is a very dangerous disease, as it is in many cases accompanied by bone infection. In highly advanced cases, sometimes amputation is the only realistic treatment. However, it is far from the only treatment.

“There are reconstruction options for many Charcot patients, but there needs to be circulation in the foot for it to heal.”, according to Dr. Rocchio. “Infection can affect the result as well. The remaining reconstructed bone must be free from infection and there must be enough healthy soft tissue to close the incisions. Usually an aggressive external fixation is needed to stabilize the reconstruction. Unfortunately, no complete answer can be given without an exam of the patient.”

Dr. Adam Teichman adds, “There are treatments to stabilize, correct, and prevent Charcot and the breakdown of the foot. For instance, if  ulcers can be healed, infection can be cured, which allows a number of options to save the foot. Amputation is not a therapy, it’s a last resort.”

Read more about Charcot foot disorder

Early diagnosis of Charcot is key to saving the foot, which is why every diabetic should have their feet checked regularly by a podiatrist. Manohar, we’d be happy to examine your father and give you a complete diagnosis and treatment plan if you and he can travel to the States.

What’s the difference between Type 1 and Type 2 Diabetes?

9 Jul

Do you know the difference between the two forms of diabetes – commonly called Type 1 and Type 2?

type 2 diabetes, type 1 diabetes

First, let’s explain what diabetes is. Diabetes Mellitus is a disease which develops when your blood glucose, also known as blood sugar, is consistently too high. Blood glucose is a necessary component of your blood, as it provides the main source of energy for your body’s cells. It’s derived from the food you eat, like bread, pasta, fruit, some vegetables, rice, potatoes, and cereal, and is also manufactured in your liver and in your muscles.

For blood glucose to be used properly by your cells, you need a hormone called insulin, which is manufactured in your pancreas (located between your stomach and your spine). Insulin acts as a kind of escort for the blood glucose, aiding its absorption by your muscle, liver, and fat cells. It’s absolutely necessary for the conversion of glucose into energy. When you eat, your pancreas releases insulin into your bloodstream. The more sugar that enters your bloodstream, the more insulin your pancreas makes.

When your body can’t make enough insulin, or if your cells become resistant to the insulin, the blood glucose can’t find its way into your cells. As a result, the glucose in your blood isn’t turned into energy, and remains in your bloodstream. This is what causes diabetes.

Type 1 diabetes, formerly known as Juvenile Diabetes, typically develops in young people as early as 3 years old, but it can also appear in adults. Type 2 diabetes, formerly known as adult-onset diabetes, most commonly develops in those over 35. However, in the last twenty years, an alarming spike has been seen in children developing the disease.

The differences between Type 1 and Type 2 diabetes

Type 1 diabetes is an autoimmune disease, and is not caused by diet or lifestyle.  It appears in roughly 10% of all of the people with diabetes. In Type 1, your body makes no insulin or has trouble making insulin, because your immune system attacks and destroys the cells in your pancreas which manufacture it. If you are diagnosed with Type 1 diabetes, you’ll have to take insulin for the rest of your life, either through injections or an insulin pump.

Meet Carly Lenett: Type 1 diabetes can’t stop this pre-teen

Type 2 diabetes usually begins with “insulin resistance”, which occurs when your cells have difficulty using insulin to convert glucose into energy. The pancreas is asked to produce more insulin, which at first it does – there is sufficient insulin in the blood. But over time, as the cells become even more resistant to insulin, the pancreas can’t make enough, especially right after meals when blood sugar spikes. Then it becomes impossible to maintain normal blood sugar levels. Insulin resistance can be caused by eating too many foods high in sugar, but also has a strong genetic link. Eighty percent of people with Type 2 diabetes are overweight, according to the Centers For Disease Control and Prevention.

According to the Mayo Clinic, “Symptoms [of Type 1 or Type 2] include increased urination, thirst or dry mouth, hunger, weight loss despite normal or increased eating, blurred vision, frequent or continuous infections and tingling or pain in the hands, feet or both.”

