Pre-Diabetes Community

insulin resistance

2008-08-04T16:15:43Z

Hi, I just learned that even though my fasting and two hour glucose levels are normal (just barely), 92 and 141, my insulin level is high, 22 and 120. My doctor is pushing metformin because meta-analysis of all related studies shows metformin to be significantly better than just diet and exercise (even assuming you are strict about it). Any ideas and experiences that would help me decide?

Lifestyle Interventions Over 6 Years Prevents or Delays Diabetes 14-20 Years

2008-08-02T13:50:13Z

The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20-year follow-up study. Prof Guangwei Li MD, Dr Ping Zhang PhD, Jinping Wang MD et al.

The Lancet, 24 May 2008, Volume 371, Issue 9626, Pg 1783-1789

Intensive lifestyle interventions can reduce the incidence of type 2 diabetes in people with impaired glucose tolerance, but how long these benefits extend beyond the period of active intervention, and whether such interventions reduce the risk of cardiovascular disease (CVD) and mortality, is unclear. The researchers from China, the USA and Switzerland aimed to assess whether intensive lifestyle interventions have a long-term effect on the risk of diabetes, diabetes-related macrovascular and microvascular complications, and mortality. In 1986, 577 adults with impaired glucose tolerance from 33 clinics in China were randomly assigned to either the control group or to one of three lifestyle intervention groups (diet, exercise, or diet plus exercise). Active intervention took place over 6 years until 1992. In 2006, study participants were followed-up to assess the long-term effect of the interventions.

Compared with control participants, those in the combined lifestyle intervention groups had a 51% lower incidence of diabetes (hazard rate ratio or "HRR" = 0.49) during the active intervention period and a 43% lower incidence (HRR = 0.57) over the 20 year period, controlled for age and clustering by clinic. The average annual incidence of diabetes was 7% for intervention participants versus 11% in control participants, with 20-year cumulative incidence of 80% in the intervention groups and 93% in the control group. Participants in the intervention group spent an average of 3.6 fewer years with diabetes than those in the control group. There was no significant difference between the intervention and control groups in the rate of first CVD events (HRR = 0.98), CVD mortality (HRR = 0.83), and all-cause mortality (HRR = 0.96), but our study had limited statistical power to detect differences for these outcomes.

Conclusion: "Group-based lifestyle interventions over 6 years can prevent or delay diabetes for up to 14 years after the active intervention. However, whether lifestyle intervention also leads to reduced CVD and mortality remains unclear."

A First! -- New AACE Guidelines for Prediabetes Management

2008-07-30T18:15:37Z

The consensus statement was released July 23, 2008 by the American Association of Clinical Endocrinologists (AACE). Publication of the final document is planned for later this year.

You can read the consensus statement at http://www.aace.com/meetings/consensus/hyperglycemia/hyperglycemia.pdf

Questions? Feel free to ask!

Folks w/fasting glucose betw 95 to 99 mg/dL were 2.33 times more likely to develop diabetes.

2008-07-02T17:40:36Z

In prior entries, I've indicated how my own fasting glucose results (avg 96mg/dl which is considered 'normal') were not helpful in discovering my prediabetic state. It wasn't until I performed a 2 hour glucose tolerance test (GTT) that I learned my glucose levels (180mg/dl) were well into the prediabetic state known as "Impaired Glucose Tolerance (IGT)". For reference, a full blown Type 2 diagnosis is determined when the 2 hour GTT reaches 200mg/dl.

Here's the result of a study that confirms my own experience:

Normal Fasting Plasma Glucose and Risk of Type 2 Diabetes Diagnosis
Gregory A. Nichols, PhD, Teresa A. Hillier, MD, MS, Jonathan B. Brown, PhD, MPP
Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon.

PURPOSE: The study compares the risk of incident diabetes associated with fasting plasma glucose levels in the normal range, controlling for other risk factors.

METHODS: We identified 46,578 members of Kaiser Permanente Northwest who had fasting plasma glucose levels less than 100 mg/dL between January 1, 1997, and December 31, 2000, and who did not previously have diabetes or impaired fasting glucose. After assigning subjects to 1 of 4 categories (<85, 85-89, 90-94, or 95-99 mg/dL), we followed them until they developed diabetes, died, or left the health plan, or until April 30, 2007. We used Cox regression analysis to estimate the risk of incident diabetes, adjusted for age, sex, body mass index, blood pressure, lipids, smoking, cardiovascular disease, and hypertension.

