Home Diabetes Cure

Reverse Diabetes Now

Reverse Your Diabetes by Matt Traverso was developed with the objective of curing diabetes effortlessly and forever. Reverse Your Diabetes Today guarantees to help patients end this illness in just 3 weeks! The treatment requires absolutely no drugs nor medication or medical interventions for it to be successful. The easy to implement concepts and techniques taught in the Reverse Your Diabetes Today system use simple, but highly effective diet and lifestyle changes to cleanse your body from harmful acids and heal your pancreas, allowing it to produce and regulate insulin naturally again. Reverse Diabetes Today PDF is an extremely comprehensive treatment that encourages people to make positive changes in daily habits, more concretely, dieting, regularly exercising, and weight managing routines to reverse diabetics. Continue reading...

Reverse Diabetes Now Overview

Rating:

4.8 stars out of 18 votes

Contents: EBook
Author: Matt Traverso
Official Website: www.reverse-diabetes-today.com
Price: $47.00

Access Now

My Reverse Diabetes Now Review

Highly Recommended

The very first point I want to make certain that Reverse Diabetes Now definitely offers the greatest results.

When compared to other e-books and paper publications I have read, I consider this to be the bible for this topic. Get this and you will never regret the decision.

Treatment for Diabetes

Treatment for diabetes involves following a regimen of diet, exercise, self-monitoring of blood glucose, and taking medication or insulin injections. Although type 1 diabetes is primarily managed with daily insulin injections, type 2 diabetes can be controlled with diet and exercise. However, when diet and exercise fail, medication is added to stimulate the production of insulin, reduce insulin resistance, decrease the liver's output of glucose, or slow absorption of carbohydrate from the gastrointestinal tract. When medication fails, insulin is required. Following the diagnosis of diabetes, a diabetic patient undergoes medical nutrition therapy. In other words, a registered dietician performs a nutritional assessment to evaluate the diabetic patient's food intake, metabolic status, lifestyle, and readiness to make changes, along with providing dietary instruction and goal setting. The assessment is individualized and takes into account cultural, lifestyle, and financial...

Estimated Healthcare Expenditures Associated With Diabetes

Diabetes mellitus has been present since antiquity. It was described in 400 B.C. as a disease of well-fed people, and Bose wrote in 1895 amongst the Zemindars and Talookdars, who consider it a pride and honor to lead an indolent life, diabetes is a common disorder (1). It is a common disease that is now estimated to affect more than 16 million Americans and more than 100 million people worldwide (2, 3). It is most prevalent in countries such as India, China, and the U.S. (4). Its direct and indirect costs account for at least 15 percent of health-care expenditure in the U.S., which totals at least 100 billion annually (2, 5, 6). The annual estimated cost in other countries is just as formidable. The estimated annual health-care costs associated with diabetes in various developed countries in 1995 (4) are shown in Table 9.1. A large portion of the costs of diabetes is associated with its complications (7). The University Group Diabetes Program, the earliest randomized clinical trial of...

Classification of diabetes

The American Diabetes Association defines diabetes mellitus as a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action or both 12 . The main classification of diabetes mellitus is type 1, type 2, and GDM. Type 1 diabetes, formerly known as insulin-dependent or juvenile-onset diabetes, is characterized by autoimmune destruction of the pancreatic beta-cells and accounts for 5-10 of all diabetes cases. Type 1 diabetes requires exogenous insulin for survival and is diagnosed primarily in persons less than 30 years of age. Type 2 diabetes, which accounts for almost 90 of diabetes cases, was previously known as adult-onset or non-insulin dependent diabetes. Insulin resistance rather than insulin deficiency and obesity are associated with type 2 diabetes. GDM is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. The definition applies if medication or MNT is used in treatment or the...

Posttransplantation Diabetes

Posttransplantation diabetes (PTDM) is, as the name implies, the development of diabetes after transplantation. Steroid diabetes was first reported in renal-transplant recipients (38). Its early frequency was 40 percent to 60 percent (38). The incidence ranges from 2 percent to 50 percent, with most cases being diagnosed within three months of transplantation (39, 40). Risk factors for posttransplant diabetes include age, non-Caucasian ethnicity (risk of posttransplantation diabetes is higher in African American recipients than Caucasian recipients), and immunosuppression (39). Transplant recipients with posttransplant diabetes tend to be 0 to 12 years older than those without (39). Non-Caucasian patients had a twofold increased risk of post-transplant diabetes (RR 3.3, 95 percent CI 1.7-7.0) (39). There is an increased incidence of posttransplant diabetes in patients treated with glucocorticoid therapy, cyclosporine, and those treated with high doses of tacrolimus (39, 41). The mean...

Diabetes Carbohydrate Modified Diets and Carbohydrate Counting

Diabetes is a condition that alters the way the body handles carbohydrates. In terms of diet modifications, diabetics can control blood sugar levels by appropriately managing the carbohydrates, proteins, and fats in their meals. The amount of carbohydrates, not necessarily the source, is the primary issue. Blood glucose levels after a meal can be related to the process of food preparation, the amount of food eaten, fat intake, sugar absorption, and the combination of foods in the meal or snack. One method of monitoring carbohydrate levels carbohydrate counting assigns a certain number of carbohydrate grams or exchanges to specific foods. Calculations are used to determine insulin need, resulting in better control of blood glucose levels with a larger variety of foods. Overall, diabetic diets can include moderate amounts of sugar, as long as they are carefully monitored. see also Diabetes Mellitus Fats Nutrients Protein Weight Loss Diets. American Diabetes Association. < http...

Diagnosing Diabetes Is Easy

In fact, it's one of the simplest disorders to diagnose. A simple finger prick yields a couple of drops of blood that are analyzed for the presence of sugar. In nonpregnant adults, the criteria for diagnosis is as follows a blood-sugar level of greater than 200 mg dl, a fasting blood-sugar level of greater than 126 mg dl, or a two-hour blood-sugar level of greater than 200 mg dl during an oral glucose tolerance test. All pregnant women should be tested for GDM between 24 and 28 weeks of gestation. The testing, called an oral glucose tolerance test (OGTT), is painless and reliable. A blood-sugar level is obtained, and then the patient drinks a glass of sugary liquid. One hour later, a second blood-sugar reading is obtained. If a mom-to-be has a fasting blood sugar of greater than 126 mg dl, or a random blood sugar of greater than 200 mg dl, she meets the criteria for diabetes. It's very important to diagnose GDM because, when treated with proper diet and possibly insulin therapy,...

Estimated Prevalence of Diabetes Mellitus Among Ethnic Groups in the US

Is undiagnosed in one-third of all people with diabetes (13). The lifetime risk of developing diabetes mellitus is 40 percent if there is one parent with type 2 diabetes mellitus, 80 percent to 100 percent if there are two affected parents, 35 percent if there is an affected sibling, and 70 percent to 80 percent among monozygotic twins (11). Only 5 percent to 10 percent of type 2 diabetes mellitus cases are due to slowly progressive beta-cell dysfunction (11). Approximately 10 percent to 15 percent of people diagnosed with type 2 diabetes mellitus after the age of 40 have positive islet cell cytoplasmic antibodies and GaD65 autoantibodies, which actually represent a subgroup of type 1 diabetes mellitus, also known as latent autoimmune diabetes (11). Although classically thought to primarily affect adults, type 2 diabetes mellitus also affects youths (14). In a recent analysis, prevalence was 15.9 per 1000 among 15- to 19-year-old Pima Indians, 4.5 per 1000 for all U.S. American...

Defining Impaired Glucose Tolerance Insulin Resistance And Diabetes Mellitus

Impaired glucose tolerance (IGT), determined by the postload glucose value of the oral glucose tolerance test (OGTT), is found in individuals with moderately disturbed glucose metabolism (22). These individuals are generally hyperinsulinemic and have an increased risk of developing diabetes (22). The National Diabetes Data Group guidelines require at least one intermediate glucose level greater than 11.1 mmol L for the diagnosis of IGT (22). According to current American Diabetes Association guidelines, a two-hour postload glucose > 140 (7.8 mmol l) and < 200 mg dl (11.1 mmol l) is defined as impaired glucose tolerance (23). Insulin resistance, manifested by a diminished ability to keep glucose levels low with insulin levels in the normal range, precedes the onset of noninsulin-dependent diabetes mellitus. The glucose-clamp technique is the gold standard for the assessment of insulin resistance (22, 24). In individuals with insulin resistance, the glucose level is slightly raised,...

Diagnostic Criteria For Diabetes Mellitus

Prior to 1979, various criteria existed, and there was no consensus on how to diagnose diabetes (33). In 1979, the National Diabetes Data Group developed guidelines for diagnosing diabetes mellitus and impaired glucose tolerance, which were adopted by the American Diabetes Association in 1993 (33). According to these guidelines, diabetes was diagnosed when 1) there was unequivocal elevation of plasma glucose (> 200 mg dl 11.1 mmol l ) and presence of classic symptoms of diabetes including polydipsia, polyuria, polyphagia, and weight loss 2) fasting plasma glucose > 140 mg dl (7.8 mmol l) on two occasions 3) fasting plasma glucose less than 104 mg dl and two OGTTs with the two-hour plasma glucose > to 200 mg dl and one intervening value > 200 mg dl after a 75-gram glucose load (33). Impaired glucose tolerance was defined by fasting plasma glucose less than 140 mg dl and two-hour plasma > 140 mg dl, and less than 200 mg dl with one intervening value > 200 mg dl after a...

Management of Gestational Diabetes

There are no universal guidelines in the management of GDM. A recent Australian randomized, controlled trial of 1,000 women with gestational diabetes showed that treating women with GDM reduced the risk of perinatal complications 60 . In this study by Crowther et al., the intervention group received MNT, self-monitored their blood glucose levels, and if indicated received insulin therapy. Perinatal complications were 1 in the intervention group and 4 in the group receiving routine care. MNT is the cornerstone of treatment in the management of GDM. The American Diabetes Association and the American College of Obstetricians and Gynecologists recommend nutritional counseling by a registered dietitian and an individualized meal plan 3, 58 . The American Dietetic Association's evidence-based Nutrition Practice Guidelines have identified the following MNT goals for GDM (1) to achieve and main- Diagnostic Criteria for Gestational Diabetes Mellitus tain normoglycemia, (2) to provide...