With either form of diabetes, you’ll need to balance nutrition with exercise and if necessary, weight management (but plenty of slim people develop either form of diabetes). It’s also essential that you regularly check your blood sugar multiple times each day. With Type 2, it may not be possible to reduce your blood sugar sufficiently with diet and exercise, and oral medicine, including insulin, may be required.

If you’re diagnosed with either form of diabetes, it’s essential that you regularly see your family physician, an endocrinologist, and a podiatrist. Many symptoms of diabetic injury are seen first in the feet and toes, and if identified early, can be treated and resolved. If undiscovered, diabetic injury can include Charcot Foot, Diabetic Peripheral Neuropathy, and other conditions, which may result in partial or complete amputation of a toe, foot, or leg.

To learn more about controlling your diabetes, see all of our posts, or these:

Add yogurt to your diet to fight diabetes

Fried foods may increase your risk of diabetes

Free smartphone apps for diabetics

How to prevent diabetes

Hidden sugars in your food

Drink More coffee if you have diabetes

Walk off your diabetes

Holiday meal plans for diabetics

Eat a hearty breakfast to help control your diabetes

The symptoms of prediabetes

Cakes and cookies actually make you hungrier

Can too much red meat cause diabetes?

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Yogurt: A Superfood To Fight Type 2 Diabetes?

1 Jul

Good news for dairy lovers.

yogurt type 2 diabetes

A recent study found that those who ate low-fat, fermented dairy products like yogurt, were 24 percent less likely to develop Type 2 diabetes than those who ate little or none.

There’s new evidence which shows that eating fermented dairy products like low-fat yogurt and cottage cheese may help to prevent Type 2 diabetes. The new findings are from the conclusions of an 11 year study of 3,500 men and women in Britain, whose eating and drinking habits were studied in detail.

Even when adjusted for obesity and genetic links for Type 2 diabetes, it was found that those who ate low-fat, fermented dairy products including yogurt and certain cheeses, were 24 percent less likely to develop the disease than the study participants who ate very little or none of the products. Curiously, only low-fat fermented dairy products had any affect – milk and full-fat fermented versions had no impact.

When isolated in the study, low-fat yogurt accounted for a 28 percent reduced risk in developing Type 2 diabetes. If study participants ate low-fat yogurt as a snack instead of salty chips or sugary snacks, their likelihood of developing the disease dropped by a whopping 47 percent.

Why does low-fat yogurt help to prevent Type 2 diabetes?

The study, published in the journal Diabetologia (the journal of the European Association for the Study of Diabetes) , didn’t probe why yogurt and other dairy products had this affect, as it only tracked eating  habits and disease. But the paper’s authors suggest that probiotic bacteria and Vitamin K in yogurt and other fermented dairy products might be at the heart of the matter.

In previous studies, probiotic bacteria have been found to improve lipid profiles and antioxidant levels in patients with type 2 diabetes. Low-fat fermented dairy products are also low energy-dense foods, due to their low fat and high water content. According to the authors, “Studies have shown an independent association of low energy-dense foods with lower fasting insulin levels and the metabolic syndrome and a lower risk of type 2 diabetes.”  Dairy products are also rich in Vitamin D, calcium, magnesium, and beneficial fatty acids.

“At a time when we have a lot of other evidence that consuming high amounts of certain foods, such as added sugars and sugary drinks, is bad for our health, it is very reassuring to have messages about other foods like yogurt and low-fat fermented dairy products that could be good for our health,” said lead author Nita Forouhi, an epidemiologist at the University of Cambridge.

“In public-health terms this equates to 4.5 standard-size portions per week of low-fat fermented dairy products, largely composed of yogurt… and including low-fat unripened cheese such as low-fat cottage cheese,” Forouhi said.

But we should include a note of caution when buying yogurt in American supermarkets: Avoid flavored, pre-packaged yogurts and buy plain, unflavored low-fat yogurt instead. Flavored yogurts frequently contain extraordinary amounts of sugars and fillers, and may have very little actual yogurt. Instead, buy plain yogurt, and add your favorite fruit or seasonings like cinnamon for flavor. We also suggest that you include it in your breakfast, as the high protein in plain yogurt will keep the mid-morning hungries away.

