What is Brittle Diabetes?

July 4th, 2011

Brittle diabetes is an uncontrolled form of type 1, or insulin dependent, diabetes. It's also referred to as uncontrolled or labile (open to change) diabetes. While most diabetics experience some fluctuations in blood sugar, brittle diabetics have dramatic, regular, yet unpredictable swings in glucose levels, even when doing their best to control their condition with insulin injections, exercise and diet.

These wildly fluctuating blood glucose levels can result in either high blood sugar (hyperglycemia) or low blood sugar (hypoglycemia). Symptoms of hypoglycemia include:

  • trembling
  • dizziness
  • cold sweats
  • tiredness
  • weakness
  • headache
  • blurred vision
  • racing or pounding heart
  • irritability
  • confusion

Severe low blood sugar can result in disorientation, convulsions, and loss of consciousness.

Symptoms of hyperglycemia include:

  • thirst
  • headache
  • blurred vision
  • frequent urination
  • trouble concentrating
  • fatigue

Hyperglycemia is frequently accompanied by ketosis, or elevated levels of ketones. Ketones are compounds caused by the breakdown of fatty acids in the body.

Ketosis is not normal, but it's not necessarily harmful. However extreme ketosis can lead to ketoacidosis, a dangerous condition in which the blood's ph is lowered to very acidic levels. Ketoacidosis can result in a life threatening diabetic coma. One telltale sign of ketoacidosis is a fruity or nail polish remover-like odor on the diabetic's breath (caused by acetone, a byproduct of ketone breakdown).

Luckily, only about 2 percent of diabetics suffer from brittle diabetes. It is most common in young (aged 15 to 30) women, especially overweight women. Brittle diabetes can be caused or made worse by:

  • poor diabetes control (high sugar diet, missing doses of diabetes medication)
  • gastrointestinal absorption problems
  • poor insulin absorption
  • thyroid problems (hypothyroidism)
  • adrenal gland problems
  • drug and alcohol interactions
  • hormonal imbalances
  • stress
  • depression

Brittle diabetes often has to be treated in a hospital, where food intake, insulin injections, and blood sugar levels can be closely controlled and monitored. As there may be a psychological component to brittle diabetes, psychotherapy is helpful in some cases.

Thirty Seven Strawberries a Day Keep the Doctor Away

July 5th, 2011

A flavonoid called fisetin, found in abundance in strawberries, has been found to lessen complications of diabetes in mice. Fisetin is a neuroprotective flavonoid that can target multiple organs, suggesting that a single natural remedy could be developed to address numerous diabetes complications.

But obtaining a protective patent to bring a natural product like fisetin to market is difficult, meaning further research is stalled until researchers can find someone willing to support a clinical trial. Read more about the benefits of strawberries and the recent research on fisetin and diabetic complications on Diabetic Live.

Researchers Invent New Drug Delivery Device to Treat Diabetes-Related Vision Loss

July 6th, 2011

ScienceDaily (2011-06-29) -- Engineers and scientists have developed a device that can be implanted behind the eye for controlled and on-demand release of drugs to treat retinal damage caused by diabetes. Diabetic retinopathy is the leading cause of vision loss among patients with diabetes. The disease is caused by the unwanted growth of capillary cells in the retina, which in its advanced stages can result in blindness.

The novel drug delivery mechanism is detailed in the current issue of Lab on a Chip, a multidisciplinary journal on innovative microfluidic and nanofluidic technologies.

Read the full article...

More Progress Made Towards the Development of an Artificial Pancreas

July 7th, 2011

Researchers are continuing to make progress in the development of an artificial pancreas for insulin dependent type 1 diabetics. An artificial pancreas is an automated, closed-loop system consisting of a continuous glucose monitor, a glucose meter to calibrate the monitor, and an insulin pump.

With the help of a sophisticated computer system, an artificial pancreas produces insulin and controls blood sugar in a diabetic much as a normal pancreas does in a person without diabetes. The sophisticated system senses when the body needs insulin, calculates the dose needed, and delivers automatically, eliminating the need for insulin injections.

To read more about several recent advances towards the development of an artificial pancreas on WebMD, >CLICK HERE<.

Diabetes Drug Metformin Safer for the Heart

July 12th, 2011

The type 2 diabetes drug metformin is safer for the heart than other older diabetes medication, according to a two-year study. The findings are important because older patients with diabetes are at particular risk for cardiovascular disease, and because many of them are prescribed a class of diabetes medications called sulfonylureas that may raise this risk.

The controversial diabetes drug Avandia, which has been linked to heart problems, is a sulfonylureas diabetes drug. Sulfonylureas have also been linked to episodes of low blood sugar, and to weight gain.

Sulfonylureas drugs and metformin (also known by the brand name Glucophage) lower blood sugar in different ways. Metformin works by suppressing sugar production in the liver, while sulfonylureas work by increasing insulin production. To read more about the study findings on WebMD, >CLICK HERE.<

American Diabetes Association Releases Diabetes 24/7

July 14th, 2011

The American Diabetes Association has released new software to help diabetics enhance their diabetes control. The online tool, called Diabetes 24/7, is a personal health record which allows diabetics to store and track relevant medical information such as glucose readings, diabetes medications and test results. Healthcare providers such as doctors, pharmacies, laboratories and clinics can also access the information, with the patient's permission.