Recommendations for OWOB Individuals with Type Diabetes and Those At Risk for the Disease

Weight loss is recommended for all those with type 2 diabetes mellitus whose BMI exceeds 25 percent to 10 percent of initial body mass will help prevent the development of diabetes and enhance metabolic control for those in whom the disease is already established. pharmacologic treatments, including insulin (20), as discussed in the chpater by Lien and Feinglos in Section II of this book. In patients with longstanding disease or pronounced pancreatic P-cell dysfunction, moderate weight loss may not be sufficient to achieve satisfactory glycemic control. There may be a need for more intensive, ongoing intervention, including an escalation of calorie restriction to a very low-calorie diet, e.g., 800 Kcal day or less (4, 55). In this event, a routine vitamin mineral supplement and routine nutritional monitoring should be employed, and indications of medical complications, including gallstones (56), should be monitored. Weight-loss-promoting medications may need to be considered in some...

The Enteroinsular Axis In Diabetes

The importance of the enteroinsular axis in healthy individuals gave rise to the possibility that an incretin defect might be partially responsible for the metabolic abnormalities observed in type 2 diabetes. Several studies showed that the incretin effect (as studied by comparing isoglycemic oral and IV glucose loads) is reduced or abolished in these individuals 51 . Work in this area initially centered on the possibility of impaired GIP secretion, but early publications reached no consensus, as normal, increased, and decreased GIP secretion have all been reported in type 2 diabetes 52 . Some of these conflicting results could be attributed to the varying degrees of cross-reactivity that GIP assays displayed with biologically inactive forms of the hormone. A recent study has found normal or marginally impaired GIP secretion in diabetics drawn from a population with a wide spectrum of the disease 53 . However, similar studies with GLP 1 have shown a significant impairment of GLP 1...

Diabetes Heart Disease and Stroke

Many people with diabetes are not aware that they are at particularly high risk for heart disease and stroke, which can result from the poor blood flow that is a symptom of diabetes. In addition, people with type 2 diabetes have higher rates of hypertension and obesity, which are additional risk factors. Diabetics are two to four times more likely to have a heart attack than nondiabetics, and at least 65 percent of people with diabetes die from heart attack or stroke. While deaths from heart disease have been declining overall, deaths from heart disease among women with diabetes have increased, and deaths from heart disease among men with diabetes have not declined nearly as rapidly as they have among the general male population. The National Diabetes Education Program has launched a campaign to bring the problem to public attention. Patients are advised to work with medical personnel to control their glucose level, blood pressure, and cholesterol level and, of course, to avoid...

Pregnancy and Diabetes

Gestational diabetes which may start around the middle of pregnancy and end after delivery is a health problem for some pregnant women. Who's at risk Women with a family history of diabetes, obese women, those with a problem pregnancy, and women over age forty. Most women are routinely tested for gestational diabetes at about twenty-four to twenty-eight weeks. Whether it's preexisting or gestational, diabetes during pregnancy increases the risk for high blood pressure and toxemia. Toxemia, accompanied by swelling, high blood pressure, and excess protein in urine, is dangerous. Women with gestational diabetes often have big babies, who may be difficult to deliver, and they may need a cesarean delivery. The risk for getting diabetes later in life is higher among women who develop gestational diabetes. If you have diabetes, you can deliver a healthy baby. However, it's important for your doctor to monitor it carefully and prescribe treatment, typically a combination of diet and physical...

Design Of Treatment For Type Diabetes Based On Nutrient Interactions

It is perhaps apparent by now that increased lipid availability can impair glucose utilization through many different mechanisms and result in the hyperglycemia of type 2 diabetes. Consequently, there are as many different approaches that can be used to design effective treatment strategies for the disease on the basis of the competition of nutrients as substrates for metabolic reactions. These strategies include limiting the availability of lipids as metabolic fuels inhibition of fatty-acid uptake and oxidation inhibition of gluconeogenesis and uncoupling the energy obtained during fatty-acid oxidation with concomitant manipulation of the fatty-acid As pointed out earlier, fatty-acid oxidation affects glycemic control not only by decreasing peripheral glucose utilization, but also by enhancing gluconeogenesis. Hence, inhibition of lipolysis is an effective strategy to reduce the availability of free fatty acids for oxidation and thus enhance glucose oxidation and decrease...

Blunted Muscle Insulin Signal Transduction in Obesity

The inability of insulin to stimulate glucose transport in muscle of obese individuals raises the question as to whether this effect is caused by a defect in the glucose-transport system (i.e., glucose transporter 4 GLUT4 translocation and activation) or in the insulin signaling system (i.e., insulin-signal transduction). To differentiate between these alternative mechanisms for insulin resistance, a number of experiments have been conducted to test whether glucose transport could be stimulated in insulin-resistant muscle if a signal other than insulin were presented. Exercise and muscle contraction have been shown to stimulate glucose transport by causing translocation of glucose transporters to the cell surface, analogous to the stimulation by insulin.36 Maximal stimulation of transport by insulin and exercise are additive, suggesting that the two stimuli act through different signaling pathways. Several groups have investigated stimulation of glucose transport in the...

Evidence for Genetic Overlap between Type and Type Diabetes

Even though, as described above, type 1 and type 2 diabetes represent two different disease entities, the clinical and etiological distinction between them is becoming more difficult as there is increasing evidence of a significant overlap between the two disease states. Clinical studies have reported that even within the same family both type 1 and type 2 diabetes may co-occur and patients with such double genetic predisposition have intermediate phenotype (259). As an example of common genetic predisposition, a variable number of tandem repeats polymorphism in the insulin gene promoter region has been associated with both type 1 and type 2 diabetes (259). The accelerator hypothesis suggests that both type 1 and type 2 diabetes are the same disorder of insulin resistance set against different genetic background (260). According to this hypothesis, type 1 and type 2 diabetes are one and the same entity, distinguished only by the rate of P cell loss. Instead of overlap between the two...

Insulin Resistance In Obesity

The metabolic syndrome is a condition characterized by hyperinsulinemia, hypertension, visceral obesity, dyslipidemia, and glucose intolerance, which leads to increased risk of coronary-artery disease and type 2 diabetes. The National Health and Nutrition Examination Survey (NHANES III) indicated that 45 percent of the U.S. population over age 50 has metabolic syndrome, and, because of the increase in the prevalence of obesity, the incidence of the metabolic syndrome has increased by 60 percent over the last decade. Obesity is generally accompanied by insulin resistance, which is manifest as fasting hyperinsulinemia. In addition, an elevated area under the curve for insulin values during an oral glucose-tolerance test is usual for insulin-resistant, obese individuals, and glucose utilization is markedly depressed in euglycemic insulin-clamp studies.58,59 Stimulation of glucose transport by insulin is markedly blunted in muscle of obese individuals.273459'82 This observation likely...

Eating Smart When You Have Diabetes

If you're diagnosed with diabetes, you should definitely seek the nutritional advice of a registered dietitian, preferably one who is certified as a diabetes educator (credentials will read R.D., C.D.E.). The goal of nutrition therapy is to restore and maintain blood glucose levels to as near normal as possible. This means balancing your food with insulin and activity levels. What's more, you'll want to maintain appropriate cholesterol and trigylceride levels, consume the right number of calories for maintaining a reasonable weight, and improve your overall health by eating right.

Diabetes and Microalbuminuria

Microalbuminuria has been shown to be an important risk factor for cardiovascular disease and nephropathy in patients with type 2 diabetes (51). Meta-analysis has shown that the presence of microalbuminuria doubles the risk of cardiovascular morbidity or mortality and doubles the risk of total mortality (51). In patients with diabetes, the presence of microalbuminuria confers a tenfold higher risk of developing diabetic nephropathy annually, compared to patients without microalbuminuria (51). In a large cross-sectional analysis, when compared to patients with diabetes and normoalbuminuria, patients with diabetes and microalbuminuria had a longer duration of diabetes and higher waist-to-hip ratio, systolic and diastolic blood pressure, hemoglobin A1c (HbA1c), ankle-to-arm index, and serum creatinine (51). They were more likely to have a history of retinal laser therapy, hypertension, cerebrovas-cular disease, peripheral vascular disease, require insulin therapy, be smokers, and have...

Glucose Intolerance and Insulin Resistance

People with diabetes (both non-insulin-dependent and insulin-dependent) or with impaired glucose tolerance have a higher risk of CHD than people with normal glucose tolerance.34 Some of this association is due to the coexistence of glucose intolerance with low HDL cholesterol, high blood Vegetarian diets do not have a well-defined effect on glucose tolerance. Western vegetarian diets generally include more low glycemic index foods, such as legumes and fruit, than non-vegetarian Western diets and might therefore reduce the incidence of glucose intolerance. Snowdon and Phillips43 found that self-reported diabetes was less prevalent among vegetarian than among non-vegetarian Seventh-Day Adven-tists, and that diabetes was only half as common as a cause of death among Seventh-Day Adventists, as compared with the American population as a whole. However, Asian vegetarians from the Indian subcontinent suffer a high incidence of diabetes, despite eating relatively large amounts of legumes. It...

Introduction To The Problem The Critical Link Between Diabetes And Excess Body Weight

The problem of obesity has reached epidemic proportions in the United States (see also other chapters by Boan and McMahon), and evidence of its negative impact on health is rapidly accumulating. Excessive body mass, defined as a body-mass index (BMI) over 25 kg m2 (overweight OW) and > 30 kg m2 (obese OB) is linked with an increased risk for a number of serious chronic diseases, including cardiovascular disease (CVD), hypertension, and some cancers, as well as type 2 diabetes (1-3). The relationship between OW OB and diabetes is exceedingly strong, with the prevalence of type 2 diabetes increasing along with OW OB in a dose-dependent manner (3). In fact, as many as 90 percent of all type 2 diabetic individuals fit the OW OB BMI criteria (4). Thus, OW OB and type 2 diabetes are inextricably linked (5), the term diabesity having been coined by Astrup and Finer (6) to emphasize the close connection between the two disorders. The need to deal with the obesity problem by restoring...

Diabetes Complications

People with diabetes are at increased risk for serious long-term complications. Hyperglycemia, as measured by fasting plasma glucose concentration or glycosylated hemoglobin (HbA1c), causes structural and functional changes in the retina, nerves, kidneys, and blood vessels. This damage can lead to blindness, numbness, reduced circulation, amputations, kidney disease, and cardiovascular disease. Type 1 diabetes is more likely to lead to kidney failure. About 40 percent of people with type 1 diabetes develop severe kidney disease and kidney failure by the age of fifty. Nevertheless, between 1993 and 1997, more than 100,000 people in the United States were treated for kidney failure caused by type 2 diabetes. African Americans experience higher rates of diabetes-related complications such as eye disease, kidney failure, and amputations. They also experience greater disability from these complications. The frequency of diabetic retinopathy (disease of the small blood vessels in the retina...