RESULTS: Subjects developed diabetes at a rate of less than 1% per year during a mean follow-up of 81.0 months. Each milligram per deciliter of fasting plasma glucose increased diabetes risk by 6% (hazard ratio [HR] 1.06, 95% confidence interval [CI], 1.05-1.07, P < .0001) after controlling for other risk factors. Compared with those with fasting plasma glucose levels less than 85 mg/dL, subjects with glucose levels of 95 to 99 mg/dL were 2.33 times more likely to develop diabetes (HR 2.33; 95% CI, 1.95-2.79; P < .0001). Subjects in the 90 to 94 mg/dL group were 49% more likely to progress to diabetes (HR 1.49; 95% CI, 1.23-1.79; P <.0001). All other risk factors except sex were significantly associated with a diabetes diagnosis.

CONCLUSIONS: The strong independent association between the level of normal fasting plasma glucose and the incidence of diabetes after controlling for other risk factors suggests that diabetes risk increases as fasting plasma glucose levels increase, even within the currently accepted normal range.

© 2008 Elsevier Inc. All rights reserved.
The American Journal of Medicine (2008) 121, 519-524

Full text PDF at: http://download.journals.elsevierhealth.com/pdfs/journals/0002-9343/PIIS0002934308002313.pdf

pre_diabetes @ 2008-05-26T19:31:00

2008-05-27T02:33:34Z

All right. So I went to Jenny's site and did the self-test(take fasting glucose, eat a shit-ton of carbs and test again at 1,2,3 hours)

Here's the results:

fasting: 89
@60 min: 126
120 min: 111
180 min: 101
220 min: 93

Seems like it doesn't go up super-high, but it takes its sweet time going back to normal. Huh?

first post, the post that hurts the most

2008-05-25T21:33:33Z

Hello, hello. :D I'm not sure where to begin actually. I think I have IR, but I haven't been tested yet. I know I'm definitely at high risk for Type 2 diabetes due to various factors, so I've decided to start on an IR diet just in case.

What do you all think of the 'Link and Balance' plan in the Grossman book? I'm trying to figure out what makes it work or not work before I commit to it long term.

nutritional supplements

2007-05-05T18:33:29Z

First, thanks to italiangm for the great answer to my previous question.

Second, does anyone here take any nutritional supplements in order to control blood sugar?

I've read in a couple of books, Reversing Diabetes: Reduce or Even Eliminate Your Dependence on Insulin or Oral Drugs and Reversing Hypertension: A Vital New Program to Prevent, Treat, and Reduce High Blood Pressure about things like vanadium (vanadyl sulfate) and chromium and magnesium/calcium and how these minerals can positively affect blood sugar and/or insulin sensitivity.

Both books being from the same author, it may be that this info is 1 sided and has been debunked a thousand times over. I was just wondering if anyone else had read similar information, and if anyone is actively taking these or other nutritional supplements in addition to, or better yet, instead of prescription medications?

Thank you!

recently pre-diabetic

2007-05-04T04:04:02Z

I went to the doctor for a toe infection, and left the doctor with pre-diabetes/pre-hypertension.

Can anyone suggest an accurate blood glucose monitor that's not too expensive and is easy to use? I know nothing!

Thanks!

Why is the ADA's Consensus Statement Important?

2007-04-19T20:43:19Z

Essentially, the ADA is finally admitting that:

[1] not only is there a prediabetic stage between normal glucose tolerance and type 2 diabetes,

[2] but if detected early, progression to type 2 could be delayed/stopped if the right interventions are put in place.

Before this consensus statement, the ADA dragged its collective feet about the subject of prediabetes, never really committing themselves.

Because of the ADA's non-commitment, many insurance companies didn't recognize prediabetes as a treatable condition and wouldn't pay for testing, education and medication unless one's blood sugar control had deteriorated enough to be diagnosed with Type 2 diabetes.

Hopefully, this new statement will get insurance companies to pay for earlier interventions and save folks from a lot of grief. :)

Finally! ADA Consensus Statement acknowledges earlier testing for prediabetes!!!

2007-04-19T19:06:06Z

While they still don't get it quite right, at least they're on the right track:

The most efficient sequence of testing is an FPG¹ first (currently recommended as the preferred test to detect diabetes) followed by the 2-h OGTT² on a subsequent day to demonstrate the presence of combined IFG/IGT.

The part they got wrong is depending on FPG results to trigger the OGTT.

There are many people, myself included, with normal FPG results that are well within impaired glucose tolerance (IGT) and sometimes Type 2 range when an OGTT is performed.

However, the fact that the ADA is actually recommending the OGTT at all is nothing short of a miracle.

