Wednesday, September 28, 2011

#Diabetes - Dawn Phenomenon

Another interesting article I want to post - helps to share and helps me to find it again for future reference.




Dawn phenomenon
by Jim Hartmann
One of the most frustrating things that diabetics deal with is an unexpected rise in blood glucose overnight. You go to bed with a BG of 100 mg/dL (5.6 mmol/L), and wake up with a BG of 130 (7.2)! You didn’t eat, so what happened?
This results from two distinctly different processes: Dawn Phenomenon and Somogyi Effect. Here are some basics.

DAWN PHENOMENON

Everyone, diabetic or not, exhibits some Dawn Phenomenon. It is a natural part of our bodies’ circadian rhythms. Some have said it is the way our ancestors had the strength to rise and slay a woolly behemoth for breakfast.
Since most of us fast while sleeping, with teenagers a possible exception, our bodies use stored energy during sleep. The body uses all three macro-nutrients (carbohydrates, proteins, and fats) to store energy.
The most easily used is the storage medium of carbohydrates, called glycogen. Glycogen is made from glucose, and is stored in the liver and muscles. Since it is basically nothing more than a complex matrix of glucose, it is easy for the body to store and use, something the body does all day long. The technical term for the act of creating and storing glycogen is glycogenesis. When the body calls for the conversion of glycogen back to glucose it is called glycogenolysis.
Another macro-nutrient that is available to be converted to glucose is protein. Most of us think of our protein as being stored in muscle, but the body has protective mechanisms to make muscle wasting its last choice. One of the most useful and readily available sources of protein storage is in blood components, i.e., albumin (plasma). The body uses a process performed in the liver to convert amino acids, the building blocks of proteins, into glucose. The name for this process is gluconeogenesis, literally “the creation of new glucose”.
So, what does all this have to do with a high fasting BG? Overnight, usually between 4am and 11am, your body releases some hormones. These are Growth Hormone (GH) from the anterior pituitary gland, cortisol from the adrenal cortex, glucagon from your pancreatic alpha-cells, and epinephrine (adrenalin). These hormones cause an increase in insulin resistance, raising your BG. In addition, these hormones trigger glycogenolysis and gluconeogenesis, adding stored or new glucose to your bloodstream.
Dawn Phenomenon, and its associated increase in insulin resistance, is the reason most diabetics are far more sensitive to carbs in the morning.

Dealing with Dawn Phenomenon

There are many ways of defeating Dawn Phenomenon. You will have to experiment with the following suggestions to see what works for you.
  1. Try eating no food after dinner. This works for people whose Dawn Phenomenon isn’t very strong. Basically, it lowers their baseline BG, so that when DP does hit them, the increase keeps them below a certain level, usually 120 (6.7).
  2. Try eating a small snack of fat and protein before bed. Most find that a tablespoon of peanut butter, or some cheese and deli meat are effective. The theory here is that the slow-digesting fat and protein holds their BG high enough overnight to avoid Somogyi Effect (see below).
  3. Eventually, you will learn how the two disparate approaches above work for you. Hopefully, you will set personal targets to guide you, eg., if my BG is below XXX (insert your target here), I need a snack. If my BG is over XXX, I don’t need a snack.
  4. The prescription medication Metformin HCl (Glucophage) is often very effective in limiting Dawn Phenomenon for Type-2s and insulin resistant Type-1s. Of course, Type-1s can adjust their basal (slow) insulin regimen to account for Dawn Phenomenon.
  5. Lastly, EAT BREAKFAST. The resulting increase in blood glucose from food will often turn off the continued rise. If you don’t, some diabetics will continue to rise until 10-11 am.

SOMOGYI EFFECT

Somogyi Effect, named for Dr. Robert Somogyi, its discoverer, is a high morning BG due to a low overnight. It is most commonly seen with insulin using diabetics, but is also seen with overnight reactive hypoglycemics.
The mechanism is a low overnight, which causes the body to react by releasing many of the same hormones seen in DP. The strongest blood glucose increasing hormone, glucagon, plays an important role. It tells your liver to start glycogenolysis and gluconeogenesis to provide enough glucose for your body to survive. This is sometimes referred to as a Liver Dump. Often, this mechanism over-produces, and you wake to a significantly higher BG.
Setting your bedtime BG target a bit higher, will usually prevent you from having a hypoglycemic event overnight.

Thursday, September 15, 2011

New to #Diabetes? Ask Your Doctor These Questions!