Diabetes 24/7 is designed to integrate with the free Microsoft program Health Vault, where the information is securely stored. Health Vault provides users with an easily accessible place to import, organize and share important healthcare records and information, all under the user's control. The site also offers a variety of online health management tools.

To learn more about Diabetes 24/7 on the American Diabetes Association website, >CLICK HERE<.

Stem Cell "Memory" Can Boost Insulin Levels

July 15th, 2011

ScienceDaily (2011-07-14) -- Scientist have now derived embryonic-like stem cells from adult stem cells that appear to retain their effectiveness in producing insulin in the human body. This research may promise a new avenue of treatment that avoids costly and dangerous pancreas transplants.

Stem cells from early embryos can be coaxed into becoming a diverse array of specialized cells to revive and repair different areas of the body. Therapies based on these stem cells have long been contemplated for the treatment of diabetes, but have been held back by medical and ethical drawbacks.

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Diabetes and Gastroparesis: A Vicious Cycle

July 18th, 2011

Diabetes is the most common cause of gastroparesis, or delayed stomach emptying. That's because years of high blood glucose damage the vagus nerve, which controls the movement of food from the stomach through the digestive tract. Both type 1 and type 2 diabetics are at risk of gastroparesis.

When the vagus nerve is damaged, food either moves too slowly through the digestive system, or doesn't move at all. As a result, people with gastroparesis often feel bloated, feel full after eating a small amount, and may experience heartburn, stomach and abdominal pain, nausea and vomiting, loss of appetite, and acid reflux.

Gastroparesis is a vicious cycle for a diabetic. Not only does uncontrolled blood sugar lead to gastroparesis, gastroparesis leads to poor blood sugar control due to the irregular passage of food through the digestive system. When food is finally absorbed, blood sugar levels may rise unexpectedly.

Diabetics with gastroparesis must check their blood glucose regularly. They may need to adjust their insulin therapy by changing their insulin dose, the type of insulin they take, or the time of day they take it.

Gastroparesis Diagnosis

Gastroparesis can be difficult to diagnose because of the wide range of both type and severity of symptoms. The condition is usually confirmed with stomach x-rays, a manometer (a device that measures pressure and muscle movements), and gastric emptying scans.

Until recently, those undergoing gastric emptying scans were given egg meal mixed with a radioactive isotope to allow tracking of the stomach contents using radioactivity detectors - a process called radiolabeling. This posed a problem for those patients who were allergic to eggs, or couldn't eat them for religious or lifestyle reasons.

Recently, nuclear medicine researchers discovered a way to incorporate the isotopes into instant oatmeal instead of egg meal. Radiolabeling using both regular and gluten free oatmeal proved just as effective for the molecular imaging of gastric emptying as the tests using standard egg meal.

Gastroparesis Treatment

Gastroparesis is almost always a chronic condition. It can be treated, but rarely cured. There are two main treatment goals for diabetics with gastroparesis - to improve stomach emptying, and to control blood sugar levels.

Patients are advised to avoid high fat and high fiber foods, to eat frequent small meals for easier digestion, and in some cases to eat only pureed or liquid meals until their symptoms improve.

If dietary changes alone don't help, the next line of treatment in the US is usually prescription metoclopramide to treat nausea and vomiting, and to facilitate gastric emptying. Due to the risk of side effects including drowsiness, dizziness, weakness and irreversible movement disorders, it is only approved for short-term treatment. The risk of developing a permanent movement disorder (tardive dyskinesia) is higher for people with diabetes.

Less frequently, the antibiotic erythromycin is prescribed to speed up stomach emptying. Like metoclopramide, it can have serious side effects, and can worsen symptoms like nausea.

Prescription domperidone (Motilium) is the preferred treatment in most countries, and has been for many years. Domperidone both aids gastric emptying and eases gastroparesis symptoms. Side effects of domperidone are less serious, and tend to disappear as the body adjusts to the medication.

But, despite numerous US clinical trials that established its safety and effectiveness, and the fact its own division of gastrointestinal drugs approved the use of domperidone, the FDA has still not given domperidone for gastroparesis the green light.

However, the FDA is encouraging doctors who would like to prescribe domperidone to patients with severe gastrointestinal disorders to make an Investigational New Drug application, which would allow them to purchase domperidone and administer it to their patients.

In the meantime, the fight for domperidone FDA approval continues. The Gastroparesis Patient Association is circulating an online petition to urge the FDA to review its decision on domperidone medication.

Dentists Can Identify People with Undiagnosed Diabetes

July 20th, 2011

dentist

ScienceDaily (2011-07-18) -- Dental visits represent a chance to intervene in the diabetes epidemic by identifying individuals with diabetes or pre-diabetes who are unaware of their condition, according to a new study.