The entire article can be read at: http://care.diabetesjournals.org/cgi/content/full/30/3/753

1 = fasting plasma glucose
2 = oral glucose tolerance test

just joined

2006-12-28T21:24:30Z

Hello. I just signed up for this community after looking around for communities with information on insulin resistance. I have not yet received a diagnosis from a doctor about being pre-diabetic; however, I believe this to be true. I've been struggling with reactive hypoglycemia for the past decade (I'm 30), and I was terribly ill for over 6 weeks this fall. I tracked my symptoms to be directly related to my eating patterns - I did some research and I have pre-diabetic symptoms. My doctor refused to test my glucose and insulin despite the fact that my father was only 5 years older than me when he was diagnosed with type II diabetes. Also my mother has pre-diabetes. My doc did finally agree to send me to a nutritionist, after I insisted that mother began to feel better after changing her diet. I've been learning how to eat on an "Insulin Resistance" diet since mid-November, and I feel loads better and have begun to lose weight. I'm planning to find a more proactive doctor. In the meantime, I am researching pre-diabetes and insulin resistance and trying to figure out how to take care myself until I have a healthcare professional that's willing to work with me to prevent diabetes. A friend with a diabetic daughter gave me a glucose reader, but I haven't tried it yet. Anyhow, just wanted to say hello and I'm enjoying reading the previous posts in this community.

xposted to resist_insulin

Ever wonder why folks gain weight on certain antidepressants?

2006-12-07T11:50:41Z

Taste test may identify best drugs for depression
Press release issued 6 December 2006

New research has shown that it might be possible to use taste as an indicator as to whether someone is depressed, and as a way of determining which is the most suitable drug to treat their depression.

Research from the University of Bristol has shown that our ability to recognise certain tastes can be improved by administering drugs usually given for depression.

The researchers gave healthy volunteers antidepressant drugs that increase levels of the neurotransmitters serotonin and noradrenaline. They report today in the Journal of Neuroscience that these tests resulted in the volunteers being able to detect different tastes (salt, sugar, sour, and bitter) at lower concentrations, thus enhancing their ability to taste.

Dr Lucy Donaldson, senior author on the paper, said: "When we increased serotonin levels we found that people could recognise sweet and bitter taste at much lower concentrations than when their serotonin levels were normal. With increased noradrenaline levels the same people could recognise bitter and sour tastes at lower concentrations. Salt taste doesn't seem to be affected at all by altering either of these neurotransmitters."

She added: "Because we have found that different tastes change in response to changes in the two different neurotransmitters, we hope that using a taste test in depressed people will tell us which neurotransmitter is affected in their illness."

Dr Jan Melichar, the lead psychiatrist on the paper, added: "This is very exciting. Until now we have had no easy way of deciding which is the best medication for depression. As a result, we get it right about 60-80% of the time. It then takes up to four weeks to see if the drug is working, or if we need to change it. However, with a taste test, we may be able to get it right first time."

Taste is often thought to be determined genetically and, until now, people assumed it was fixed throughout life. But these studies show that the ability to recognise different tastes can be altered by the neurotransmitters serotonin and noradrenaline and by people's mood.

In the study, three drugs were given to the volunteers: SSRI (serotonin specific reuptake inhibitor) to raise serotonin levels; NARI (noradrenaline reuptake inhibitor) to raise noradrenaline levels (another neurotransmitter important in depression, and also found in taste buds); and an inactive placebo.

The volunteers were first tested for their ability to recognise certain tastes. The drug was then administered and two hours afterwards they were asked to take the same test again.

The volunteers were also assessed for anxiety levels, their overall level of anxiety being related to their ability to taste; the more anxious a person was, the less sensitive to bitter and salt taste they were.

These results give an important insight into how neurotransmitters affect the taste system. It seems that tasting bitter things can be changed by changes in both serotonin and noradrenaline levels, that sweet taste is affected by only serotonin levels, and that sour taste is affected by noradrenaline.

These findings may also explain why anxious and depressed individuals have diminished appetite. The results also show that taste is related to anxiety levels, even in generally well people.

Heath TP, Melichar JK, Nutt DJ, Donaldson LF.
Human Taste Thresholds Are Modulated by Serotonin and Noradrenaline
J. Neurosci. 2006 26: 12664-12671

First time poster

2006-10-30T12:16:47Z

Hi there!

Best to introduce myself, my name is Mary, I love in London and about a month ago, my GP alluded to the fact I am pre-diabetic.

Diabetes runs in my family, specifically most of the women on my mother's side of the family has Type II Diabetes, my (passed on) great-grandmother had it (during a time not much could be done, and so was blinded and had both legs amputated at the thigh) my grand-mother and great-aunts have it also, as far as I'm aware my mother and her sisters have fought it off by being careful with sugar all their lives. Unfortunately, all the women in my family have a tendancy to gain weight easily - which never helps.