Posting to save and share:



Being diagnosed with diabetes can be a scary time for most patients. There is typically much uncertainty and an overload of information. If you have gotten the call to come in and talk with your doctor about your recent blood glucose testing, have this list of questions ready so that you can better understand your new diagnosis.
1. What is my fasting blood sugar? The fasting blood sugar is used to determine if a patient has hyperglycemia, or high blood sugar, or if the patient has diabetes. Any fasting value above 100 mg/dl is considered abnormal. A fasting blood sugar higher than 126 is diagnostic for diabetes. Anything in between these numbers is borderline high and at risk for developing type 2 diabetes.

2. What is my HbA1c? A hemoglobin A1c is a test that measures your blood sugar over 2-3 months. It gives an idea of what your average sugars have been. To manage diabetes with diet and exercise, the HbA1c should be below 7.0%. Anything higher than this may require the use of medications.

3. Do I need to see any specialists? Ask your doctor for a referral for an eye exam and ask if you need to see a foot doctor.

4. Can I test my sugars at home? Ask your doctor for a blood glucose machine, testing strips and lancets. Keep a daily log of readings and your food intake.

5. Can I see a certified diabetic educator? This may be the most valuable referral! These professionals will explain your condition and work with you to develop a personalized management plan.

6. Is it safe for me to exercise? You may need testing on your heart before you begin but weight loss and exercise are important parts of managing diabetes. Be sure that your doctor thinks that you are healthy enough to exercise before your begin.

7. Do I need any medications? As above, the need for medications depend on your blood sugar readings.

8. How often do I need to see my doctor or have blood work? You will likely need blood work checked every 3-6 months.

9. Is my blood pressure acceptable? Blood pressure readings should be less than 130/80 in diabetic patients.

10. Is my cholesterol acceptable? Your cholesterol should be in good control. Ask your doctors if your numbers are in line with the current recommendations for diabetic patients.
Bring this list with you to your appointment if you are overwhelmed and not sure which questions to ask. Understanding your diagnosis is the first step in learning how to live with diabetes and improve your blood sugars.

Tuesday, September 13, 2011

Leptin May Prevent Type 2 #Diabetes


(Found an article I want to "Save and Share")


Pre-Existing Drugs May Restore Sensitivity to Leptin, an Appetite Suppressing Hormone

Jan 22, 2009
Hearts in the medical community beat with considerable excitement at the discovery of leptin in 1994. A hormone produced by fat, leptin has a very useful talent: it tells the brain when to stop eating. So hopes were high that leptin would become the basis of an anti-obesity treatment. What could be simpler than to dose an obese person with a hormone that says, "You're not hungry any more, and you want to stop eating."
Unfortunately, a snag soon emerged. Obese people do not respond to leptin. Scientists faced two mysteries: First, how do people become resistant to leptin in the first place? And second, are there any drugs that increase sensitivity to leptin?
Those questions have remained unanswered for a long time. But a Children's Hospital Boston study, published in the January 7 issue ofCell Metabolism, may have found the answers to both.
First, it appears that a stress-induced condition causes the hypothalamus, the region of the brain that responds to leptin, to resist the hormone.
Second, two drugs (4-PBA and TUDCA), which are already approved by the FDA for use in other medical applications, appear to greatly increase leptin sensitivity. The receptivity of lab mice resistant to the hormone increased as much as 10-fold when the two drugs were used as "chemical chaperones" to prime the mice for leptin injections.
The Boston study found that a condition called "endoplasmic reticulum" stress in the body's peripheral organs leads to leptin resistance. The endoplasmic reticulum (ER) is a cellular component that produces proteins. Other cellular components, called "molecular chaperones," then fold the protein into its ultimate three-dimensional shape and transport it. When the chaperones can't keep up, a stress response is triggered, called "unfolded protein response" (UPR).
The researchers suspected that ER stress and UPR blocked leptin's action in the brain and were at fault for the hypothalamus's leptin resistance. Previous studies had already shown that mice bred to have ER stress were leptin-resistant and tended to obesity. Once the researchers ascertained that such was the case, they turned to an experimental drug therapy that involved using 4-PBA and TUDCA as chemical chaperones.
Currently, 4-PBA (buphenyl) is used to treat cystic fibrosis and urea cycle disorders, while TUDCA (tauroursodeoxycholic acid) is used to treat liver diseases. Both are also being studied for possible treatment of Alzheimer's and Huntington's diseases. Because both drugs are already FDA-approved, the researchers believe that it will be easy to move them quickly to human trials.
A side benefit of the drugs' role as chemical chaperones is that they have also been shown to reduce ER stress in mice with type 2, restoringinsulin sensitivity and normalizing blood sugar levels.
Besides being a safe treatment for increasing leptin sensitivity in obese people, the drugs could also enter the rapidly expanding pharmacopeia of diabetes treatment medicines.