Preeclampsia and Gestational Diabetes

While the normal pregnancy is characterized by maternal hemodynamic changes and an insulin resistant state, obesity in pregnancy appears to complicate these expected physiological adaptations to pregnancy. Accordingly, the risk for hypertensive disorders and gestational diabetes (GDM) is reportedly higher in obese and morbidly obese women compared to women who are not obese. In a prospective, multicenter study of more than 16,000 women, Weiss et al. 31 observed a 2.5-fold greater risk of gestational hypertension, and a 2.6-fold greater risk of GDM among obese versus nonobese women. Risk for these conditions was even greater in a morbidly obese subset, e.g., 3.2- and 4-fold respectively. Similarly, these researchers found the risk for developing preeclampsia was 1.6 and 3.3 times more likely to develop in obese and morbidly obese women, respectively. Results from this study have been confirmed by others 32, 33 and found to be independent of other related factors including age, parity,...

Diabetes A Growing Health Concern

Diabetes has become an epidemic, affecting about twenty-one million Americans. Yet more than six million of them perhaps you or someone in your fam-ily don't know they have it And nearly one million more each year are predicted to get it. In 2005 the U.S. Department of Health and Human Services and the American Diabetes Association estimated that about 41 million Americans ages 40 to 74 have pre-diabetes, which sharply raises the risk for developing type 2 diabetes and increases the risk of heart disease by 50 percent. Most people with pre-diabetes are apt to develop diabetes within a decade unless they make modest changes in both their food choices and their physical activity level. If it's not managed properly, diabetes can have serious, even life-threatening, effects on health eye problems including blindness, circulatory problems, nerve disease, and kidney disease and failure, among others. In fact, diabetes is the leading cause of blindness, leg and foot amputations, and kidney...

Children and Diabetes

Type 1 diabetes is the most common form of diabetes among children. With the parallel rise in childhood obesity, more and more children are at risk for or diagnosed with type 2 diabetes. Dealing with diabetes during the childhood and teenage years adds to the challenges of growing up. Most kids don't want to be different. The first guideline-help your child maintain or grow into a healthy weight to reduce the chance of type 2 diabetes. If your child is overweight, ask your doctor about testing for diabetes at about age ten or at puberty if your child has other risk factors. If your child is diagnosed with diabetes, accept and manage it together in a calm, careful, and positive way. Work closely with your child's healthcare team to manage diabetes and help your child grow nor-mally physically, mentally, and emotionally. Gradually involve your child in taking responsibility for his or her diabetes. Encourage rather than nag, even when things aren't perfect. Help your child learn when,...

Gestational Diabetes

Gestational diabetes affects 0.6 percent to 15 percent of pregnant women (35). It implies an increased risk of development of impaired glucose tolerance and diabetes (35). Most develop type 2 diabetes, with an incidence of at least 13.8 percent. The incidence of type 1 diabetes is reported to be 0.7 percent to 6.6 percent over 2-11 years. In a study looking at gestational diabetes, the cumulative risk for diabetes and abnormal glucose tolerance was 13.8 percent and 42.4 percent after 11 years versus 0.0 and 2.8 percent in women without diabetes (35). Independent, predictive factors for diabetes were prior hyperglycemia four abnormal glucose values on the diagnostic OGTT overt diabetes during pregnancy two-hour blood glucose > 11.7 mmol l on the diagnostic OGTT gesta-tional age at diagnosis < 24 weeks and prepregnancy body-mass index (BMI) > 26.4 kg m2 (35). Race is thought to be a risk factor for gestational diabetes (36). Recurrence rates for gestational diabetes have been...

Can You Prevent Diabetes

So far, despite a number of research studies now underway, there are no definitive answers on how to prevent Type 1 diabetes. Type 2 diabetes is another story. You can reduce many of the risk factors that increase your chances for developing the condition. Poor lifestyle habits such as a bad diet and lack of exercise can increase your chances for getting diabetes. Other nonnutrition related risk factors for Type 2 diabetes include being over the age of 45, having a parent or sibling with the disease, being of Latino, Native American, African American, or Pacific Islander descent, and, in a woman, having polycystic ovarian syndrome. Furthermore, there's strong evidence that even modest weight loss and exercise can significantly reduce the onset of Type 2 diabetes in people with an impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). In one study, individuals who lost 5 to 7 percent of their body weight and walked for 150 minutes each week reduced their risk of developing...

Diet physical activity and diabetes

Type 2 diabetes results from an interaction between genetic and environmental factors. The rapidly changing incidence rates, however, suggest a particularly important role for the latter as well as a potential for stemming the tide of the global epidemic of the disease. The most dramatic increases in type 2 diabetes are occurring in societies in which there have been major changes in the type of diet consumed, reductions in physical activity, and increases in overweight and obesity. The diets concerned are typically energy-dense, high in saturated fatty acids and depleted in NSP. In all societies, overweight and obesity are associated with an increased risk of type 2 diabetes, especially when the excess adiposity is centrally distributed. Conventional (BMI) categories may not be an appropriate means of determining the risk of developing type 2 diabetes in individuals of all population groups because of ethnic differences in body composition and because of the importance of the...

Risk Factors for Gestational Diabetes Mellitus

There is considerable controversy over the screening and diagnosis of GDM. The American Diabetes Association recommends assessing all pregnant women for risk of GDM at their first prenatal visit. Risk factors for diabetes are categorized as low, average, and high 3 . Women in the low risk category must meet all of the following criteria and require. No further screening No first-degree family history of diabetes Not a member of a group with a high prevalence of diabetes, which includes those of African, Hispanic, Asian, Pacific Islander, or Native American descent Strong family history of diabetes Member of an ethnic group with a high prevalence of diabetes (see above)

Diabetic Nephropathy

The National Health and Nutrition Examination Survey found an incidence of endstage renal disease of 0.23 100 person years, with rates of 0.29 for patients with type 1 diabetes and 0.27 for patients with type 2 diabetes (90). Factors such as African American race, gout, and hypertension more than doubled the risk of endstage renal disease (90). In a study by Klein et al., analyzing 891 patients with type 1 diabetes, the 10-year cumulative incidence of renal failure or serum creatinine > 2.0 mg dl was 14.9 percent (90). The risk of renal failure almost doubled for every 1 percent increase in HbA1c (36). Hypertension almost tripled the risk (90).

Association of Obesity with Diabetes

As extensively discussed in section I of this book, obesity and weight gain clearly seem to be associated with an increased risk of diabetes, although there are some studies that don't show the association (44-46). Each year, 300,000 U.S. adults die of causes related to obesity (44). In 2000, the prevalence of obesity was 19.8 percent among U.S. adults (65.5 percent of men and 47.6 percent of women), which was a 61 percent increase from 1991 (44, 45). Weight gain, excess BMI, waist-hip ratio, and waist circumference are major risk factors for diabetes, with the waist circumference displaying the greatest relative risk (44, 47). In a national sample of adults, for every 1-kilogram increase in measured weight, the risk of diabetes increased by 4.5 percent (44). There seems to be an association between race and modification of diabetes risk by BMI, with African Americans having an increased risk at lower BMIs (i.e., adjusted RR for African Americans for Caucasians, it was 2.83 for men...

Diabetes and Mental Health

National surveys have reported that mentally ill people have worse health insurance and poorer access to care than people that are not mentally ill (56). A multicenter Veterans Administration hospital study, however, found little difference in the quality of diabetes care between those that were mentally ill and those that were not (56). This finding may be unique to that setting, owing to accessibility and monitoring of the level of care that occurs in that setting, and may not be reflective of national trends outside of the VA (56).

Most foods that rapidly raise blood sugar are bereft of any nutritive value

Too much sugar and other carbs can set off spikes in insulin levels that leave you craving still more sweets and starches. High insulin levels also stimulate the storage of fat. Too much insulin also inhibits fat burning. Obviously, then, you need to keep your blood sugar and insulin levels in control.

Why You Should Steady Your Blood Sugar Decrease Midriff

Having trouble losing the love handles or jelly belly You may be caught in the vicious cycle of eating TOO many carbohydrates, especially the kinds you think are healthy - bagels, pasta, rice, cereals, breads. This causes an excessive amount of blood sugar, which results in an excessive amount of insulin to be shot into your bloodstream. Insulin is also known as the fat gatekeeper, storing excess calories while at the same time locking in whatever fat it can get. Try decreasing your intake of these starchy carbs and substitute them with fiber-rich fruits and vegetables and see what happens.

Activation of PKC May Cause Insulin Resistance

Protein kinase C (PKC) can directly phosphorylate and inactivate the insulin receptor.67 Likewise, overexpression of PKC isoforms in cultured cells causes phosphorylation of the insulin receptor and insulin resistance.14,22 These findings led to the hypothesis that PKC causes insulin resistance in skeletal muscle.23 Several groups have reported that PKC activity and protein were increased in muscle of animals with insulin resis-tance.6,29,45,64,93,94 To determine if one of the PKC isoforms is increased in insulin-resistant muscle and causes serine threonine phosphorylation of the insulin receptor, we measured the protein content of eight PKC isoforms in the membrane fractions of muscles from lean and obese patients. The only PKC isoform that was increased in the membrane of insulin-resistant muscle (obese) was PKCp. Basal PKCp was higher in the in vitro incubated muscle of obese individuals, and insulin increased PKCp in the membrane fraction in muscle of obese, but not lean,...

Mechanisms Causing Insulin Resistance in Obesity

Although the mechanisms that cause insulin resistance in muscle are not known with certainty, there appear to be some generally accepted concepts that form the basis of a model that serves as the basis for future hypothesis testing. In response to either TNFa or intramuscular lipids (fatty acyl-CoA, diacylglycerol, or ceram-ides), there is activation of a serine kinase (PKC, JNK, or IkKP) and inactivation of a protein phosphatase (PP2A), such that IRS-1 and the insulin receptor become serine phosphorylated. These events then depress insulin-signal transduction to cause insulin resistance. Figure 5.1 displays a representation of insulin signaling in a muscle cell.