I was basically diagnosed when I went for my yearly check up and to get a renewed prescription of the pill. I was weighed and blood pressure checked. My blood pressure was prefectly normal, but my weight (of 81.5 kgs -179.3lbs, at the time - I'm 4'11.5" tall) seriously worried my doctor who knew of my families history, asking whether I felt sudden bursts of energy and feeling tired for most of the day when I shouldn't be and if I had cravings for sugar (which was most of the time), among other questions. Basically telling me if I stayed at the weight I was, or kept gaining weight, and didn't cut back on sugar and monitored my energy levels by the time I was 30 (I'm 23) I would have Type II Diabetes. She told me that she could only give me a 3 months supply of the pill until I could proove I could lose the weight on my own and cut back on sugar, as the side effects of being on a contraceptive increase for those who are overweight, as well as being harmful for those with diabetes.

Naturally this scared the living daylights out of me.

To combat this, I have tried to cut out added sugars in my diet, trying to eat 5 small meals a day to stave off both hunger and energy spikes, keeping my body feulled for longer and trying to get to the gym 4 times a week, keeping my heart rate at 155bpm for at least 30 mins (if my heart rate goes over about 160bpm, I then enter anaerobic excercise, instead of aerobic, which is what I want). I'm trying to approach this with a more scientific mind, treating my body as a machine that needs proper maintenance.

So far I've lost about 4kgs (8.8 lbs) in the last 6 weeks and hope to lose a further 5kgs (11 lbs) in the next 8 weeks to try and get to the weight I was a year ago, as well as prove I can do it to my doctor and to stave off her threat of looking into "medical options" of getting my weight down and getting me out of the pre-diabetic stage. My ultimate goal is to get to 50kgs (110 lbs) within the next 18 months and steer clear of diabetes for good.

Just glad there's a community targeting pre-diabetics, any information I can get in combating this would be excellent.

For those who take Metformin

2006-10-25T15:52:15Z

Metformin Use Increases Vitamin B12 Deficiency

Results indicate an increased risk of vitamin B12 deficiency associated with current dose and duration of metformin.

A nested case-control study identified risk factors for vitamin B12 deficiency in patients with diabetes treated with metformin.

"Identification of risk factors for metformin-related vitamin B12 deficiency has major potential implications regarding the management of diabetes mellitus," write Rose Zhao-Wei Ting, MBBS, from Prince of Wales Hospital. "First, there is likely to be an improved yield of detecting vitamin B12 deficiency if high-risk individuals can be identified. Second, subjects identified as having substantial risk for metformin-related vitamin B12 deficiency might benefit from empirical screening or primary prevention with other means such as calcium supplementation."

The source population for this nested case-control study was a database that consisted of subjects who had levels of both serum vitamin B12 and hemoglobin A1c and were checked in a central laboratory. The investigators identified 155 cases of diabetes mellitus and vitamin B12 deficiency secondary to metformin treatment, as well as 310 controls who did not have vitamin B12 deficiency while taking metformin.

After adjustment for confounders, there were clinically important and statistically significant associations of vitamin B12 deficiency with dose and duration of metformin use. Each 1-g/day increment in metformin dose conferred an odds ratio of 2.88 (95% confidence interval [CI], 2.15 - 3.87) of developing vitamin B12 deficiency (P < .001).

"Our results indicate an increased risk of vitamin B12 deficiency associated with current dose and duration of metformin use despite adjustment for many potential confounders," the authors write. "The risk factors identified have implications for planning screening or prevention strategies in metformin-treated patients."

"We believe our findings should reinforce the heightened vigilance about vitamin B12 deficiency," the authors conclude. "Enough concerns exist to call attention to the value of vitamin B12 screening, particularly among at-risk patients receiving metformin. Our data underscore the need for monitoring subjects undergoing high-dose and/or prolonged-course metformin therapy."

Arch Intern Med. 2006;166:1975-1979.

Here's a review of what vitamin B12 is, why it's important, and what foods have it: http://dietary-supplements.info.nih.gov/factsheets/vitaminb12.asp

If you use OneTouch® Brand Test Strips...

2006-10-14T14:09:46Z

Counterfeit test strips have been discovered in the US. Details at http://www.lifescan.com/company/about/press/counterfeit

New Member

2006-09-28T03:06:09Z

Hello!

I am a new member here, recently diagnoised (this afternoon) with at the very 'least', pre-diabetes or borderline diabetes. Possibly mild Type II. I have to go get bloodwork done to rule the later out.

