#Diabetes - Type 2 Diabetes and Fatty Liver Disease

This article makes me wish I had researched Fatty Liver Disease when my doctor started treating me for that about 18 months before my Diabetes diagnosis. But I didn't, because he put me on medicine that was improving my triglyceride numbers so I figured it was getting in better and it was all good. Now I realize that treating the triglycerides was a band-aid for the Fatty Liver Disease but was not the cure for the cause. The same cause that fed the Diabetes.


But in all honesty, I never knew anyone diagnosed with Fatty liver Disease so I had no fear of it. I had known people with Diabetes and I knew how it had impacted their lives and in many cases how it had complicated other medical issues - so I had a fear of Diabetes. Diabetes made me start doing online research where Fatty Liver Disease did not.


And some might say my doctor should have told me Fatty liver Disease & T2 Diabetes are commonly seen almost hand in hand, but I can't fault him. He did tell me I needed to lose weight when he prescribed the meds for the Fatty Liver Disease. But his style is not to use scare tactics and I'm sure there are other medical complications that could come from Fatty Liver Disease also, so he would have sounded like he was reciting medical journals at that time. No, the fault is my own since I didn't do my due diligence. I took the script and expected the meds to make it all better and make it just go away. But it just doesn't work that way.


Anyway. Here is the article that prompted this post. It is from Everyday Health DOT com and can be found on their website through THIS LINK.

Type 2 Diabetes and Fatty Liver Disease

If you have type 2 diabetes, you are at risk of developing non-alcoholic fatty liver disease. Find out why and what you can do about it.

By Andrea Bledsoe, PhD

Medically reviewed by Lindsey Marcellin, MD, MPH

Non-alcoholic fatty liver disease is a group of conditions in which fat builds up in the liver, leading to inflammation of the cells where it is stored and causing the liver to get bigger. It can progress to more serious conditions, including fibrosis and cirrhosis of the liver.

Fatty liver disease "is so common. It’s present arguably in a majority of type 2 diabetics,” says Daniel Einhorn, MD, clinical professor of medicine at the University of California, San Diego and the medical director of the Scripps Whittier Diabetes Institute. “None of us thought about it more than about 10 years ago, then all of a sudden we discovered it and see it all the time.”

Fatty Liver Disease and Type 2 Diabetes: The Connection

Diabetes does not cause fatty liver disease. Instead, the two diseases tend to occur in the same people because the same conditions cause both problems. “So, it’s not the diabetes per se. People with diabetes also have obesity and insulin resistance, and so the fatty liver is thought to be part of that,” Dr. Einhorn explains.

Einhorn says that most cases of fatty liver disease do not cause any harm. However, since type 2 diabetes and obesity are so common in the United States, fatty liver disease is now a leading cause of end-stage (fatal) liver disease requiring a liver transplant, along with alcohol abuse and hepatitis.

Fatty Liver Disease Diagnosis

Fatty liver disease has no symptoms. People who are being treated for diabetes will have liver enzyme tests as part of their routine blood work during medical exams. Ninety-nine percent of the cases of fatty liver disease are detected by this test, says Einhorn. In some cases it will be picked up during the physical exam or in imaging studies, like a computed tomography scan of the abdomen or a liver ultrasound.

Einhorn says that fatty liver disease is not treated as a separate disease; therefore, doctors do not usually pin down the diagnosis with any additional studies unless liver enzymes are elevated unexpectedly, such as in a person without diabetes or obesity, or if the levels are very high and it appears that something else may be going on.

Fatty Liver Disease Treatment

There are no drugs that treat fatty liver disease. Instead, this condition is treated indirectly with lifestyle changes such as losing weight, getting in better physical shape, and controlling blood sugar and triglycerides — fats in the blood that can contribute to fatty liver. “You try to get the best possible control and hope that the fatty liver responds to that control,” says Einhorn.