Inflammatory Pathways and Insulin Action in Obesity

The proinflammatory cytokine tumor necrosis factor alpha (TNFa) has also been proposed as a link between adiposity and the development of insulin resistance.47 TNFa initiates an inflammatory response by stimulating IkB kinase- (IkK-P). Serine phosphorylation of inhibitor protein of kB (IkB) triggers ubiquitination and degradation of IkB, and, eventually, activation of the nuclear factor kB (NF-kB), a transcription factor involved in immune and inflammatory responses. TNFa is highly expressed in adipose tissue, and infusion of TNFa into rats caused insulin resistance, while neutralization of the cytokine with antibodies to TNFa reversed insulin resistance in obese rats. The insulin resistance induced by TNFa can be prevented by treatment with the salicylate, which is known to inhibit IkK . Treatment of adipocytes and skeletal muscle with TNFa causes insulin resistance by decreasing insulin-induced IRS-1 tyrosine phoshorylation and activation of IRS-1-associated PI 3-kinase. This is...

Exercise Training Effects on Insulin Sensitivity

The metabolic syndrome is conceptually the same as the insulin-resistance syndrome, and the names are essentially interchangeable. That some prefer the term insulin-resistance syndrome is due to the common understanding that an observable decrease in insulin sensitivity is the first detectable aberration in course toward metabolic syndrome. In fact, some deterioration in insulin sensitivity is generally observed prior to elevations in triglycerides levels, decreases in HDL-C concentrations, which in turn precede deterioration in fasting glucose, and glucose-tolerance measures, and perhaps even before clinically significant increases in body weight, body-mass index, and waist circumference are apparent. In fact, as a reflection of this understanding, the WHO includes a resting measure of insulin resistance in its definition of metabolic syndrome (Table 4.2). The relationship between exercise and insulin resistance is clear. In fact, one of the most consistent, beneficial effects of...

Relationship of Skeletal Muscle Insulin Resistance and Intramyocellular Lipid Accumulation

It is well-established that intramyocellular triacylglycerol (IMTG) accumulation is associated with skeletal-muscle insulin resistance.10,56,73 However, it is unlikely that triacylglycerols are the culprit for reduced skeletal-muscle insulin action, but more likely they are an inert marker of other lipid intermediates known to suppress insulin sensitivity. An increase in the intramyocellular concentration of lipid intermediates such as fatty acyl-CoAs,50 ceramides,339 and diacylglycerols52 not only correlate with insulin resistance but also directly and indirectly alter insulin signaling.92 Considerable evidence linking increased skeletal-muscle lipid content to insulin resistance has been derived from animal studies employing acute and chronic high-fat diets.24 Fatty acid-induced insulin resistance appears to occur in concert with increased fatty acyl-CoAs.24 Moreover, insulin sensitivity is restored by treatments that reduce intramyocellular lipid accumulation (i.e., low-fat feeding...

GLUT Insulin Responsive Glucose Transporter

Glucose is transported across the cell membranes of adipocytes (fat cells), and its rate of transport can be speeded up 20- to 30-fold within 2 or 3 minutes by addition of insulin, without evidence of protein synthesis. Studies showed that this stimulation of glucose transport was due in part to translocation of GLUT 1 from an intracellular pool into the membrane. Careful quantitative measurements showed, however, that this could account for only a 12- to 15-fold increase in glucose transport. It became obvious that another transporter would have to be involved to account for the much larger insulin-stimulated transport. This new transporter, GLUT 4, was first identified in rat adipocytes by use of a monoclonal antibody. Subsequently, it has been cloned from rat, mouse, and human DNA (19). It is a protein with 509 amino acid residues (Tab_Le_3_._4), with 65 identity with GLUT 1, 54 identity with GLUT 2, and 58 identity with GLUT 3. Rat and mouse GLUT 4s have 95 and 96 identity,...

Diabetes and Physical Limitations

People with diabetes have a higher prevalence of risk factors, such as obesity and sedentary behavior, and higher prevalence of health conditions, such as vision loss, depression, and cardiovascular disease, that are associated with physical limitations (54). In a nationwide, cross-sectional analysis, people with diabetes had a higher proportion of physical limitation than people without diabetes overall (66 percent versus 29 percent, p < 0.001), for men (59 percent versus 24 percent, p < 0.001), and women (72 percent versus 34 percent, p < 0.001) (54). The difference declined with increasing age 18-44 years (46 percent versus 18 percent), 45-64 years (63 percent versus 35 percent), 65-74 years (74 percent versus 53 percent), and > 75 years (85 versus 70 percent) (54). The OR for physical limitation among adults with diabetes versus adults without diabetes was 1.9 (95 percent CI, 1.8-2.1) (54). Although this association is not clearly defined, women seem to have a greater...

Eating to Overcome Hypoglycemia And Diabetes

Sunfood Triangle

Eating animal foods typically weakens the system to the point where hypoglycemia and diabetes manifest, but (aside from the obviously dangerous white sugar and high fructose corn syrup) cooked hybridized plant starch is the real culprit. Hypoglycemia and diabetes are caused by eating cooked hybrid starchy foods, the worst of which includes white or wheat breads, beer, cooked corn of all types, stewed carrots, refined (beet) sugar, baked potatoes, white rice, French fries, cookies, potato chips, etc. All these food types contain hybrid sugars the liver does not fully recognize and cannot regulate. These sugars send the glycemic index of the blood shooting sky-high causing either too much or too little insulin to be secreted by the pancreas (reference the Glycemic Index Chart in Lesson 11 The Secret Revealed). Hypoglycemia is a condition where too much insulin is secreted into the blood by the pancreas to control blood sugar. Too much insulin in the blood causes blood sugar to drop too...

Role of Glutamine in the Pathogenesis of Type Diabetes

Since glutamine appears to act to promote lymphocyte activity, it has been proposed that increased availability of glutamine could play a role in the patho-genesis of some autoimmune conditions, such as type 1 diabetes (Wu et al., 1991). Indeed, the administration of the anti-glutamine-utilization drug acivicin delayed or stopped the progression of the disease in diabetes-prone rats (Misra et al., 1996). Addition of the glutaminase inhibitor 6-diazo-5-oxo-norleucine to macrophages before exposure to rat pancreatic p cells in vitro virtually abolished the lytic capacity of the macrophage towards the target p cells (Murphy and Newsholme, 1999). The glutamine concentration in the plasma of moderately ketoacidotic diabetics at diagnosis is significantly elevated compared with that of age- and sex-matched normal control individuals (P Newsholme, unpublished observations), adding further weight to the argument that this amino acid is important to the pathogenic process.

Food Pyramids Obesity And Diabetes

Food Pyramid Including Corn

According to the World Health Organization, obesity has become a worldwide problem that has significant effects on health. Problems that were once considered limited to developed or industrialized countries now affect everyone. Because of obesity, the incidence of diseases such as heart disease, type 2 diabetes mellitus, and hypertension has increased around the world. Obese individuals are also prone to pulmonary disease, varicose veins, and gallbladder disease. They have an increased risk of breast, uterine, and colon cancers. The incidence of obesity and type 2 diabetes mellitus has increased dramatically in the United States. Approximately 20 of the U.S. population is obese. The number of individuals who are merely overweight is considerably higher. Diabetes is a condition where the body does not break down glucose, and thus the glucose cannot be used to produce energy. There are two major types of diabetes type 1 and type 2. Type 1 diabetes, which accounts for 10 of people with...

Nutrition And Diabetes Mellitus

Diabetes mellitus gets its name from the ancient Greek word for a siphon (tube), because early physicians noted that diabetics tend to be unusually thirsty and to urinate a lot, as if a tube quickly drained out everything they drank. Mellitus is from the Latin version of the ancient Greek word for honey it was used because doctors in centuries past diagnosed the disease by the sweet taste of the patient's urine. The number of people diagnosed with diabetes has almost doubled since 1990. In 2002, some 18.2 million people had diabetes, over 6 percent of the population. Among those 18.2 million people, 13 million have been diagnosed and over 5 million have diabetes but don't know it yet. Figure 11-11 lists risk factors for diabetes. Diabetes is a disease in which there is insufficient or ineffective insulin, a hormone that helps regulate the blood sugar level. When the blood sugar rises, such as after eating a meal, the pancreas releases insulin. The insulin facilitates the entry of...

Diabetes mellitus a failure of regulation of blood glucose concentration

Diabetes mellitus is an impaired ability to regulate the concentration of blood glucose as a result of a failure of the normal control by insulin. Therefore, the plasma glucose concentration is considerably higher than normal, especially after a meal. When it rises above the capacity of the kidney to reabsorb it from the glomerular filtrate (the renal threshold, 11 mmol L), the result is glucosuria excretion of glucose in the urine. As a result of glucosuria, there is increased excretion of urine because of osmotic diuresis one of the common presenting signs of diabetes is frequent urination, accompanied by excessive thirst. The diagnosis of diabetes mellitus is by measurement of plasma glucose after an oral dose of 1 g of glucose per kilogram body weight an oral glucose tolerance test. Figure 10.14 shows the response of plasma glucose in a control subject there is a modest increase, and then glucose is cleared rapidly as it is taken up into liver, muscle and adipose tissue for...

Complications Associated with Preexisting Diabetes

Complications associated with diabetes can adversely affect both the woman and fetus. The incidence of fetal complications is correlated with maternal glycemic control and the trimester of pregnancy. Macrosomia is the most common complication associated with diabetes and pregnancy, estimated at 20-45 , depending on the population 24, 25 . The definition of macrosomia varies and ranges from 4,000 to 4,500 g 26 . Macrosomia is thought to occur if maternal glycemic levels are elevated in the third trimester. Pedersen hypothesized that maternal hyperglycemia leads to fetal hyperglycemia, which stimulates the fetal pancreas to produce excessive insulin and results in excess growth 27 . Macrosomic infants have disproportional large fetal trunks in relation to their head size, thereby increasing the risk of difficult delivery, shoulder dystocia, brachial plexus palsy, or facial nerve injury. Advances in diabetes research and management have led to decreased risks of stillbirth in infants...

American Diabetes Association Recommendations Regarding Diagnosis of Diabetes Mellitus

Diabetes Mellitus Normal fasting plasma glucose Impaired fasting plasma glucose Provisional diagnosis of diabetes tolerance a two-hour postload glucose > 140 (7.8 mmol l) and < 200 mg dl (11.1 mmol l) is defined as impaired glucose tolerance and a two-hour postload glucose > 200 mg dl (11.1 mmol l) gives a provisional diagnosis of diabetes (23). There has been much debate regarding the impact of changes in methods of diagnosing diabetes on prevalence rates and on the number of nondiagnosed cases of diabetes. It is clear, however, that the current system of diagnosis is much more organized than it was prior to 1979.