I do have a history of blood sugar problems. I've had hypoglycemia for over 10 years now. At first they told me I was just sensitive to the changes in my blood sugar. Then eventually, I was taken more seriously and tests were done and a diagnoisis of Hypo was given. Stress was a huge factor and what I ate was, as well as my weight, sometimes it bothered me for weeks, and sometimes it didn't hardly bother me for months at a time.

Recently, (over the summer) I lost 30lbs. I had been trying to diet and lose 50lbs for a long time, and it just wasen't working, then all of a sudden, it was falling off. Good for me, I finally developed some will power. Then there was the fact that if I ate too big of a meal, I HAVE. HAVE to go sleep. There is no question about it, I must go to sleep, or I am nasty and mean temptered and cranky and can't hardly keep my eyes open anyway and very lethargic. I have been getting very dehydrated lately as well, to the point of getting dizzy while working out or in TKD class, I've even had to leave class just to get a drink (which is a big nono really, in taekwondo class) so I would stop feeling like I would pass out or fall over.

Then, wise 'ol me (I won't mention how I am a nursing student) remembered how I'm supposed to test with my meter every so often to check on my glucose. But bummer, dude, my meter was broke. Being a single Mom on a TIGHT budget, I so very much did not want to go get another one. My best friend, however, found out I wasen't testing and gave me hell until I went and got one. And that's when my jaw hit the floor when I saw numbers like 184, 166, 147, two hours after eating. And numbers like 105 and 110 for fasting. When I am used to numbers like 67 for fasting.

How I went from Hypo to Hyper, I don't get. It doesn't run in the family. Either side. I think I have one other cousin that is Hypo, maybe, my Mom said. What's the difference between pre-diabetes and borderline? I know all about type II, but I don't quite understand the difference between the other two.

So it didn't turn out to be newly discovered will power at all, but instead my body trying to self-preserve that lead to the sudden weight loss, I guess. The doctor seemed happy I haven't lost any more in the past couple months, but not very happy I lost so much in a short amount of time.

Anyone else go from Hypo to Hyper? That's the part I still don't get. I'll have to go bug my A&P professor or something. Anyhow, thanks for letting me ramble! :)

Adios

2006-08-15T22:18:24Z

Hey guys,

I wanted to let you know that I am leaving this community, not because you weren't helpful (you were!) but because my doctor ordered a retest and I do not have a single sign of diabetes, high blood sugar or insulin, or high hemoglobin A1c. The blood tests showed me as perfectly normal, even good, and so did my self-testing with a glucometer. The docs say that there must have been a lab error with the first test that showed me with high hemoglobin a1c levels.

So thank you for all your help, anyway. I still gained useful knowledge - you never know when diabetes could become a problem for me or my family in the future.

Your first clue may not be a glucose test, frequent urination, etc.

2006-08-09T01:19:16Z

Moving my left (non-dominant) arm at the shoulder became limited and painful during the summer of 2004. So painful that it kept me awake at night. Range of movement became so restricted I could not lift my arm up sideways more than halfway to the horizon. I couldn't even reach around to fetch my wallet out of my back pocket, nor reach out to close the car door without extreme pain.

I thought I had pulled a muscle, so I went to my doc who took x-rays and confirmed my extremely limited range of movement. He couldn't find anything in the x-rays and had no clues.

Meanwhile, I began looking up my symptoms online and kept hitting this thing called 'frozen shoulder' (aka "adhesive capsulitis"). Every medical text I looked in kept mentioning the condition is prevalent in diabetics. I was pretty sure I wasn't diabetic and confirmed this by reviewing all my past fasting glucose tests from physicals. They were all normal. However, most texts suggested an oral glucose tolerance test (OGTT) was the gold standard for confirming a diabetes diagnosis, so I decided to get one and remove all doubt. (I'm one of those people that work better *with* information than without.)

Right around the same time I noticed a coupon for a free meter in a supermarket ad. So I got one and decided to perform my own OGTT. I ate so that total carb consumption each day was 150g and did this for 3 days prior to the test, exactly as the protocol calls for. On the fourth day I powdered enough glucose tablets to make 75g of the stuff and mixed it with 6oz of water til dissolved. The meter came with 10 strips so I used one to verify calibration, one for a fasting glucose (96 - normal) then drank the glucose. I used five strips to test at 30, 60, 120, 180 and 240min. The 120min result was 180 which a doctor would have diagnosed as Impaired Glucose Tolerance (IGT). I showed my doc. He agreed with both the IGT and frozen shoulder diagnosis, and congratulated me on my detective skills. :)

Thus began my entry into the world of pre-diabetes. Moral of the story? Not everyone gets the usual symptoms and docs may not pick up on the clues. Keep an eye out for less common symptoms.