Fried Foods Tied To Increased Risk Of Diabetes

23 Jun

The American Journal of Clinical Nutrition released new research this week, demonstrating a link between eating fried foods and developing Type 2 diabetes and heart disease.

fried foods heart disease diabetes

But the study also suggested that not all frying oils are equally dangerous, or pose the same health risks.

The research team, led by the Harvard School of Public Health’s Department of Nutrition and Epidemiology, analyzed diet and disease data from a group of more than 100,000 women and men. They concluded that those who ate fried foods four to six times a week, saw their risk for developing Type 2 diabetes spike 39%, compared to those who ate fried foods less than once a week. Coronary disease jumped by 23% in the same group.

That level of consumption of fried foods equates to almost one meal of fried food every day. But the real culprit in the study is the widespread use of the kind of oil used to fry foods – partially hydrogenated vegetable oil, the king of trans-fat. Margarine and shortening are hydrogenated vegetable oils as well.

“Trans fat is made by adding hydrogen to vegetable oil through a process called hydrogenation, which makes the oil less likely to spoil. Using trans fats in the manufacturing of foods helps foods stay fresh longer, have a longer shelf life and have a less greasy feel.

Scientists aren’t sure exactly why, but the addition of hydrogen to oil increases your cholesterol more than do other types of fats. It’s thought that adding hydrogen to oil makes the oil more difficult to digest, and your body recognizes trans fats as saturated fats.”  – Mayo Clinic.

Oils with trans-fats are the worst for you

All cooking oils break down when they’re heated to the temperatures required to fry foods. Most importantly, the structure of the fatty acids change. Oils with trans-fats create a high level of oxidative stress in our bodies, which means that we can’t neutralize all of the antioxidants these fats create. As a result, the substances thrown off by the heated oils are stored in our fat tissues and lead to a host of health problems, including Type 2 diabetes and heart disease, as well as high cholesterol, obesity, and hypertension.

Especially troublesome is the fact that restaurants re-use these oils to fry and fry again, which makes them even more dangerous. It’s one of the reasons New York City cracked down on the use of trans-fats in restaurants. The benefit to restaurants is that they last longer and can be reused, but unfortunately, that also makes them toxic for humans.

To be fair, many restaurants have reduced their use of trans-fats in cooking oils, but they’re still prevalent in some chains, and ubiquitous in prepared foods.

A co-author of the study, Leah Cahill, research fellow in nutritional sciences at the Harvard School of Public Health, says that past research hints that cooking oils which are free of trans-fats may pose fewer health risks. But as far as which fried foods you should eat, and which ones you shouldn’t, that’s too complex a question.

If you’re really craving fried chicken tonight, cook it at home in peanut oil (as in this recipe from Bon Appetit), olive oil, or even lard. Any of these cooking oil choices is safer than buying it from a fast food restaurant which uses the same oils over and over again.

But of course, fried chicken is a heavyweight when it comes to calories, regardless of trans-fats or good fats. So if you’re on a weight management program, it’s probably a road you shouldn’t go down at all.

What Your Feet Tell You About Your Health

28 May

foot health

Seems to us that every general physician should ask you to take your socks off. Even if you’ve gone to see your doctor complaining of a chest cold, an inspection of your feet might inform them of the early symptoms of many conditions.

Our feet are farthest from our hearts and spine, so in many cases they’re the first area to indicate problems with the nerves or circulatory disorders. The brain and internal organs receive blood before our toes and feet do, so our appendages are the first to suffer.

Nine health problems which first show up in your feet

1.Always cold feet could be a sign of hypothyroidism, a condition in which your thyroid gland is underperforming. Most common as we approach middle age, hypothyroidism can also cause hair loss, fatigue, weight gain, and depression. A simple blood test ordered by your doctor can confirm this condition, and daily oral medication can get your thyroid gland functioning properly.

2. Suddenly hairless toes and feet could be a sign of a circulatory disorder, as your feet may not be receiving enough blood flow to sustain hair growth. Your doctor should check for a pulse in your feet, and if she has any doubts, should order a thorough cardiovascular screen.