In a study, Identification of Unrecognized Diabetes and Pre-diabetes in a Dental Setting, published in the July 2011 issue of the Journal of Dental Research, researchers at Columbia University College of Dental Medicine found that dental visits represented a chance to intervene in the diabetes epidemic by identifying individuals with diabetes or pre-diabetes who are unaware of their condition.

Read full article ...

Choosing the Best Blood Sugar Meter

July 21st, 2011

About.com diabetes guide Gary Gilles has written an informative guide to finding the best blood sugar meter. The guide covers important features and new developments in blood glucose meters, such as audible meters, meters that can communicate with an insulin pump, and glucose meters that also test blood ketones. >CLICK HERE< to read the blood sugar meter guide on About.com.

Paxil and Pravachol Taken Together Have Unexpected Effect on Blood Sugar

July 25th, 2011

Analysis of an FDA data base has revealed that commonly prescribed depression and high cholesterol drugs may raise blood sugar levels if taken together. This previously undiscovered effect on blood glucose has important implications for diabetics and those at risk of developing diabetes.

The data mining revealed an unexpected spike in blood sugar in patients talking both the antidepressant Paxil (paroxetine) and the cholesterol drug Pravachol (pravastatin). An estimated up to one million Americans are taking the two drugs, many of them diabetics.

"If a physician has a patient on these [two] medications and their diabetes becomes harder to control, the physician may want to consider changing the medications," said the study's principal investigator, Stanford University professor Dr. Russ Altman.

To read more about the implications of this possibly harmful interaction on glucose metabolism and diabetes control on InformationWeek, >CLICK HERE.<

FDA Panel Recommends Against Approval of new Diabetes Medication

July 27th, 2011

diabetes medication

A panel of Food & Drug Administration advisors has voted 9 to 6 against the approval of the new oral diabetes drug, dapaglifozin. Dapaglifozin was developed by Bristol-Myers Squibb, and was to be marketed by AstraZeneca. The panel expressed concerns about both the medication's safety and its effectiveness, especially in the elderly.

Dapaglifozin proved as effective as current oral diabetes medications in otherwise healthy diabetics, but was not as effective in those with impaired kidney function. The panel was primarily concerned about a potential risk of breast and bladder cancers. In a two-year study, there were nine cases of bladder cancer and nine cases of breast cancer in the just under 5478 patients taking the new diabetes medication, compared to only one case of bladder cancer and one case of breast cancer in the 3156 patients in the control group.

There were also indications of possible kidney damage, and increased risks of genital and urinary tract infections. The panel also complained of insufficient data on which patient population the diabetes drug was best suited to, and on potential interactions with other medications.

Dapaglifozin belongs to a class of medications called SGLT2 inhibitors. SGLT2 inhibitors work by inhibiting the return of glucose filtered by the kidneys to the blood stream, redirecting it through the urinary tract to be excreted in the urine. It's believed the resulting high sugar levels in the urine is the cause of the increase in genital and urinary tract infections.

One advantage of SGLT2 inhibitors is that they work independently of insulin injections, allowing for more freedom in combining them with other diabetes medications. People taking dapaglifozin in clinical trials also lost an average of five pounds, and experienced a slight drop in blood pressure.

The panel recommendation will not only likely result in the FDA rejecting the diabetes medication, but it will also effect the approval of similar SGLT2 inhibitors being developed by a number of other major pharmaceutical companies, including Johnson & Johnson, GlaxoSmithKline, Boehringer Ingelheim and Eli Lilly.

The panel is calling for more clinical studies of the proposed diabetes drug. The FDA will make a final decision by the end of October, 2011, but given the panel's request for more trials, the approval of dapaglifozin is expected to be about two years away.

Intensive Glucose Lowering Treatment Can be Risky

July 28th, 2011

glucose monitor

According to a HealthDay News article, intensive glucose-lowering treatment for people with type 2 diabetes doesn't reduce the risk of cardiovascular-related death, and doctors need to be cautious about prescribing this type of treatment.

Patients with type 2 diabetes are at increased risk for cardiovascular disease. Intensive glucose-lowering treatment is widely used for these patients even though previous research hasn't shown any clear benefits, researchers pointed out in a report published in a recent online edition of the British Medical Journal.

Catherine Cornu, a research physician at the Clinical Investigation Centre, Louis Pradel Hospital in Bron, France, and colleagues reviewed 13 studies that included a total of 34,533 diabetes patients -- 18,315 who underwent intensive glucose-lowering treatment and 16,218 who received standard treatment.

To read the full article on HealthDay News, >CLICK HERE.<

Diabetic Kidney Disease Reversed by Ketogenic Diet

July 29th, 2011

Researchers have for the first time determined that the ketogenic diet, a specialized high-fat, low carbohydrate diet, may reverse impaired kidney function in people with Type 1 and Type 2 diabetes. They also identified a previously unreported panel of genes associated with diabetes-related kidney failure, whose expression was reversed by the diet.

The study is the first to show that a dietary intervention alone is enough to reverse this serious complication of diabetes, a finding with significant implications for the tens of thousands of Americans diagnosed with diabetic kidney disease. To read more about this promising new diabetes dietonline at Science Daily, >CLICK HERE<