p.s. My frozen shoulder finally resolved 14 months later with gentle exercise and lots of tylenol. I regained about 95% range of motion. Unfortunately, the insomnia resulting from those sleepless nights hung around a bit longer. Till 3 months ago, in fact. But I'm getting good sleep now thanks to mirtazapine. :)

p.p.s. CAUTION: Some folks can experience a pretty strong dip in glucose levels (hypoglycemia) after a big rise in glucose. You should have someone handy if you try the OGTT by yourself. Make sure you have a FULL SUGAR DRINK (NO DIET STUFF!!) on hand in case you experience such a crash, and instruct your assistant to give you SMALL sips of it while you are SITTING UPRIGHT to avoid choking. A third of a 12oz drink (that's 4oz) should be enough. No need to trigger another rollercoaster ride with the full 12oz.

monitor questions

2006-07-18T19:30:47Z

I forked over the money (my god, those strips are pricy!) to get a blood glucose monitor. Someone in a previous post said their target is lower than 140. Is that the goal for everyone, or do I need to take into consideration my height, weight, gender, etc.? I took a random reading when I got home and it said 111.

When I talked about all this with the pharmacist, I got even more confused. I don't seem to have the signs of diabetes, and I DO seem to have signs of low blood sugar, but my blood tests a few months ago pointed to high blood sugar? Is this common?

ETA: reading 1 hr. after eating lean meat, high protein bread, and veggies was 105. Guess I need to test this with a heap of french fries next?

Nutrition and Metabolic Aspects of Carbohydrate Restriction

2006-07-01T12:23:59Z

Conclusions from conference papers presented at the American Diabetes Association's 66th Scientific Sessions:

"The presentations at the Nutritional and Metabolic Aspects of Carbohydrate Restriction Conference support the metabolic benefits of a lower carbohydrate content of the diet. Although not discussed at the conference, recent data indicates carbohydrate-restricted diets work significantly better in those individuals with existing IR (insulin resistance) and indicate that the metabolic state of the individual may determine which diet is appropriate for maximum weight loss.^[48] Identifying genetic markers to target these individuals, and those who may best respond to carbohydrate restricted diets, is emerging from the work of Ruano and colleagues.^[49]

Research suggests that favorable metabolic changes can occur with very low-carbohydrate and/or moderate-carbohydrate restricted diets. Diets involving moderate protein intake can improve glycemic (blood sugar) control and blood lipid (cholesterol) levels. This suggests that weight loss and metabolic enhancements might be due to the combination of an increased protein intake and restriction of carbohydrate. A diet consisting of 150g or less of carbohydrate, with 120g or greater of protein per day is recommended by Layman.^[50] This moderate diet approach reduces hepatic (liver) glucose production and minimizes the excessive secretion of insulin giving rise to improved glycemic control.^[50] The Women's Health Initiative^[51] demonstrated that long-term, low-fat diet adherence is difficult for many people. Long-term compliance might improve with higher protein diets that promote satiety (feeling satisfied), and carbohydrate-restricted diets that improve insulin control. Further research is needed to assess long-term carbohydrate-restricted diet compliance rates as well as long-term alterations in metabolism and enzymatic reactions that occur with carbohydrate-restricted diets."

References:

[48] Cornier MA, Donahoo WT, Pereira R, et al. Insulin sensitivity determines the effectiveness of dietary macronutrient composition on weight loss in obese women. Obes Res. 2005;13:703-709

[49] Ruano G. Genetic markers for dietary treatment of obesity and metabolic syndrome. Program and abstracts of the Nutritional & Metabolic Aspects of Carbohydrate Restriction; January 20-22, 2006; Brooklyn, New York.

[50] Layman D. Impact of dietary protein on glycemic control and weight loss. Program and abstracts of the Nutritional & Metabolic Aspects of Carbohydrate Restriction; January 20-22, 2006; Brooklyn, New York.

[51] Howard BV, Manson JE, Stefanick ML, et al. Low-fat dietary pattern and weight change over 7 years: the Women's Health Initiative Dietary Modification Trial. JAMA. 2006;295:39-49.

http://www.medscape.com/viewarticle/531007_1 (requires free registration)

Figuring out refined carbs

2006-06-13T23:09:07Z

I know that I should avoid refined sugars and grains, but I'm not sure how to gauge. Is there some kind of guideline, like "avoid having more than X grams in one serving" or something? Or should I listen to the people who tell me that I should never have even a bite of anything sweet/starchy ever again? I have cut way back on this stuff, but I don't know if it's enough.