Insulin

Diabetes Mellitus IDDM (Type I) and NIDDM (Type II). Insulin has a central role in regulating blood glucose. It is secreted by the b cells in the islets of Langerhans in the human pancreas the daily output is some 40 to 50 units, which is about 15 to 20 of the amount stored in the gland. The glucose level in the blood controls insulin release high blood glucose levels (hyperglycemia) cause secretion of insulin, low levels (hypoglycemia) inhibit. When the pancreas is unable to secrete insulin or secretes too little, the medical condition is known as diabetes mellitus. This disease, the third most prevalent in the Western world, is normally classified as type I, or insulin-dependent (IDDM), or type II, non-insulin-dependent (NIDDM). NIDDM accounts for approximately 90 of all diabetic patients. IDDM patients have an autoimmune disease of the b cells they cannot make insulin and need daily injections of the hormone. IdDm affects children and younger adults predominantly and becomes...

Type Diabetes

Typically diagnosed in childhood and with most cases occurring before the age of 30, this is the end result of an autoimmune attack. Special kind of cells in the pancreas called beta cells are destroyed, and this means the individual can no longer produce insulin and must rely on medication (insulin) to survive. While less common (just 10 percent of all diabetics in the United States have either Type 1, gestational diabetes, or secondary diabetes), Type 1 diabetes is also the most serious. Symptoms include weight loss, frequent urination, and thirst. If it's untreated, these same signs and symptoms can occur, along with nausea, dehydration, and vomiting. Once diagnosed, it is imperative that blood-sugar levels be well-controlled or a number of complications, including loss of vision and kidney disease, can occur. Those with Type 1 diabetes are also at an increased risk for hypertension, stroke, heart disease, and problems with the teeth and gums. So obviously, keeping a vigilant watch...

What Is Diabetes

Simply defined, diabetes is a physiological condition that affects the way the body uses energy from sugar, starch, and other foods. Carbohydrates (sugars and starches) don't cause diabetes. Instead insulin, a hormone produced by the pancreas, isn't produced or doesn't work correctly in the body and therefore, can't be used properly for energy metabolism. How does insulin work for healthy people During digestion, glucose is released from carbohydrates and absorbed to circulate as blood glucose, or blood sugar, to body cells. Among healthy people, insulin regulates blood sugar levels. It allows glucose to pass from blood into body cells for energy production. Insulin also helps the body use amino acids and fatty acids from food. For people without diabetes, insulin helps blood sugar levels stay in a normal range so eating has little effect on blood sugar. With diabetes, the body can't control blood sugar levels normally. Too little or no insulin, or the inability to use insulin...

If You Have Diabetes

The goal for diabetes management is this controlling your blood sugar levels so they stay as near to normal as possible. Like a teeter-totter, blood sugar levels go up (hyperglycemia) and down (hypoglycemia) that's part of dealing with diabetes. Those swings can be dangerous when diet, physical activity, and medication such as insulin aren't balanced properly. Too much food or too little insulin Your blood sugar level can soar, affecting your health now and very seriously down the road. Too much exercise or too much insulin Blood sugar drops, and your body can't use blood glucose to produce enough energy. To control the ups and the downs, carefully manage what you eat, how much, and when no matter what type of diabetes you have. Eating raises your blood sugar level physical activity and medication lower it. For example, in case of low blood sugar, consume a small amount of a quick-acting carbohydrate, such as V2 cup juice, followed by a small amount of protein food, perhaps a cheese...

GABA and Diabetes

GABA can inhibit the secretion of glucagons by a-cells61 and stimulate the expression of glutamate decarboxylase(65) (GAD65) . GAD65 will stimulate P-cells to produce GAD. Then GAD catalyzes the decarboxylation of glutamate to synthesize GABA . This mechanism has the feedback function to inhibit the activity of GAD . 8 Pancreatic GAD65 was identified as a target antigen for autoantibody found in blood circulation of patients with insulin-dependent diabetes mellitus (IDDM) . Other studies have shown that streptozotocin-induced diabetes brought about an imbalance in GABA metabolite concentration in the ventromedial hypothalamus 62 Pancreatic islet binding sites for GABA and benzodiazepines have been shown to be of functional significance in the secretion of insulin in rodents and humans A decrease in GABA concentration in pancreatic islet cells was associated with the decline of insulin synthesis and release levels present in diabetes .14 The functions of GABA and GAD in pancreatic...

Diabetes Mellitus

Diabetes mellitus is a common metabolic disorder resulting from defects in insulin action, insulin production, or both. Insulin, a hormone secreted by the pancreas, helps the body use and store glucose produced during the digestion of food. Characterized by hyperglycemia, symptoms of diabetes include frequent urination, increased thirst, dehydration, weight loss, blurred vision, fatigue, and, occasionally, coma. Uncontrolled hyper-glycemia over time damages the eyes, nerves, blood vessels, kidneys, and heart, causing organ dysfunction and failure. A number of risk factors are attributed to the incidence of diabetes, including family history, age, ethnicity, and social group characteristics, as well as behavioral, lifestyle, psychological, and clinical factors. The World Health Organization estimates that 150 million people had diabetes worldwide in 2002. This number is projected to double by the year 2025. Much of this increase will occur in developing countries and will be due to...

Diet and Diabetes

Studies examining effects of total fibers or types of fiber on self-reported incidence of diabetes have shown mixed results, with some showing no association and others showing inverse associations between diabetes risk and fiber intake (49). It has been well-established that carbohydrate intake can produce different glycemic responses, although there is some controversy surrounding the validity of the glycemic index and its use as a predictor of diabetes risk (49). Several studies have shown that fat intake is associated with impaired glucose metabolism (50), as reviewed in chapter 10 of this book. Glucose levels, insulin resistance, and hyperinsulinemia have been found to correlate with fat intake, particularly saturated fatty acids (50). Increased intake of vegetables and legumes is inversely associated with the development of impaired glucose tolerance or diabetes mellitus (50). The intake of vitamin C has been inversely associated with two-hour plasma glucose levels, although not...

Diabetes

Diabetes is a chronic disease caused by inadequate secretion of, or peripheral resistance to, insulin. It is characterized by hyperglycemia and hyperlipidemia. Diabetes, when poorly controlled, causes widespread damage to blood vessels and nerves, which can result in blindness, kidney failure, or heart attack. There are two main forms of diabetes. Type 1 diabetes appears suddenly in childhood and is caused by autoimmune destruction of the pancreatic beta cells and loss of insulin production. Type 2 diabetes appears gradually in older people and is characterized by loss of insulin sensitivity - that is, cells no longer respond to signals from insulin. More than 90 of diabetic patients have type 2 diabetes.

Fiber and Diabetes

Fiber, especially soluble fiber, lowers elevated blood sugar levels. Fruits, vegetables, and some seeds, such as pectins, gums, and mucilages are good sources of soluble fiber. Flaxseed has one of the highest levels of both soluble and insoluble fiber known for any food. It also contains a substance called lignan, which inhibits breast and prostate cancer. One test of non-diabetics demonstrated that taking fifty grams of water plus flaxseed mucilage reduced by 27 percent normally elevated blood sugar levels following a high-glucose meal.422 Fenugreek seed, which contains about 50 percent fiber, is another good source of soluble fiber. Similar tests in diabetic patients have found a significant reduction in blood glucose levels.423 Another advantage of increasing fiber intake to control diabetes is that it significantly reduces cell glycation. Remember, this process is responsible for much diabetes-related damage. In addition, a high-fiber diet removes dietary toxins, improves bowel...

Diet Diabetes

The best way to prevent type 2 diabetes is to avoid gaining weight. Overweight people are four times more likely to develop type 2 diabetes than those who maintain normal body weight. Overweight diabetic patients can often reduce their need for drugs and control their blood sugar by weight loss. The glucose tolerance factor (GTF) is a naturally occuring compound that helps regulate blood sugar. It is found in rich amounts in brewer's yeast. Chromium is an essential component of GTF, and diets deficient in chromium produce glucose intolerance (see Fig. 5.11 ).1-3 Diabetics who excrete glucose in their urine have increased urinary loss of minerals (such as magnesium, zinc, and chro mium). Deficiencies of these important minerals further impair the ability to control blood glucose. Therefore, diabetic diets should emphasize foods rich in these minerals. The best diet for most diabetics is one low in refined sugars and high in complex carbohydrates and fiber (which slow absorption of...

Types of Diabetes

Diabetes mellitus is classified into four categories type 1, type 2, gestational diabetes, and other. In type 1 diabetes, specialized cells in the pancreas are destroyed, leading to a deficiency in insulin production. Type 1 diabetes frequently develops over the course of a few days or weeks. Over 95 percent of people with type 1 diabetes are diagnosed before the age of twenty-five. Estimates show 5.3 million people worldwide live with type 1 diabetes. Although the diagnosis of type 1 diabetes occurs equally among men and women, an increased prevalence exists in the white population. Type 1 diabetes in Asian children is relatively rare. types of foods eaten 1 diabetes. Studies have found an increased risk in children whose parents have type 1 diabetes, and this risk increases with maternal age. Environ-toxins poison mental factors such as viral infections, toxins, and exposure to cow's milk are being contested as causing or modifying the development of type 1 diabetes. Type 2 diabetes...

Cerebrovascular Disease

People with diabetes are at increased risk for cerebrovascular events (83). The estimated relative risk for patients with diabetes was initially reported to be 2.5-fold to 3.5-fold greater in diabetic patients that were aged 45 to 74 in the Framingham study (83). It was later modified to 1.4 for diabetic men and 1.72 for diabetic women after adjusting for other known risk factors (84). Diabetes was found to be responsible for 16 percent of stroke deaths in men and 33 percent in women, in a study reviewing stroke mortality (85). In a stroke-survival study, the 30-day survival rate was 89 percent in men and 79 percent in women one-year survival was 79 percent for men and 64 percent for women (86). There may be specific patterns of stroke associated with diabetic patients. Review of a prospective, community-based registry showed that diabetes mellitus was associated with a lower relative prevalence of intracerebral hemorrhage (OR 95 percent CI 0.63 (0.45 to 09.9) p 0.022), higher...