Diabetes medications known as “insulin sensitizers” have been shown to have an effect in reducing fat in the liver; these include thiazolidinediones or glitazones such as pioglitazone (Actos) and rosiglitazone (Avandia), which are used to treat insulin resistance. It makes sense to use them if insulin resistance is part of fatty liver, explains Einhorn, but they are not U.S. Food and Drug Administration-approved for treating fatty liver disease.

Fatty Liver Disease Prevention

Type 2 diabetes, obesity, and fatty liver disease seem to go hand-in-hand. But it is not a given that if you have type 2 diabetes you will automatically develop fatty liver disease. Since obesity, insulin resistance, and high levels of triglycerides in the blood increase the risk of fatty liver disease, treating these other conditions can prevent its development.

Maintaining a healthy weight or losing weight if you are overweight or obese; exercising regularly; and controlling your blood sugar and triglyceride levels will go a long way toward safeguarding against fatty liver disease.

source: http://www.everydayhealth.com/type-2-diabetes/fatty-liver-disease-connection.aspx

 

#Diabetes - This Day in History - Insulin isolated in Toronto

Jul 27, 1921:

Insulin isolated in Toronto

At the University of Toronto, Canadian scientists Frederick Banting and Charles Best successfully isolate insulin--a hormone they believe could prevent diabetes--for the first time. Within a year, the first human sufferers of diabetes were receiving insulin treatments, and countless lives were saved from what was previously regarded as a fatal disease.

Diabetes has been recognized as a distinct medical condition for more than 3,000 years, but its exact cause was a mystery until the 20th century. By the early 1920s, many researchers strongly suspected that diabetes was caused by a malfunction in the digestive system related to the pancreas gland, a small organ that sits on top of the liver. At that time, the only way to treat the fatal disease was through a diet low in carbohydrates and sugar and high in fat and protein. Instead of dying shortly after diagnosis, this diet allowed diabetics to live--for about a year.

A breakthrough came at the University of Toronto in the summer of 1921, when Canadians Frederick Banting and Charles Best successfully isolated insulin from canine test subjects, produced diabetic symptoms in the animals, and then began a program of insulin injections that returned the dogs to normalcy. On November 14, the discovery was announced to the world.

Two months later, with the support of J.J.R. MacLeod of the University of Toronto, the two scientists began preparations for an insulin treatment of a human subject. Enlisting the aid of biochemist J.B. Collip, they were able to extract a reasonably pure formula of insulin from the pancreases of cattle from slaughterhouses. On January 23, 1921, they began treating 14-year-old Leonard Thompson with insulin injections. The diabetic teenager improved dramatically, and the University of Toronto immediately gave pharmaceutical companies license to produce insulin, free of royalties. By 1923, insulin had become widely available, and Banting and Macleod were awarded the Nobel Prize in medicine.

source: This Day in History

The Discovery of Insulin: the Work of Frederick Banting and Charles Best

1. Robert D. Simoni, 
2. Robert L. Hill and 
3. Martha Vaughan

 

Next Section

The Preparation of Insulin
 (Best, C. H., and Scott, D. A. (1923) J. Biol. Chem. 57, 709–723)

The story of the discovery of insulin has been well chronicled beginning with a young physician, Frederick Banting, in London, Ontario, imagining that it might be possible to isolate the internal secretions of the pancreas by ligating the pancreatic ducts to induce atrophy of the acinar cells and thereby minimize contamination of the tissue extract with digestive enzymes. Banting presented his suggestion to J. J. R. Macleod, a distinguished physiologist at the University of Toronto who provided Banting with a laboratory for the summer and some dogs for the experiments. Macleod also assigned Charles Best, a young student, to work as Banting's assistant for the summer. During the summer of 1921, Banting and Best made remarkable progress, and by fall they had isolated material from pancreas extracts that dramatically prolonged the lives of dogs made diabetic by removal of the pancreas. In the winter of 1922, Banting and Best treated their first human patient, a young boy, who's life was saved by the treatment. This was a stunning accomplishment. Consider that from the start of the research in the summer of 1921 to treating a human patient successfully in the winter of 1922, the pace, especially by current standards for clinical treatments, was remarkable.