The websites I've been to aren't helpful because they just say to "consult with your dietician for a personal recommendation." My insurance won't cover it and I can't afford it at the moment, so I need to figure this out on my own. Thanks for any help anyone can give me.

Antidepressants Can Increase Diabetes Risk in Certain Cases

2006-06-12T00:20:46Z

Study: Those already at high risk for type 2 boost chances by taking drugs to fight depression

By Kathleen Doheny
HealthDay Reporter

SATURDAY, June 10 (HealthDay News) -- If you are already at high risk for getting type 2 diabetes, antidepressant drugs can boost that risk, according to new research reported Saturday.

The report was based on a re-analysis of part of the Diabetes Prevention Program, a large-scale study in which researchers reported in 2002 that those at high risk for getting type 2 diabetes who lost excess weight and exercised were able to prevent the onset of diabetes much of the time.

In the new study, to be presented at the annual meeting of the American Diabetes Association (ADA) in Washington, D.C., researchers looked at the effect of antidepressant drugs on a person's proclivity for getting diabetes. They evaluated the effect on those in the three groups studied in the Diabetes Prevention Program: the lifestyle intervention group, the placebo group and the group given the diabetes drug metformin (Glucophage).

Those in the placebo and lifestyle groups who were on antidepressants had a two-to-three times greater risk of getting type 2 diabetes than those from the metformin group taking antidepressants, said Richard Rubin, the lead author and the president-elect of health care and education for the ADA.

"No one has ever looked at whether antidepressant use could increase the risk of adult onset diabetes," said Rubin, who is also associate professor of medicine and pediatrics at the Johns Hopkins University School of Medicine in Baltimore.

For years the debate on whether depression causes diabetes, or vice versa, has been unresolved. But Rubin said this was the first large study to examine the effect of antidepressants on people at high risk of type 2 diabetes.

"We looked at 3,187 participants [in the Diabetes Prevention Program trial] who completed the depression screener," he said. "At the beginning, 5.7 percent were on antidepressants. During the study, about 13.5 percent were taking antidepressants [at least] some of the time."

Some experts think the use of certain types of antidepressants known as SSRIS (such as Prozac and Paxil) could cut the risk of getting diabetes, Rubin said, because some people lose weight on those. But, he added, many experts are finding that the weight loss only occurs soon after the drugs are started, then tapers off or ends.

But taking any kind of antidepressant boosted the risk of getting diabetes, he found. "It didn't matter what antidepressant you were taking (tricyclic antidepressant or SSRI), the risk of getting diabetes was still there in the placebo or lifestyle arm," he said.

Why this effect occurs and why metformin seems to protect against it is not known, Rubin added.

In the analysis, he ruled out whether those who developed diabetes did so because of weight gain alone, less physical activity or increased insulin resistance, all of which boost the risk of getting type 2 diabetes.

The findings could have enormous public health implications, Rubin said. "Forty million people in the United States are pre-diabetic," he said, referring to a condition in which blood glucose levels are rising, putting the person at risk of developing type 2 diabetes. According to the U.S. government's National Diabetes Information Clearinghouse, almost 21 million Americans already have type 2 diabetes.

The finding does not prove cause and effect, Rubin said, but it does indicate an association between taking antidepressants and increasing the risk of getting diabetes among those already at high risk.

But, Rubin cautions, "this definitely does not mean that people should stop taking their antidepressant medication. If you think you are at high risk for developing diabetes, talk to your doctor. Be sure you monitor your blood glucose very carefully."

The study is interesting, but "more research is needed," said Cathy Nonas, a registered dietitian and director of the diabetes and obesity programs at North General Hospital in New York City.

For years, Nonas noted, the "chicken-or-the-egg" debate has continued, with researchers trying to analyze which came first -- depression leading to diabetes or vice versa. Like Rubin, she emphasized that depression is a condition that can't be ignored. "You have to treat the depression. If you don't, people can become nonfunctional," she said.

For example, Nonas added, if one of her patients is on an antidepressant, she always asks about weight gain. "If they have gained weight recently, I call their psychiatrist to see if the person can be switched [to another antidepressant that may not cause as much weight gain]."

The issue is far from resolved. In another study presented at the meeting, researchers reported that while diagnosed depression has been associated with developing diabetes, those in their study who had glucose intolerance did not have any more depressive symptoms than did others with more normal glucose levels. In yet another study, researchers reported that depression interfered with a person's ability to manage their diabetes.

SOURCES: Richard Rubin, Ph.D., associate professor of medicine and pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md., and president-elect of health care and education, American Diabetes Association; Cathy Nonas, M.S., R.D., director, diabetes and obesity programs, North General Hospital, New York City; June 10, 2006, presentations, American Diabetes Association scientific session, Washington, D.C.