3. Foot cramps that won’t quit may indicate a nutritional deficiency or dehydration. Sure, everybody’s feet cramp up now and then, but what matters is how often and how severe. If you exercise a lot, make sure you drink plenty of water to hydrate your muscles. You also should eat a balanced diet with plenty of potassium, magnesium, and calcium, as a lack of these nutrients can also cause cramping (good sources are nuts, leafy greens, and dairy). To relieve cramps in your feet, stretch your toes up, not down. If the cramping in your feet just won’t let up, see your podiatrist so that he or she can test for circulation issues or nerve damage.

4. Yellowing toenails is a sign of aging, but may also indicate a fungal infection. Yellowing can also occur when you wear nail polish for months without a break. If your toenails are flaky or brittle, you probably have a fungal infection and should see a podiatrist for treatment.

5. Flaky, itchy, or peeling skin between your toes is a sure sign of athlete’s foot. Even if you’re not an athlete, it’s easy to pick up a case of athlete’s foot if your feet are crammed in shoes all day or you walk barefoot in common areas like a sauna or swimming pool. Use an over the counter creme to relieve the symptoms, but if your flaking, itching, or peeling continues, you may have psoriasis or eczema. Your podiatrist can determine which is which and suggest a course of treatment.

6. Your big toe suddenly becomes swollen and painful. This is an almost sure sign that you have gout, a condition that inflames the joint. But it might also indicate inflammatory arthritis or infection. If it’s due to trauma, like someone landing on your foot after a jump shot, well, you’ll probably figure that one out.

7. A sore on your foot that won’t heal is a common side effect of diabetes, skin cancer, or circulatory disorders. In the case of diabetes, blood glucose levels that have raged out of control for long periods lead to nerve damage and small blood vessel damage, which in many cases appears first in your feet.  If the sore gets infected, it can lead to an amputation. But a sore on your foot – even between your toes – can also indicate certain kinds of skin cancer, so be sure to have it checked out by your podiatrist as soon as you discover it.

8. A slowly enlarging “growth” aside your big toe is probably a bunion. Faulty, inherited foot structure leads to this common foot deformity, which can be exacerbated by poor choices in footwear like high heels and flip flops. Unfortunately, bunions rarely stop growing, so that small, slightly sore bump today may be quite large and painful years from now. The only sure way to correct a bunion is with surgery. Splints, toe separators, and the like are temporary measures which will relieve symptoms, but won’t stop the deformity from becoming worse.

9. Pain in your heel may indicate plantar fasciitis, an inflammation of the tissue which connects your heel to your arch. If you have a sharp pain in your heel when you get out of bed in the morning, which slowly subsides as you move around, you probably have PF. There are many causes of plantar fasciitis, but primarily poor footwear, obesity, or working out too aggressively are to blame. To relieve minor symptoms of plantar fasciitis, ease up on your exercise program, lose weight, or wear shoes which support your feet properly. If symptoms persist, see your podiatrist for treatment.

A Sampling Of Free Apps To Manage Your Diabetes

16 May

When you’re newly diagnosed with diabetes, a radical change in your diet is nearly always required – and that can be a steep educational curve. You have to learn to monitor blood glucose levels, the difference between good carbs and bad carbs, what proper portion sizes are, take your blood glucose control medicine as prescribed, and begin an exercise program.

wavesense app

For those who embrace technology, smartphone and tablet apps can be very helpful in managing all of these tasks. The only problem is that a quick google search will show that there are more than 1,000 diabetes management apps available.

We combed through a number of sources to find a general consensus on what are considered the best FREE smartphone apps to manage your diabetes, and here are the results, in no particular order.

Please note that the free versions of some of these apps are “lite” versions. Full access with all of the bells and whistles may require a paid subscription.