With that achievement, Macleod, who had been initially unenthusiastic about the work, assigned his entire laboratory to the insulin project. He also enlisted the Eli Lilly Company to aid in the large scale, commercial preparation of insulin although the University of Toronto received the patent for insulin production. By 1923, insulin was available in quantities adequate for relatively widespread treatment of diabetes. Although the success of the insulin project was remarkable, the rewards for the research workers were, it seems, quite controversial. The 1923 Noble Prize in Physiology or Medicine was awarded to Banting and Macleod. Apparently, Banting was annoyed at the omission of Best and gave him half of his share of the prize. There was also, perhaps, the feeling that Macleod had done little in the initial stages of the work and was an undeserving recipient. Macleod split his share of the Prize with J. B. Collip who had made contributions to the later stages of the work on insulin purification.

After the spectacular events of 1921–1923, the University of Toronto established the Banting and Best Department of Medical Research separate from the University. Banting accomplished little during the rest of his career and died in a plane crash in 1940. Best, however, had a long successful tenure at the University of Toronto working on insulin and subsequently other important topics including the importance of dietary choline and the development of heparin as an anticoagulant.

The paper selected as this Journal of Biological Chemistry Classic is not itself “classic” in the usual sense. It reviews very well, however, a remarkable body of classic work. The information regarding various procedures that had been developed quickly and compared in attempts to improve the yield and purity of insulin also contains clues to some special properties of the protein, although so little was known at that time about the structure of insulin (or any protein) that there seemed little rationale for its purification. Insulin was crystallized in 1926 by John J. Abel (1). Virtually all of the information in this Introduction is from Ref.2.

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Frederick G. Banting. Photo courtesy of the National Library of Medicine.

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Charles H. Best. Photo courtesy of the National Library of Medicine.

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Footnotes

• The American Society for Biochemistry and Molecular Biology, Inc.

Previous Section

 

References

1. ↵ 
   Abel, J. J. (1926) Crystalline insulin. Proc. Natl. Acad. Sci. U. S. A. 12,132– 136

    

   FREE Full Text
2. ↵ 
   Bliss, M. (1982) The Discovery of Insulin, The University of Chicago Press, Chicago, IL

source: The Journal of Biological Chemistry

#Diabetes: Before Disaster Strikes

Living in Alabama makes the following article from Diabetes Health dot com a lot more personal for me after the April 27, 2011 tornadoes. The morning round skirted by just slightly south-east of us and the afternoon round skirted by just slightly north-west of us. We have lived here for over 25 years and it seems as if this small space where we are situated gets "skirted" by these bad storms a lot. But, even thinking that the terrain directs them around us I still freak, grab stuff and run hide in the basement. 


On April 27 I grabbed an old handbag and dumped all our prescriptions in it and took them all to the basement with me. 

Those are my both hubby's and mine. Some of these are duplicate meds since we have to get meds in 90 day supplies, so I pour a smaller amount into smaller script bottles for daily use. And also pictured is my flashlight named Tampa. She is named Tampa because she was given to me by the hotel staff in Tampa when I was there for a customer conference a few years ago and the hotel lost power for several hours one night.

My "daily use" diabetes kit is always in a Sterlite Snapware case that sits on a small table in my den, so it was easy enough to grab and run with.

Handy little box. I have my meter, lancet, test strips, alcohol wipes, ink pen log book and reading glasses in the top compartment. I also have a spare meter and lancet kit (in the blue & white pouch under the log book) in the top compartment  I use the spare meter if I ever test other people so my pink meter stays pure with just my numbers. 


Second level compartment has extra test strips, lancets, alcohol wipes and Pen Needles (I no longer use insulin, but I won't dispose of my needles since I know one day I might have to use them again).


Third level holds literature and prescription refill labels.


In addition I have a larger sterlite box in the hall closet that holds battery operated lanterns and radio.