Therapeutic Aspects Of Gip And

Type 2 Diabetes Mellitus The potent insulinotropic actions of GIP and GLP 1 and their strict glucose dependency, thereby avoiding hypoglycemia, make these hormones potentially important agents in the treatment of type 2 diabetes. GLP 1's other antihyperglycemic actions (inhibition of glucagon secretion, gastric emptying, food intake, etc.) additionally make it particularly suited to an antidiabetic role. However, there are two major difficulties associated with using these hormones as therapeutic agents, 1) their extremely rapid degradation in circulation (particularly GLP 1), and 2) the diminished responsiveness of diabetic individuals to the insulinotropic action of GIP. This latter difficulty has resulted in most work on the therapeutic potential of the incretins in type 2 diabetes, focusing on the possible use of GLP 1 or its analogues. Continuous IV infusion of GLP 1 can effectively normalize glucose concentrations in type 2 diabetes 61 , but simple subcutaneous injections are...

The Role Of Exercise In The Management Of Obesity

Exercise has a powerful effect on insulin sensitivity. Studies in Pima Indians and persons of European ancestry demonstrated that physical fitness was as powerful a modulator of insulin resistance as was body weight each variable accounted for approximately 25 percent of the differences in insulin-mediated glucose disposal in nondiabetic persons.32 Obese individuals with type 2 diabetes mellitus had an increase in insulin sensitivity following low-intensity bicycle riding.33 In nonobese, insulin-resistant relatives of type 2 diabetic subjects, moderate-intensity exercise had a 40 percent increase in insulin sensitivity.34 The Diabetes Prevention Program found that intensive exercise in combination with a change in diet could lower the risk of progressing to diabetes by 58 percent.35 Despite recommendations of exercise for prevention of weight gain and improvement of cardiovascular fitness and insulin sensitivity, the major challenge is adoption of a regular exercise pattern. Recent...

Exercise Training Effects on Waist Circumference

Lakka et al. suggested that a sedentary lifestyle and especially poor cardiorespiratory fitness are not only associated with metabolic syndrome but could be considered central, defining features of metabolic syndrome.25 Further, they suggested that measurement of peak VO2 in sedentary men with risk factors could provide a means of identifying individuals who would most benefit from interventions, especially lifestyle interventions, in individuals at risk of developing diabetes mellitus. Numerous studies have revealed a clear, independent relationship between exercise capacity (cardiorespiratory fitness) and cardiovascular events and all causes of deaths in men.161775-82 And in a recent study by Gulati et al.,83 the authors reported a strong, independent relationship between exercise capacity as a predictor of death in asymptomatic women, which they observed was stronger than what had been previously established among men. Even after adjusting for traditional cardiovascular risk...

Biliopancreatic Diversion

Short- and long-term weight loss and weight maintenance has been excellent. Loss of excess body weight has been 74 percent and 78 percent at 2 and 14 years, respectively. Other beneficial effects include significant improvement of the hypoventilation and obstructive sleep apnea syndromes, hypertension, venous stasis disease, hypercholesterolemia, glucose intolerance, and adult-onset diabetes mellitus following the procedure. Marceau and associates51 in Canada reported results in 465 patients undergoing BPD-DS. Mean percentage excess weight loss at 51 months follow-up was 73 percent, or an average of 101.2 pounds per patient. Only 4 percent of patients with diabetes mellitus, 42 percent with hypertension, and 49 percent with obstructive sleep apnea or hypoventilation syndromes still required medical treatment for these obesity-related conditions. When Marceau51 compared the 457 patients undergoing BPD-DS to 233 previous patients undergoing BPD, revision rates were lower and...

Management of Existing Disease

It is well recognized that OW OB complicates the management of type 2 diabetes via increased insulin resistance and blood-glucose levels (16). For persons with type 2 diabetes who are OW OB, targeting efforts to reach a healthy BMI (ideally < 25 kg m2) is the most important goal of lifestyle interventions (17, 18). When combined with increased activity, weight loss can dramatically enhance insulin sensitivity and glycemic control (8). Improvements occur in insulin action and blood-glucose concentrations, and required doses of diabetes medications may be reduced. Reductions in fasting glucose levels correspond directly to the amount of weight reduction (8,19). Alternatively, if excess weight is not reduced, glycemic control is likely to deteriorate over time, in as little as 12 months (7).

Weight Reduction Diets

By restoring a healthier body weight, dietary treatment (WR) in OW OB individuals can provide significant clinical benefits. Unfortunately, the nature of diabetes and its treatment can hinder weight loss and even promote weight gain. This is because the progressive dysfunction of pancreatic B cells and increasing insulin resistance necessitate increasingly higher insulin dosages. This, in turn, promotes weight gain, and in a negative vicious cycle, makes weight loss even more difficult to achieve than for the nondiabetic obese individual (20).

Effects of Alcohol and Cigarettes

Data from a prospective study of 87,938 subjects indicated that low to moderate consumption of alcohol is associated with decreased risk of coronary vascular disease in men with diabetes comparable to those without diabetes (52). There are several prospective cohort studies that suggest smoking is associated with the etiology of diabetes (53). In one study, the relative risk of type 2 diabetes in women smoking > 25 cigarettes per year versus women who never smoked was 1.42 (95 percent CI, 1.18-1.72) (53). It was concluded that this suggested a moderate association between smoking and subsequent development of diabetes (53). In a similar study, the relative risk of type 2 diabetes in men smoking > 25 cigarettes per year versus men who never smoked was 1.94 (95 percent CI, 1.25-3.03) (53). Furthermore, cigarette smoking has been associated with insulin resistance, larger upper-body fat distribution (a marker of insulin resistance), and raised plasma-glucose concentration (53). It...

Weight Classification Body Mass Index BMI

It is often assumed that obesity equals insulin resistance, since overweight people tend to become more insulin sensitive with weight loss.5 However, results from the European Group for the Study of Insulin Resistance have shown that only 25 percent of people who are overweight had evidence of insulin resistance.6 Epidemiological evidence suggests that persons in the upper tertile of insulin resistance (measured by insulin-mediated glucose disposal) are at a statistically, significantly increased risk for developing type 2 diabetes, coronary heart disease, or hypertension.7,8 Recently, several well-designed clinical trials suggest that changes in lifestyle can prevent the onset of diabetes. In the Finnish Study, 522 obese (mean BMI 31 kg m2) subjects were randomized to receive brief or individualized lifestyle instruction. After 3.2 years, there was a 58 percent relative reduction in the incidence of diabetes in the intervention group with individualized instruction.9 Diabetes...

Concluding Comments On Maintenance Of Weight Loss And Improved Fitness

Specific recommendations for weight-loss interventions for individuals with type 2 diabetes and OW OB are summarized in Table 3.3. But it is recognized that for individuals who are OW OB, achieving and maintaining an optimal body mass can be an uphill battle even in the absence of type 2 diabetes complications. While some patients are successful in maintaining at least some of their weight-loss achievement in the long term (54), dietary recidivism seems to be the rule rather than the exception. Thus, while many different dietary schemes show good success in the short term, most OB patients are unable to fully maintain their lower body weights in the long term. As an additional challenge, OB patients who have type 2 diabetes may be more resistant to the maintenance of weight loss because antidiabetic drugs, such as insulin and sulfonylurea, often promote weight gain. The progressive nature of diabetes means that even with successful monotherapy (e.g., management by diet weight loss)...

Future directions for research

It seems clear that regular exercise physical activity has beneficial effects both for preventing and treating type 2 diabetes and metabolic syndrome. Particularly promising areas of research are (a) the most effective amounts and intensities of exercise that lead to these benefits in individuals with diabetes (b) investigating the unique role that resistance-training exercise may have on insulin sensitivity and metabolic syndrome and (c) the interactions between exercise, environment, and genetics. We are currently in the early phases of a study of the separate and combined effects of aerobic and resistance exercise on individuals with aspects of the metabolic syndrome (central obesity, dyslipidemia, and sedentary lifestyle). We anticipate that such lines of investigation hold great promise for improving our effectiveness in diagnosing individuals with metabolic syndrome on the road to type 2 diabetes and in ultimately preventing its development in susceptible individuals.

Fatty Acid Transport into Skeletal Muscle

Transport of fatty acids into the cell is a dynamic process upregulated by both contraction and insulin stimulation. Contraction and insulin both activate the translocation of FAT CD36 from intracellular stores to the plasma membrane.11,70 During the same conditions, rates of fatty-acid uptake are elevated, demonstrating that FAT CD36 is the primary protein involved in facilitated transport. Stimulation of fatty-acid transport by insulin and muscle contraction occur through different mechanisms and are additive.11 Therefore, there are two mechanisms regulating fatty-acid transport in muscle acute regulation through translocation of FAT CD36 (following insulin and contraction) and chronic regulation through increased expression of transporter proteins.11 There is ample evidence suggesting that muscle fatty-acid transport is altered with insulin resistance. Studies examining aging and insulin resistance have shown that skeletal muscle from older animals has increased rates of palmitate...

Table Atp Iii Criteria

Diagnostic purposes, it is not clear that it has much predictive capacity, thus limiting its clinical utility. Most consider metabolic syndrome to be a prediabetic state, as the various components of the condition are invariably associated with some degree of insulin resistance. However, there are relatively little to no definitive data on the conversion rate of individuals with metabolic syndrome to frank diabetes. Also, although the ATP III guidelines provide a useful working definition, it is clear that the five diagnostic criteria are not independent. For example, low-serum HDL cholesterol and high-serum triglycerides tend to track together in individuals. This makes the current scoring mechanism (i.e., the need to have three of the five diagnostic criteria) seem somewhat artificial and negatively impacts its predictive utility. Thus, there is room for further refining the clinical definition of metabolic syndrome. One potential improvement would be to provide differential...

Hypothalamic Neuropeptides That Stimulate Food Intake

AgRP is expressed exclusively in the arcuate nucleus of the hypothalamus and colocalizes to the same neurons that secrete NPY (10). Several reports have confirmed the status of AgRP as a potent orexigenic factor A single i.c.v. injection of AgRP increases food intake for several days in rodents (11). In contrast to the shortlived effect of NPY, chronic treatment with AgRP leads to sustained hyperphagia and obesity (12). The orexigenic effect of AgRP is mediated through antagonism of MC3 and MC4 receptors. Such antagonism effectively reverses the inhibition of food intake induced by alpha-MSH. The arcuate neurones that cosecrete NPY AgRP are potently inhibited by leptin and insulin, and activated by ghrelin (8, 13). The latter finding is inconsistent with a primary orexigenic role of the hypocre-tins orexins as the mechanism for the increased prevalence of obesity, insulin resistance, and type 2 diabetes among patients with narcolepsy (Nishino 2001b). These metabolic disorders are more...