Glooko

This is brilliant – a smartphone app that syncs with your blood glucose meter to keep track of your readings. Glooko also includes nutrition data from hundreds of grocery stores and restaurants so you make the right choices at the point of purchase. Glooko, like many other apps, allows you to share your data with your healthcare provider so they can analyze it and suggest changes.

dLife Diabetes Companion

The dLife Diabetes Companion claims to be “Your Ultimate Diabetes Lifestyle Manager and Tracker”. It enables you to “Track blood glucose levels, find diabetes friendly recipes, watch videos from dLifeTV, and get expert answers to your diabetes questions.”

WaveSense Diabetes Manager

Customers in the iTunes store give WaveSense 3.5 out of 4 stars. A review on EatRight.org states:, “The WaveSense Diabetes Manager app is one of the most useful free diabetes resources I’ve found in the App Store. This app would be a useful addition for anyone hoping to track his or her progress and make healthier decisions throughout the day.”

WaveSense Diabetes Manager offers a library of videos that can help you learn more about diabetes-friendly diets, how to make healthy lifestyle choices. It aso allows you to share your info with your medical provider.

Glucose Buddy

Glucose Buddy is a data storage utility.  Users manually enter glucose numbers, carbohydrate consumption, insulin dosages, and activities via smartphone, and then can view their data on a free GlucoseBuddy.com account.

Diabetic Audio Recipes Lite

The developers of Diabetic Audio Recipes Lite tells us, “Our delicious diabetes cookbook offers a selection of popular recipes for your daily menu or any dinner party. It includes a selection of simple, healthy, low sugar/ sugar free, low fat recipes for appetizers, breads, muffins, scones, desserts, condiments, side dishes and main dishes.” You can play the audio recipes with speed control, and listen to the audio while reading the recipes.

carb counter for diabetic kids

Lenny The Lion helps kids manage their diabetes.

dbees.com app

Not every diabetic is alike, so dbees gives each user the “freedom of personalization. It helps you manage your insulin, insulin pump, medications, and diet. It also allows you to set reminders, access your data online and send reports directly to your physician.

For Kids: Carb Counting With Lenny

Counting Carbs is an essential skill for managing diabetes, and Lenny The Lion makes it easy and fun for kids. Lenny increases their confidence in managing their diabetes and helps them maintain their blood glucose levels.

New Study Shows Big Diabetes Spike In Children

9 May

A study published this week in the Journal of the American Medical Association shows an alarming increase in the rate of diabetes among those under twenty years of age: Type 1 Diabetes has increased by 21 percent, and  Type 2 diabetes has increased by 30 percent. The study tracked data reported by medical professionals between 2001 and 2009 from 3 million children in 5 states.

diabetes-in-children

The new study found a particularly big increase in Type 1 diabetes among black and hispanic youths. In Type 1 diabetes, a patient’s immune system attacks cells in the pancreas that make insulin, a hormone required to control blood sugar levels. Historically, children affected by diabetes were most often white.

Dr. Dana Dabelea, the lead author of the study and a professor of epidemiology and pediatrics at the Colorado School of Public Health, called the increase in Type 1 diabetes among youth “particularly worrisome.” Statistically, some black and hispanic children have historically been less likely to control their high blood sugar, and were more likely to suffer complications of diabetes, like eye disease, kidney disease, heart disease and limb amputations. If that trend continues, it will be overwhelming for the public health system.

Type 2 diabetes is thought to occur when there is a genetic predisposition to insulin resistance, usually made worse by obesity and inactivity. Until the mid-90’s, Type 2 diabetes was very unusual to see in children, and was even called “adult-onset” diabetes. But during the last half of that decade, diabetes rates among youth started to inch up to what are now historically high levels and what some may classify as epidemic levels.  The study’s authors believe that the uptick may be the result of “minority population growth, obesity, exposure to diabetes in utero and perhaps endocrine-disrupting chemicals.”

Unfortunately, this increase among youth will have vast public health consequences. As the children become young adults, they will suffer the complications and side effects of living a decade or more with diabetes. Additionally, their children, having been exposed to the disease in utero, will also be at risk for diabetes.

The research was funded by the Centers for Disease Control and Prevention and the National Institutes of Health and is part of a continuing study, Search for Diabetes in Youth, examining the condition among children.

Learn how PA Foot and Ankle Associates is helping to find a cure for diabetes.

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