Most of the other items listed for an emergency I have covered also - glucose tablets, insurance cards etc are in my purse. I don't have an emergency supply of food and water set aside, but I have bottled water in the house.


Here is a good article on preparedness:

Before Disaster Strikes

Olivia Grider
Jul 22, 2011

Preparing for emergencies requires extra thought and effort-and is extra important-for people with diabetes

With severe weather predicted for Tuscaloosa, Alabama, Meredith Cummings thought carefully about where to park her car-eyeing the large trees in her historic neighborhood-when she arrived home on the afternoon of April 27. As she walked to her door, she reassured herself: Those trees had been there for more than 100 years. What were the odds of them coming down today?

Later, as tornado sirens blared and she ushered her eight-year-old daughter into a closet to take cover, Cummings, who has had type 1 diabetes since age 13, continued to plan for the worst. She grabbed a small pouch containing insulin pump supplies and placed her shoes right outside the closet ("just in case") before wrapping pillows and her own body over her daughter.

"I'm an exceptionally prepared person," Cummings says. "My family knows my mantra is ‘Plan ahead.'" But nothing could have prepared her for the F4 tornado that roared through her neighborhood at 5:13 p.m., leaving a six-mile-long, nearly half-mile-wide gash of destruction through the college town of Tuscaloosa. "It was the most frightening thing I've ever been through," says Cummings, who has suffered several near-death experiences, including technically "dying" when her daughter was born. "I've never in my life felt a more loud and violent thing. It was shaking us like the world's most violent tilt-a-whirl."

When it was over, the century-old trees were in the bedroom adjacent to the closet where Cummings and her daughter had taken shelter, but that was the least of their concerns. The sky was still ominous, and cell phone service was jammed. Cummings finally got a call through to her brother, who told her "you have 30 minutes" before the next one hits. Cummings absentmindedly snatched her glass-filled purse and began the mile-long hike over trees and debris to her office at the University of Alabama, where she's a journalism instructor.

The purse, which contained a small vial of insulin and her glucose meter, and the pouch of supplies proved invaluable when Cummings arrived at her mother's home near Birmingham almost exactly 12 hours after the tornado struck and realized that her pump was nearly out of insulin.

In hindsight, Cummings wishes that she had stored insulin and other supplies somewhere other than her home prior to the storm. The American Diabetes Association recommends keeping basic supplies at home, at work, and in the car. In addition, an emergency kit should contain medications, supplies, food, and documentation. (See the sidebar for a detailed list.) Many people, however, fail to assemble such a kit. In a recent dLife network poll, 44 percent of respondents said that they've thought about preparing a diabetes emergency kit, but don't currently have one.
"What I often see is complacency," confirms Jackie Kloosterboer, emergency coordinator for the city of Vancouver, British Columbia, author of "Plan for the Worst-A Common Sense Guide to Emergency Preparedness," and a person with type 1 diabetes for more than 40 years. "People have great intentions to put their kits together, get the supplies they need, but we all live busy lives and we never get to it. The time to prepare is now, before the disaster strikes."

Here are more tips for planning for an emergency, be it a tornado, flood, hurricane, earthquake, or terrorist attack.

Keep extra supplies on hand

This is easier said than done because prescriptions are generally written just for the amount of supplies/medication/insulin that a person needs for a given time period. Kloosterboer advises stocking your emergency kit with items you need to survive without any outside help for a minimum of 72 hours. A month after tornadoes tore through the Southeast, the Alabama/Mississippi chapter of ADA was still fielding requests for supplies, mainly test strips and insulin. Aimee Casey, executive director of the chapter, says that some insurance companies didn't pay for prescription refills for people who had filled prescriptions within the previous 30 days. Ways to start building a reserve without spending a lot of money include:
• Getting help from your doctors and care providers. Physicians usually have free samples that they're happy to share with you. They might be able to write prescriptions for back-up medication as well.
• Buying an extra supply of cheap, generic type 2 medications.
• Obtaining a free glucose meter. Many manufacturers provide meters free or almost free (check their websites), and doctors often receive free meters to give patients.

Don't store extra insulin in your emergency kit

Keep insulin in a designated area in your refrigerator. "When evacuating-and if it's safe to do so-one extra step to the fridge is all that's needed to grab your insulin," Kloosterboer says. Also have freezer packs that you can place in a bag to keep insulin viable, says Lynn Russo, registered nurse, certified diabetes educator, and American Red Cross volunteer in northern New Jersey. If you're not able to get your insulin, advise shelter authorities of your situation as soon as you arrive.

Insulin remains safe to use when stored at room temperature (59 degrees to 86 degrees Fahrenheit) for up to 28 days. Insulin pens in use can be stored at room temperature according to manufacturers' directions. Freezer packs can protect insulin from extreme heat following a disaster, when air conditioning might not be available.

A note on the outside of your emergency kit could remind you to get items from the refrigerator/freezer, Russo says. If you don't think you'll need a reminder, consider Cummings' experience: After the tornado struck, she didn't even think about diabetes until after arriving at her office.

Build a good relationship with your pharmacist and establish an account with a major pharmacy chain

"Pharmacies are generally very helpful to people with diabetes, although I've found this more true when I know the pharmacist," says Sean Kelley, incoming chairman of the Alabama/Mississippi ADA chapter. "Building a good relationship with someone local-even when you buy most of your medications through mail order-may be helpful in an emergency."

Establishing an account with a major chain could make obtaining supplies in an unaffected area after a disaster easier because the pharmacy will have access to your information.

Create an ICE (in case of emergency) file

This should be in your emergency kit. As with supplies, however, storing the information somewhere other than your home is important. Kelley keeps his online as a Google doc. ICE apps for smart phones are available, and keeping a printed ICE file in your wallet or purse and at your workplace is also a good idea.

ICE files typically contain your name, birth date, social security number, address, list of medications and doses, pharmacy and physicians' names and numbers, prescription copies, and medical insurance information.

"If we were to lose everything, as many people did in the tornadoes, we'd still be able to access important information and begin trying to get replacement supplies," Kelley says.

Call your insurer

Ask about the company's emergency policies. That way, at least you'll know where you stand should an emergency occur.

Know what to do if you are affected by a disaster

According to ADA, people with diabetes should identify themselves as such, drink plenty of water, watch what they eat, and stick with their regular testing and medication schedule. You should also be wary of supplies that might have been compromised. Moisture can affect pills, blood glucose meters, and other supplies. When in doubt, and if you have the option, throw out affected supplies and get new ones.

In the week after the April 27 tornado, Cummings says, her blood glucose levels fluctuated more than usual-a fact that she attributes to the loss of routine, roller-coaster emotions, and the stress of dealing with debris cleanup, home and vehicle insurance claims, and rebuilding plans. For days she didn't want to eat; other times she forgot. But at the one-week mark, Cummings says, her blood sugar began leveling off. At times, her diet was healthier than usual, thanks to volunteers who brought hot plates of food into affected neighborhoods. "The outpouring of support is unbelievable," she says.

[Sidebar] Your Emergency Kit

A diabetes emergency kit should be housed in a backpack or other easily transportable container and should include:
• List of prescriptions and doses
• Names and phone numbers of physicians, pharmacy, and/or mail-order company
• Copy of medical insurance card and flexible-spending-account card
• Alcohol swabs
• Back-up glucose meter and extra batteries
• Test strips*
• Pills for type 2 diabetes*
• Lancets
• Glucose tabs or gel to treat low blood sugar
• Extra medical alert bracelet or card identifying you as diabetic
• Extra glucagon kit*
• Non-perishable food
• Water

If you use insulin:
• Syringes (even if you use a pump in case, there is a problem with it)
• Pen needles (if you use insulin pens)
• Site-change supplies and batteries (for pump users)

*These items have expiration dates, so you should use and replace them as necessary. Put a note on your calendar to help you remember.