Gastrointestinal Peptides

PYY3-36 appears to exert its anorectic effect through coordinate inhibition of orexigenic NPY neurons and stimulation of POMC neurons in the arcuate nucleus. These molecular changes are observed following peripheral administration of PYY3-36 (99). High-affinity hypothalamic Y receptors are the target of PYY3-36 action. Activation of the Y2 receptor subtype on NPY neurons triggers inhibitory presynaptic signals. Consonant with this mechanism, Y2 receptor knock-out mice lose their responsiveness to the anorectic effect of PYY3-36 (99). Notably, the NPY neurons in the arcuate nucleus are the central integrating sites for numerous peripheral signals (including leptin, insulin, PYY3-36, and ghrelin) that regulate food intake. Initial experience indicates that PYY3-36 is well tolerated and effective in suppressing appetite over the short term in human studies (100). Clearly, PYY or its analogues hold immense promise as candidates for obesity-drug development. Glucagon-like peptide-1 (GLP-1)...

Erectile Dysfunction

Diabetes has been associated with the development of erectile dysfunction since 1798 (89). The OR of having erectile dysfunction if a man is diabetic is 1.9 to 4 times greater than in men without diabetes, and it is estimated that 25 percent to 75 percent of men with type 1 diabetes will complain of erectile dysfunction (89). There is an age association with the development of erectile dysfunction, with 15 percent of diabetic men having erectile dysfunction by age 30 and 55 percent by age 60 (89). The mechanism of diabetes-induced erectile dysfunction is multifactorial (89). Related causes include smooth-muscle dysfunction, endothelial dysfunction, and neuropathic damage (89).

Level Of Health Care

In a study looking at African Americans, Hispanics, and non-Hispanic Whites, they were found to be equally likely to receive treatment for diabetes (103). However, African Americans were more likely to have poorly controlled diabetes (HbA1c > 8.0 percent, OR 2.23, 95 percent CI 1.26-3.94) (103). A cross-sectional study suggests that underuse of recommended preventive-care practices is common among people with diabetes (48). Among this population, 78 percent practiced self-monitoring of blood glucose, 72 percent visited a health-care provider at least once in a 12-month period, 61 percent had their blood glucose examined at least once per year, and 61 percent received a dilated eye examination (48).

Indications and Body Weight Goals for Optimal Health

For all OW and OB individuals who have type 2 diabetes or strong risk factors for the disease, WR is recommended. The ideal body-weight goal is to achieve a BMI of < 25 kg m2, but it is important to set a realistic weight-loss goal that is likely to be both achievable and sustainable. As previously noted, a weight loss as small as 5 percent to 10 percent of baseline can lead to significant, positive effects on health and yet not be overwhelming as an initial goal (4, 8, 21, 22). This benefit is realized regardless of the initial weight at the time WR is initiated.

Low Carbohydrate and Other Nontraditional Dietary Approaches

Among the general public, as well as those with type 2 diabetes, there has been a recent increased interest in the use of low-carbohydrate diets for OW OB intervention. Klein et al. (8) summarizes five randomized trials in adults (34-38), comparing subjects assigned to a low-fat diet ( 25 percent to 30 percent Kcal from fat and 55 percent to 60 percent Kcal from carbohydrate) to subjects randomly assigned to a low-carbohydrate, high-protein, high-fat diet ( 25 percent to 40 percent of Kcal from carbohydrate). Subjects on the low-carbohydrate diet lost more weight in the short term (six months) but not the long term (12 months). In addition, glycemic control was found to be better (35, 37) and some serum lipids were improved. While these studies may offer promising dietary alternatives for those who are OW OB, additional studies of long-term safety and efficacy are needed before low-carbohydrate diets are recommended as a WR strategy for OW OB individuals with type 2 diabetes.

Predictors Of Complications

In an analysis of the complication rate after bariatric surgery, Schwartz et al. analyzed 600 laparoscopic RYGBs and found the overall complication rate approached 26 percent.12 One of the main predictors of complications is the experience of the surgeon.13 In fact, the American Society of Bariatric Surgeons recommends that a surgeon perform 100 procedures before technical expertise is obtained. The higher the weight (body-mass index > 55 kg m2), the more likely there will be complications. Males over 50 years of age are at increased risk of complications. The presence of hypertension and sleep apnea will increase the likelihood of complications. Interestingly, the presence of diabetes is not a predictor of complications.

Rationale For Including Cardiorespiratory Fitness In Metabolic Syndrome

This concept is supported by studies from the 50s in carefully performed studies in animals86 and humans.87 Meyers et al. observed that at significant physical activity levels, increases or decreases in physical activity were matched with increases or decreases in food intake. However, below certain minimal levels of physical activity, further decreases in physical activity were not met by further decreases in food intake, but rather by increases in food intake and consequent body weight. They interpreted the data to suggest that a minimal level of physical activity might be necessary for appropriate appetite control. Recent data from our group provides support for this theory. In our study,74 inactive controls gained weight over a six-month period, whereas two different low-dose exercise-training groups (equivalent to 12 miles wk of walking or jogging) lost weight and a higher dose (equivalent to 17 mile wk) lost even more body mass. The data suggest that below a certain level,...

Example Recommended Calorie Intakes for Weight Reduction by Body Weight and Body Mass Indexa

The optimal macronutrient (fat protein carbohydrate) distribution for weight reduction has not been resolved but is currently a matter of active debate (26). In recognition of the high caloric density of dietary fat and its relatively low satiety value compared to isocaloric amounts of carbohydrate and protein, a low-fat diet has been most typically employed for WR in diabetes, as well as in the general OW OB population. However, the recent success of high-protein high-fat low-carbohydrate diets for WR has called this conventional approach into question.

Comments on Overall Diet Composition

Regardless of the approach for creating a dietary energy deficit, in the case of WR for individuals with type 2 diabetes, the advice of a nutritionist registered dietitian should be sought for the design and individualization of the dietary plan. In these patients, maintenance of a healthy body mass may require long-term calorie restriction to some degree even for weight maintenance. So, it is important that the diet plan does not limit the intakes of essential nutrients (e.g., protein, vitamins, minerals) and that the diet provides a wide variety of nutritious foods in the long term. Any need for nutritional supplements (e.g., vitamins or minerals not consumed at adequate levels from the diet) should also be identified at this point. A diet history or typical diet record or recall may be collected to provide a profile of the usual intake and food preferences so that these can be taken into account in the diet plan whenever possible. Noting the need for individualization of dietary...

Practical Strategies for Improving Diet Adherence

In fact, better adherence to diet recommendations would greatly reduce the morbidity and mortality associated with obesity and diabetes. For a number of factors, adherence to diet can be difficult and restrictive. This results in both patients and practitioners frequently abandoning diet interventions in favor of medications and even surgery, despite the many adverse effects and complications, not to mention cost, inherent to these therapies. Predictors of poor outcome include prior attempts at weight loss, poor health, psychiatric illness, and multiple life stressors.49, 50 Patients with these factors should therefore be targeted for more aggressive and supportive interventions to improve their chances of success.

The Metabolic Syndrome

The general concept of the metabolic syndrome, which describes a clustering of metabolic abnormalities associated with increased risk of cardiovascular disease, diabetes, and hypertension, has been recognized for many years.1-4 Despite a definition of syndrome by the World Health Organization (WHO)5, the most commonly used definition is relatively new. In 2002, the National Cholesterol Education Program, in its Adult Treatment Program III (ATP III),6 presented a definition of

Challenges Of Lifestyle Change In The Management Of Obesity

Lifestyle change (diet and exercise) remain the first-line therapy for many common disorders, including diabetes, obesity, hypertension, and hyperlipidemia. The reported prevalence of people trying to lose weight in a community-based survey was 28.8 percent for men and 43.6 percent for women.11 A recent, systematic review of the literature regarding obesity treatment by McTigue et al. showed that behavior and counseling (diet and exercise) result in average weight loss of 3 kg to 6 kg over 12 to 60 months.12 Since dieting is associated with a high failure rate, physicians are hesitant to recommend it as a treatment for improving obesity comorbidities. However, a recent review of long-term outcomes of dietary intervention showed a 15 percent success rate among 2131 patients followed for five years.13 Interventions most likely to be successful were high intensity (contact with the participant more often than monthly) and included more than one component (i.e., diet education, exercise...

Lipid metabolism in obesity

Obesity is associated with an increased storage of triglycerides in skeletal muscle (IMTG), accumulation of lipid intermediates (long-chain fatty acyl-CoAs, diacylg-lycerols, and ceramides) and subsequent insulin resistance. The question then presents itself Why is there an accumulation of muscle lipids in obesity FIGURE 5.1 Proposed mechanism(s) for insulin resistance in skeletal muscle. DAG, diacylg-lycerols IMTG, intramyocellular triacylglycerols PKC, protein kinase C JNK, c-Jun N terminal kinase IKK, IkB kinase- IRS-1 2, insulin receptor substrate 1 and 2 P13K, phos-phatidylinositol 3-kinase GLUT4, glucose transporter 4 (+), activation (-), inhibition. FIGURE 5.1 Proposed mechanism(s) for insulin resistance in skeletal muscle. DAG, diacylg-lycerols IMTG, intramyocellular triacylglycerols PKC, protein kinase C JNK, c-Jun N terminal kinase IKK, IkB kinase- IRS-1 2, insulin receptor substrate 1 and 2 P13K, phos-phatidylinositol 3-kinase GLUT4, glucose transporter 4 (+), activation...

Fatty Acid Oxidation in Skeletal Muscle

Kelley et al.55 examined fatty-acid uptake and indirect calorimetry across the leg in a large sample of obese and nonobese subjects. This model allowed for a measure of metabolism across the muscle of the leg without a large degree of interference from other tissues. Respiratory quotient (RQ, obtained from arterio-venous samples) was significantly higher in obese than nonobese subjects, indicating reduced fatty-acid utilization with obesity. Basal RQ values also correlated indirectly with the insulin sensitivity of the subjects, demonstrating that fat utilization could play a role in IMTG accumulation and insulin resistance. activity or ability of CPT-1 to transport fatty acyl-CoAs into the mitochondria is believed to be the rate-limiting step of fat oxidation in skeletal muscle.89 Malonyl coenzyme A (malonyl CoA), the product of acetyl coenzyme A carboxylase (ACC), allostericaly binds to and inhibits CPT-1 activity,74 thereby inhibiting transport of fatty acyl-CoAs into the...