Copyright © 2006 ScoutNews LLC. All rights reserved.

This article can be accessed directly at: http://www.healthscout.com/news/1/533206/main.html

New and hitting walls

2006-06-11T12:01:23Z

Hello,

I am new to this community and newly "diagnosed" (sorta-it's a long story) with borderline diabetes. It's very frustrating because I have no predisposition to diabetes, and I am not really overweight, and I'm 29 years old. But as usual, there's no use whining about it ...

My main stumbling block right now is that I have to avoid wheat (gluten-free right now), soy, and dairy for other reasons. That makes figuring out my new meal plan even more complicated. Most wheat-free people just eat rice and potato products, but now I know that most of those are pretty high in the glycemic index. Any suggestions about what else I could have? Brown rice is ok, sweet potatoes seem like a reasonable substitute for white potatoes, and Mung Bean threads are much lower in the GI than regular rice noodles. Other than that, I don't know. I haven't been able to find the GI rating for quinoa - anyone know?

I am a loss as to what to eat for breakfast. Rice cereal doesn't work anymore - it just makes me ill if I eat more than a small amount. I feel ok after eating eggs, but I've been told that they are too high in cholesterol. The best I can come up with is fish, which isn't really appetizing in the morning to me. There doesn't seem to be anything quick and easy that I can grab before work. Ideas?

Thanks. This is all very confusing.

(xposted to food_allergies)

Watch out for watermelon!

2006-05-05T02:03:10Z

When it gets warm, I *love* watermelon. It's fairly low in calories and is a good source of lycopene. I usually eat a couple big slices a day when it's hot out.

However, now that I know I have impaired glucose tolerance (IGT), I've also learned watermelon has lots of fast acting carbohydrates in it.

So, I decided to do a pre-meal test, eat my usual amount (imagine a pyramid with three sides and a bottom about 4" along each edge), and do some post-meal tests. Here are the results:

5:26pm -   94 mg/dl   [pre-meal - yay!]
6:00pm - 164 mg/dl   [30 min post-meal *gasp* *faint*]
6:30pm - 105 mg/dl   [60 min post-meal *whew*]

I didn't bother testing further. Since my personal target is to never exceed 140 mg/dl at any time to prevent future complications, watermelon will now be an occasional treat eaten in much smaller quantities and always with protein and/or fat to slow down conversion to glucose.

*sigh* :(

Lifestyle Changes Regenerate Nerve Fibers in Prediabetics

2006-04-15T13:07:33Z

In patients with diabetes, nerve fiber damage that causes diabetic neuropathy is irreversible.

Now, in a new study sponsored by the National Institutes of Health, researchers have found that with weight loss and exercise in patients with impaired glucose tolerance neuropathy -- so-called prediabetes -- the affected nerve fibers can be reinervated, causing a reduction in the patients' pain.

Dr. A Gordon Smith stated that, "It's been clear that aggressive control of blood glucose levels slows the risk of neuropathy, but no treatment has ever before resulted in improved neuropathy. "We certainly never thought that reinvervation would be possible at the prediabetic state."

Dr. Smith and his associates, from the University of Utah in Salt Lake City, enrolled 32 subjects with impaired glucose tolerance neuropathy, and performed skin biopsies at the distal leg and in the proximal thigh to measure intraepidermal nerve fiber density.

"Then we set a weight loss goal of 7%, along with 150 minutes of moderate exercise per week," the researcher said. "Every 3 months the patients also had individual counseling with a nutritionist."

Baseline intraepidermal nerve fiber density was 0.9 fibers/mm in the distal leg and 4.8 fibers/mm in the thigh. After 1 year of dieting and regular exercise, the investigators measured a 0.3 fiber/mm improvement in the distal leg and 1.4/mm in the thigh (p < 0.004).

Moreover, the change in fiber density in the thigh was inversely correlated with neuropathic pain (p < 0.05). However, patients with the most reduced intraepidermal nerve fiber density were unlikely to experience relief of their symptoms, Dr. Smith said.

"If you see a patient with symptoms of neuropathy - numbness, tingling pain, or absence of sensation -- you should conduct an oral glucose tolerance test and confirm nerve fiber loss by such measures as nerve conduction testing, quantitative sensory testing, and quantitative sudomotor axon reflex testing," Dr. Smith advised

"If they turn out to be glucose intolerant with peripheral neuropathy, you should treat them as aggressively as possible with diet and exercise," Dr. Smith concluded. " Simply treating them with antihyperglycemic drugs appears to not allow damaged nerve fibers to recover," he added.

Presented at the American Academy of Neurology 58th Annual Meeting in San Diego.

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