Diabetes Digest

What do superstar Gary Valenciano and broadcast journalist Mike Enriquez have in common? They both have diabetes and their respective networks are both claiming to be No.1 in ratings. There is a scene in Martin Scorsese’s The Departed where Leonardo DiCaprio’s character goes to a bar and orders…cranberry juice. Now let’s get medical: As he drinks the juice, its sugar will be converted by his intestines into blood sugar, or glucose. If excess glucose gets into his bloodstream, he will die. To prevent this, his pancreas secretes the hormone insulin to regulate his glucose level. But if he has diabetes, things can get a bit more complicated even if Matt Damon is not trying to arrest him. Type 1 diabetes is when the body fails to produce insulin. This accounts for 10-25% of diabetes cases. Treatment is a daily dose of insulin injections. Type 2 diabetes is when the body fails to respond to insulin, or when the body fails to produce adequate amounts. This has been linked to obesity and accounts for 90% of cases. Treatments are medication, diet, exercise and in certain cases, insulin shots. The transplant of insulin-secreting pancreatic islets in the liver is one of the more recent breakthroughs in the late 90s. Although the patient has to take anti-rejection (immune-suppressing) drugs for the rest of his life, “This is perhaps the most important finding in Type 1 diabetes research in the past decade,” says Dr. Richard Furlanello, director of the Juvenile Diabetes Foundation. One of the standard oral medications is metformin hydrochloride, either used alone or with sulfonylureas, drug compounds that trigger the production of more insulin. Sulfonylureas used to be the only drug treatment but uncontrolled increase in insulin leads to dangerously low glucose levels and weight gain. A more recent drug for Type 2 diabetes is rosiglitazone maleate, which sensitizes the cells to absorb more insulin. The International Diabetes Federation says that diabetes is the 4th main cause of death in developed countries today. There are currently 194 million people worldwide who are suffering, and there will be 333 million in 2025. Some good news: 1. A vegan diet can reverse diabetes. This entails not eating any animal products including poultry and dairy. “We have got a combination here that works successfully,” according to Dr. David Jenkins of the University of Toronto. The improvements among the vegan participants were striking: 1) Their average a1c glucose-control level fell by 1.23 points; 2) 43% were able to stop taking their insulin or glucose medications within 22 weeks; 3) Their “bad” LDL cholesterol level fell by an average 21%; and 4) They lost an average of 14 pounds (6.5 kgs.). “I hope this study will rekindle interest in using diet changes first, rather than prescription drugs,” says Dr. Neal Bernard, president of the U.S. Physician’s Committee for Responsible Medicine which conducted the study in partnership with George Washington University, the University of Toronto and the University of North Carolina. 2. An ideal weight reduces the risk of developing Type 2 diabetes. The 4-year landmark XENDOS (Xenical in the prevention of Diabetes in Obese Subjects) Study has found that the weight-loss drug Orlistat is effective in managing Type 2 diabetes. The study showed that weight-loss using Orlistat is 37% more effective in reducing diabetes risk compared weight-loss through other means. Age doesn’t matter in diabetes. The American Diabetes Association recommends that children as young as 10 who are more than 20% overweight and with a family history of diabetes should get tested. Dr. Alan Moses of the Joslin Diabetes Center in Boston says the best prevention is an active lifestyle and healthy weight: “Tell your children to go run around.” 3. Statins are now officially recognized as effective agents against diabetes. Statins are essentially anti-hypertensive drugs that block a liver enzyme from manufacturing cholesterol. Since it was found that 70% of diabetics ultimately die of heart attacks, diabetes is now considered as a major factor in heart disease. “Many people have adopted a high-sugar, high saturated-fat, low-fiber diet, and this state of poor nutrition had led to the greater increase in diabetes, hearts disease, stroke and cancer,” according to Dr. Ma. Teresa P. Que, endocrinologist and president of the Philippine Diabetes Association. Patient education is the key. This was the theme of the lay forum during the 11th Joint Annual Convention of the Philippine Society of Hypertension and the Philippine Lipid Society on February 2006. “Everyone should adopt a healthy lifestyle by eating at least 3-5 servings of fruits and vegestables a day, exercising regularly, maintaining ideal body weight, de-stressing regularly and not smoking,” says Que, one of the panelists. 4. A new drug that enhances the body’s ability to lower glucose levels was recently launched in the Philippines. The dipeptidyl peptidase-4 inhibitor Sitagliptin was introduced to Filipino journalists at a press conference hosted by representatives of Merck, Sharp and Dohme pharma firm. Among the panelists are endocrinologist Dr. Elizabeth Paz Pacheco and diabetologist Dr. Araceli Panelo. “Statistics indicate that approximately 6 million Filipinos have the disease and yet it is believed that twice that number are diabetics who don’t know they have it,” according to Ethel S. Timbol in her “Consumer Post” column in Manila Bulletin. This is because “the standard blood chemistry tests do not include one for diabetes of FBS (fasting blood sugar) which is the first indicator of diabetes,” writes Timbol. “There ought to be a law making it a requirement on blood tests.” 5. Physical activity regulates glucose levels – aside from giving other cardiovascular benefits. A new study from the University of Queensland and the Melbourne International Diabetes Institute found that diabetic patients who engage in intense physical activity for at least 30 minutes a day can significantly reduce their glucose levels. More tantalizing news: “Some experts feel that the most common form of diabetes (Type 2) is preventable with a proper diet – and regular activity,” wrote Carol Krucoff and Dr. Mitchell Krucoff in Healing Moves (Harmony Books). Remember: “When people exercise, the body fuels the activity by talking the glucose out of their blood to use for energy.” 6. A good night’s sleep can improve diabetic conditions. Doctors at Rush University Medical Center have established the link between sleep apnea and diabetes. In a study, patients with sleep apnea, diabetes and obesity were found to have lower glucose levels after wearing a CPAP mask (which helps keep the nasal passages open) for at least 4 hours every night. Further research is underway to determine if treating sleep apnea can actually prevent, or at least slow down, the onset of diabetes, says study author Theodore Mazzone of the University of Illinois in Chicago. 7. Insulin has been identified as the cause of the more severe form of diabetes – when the immune system attacks the cells in the pancreas. There are actually two separate research reports which reached the same conclusions and were both published in Nature. “We are excited to be part of a growing body of evidence that points to insulin as the trigger for Type 1 diabetes,” says David Hafler of Harvard Medical School. The other research team was led by George Eisenbarth of the University of Colorado Health Sciences Center in Denver. “If we and others can confirm this,” says Hafler, it will be the best in vitro evidence possible that insulin is the antigen.” An antigen is a chemical compound that pushes the body to form antibodies.

Sources: AP, AFP, Reuters, Reader's Digest, Time, Newsweek, Manila Bulletin