Anorexigenic Neuropeptides

The melanocortins are derived from site-specific, posttranslational cleavage of the precursor parent molecule proopiomelanocortin (POMC). Cleavage of POMC within the anterior pituitary gives rise to Adrenocorticotrophic hormone (ACTH), which acts through the MC2 receptor to stimulate adrenal steroidogenesis. Elsewhere in the brain, POMC is cleaved to another melanocortin, alpha-MSH, which is an agonist for the MC3 and MC4 receptors. Administration of alpha-MSH (i.c.v.) in rodents results in weight loss through inhibition of food intake and stimulation of energy expenditure (22). These actions are mediated through activation of two neuronal melanocortin receptor subtypes (MC3r and MC4r) and antagonized by an adjacent subset of hypothalamic neurons that express AgRP and NPY. The NPY AgRP neurons that inhibit MC3r and MC4r are themselves inhibited by leptin and insulin. The integrated physiology of the interactions of these opposing neuropeptides is evident from their weight-related...

Coronary Vascular Disease

In 2000, 37.2 percent of people with diabetes age 35 years or older were diagnosed with cardiovascular disease (13). Prevalence of ischemic heart disease among people with diabetes was approximately 14 times that of those without diabetes in people 18 to 44 years of age (2.7 percent versus 0.2 percent), three times more in people 45 to 64 years of age (14.3 percent versus 4.7 percent), and approximately twice more in people 65 years of age or older (13). Classical risk factors for coronary artery disease include age, male gender, hypertension, and diabetes (57). The risk of clinical or isolated subclinical ischemic heart disease is more pronounced in women than men in older individuals, although there is a lower absolute prevalence, with an increased risk noted with the presence of diabetes (58, 59). Additional factors include diet and serum cholesterol, cigarette smoking, obesity, and sedentary lifestyle (57). The Framingham Study showed that smoking, hypertension, and elevated...

Peripheral Neuropathy and Peripheral Vascular Disease

The health-care cost of problems related to the diabetic foot, the most common cause of hospitalization in patients with diabetes, is estimated to be more than 1 billion annually (73). In 2003, the total annual cost of diabetic peripheral neuropathy and its complications were estimated to be between 4.6 and 13.7 billion (74). In large cohort studies, prevalence rates for neuropathy have ranged from 7.5 percent at time of diagnosis of diabetes, to 50 percent 25 years after initial diagnosis (75). It is present in more than 80 percent of diabetic patients with foot lesions (73). Poor glycemic control is associated with an increased risk for neuropathy and amputation (76). In one study, a HbA1c > 13.4 was associated with 2.2 relative risk of amputation (76). In another study, a 50 mg dl increase in the mean random glucose was associated with a 1.6 OR for amputation (76). Diabetic peripheral neuropathy predisposes to foot ulceration and lower-extremity amputation (74). The presence of...

Pancreatic Signals

Insulin Insulin was the first peripheral signal shown to regulate food intake through interaction with central-hypothalamic neurons (87). Protagonists of popular diets have claimed in the lay press that limitation of insulin secretion is the mechanism for hunger control in subjects fed low-carbohydrate, ketotic diets. Yet, the scientific Improvement in insulin sensitivity (54, 57, 72, 84) Improvement in glucose tolerance (54, 57, 84) evidence strongly disputes that claim. Insulin fulfills the role (shared by leptin) of serving as a marker of adipose tissue mass and is secreted in direct proportion to fat mass. Insulin secretion also serves as an acute response to caloric influx Increased secretion begins within minutes of initiation of feeding, is maintained for the duration of food intake, and returns to basal secretory rate in the postabsorptive period. If insulin were an appetite stimulant (like ghrelin), its secretion would have preceded, not followed, ingestion of food. The...

Peripheral Signals In The Regulation Of Food Intake

Regulation Food Intake

The peripheral hormones that regulate food intake include several gastrointestinal, pancreatic, and adipocyte-derived peptides (Table 1.2). Based on extensive studies in rodents and limited human data, these peptides can be classified as having orexigenic (e.g., ghrelin) or anorexigenic (e.g., insulin, peptide YY, glucagon-like polypeptide, cholecystokinin, leptin) effects. Pancreatic polypeptide Insulin There is a mature and growing literature on the roles of several adipocyte products (including nonesterified fatty acids, adipocytokines, and leptin) in the regulation of metabolic fuel economy, energy balance, glucoregulation, food intake, and body weight. Products such as nonesterified fatty acids have long been proposed as mediators of obesity-associated insulin resistance and glucose dysregulation (33-35), as discussed elsewhere in this book. The adipocytokine TNF-alpha (also known as cachectin, for its association with cachexia or wasting) is a mediator of insulin resistance and...

Current Surgical Therapies for Morbid Obesity Patient Selection

In keeping with the National Institutes of Health Consensus Development Conference Statement on Gastrointestinal Surgery for Morbid Obesity, patients with a BMI exceeding 40 kg per m2 or 35 kg per m2 with obesity-related comorbidities are candidates for the surgical treatment of morbid obesity.10 Surgery for morbid obesity should be offered to patients who are well-informed and motivated, and who are acceptable to operative risks. Patients should be evaluated preoperatively by a mul-tidisciplinary team of nutritionists, nurse clinicians, internists, psychologists or psychiatrists, and surgeons. Patients should be screened for common obesity-related conditions, and these conditions should be optimized. Tests to be considered are chest x-ray electrocardiography, cardiac stress testing, and echocardiography for cardiac disorders arterial blood-gas and pulmonary-function testing, with arterial blood gases for the hypoventilation syndrome and polysomnography for the sleep apnea syndrome...

Post Operative Anastomotic Leak

Every patient with a diagnosis of diabetes should have frequent monitoring of blood glucose, and a sliding scale for subcutaneous insulin injections should be provided. Many diabetic patients decrease the need for insulin after bariatric surgery. In diabetic patients previously managed with oral medications, such as sulfonylureas or thiazolidinediones, there is an increased risk of hypoglycemia after bariatric surgery. The biguanides (metformin) is the safest drug in the postoperative period since it is not associated with dramatic fluctuations in blood glucose. The decreased requirement for insulin and modification of oral medications after bariatric surgery is due to several reasons. The average caloric intake ranges between 400-800 Kcal day for the first month and is associated with rapid weight loss, and decreased insulin needs. Weight loss can be significant in the first month postoperatively, ranging from 20-40 lbs, resulting in decreased need for insulin. It has also been...

Interrelationships Of Nutrient Metabolism And The Effect On Glucose Homeostasis

Competition between nutrients as sources of metabolic fuel has been known for more than eight decades. However, quantitatively, the most important interaction is between glucose and fatty acids (5). As already mentioned above, if there is a perturbation of the energy-supply system in the body, such as an abundance of fatty acids, a competition ensues between glucose and fatty acids as sources of metabolic fuel. This phenomenon came to be significantly recognized when Randle and colleagues proposed the glucose-fatty-acid cycle to explain the metabolic interactions between glucose and fatty acids and their role in insulin sensitivity and diabetes (5). Essentially, the Randle hypothesis states that the metabolic relationship between glucose and fatty acids is reciprocal and not dependent (5-7). More recently, to explain this reciprocal relationship, Randle has proposed that oversupply of glucose would promote glucose oxidation and glucose and lipid storage while inhibiting fatty-acid...

Muscle Mitochondria And Uncoupling Protein In Obesity

The expression of UCP3 in muscle.95 Since altered lipid metabolism is related to insulin resistance (see later sections of this chapter), uncoupling proteins may play an indirect role in the changes in metabolism seen in obesity. In addition to producing ATP, mitochondria are also a major source of reactive-oxygen species, which can cause DNA damage and peroxidation of membrane lipids. Recent evidence suggests that one of the functions of uncoupling proteins in muscle may be to prevent the proton gradient across the inner mitochondrial membrane from becoming too high, which would lead to the production of harmful reactive-oxygen species.4095 Damage to mitochondrial membranes and mitochondrial DNA by reactive-oxygen species may be responsible for the defects that have been observed in muscle mitochondria of diabetic and aged individuals.57,80 In fact, impaired mitochondrial activity may play a much larger role in disease than previously recognized, since insulin-resistant offspring of...

Exercise Training Effects on Fasting Plasma Glucose

In a recent meta-analysis of controlled clinical trials (11 randomized and three nonrandomized) on the effects of exercise training on glycemic control in individuals with type 2 diabetes, Boule and colleagues39 reported a significant (P < 0.001) beneficial exercise effect on glycosylated hemoglobin (HbA1c) (-0.66 percent) compared to the controls. The authors concluded that exercise training reduces HbA1c by an amount that should decrease the risk of diabetic complications. The difference found in this meta-analysis was close to the difference (-0.9 percent) between conventional and intensive glucose-lowering therapy reported in the United Kingdom Prospective Diabetes Study (UKPDS)40,41 an amount that was associated with significant improvement in clinical outcomes (development of microvascular and macrovascular complications of diabetes, including cardiovascular disease). The authors went on to speculate that exercise might result in a greater reduction in cardiovascular...

Metabolic Inflexibility Associated with Obesity

Healthy skeletal muscle adapts to differing concentrations of plasma substrates (carbohydrates and fats) and hormones (primarily insulin). When a substrate is in oversupply, healthy skeletal muscle is able to adjust and activate processes that are necessary for appropriate oxidation or storage. Accordingly, healthy muscle is also able to adjust substrate utilization in response to hormonal changes. This process has been termed metabolic flexibility and constantly occurs in daily life when conditions move from fasting to fed to fasting again. This term was coined by Kelley and colleagues55 following a study (previously mentioned) in which they measured differences in substrate utilization during basal- and insulin-stimulated conditions across the leg in obese and nonobese subjects. During fasting conditions, obese individuals had significantly higher rates of carbohydrate oxidation and decreased fat oxidation, which fit the hypothesis for reduced oxidative capacity in obese skeletal...

Dental Disease

Dental complications of diabetes mellitus include severe periodontitis and subsequent tooth loss, gingivitis, dental abscesses, xerostomia, and soft-tissue lesions of the tongue and oral mucosa, such as candidiasis (101). Routine, preventive dental care may be important in preventing and treating these complications. A large cross-sectional study, however, showed that dentate adults with diabetes were less likely to see a dentist than those without diabetes (65.8 percent versus 73.1 percent, p 0.0000) (101).

Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

Get My Free Ebook