Wednesday, September 7, 2011

#Diabetes - Blue Circle - The Universal Symbol for Diabetes

Here is another post that is to share a webpage that I also want to save for future reference and easy access - kinda like to "bookmark it", as it were (source link is at the very bottom). 


BLUE CIRCLE

The blue circle is the universal symbol for diabetes. Until 2006, there was no global symbol for diabetes. The purpose of the symbol is to give diabetes a common identity. It aims to:
  • Support all existing efforts to raise awareness about diabetes
  • Inspire new activities, bring diabetes to the attention of the general public
  • Brand diabetes
  • Provide a means to show support for the fight against diabetes
What is the history of the blue circle?
A global symbol for diabetes
The icon was orginially developed for the campaign that resulted in the passage of United Nations Resolution 61/225 "World Diabetes Day."
The campaign for a United Nations Resolution on diabetes was a response to the diabetes pandemic that is set to overwhelm healthcare resources everywhere. The campaign mobilised diabetes stakeholders behind the common cause of securing a United Nations Resolution on diabetes. The United Nations passed Resolution 61/225 ‘World Diabetes Day’ on December 20 2006.
Why a circle?
The circle occurs frequently in nature and has thus been widely employed since the dawn of humankind. The significance is overwhelmingly positive. Across cultures, the circle can symbolize life and health. Most significantly for the campaign, the circle symbolizes unity. Our combined strength is the key element that made this campaign so special. The global diabetes community came together to support a United Nations Resolution on diabetes and needs to remain united to make a difference. As we all know: to do nothing is no longer an option.
Why blue?
The blue border of the circle reflects the colour of the sky and the flag of the United Nations. The United Nations is in itself a symbol of unity amongst nations and is the only organization that can signal to governments everywhere that it is time to fight diabetes and reverse the global trends that will impede economic development and cause so much suffering and premature death.
Who owns the symbol?

The International Diabetes Federation (IDF) holds all rights to the blue circle for diabetes.
Promote the symbol

We encourage everyone to use the blue circle as a reference to diabetes and the millions of people affected by the disease. We welcome the use of the logo in publications: magazines, video, online information, etc.

The symbol may not be used without prior permission by IDF. It may not be used:
  • To promote or refer to anything other than diabetes
  • As a quality label
  • For merchandising or any other form of commercial aim
While IDF holds all rights to the diabetes symbol, we can provide permission for merchandising carrying the diabetes symbol on a case-by-case basis. You can submit your proposal to communications@idf.org. Grounds for permission are (amongst others):
  • Type of organisation
  • Form of distribution of the material
Examples of how the blue circle can be been used:
  • On posters
  • On t-shirts
  • Flags
  • Pins
Please direct any questions related to the usage of the blue circle to communications@idf.org.

SOURCE: http://www.idf.org/node/2064
 

Thursday, September 1, 2011

#Diabetes Art Day 2011


September 1st is Diabetes Art Day, a web-based initiative for the Diabetes Online Community to “tell a story” about life with diabetes though creative visual expression. It’s a way for us to tell our stories so we can connect and share with each other and with our loved ones. It’s a way to generate diabetes awareness outside of the DOC by sharing artwork on Facebook, Twitter, blogs and community websites. Diabetes Art Day is for people young and old with any type of diabetes and their families, so children, spouses, parents, siblings, or anyone who is affected by diabetes can participate. For this one day, you’re encouraged to break out of your linguistic comfort zone, bust out some art materials, and make a piece of artwork – painting, drawing, collage, sculpture, an installation piece, a mixed media something or other, or whatever you can imagine. Whether you have lots of experience making art or none at all, Diabetes Art Day is for you to show the world what it’s like to live with diabetes in that “a picture is worth 1000 words” kind of way.
Let your creative spirit soar!
[Above text taken directly from the Diabetes Art Day Website]
For Diabetes Art Day I submitted a picture I had taken of my supply kit that I keep in my den. I changed it to all black and white with a color-pop of pink - my pink meter. I also have a blue meter, which is not in the picture, but if it had been I would have tried doing a double color-pop. Here is my submitted image: