More than 18 million Americans have diabetes and 15% of them will develop chronic wounds like foot ulcers .
The ulcers can take weeks to heal and if the infection spreads to the bone, there are serious consequences.
A sore on your foot is a nuisance for anyone but for someone with diabetes they can be especially annoying.
Sores can easily turn into an ulcer and in serious cases, result in amputation.
Now, Baptist Hospital is offering a new approach to healing.
Football fans may know the name Ross Browner.
He lives in Nashville now, but spent a decade in the NFL as defensive end for the Cincinnati Bengals and the Green Bay Packers.
12 years ago, doctors diagnosed Browner with diabetes a condition that has now led to a serious foot ulcer.
He said, “My foot just kind of blew up and I was on antibiotics. The foot dried at the bottom, it cracked and got infected.”
Diabetic foot ulcers usually start out as a callus or blister but can quickly develop into a serious problem.
Poor blood circulation and elevated blood sugar often limit the body’s ability to repair the injured tissue. Decreased sensation in the limbs can also
To treat Browner’s ulcer, doctors at Baptist Hospital’s Wound Care Center are using a total contact cast.
Part of the cast is applied with the patient sitting up and the rest is applied with the patient lying down with his/her foot in the air. It allows fluid to drain away from the foot.
Baptist Dr. Warren Patterson said, “The cast is put on like a cone so a third of the body weight is absorbed by sides of the cast. This offloads considerable weight.”
The cast fits closely around the foot and
Patients wear casts about eight weeks and doctors change it several times to check the size of the ulcer.
With the help of this cast, doctors said the former football star should be back on his feet in no time.
Browner said, “It’s really starting to happen now and I’m really glad they have this technique now. In six weeks or so, I should be out of a cast and able to put on a shoe again.”
Doctors advise patients to check their feet for sores regularly.
Patients with type 2 diabetes are more likely to develop Parkinson’s disease, although the reasons are unclear, Finnish researchers say.
They found that people with type 2 diabetes were 83 per cent more likely to be diagnosed with Parkinson’s later in life than people in the general population.
This risk was the same for men and women and was independent of other risk factors.
“Diabetes might increase the risk of Parkinson’s disease partly through excess body weight,” the researchers wrote in the April issue of Diabetes Care.
Being overweight and not exercising enough are linked with type 2 diabetes, which is becoming more common around the world. Diabetes can lead to blindness, limb loss, heart disease and early death.
Parkinson’s is a movement disorder caused by the destruction of certain brain cells. People often develop tremors first, but the incurable disease can progress to paralysis and death.
There are no known major risk factors for Parkinson’s, but some studies suggest exposure to chemicals such as pesticides may cause some cases. It affects about one million people in the United States alone.
Dr Gang Hu and colleagues at the National Public Health Institute in Helsinki, Finland, followed 51,552 Finnish men and women aged 25 to 74 for 18 years. None had Parkinson’s disease at the beginning of the study.
About 600 developed Parkinson’s by the end of it, and those who did were nearly twice as likely to have diabetes as well, the researchers found.
They said they would investigate the link further.
Aspirin resistance is more common among diabetics patients than nondiabetics, potentially requiring higher doses for adequate protection against a heart attack, researchers here said.
Resistance to low-dose aspirin recommended for cardioprotection was found among 13% to 37% of patients with diabetes but only 3% to 14% of nondiabetic patients with a history of coronary artery disease, said Paul A. Gurbel, M.D., of Sinai Hospital and Johns Hopkins in Baltimore.
Testing by platelet aggregation or thromboxane metabolite generation showed that increasing the dose to 162 mg or 325 mg eliminated the difference between groups, he reported at the American College of Cardiology meeting.
“The one size fits all mentality is not really appropriate in diabetic patients,” Dr. Gurbel said. “In selected diabetic patients baby aspirin is not enough.”
However, further evidence from larger studies would be needed before routine high-dose aspirin — which increases bleeding risk — or routine aspirin resistance testing could be recommended for patients with diabetes, he cautioned.
Nevertheless, the results suggest aspirin resistance testing may be useful for individual diabetic patients, commented Robert S. Rosenson, M.D., of Northwestern University in Chicago, who moderated a press conference during which the study was discussed.
“We know that many individuals who are on aspirin therapy still have a heart attack, still have a stroke,” Dr. Rosenson said. “How can we better help these individuals? How can we individualize the therapy? Perhaps measuring tests of platelet function in getting the right aspirin dose for that individual patient.”
The double-blind, crossover study included 120 stable outpatients with a history of coronary artery disease treated with 81 mg, 162 mg, and 325 mg aspirin daily for four weeks. Thirty of the patients had diabetes, type 2 for most of them.
Platelet aggregation was evaluated after each dose period using blood and urine samples in four methods. Compliance was also strictly monitored.
Aspirin resistance was defined according to standard platelet aggregation or thromboxane metabolite generation cutpoints for each of the tests.
Among the aspirin resistance findings, the researchers reported:
The overall efficacy of aspirin in reducing platelet aggregation was lower for diabetics than nondiabetics at the lowest dose only. For the 81-mg dose, aggregation was about 50% for diabetics compared with about 30% for nondiabetics. At the 162 mg and 325 mg, agreggation was about 30% for both diabetics and nondiabetics (P<0.001 versus 81 mg among diabetics).
“The dose dependent effects of aspirin suggest that the antithrombotic properties of the drug are not all explained by COX-1 inhibition,” Dr. Gobel said.
He speculated that vessel-wall components, such as collagen, may be involved.
Source? American College of Cardiology meeting
Source reference:
Gurbel PA, et al “Effects of Diabetes on the Prevalence of Aspirin Resistance During Low Dose Aspirin Therapy” ACC meeting 2007
4 small skinless chicken breasts (about 4 ounces each)
1/3 cup lemon juice
1/4 cup water
1/2 teaspoon garlic powder
1/4 teaspoon onion powder
1 teaspoon dried parsley
1/4 teaspoon salt
Mix all the ingredients together except for the chicken breasts. Pour mixture over chicken. Let chicken marinate in the refrigerator for 2 hours or overnight. Grill over a slow charcoal or gas grill on low, turning and marinating occasionally until done. Put reserved marinade into a saucepan and bring to a boil; serve on the side as a sauce. Makes 4 servings.
Nutritional Information (1 serving):
Calories: 148
Carbohydrate: 2 grams
Protein: 27 grams
Fat: 3 grams
Saturated Fat: 1 grams
Cholesterol: 73 mg
Fiber: trace
Sodium: 201 mg
Potassium: 248 mg
Calcium: 16 mg
Women with high blood sugar levels are at an increased risk of developing cancer, a major European study finds.
Diabetes causes high blood sugar, as does eating too much sugary food.
The Swedish research, which looked at 64,500 people, linked raised blood sugar with pancreas, skin, womb, and urinary tract cancers in women.
Diabetes experts said more evidence was needed to confirm the link. The study comes as other work links a high fat diet to increased breast cancer risk.
In this study, carried out by a team at the University of Umea, high blood sugar was also linked to breast cancer risk - for women under 49.
Overall, the research found women in the top 25% range of blood sugar readings after fasting had a 26% higher chance of developing cancer than those in the bottom quarter.
The research was part of the Vasterbotten Intervention Project, a major health investigation in Sweden.
Participants were invited into the study at the ages of 40, 50 or 60 in the mid-1980s.
Fasting blood sugar levels were measured, as well as the amount of sugar in the blood after an infusion of glucose. Overall, the study spanned 13 years.
During the course of the research, 2,478 cases of cancer were identified.
The research also found clear evidence of higher rates of hyperglycaemia - unusually high blood sugar levels - with increasing age.
Lifestyle change
The researchers, led by Dr Par Stattin, said: “Abnormal glucose metabolism was associated with a statistically significantly increased risk of cancer overall in women but not in men.”
In men, raised blood sugar levels in men appeared to protect against prostate cancer, though not to a significant degree.
The research was partly paid for by the World Cancer Research Fund (WCRF).
Dr Greg Martin, science and research manager for WCRF UK, said: “The results of this research are concerning.
“However, they are important because if women are aware of the facts, they are likely to be more motivated to change their lifestyle if their blood sugar levels are too high.
“And the good news is that it is possible to reduce your blood sugar levels by eating a healthy balanced diet with lots of fruit and vegetables and maintaining a healthy weight.
“We know that up to 40% of cancer cases can be prevented by this type of healthy lifestyle, so this is just another reason for people to make those small changes that could make a big difference.”
Blood test
Previous research has shown an increased risk of cancer in patients with type 2 diabetes.
However, this new research shows that even when people do not have the condition, rising blood sugar levels are associated with increased cancer risk in women.
Natasha Marsland, care manager at the charity Diabetes UK, said: “This is an interesting study.
“However, much more research needs to be done before we can ?onclude if there is a link between high blood glucose levels and cancer.
“A simple blood test at your doctor’s is the best way to find out if you have a high blood glucose level.
“Having a high blood glucose level can indicate diabetes but this is not always the case.
“If someone is white and over 40, or over 25 from a black or South Asian background, and has either a family history of Type 2 diabetes or is overweight, they should consider asking their doctor for the simple blood test to determine whether or not they have diabetes.”
Source: BBC News
A new treatment designed to delay or even prevent type 1 diabetes is about to start clinical trials.
It is aimed at patients who are at risk of developing the disease and targets the immune system, preventing it from attacking the cells that produce insulin.
In patients who do not have enough insulin in their system, glucose builds up in the bloodstream, increasing the risk of a number of health problems including blindness, heart disease, kidney problems, limb amputation and nerve damage.
Now, if successful, the new treatment will be the first to delay the start of the disease, which has shown a sharp increase in recent years in children under the age of five.
“The idea of the treatment is that it dampens down the immune system’s response to insulinmaking cells in the pancreas,” said Professor Polly Bingley of Bristol University, who is leading the UK end of the trial.
She added: “In type 1 diabetes, the process that leads to the disease starts very early on in life, around the age of two. Then there is a gradual progression until people actually develop diabetes.”
Onset can be in early childhood or later in life, but it usually appears before the age of 40.
“In many cases, you therefore have a long window of opportunity in which you can hopefully delay or conceivably prevent the clinical onset of the disease,” said Professor Bingley.
In type 1 diabetes, the immune system mistakenly attacks and destroys the cells in the pancreas that produce insulin. As these cells are destroyed, the body’s ability to produce insulin decreases. This type of diabetes accounts for up to 15 per cent of all cases.
According to Diabetes UK, a charity supporting people living with the condition, there are more than two million people with both types of diabetes, plus an estimated 750,000 people who are undiagnosed.
Recent research has revealed a five-fold increase between 1985 and 2004 of under-fives with type 1 diabetes. There was a doubling of the numbers of under-15s with th? condition.
Although type 1 diabetes can neither be cured nor prevented, it can be treated with insulin injections, diet changes and regular exercise. Patients usually take either two or four injections of insulin each day.
The research team now plans to identify people at high risk and give them daily treatment with oral insulin crystals.
The idea is that when the immune system encounters the insulin in the intestine, it will learn not to perceive it as a threat.
In effect, the immune system will be re-educated, and, as a result, it will no longer attack the patient’s own insulinproducing cells.
“There is evidence from earlier research that repeated use of the same protein that the immune system is reacting to may result in a protective immunity and cause the immune system to stop its attack.
“This study will explore the potential role of oral insulin to delay or prevent type 1 diabetes,” said the researchers.
People aged between three and 45 will take part in trials in six countries, including the UK.
People at risk - those who have a relative who has been diagnosed with type 1 diabetes - will be screened and tested to identify anyone with high levels of antibodies compared to insulin levels in their blood.
Professor Bingley said: “Earlier work does seem to suggest it may have a promising effect.”
For information on how to take part in the study, visit trialnetuk@bristol.ac.uk.
• A pinch of cinnamon a day may lower blood sugar levels in people with type 2 diabetes.
Patients are to be given 1g of the spice a day in a new clinical trial, following reports that it can lower blood glucose levels - which can become dangerously high in diabetes sufferers - by up to 29 per cent after 40 days.
In the seven-month trial, starting this month at Eglin Hospital, Florida, 140 patients will be given either cinnamon or a placebo, and at the end doctors will measure long-term changes in blood glucose levels.
Just how cinnamon works is not clear, but one theory is that a type of antioxidant found in the spice works in a similar way to insulin.
Exposure to agricultural pesticides in the first-trimester increases a woman’s risk of developing diabetes during pregnancy, research shows.
Previous studies have examined the relationship between pesticides and diabetes, the authors explain, but none have focused on pregnancy-related or “gestational” diabetes.
Dr. Tina M. Saldana from the National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina and colleagues assessed the risk of developing gestational diabetes following pesticide exposures among wives of farmers enrolled in the Agricultural Health Study.
Of 11,273 women who became pregnant within 25 years after entering the study, 506 (4.5 percent) reported having gestational diabetes.
Overall, 57 percent of women reported having mixed or applied pesticides at some time in their life, and the proportion was similar for those with and without gestational diabetes mellitus, the authors report in the journal Diabetes Care.
However, women who mixed or applied pesticides or repaired pesticide-related equipment during the first trimester of pregnancy had a more than twofold increased risk of developing gestational diabetes, the report indicates.
In contrast, there was no increased gestational diabetes risk among women with residential exposures to pesticides or indirect exposures during the first trimester.
Similarly, the researchers note, women who had mixed or applied pesticides at any time before enrollment in the study did not face an increased risk of gestational diabetes compared with those who did not.
Although much is known about common risk factors for pregnancy-related diabetes, “our understanding of whether and how environmental exposures may affect risk is still limited,” the authors conclude.
Understanding any potential effect of environmental exposures on glucose (sugar) tolerance during pregnancy “may have substantial public health importance beyond the direct effects on gestational diabetes.”
SOURCE: Diabetes Care, March 2007.
A new study sheds additional light on how erectile dysfunction (ED) interacts with diabetes. The study is another step in uncovering the link between the two disorders, and may lead to improved efficacy in treatments.
Cialis, Viagra, and Levitra (vardenafil) are 3 major FDA approved medications that treats ED but there is no cure for this yet.
The study, “Lack of Central Nitric Oxide Triggers Erectile Dysfunction in Diabetes,” was conducted by Hong Zheng, William G. Mayhan, and Kaushik P. Patel, Departments of Cellular and Integrative Physiology; and Keshore R. Bidasee, Department of Pharmacology, University of Nebraska Medical Center, Omaha, NE. The results appear in the March 2007 edition of the American Journal of Physiology – Regulatory, Integrative and Comparative Physiology, one of 11 peer-reviewed scientific publications issued monthly by The American Physiological Society (APS).
Background
Sexual dysfunction is a well-recognized consequence of diabetes mellitus in men. Erectile dysfunction, retrograde ejaculation and the loss of seminal emission have all been described by such patients. This study examined induced penile erection, yawning and stretch in diabetic rats. Male Sprague-Dawley rats treated with streptozotocin (STZ) to induce diabetes were used as they exhibit sexual and behavioral symptoms similar to those found in diabetic men with sexual dysfunction.
The researchers focused on the paraventricular nucleus (PVN) of the hypothalamus, located in the brain, an integration center between the central and peripheral nervous systems. The site is involved in numerous functions, including erectile function and sexual behavior, and is a primary site within the forebrain that has been implicated in penile erection. The investigators also examined central nitric oxide (NO within the PVN) which plays an important role in the neurotransmission of normal penile erection.
Penile erection is a behavioral response that occurs in response to the administration of N-methyl-D-aspartic acid (NMDA) within the PVN. At the same time, inhibition of NO synthase with NG-monomethly-L-argining (L-NMMA) prevents NMDA-induced erection. The researchers hypothesized that the blunted NMDA mediated responses in diabetes reflects an impaired NO mechanism within the PVN. The involvement of an NO mechanism in the NMDA mediated behavioral response was also explored.
Methodology
The rats were exposed to a light/dark cycle, with standard temperature and humidity levels. The animals were randomly selected to receive chemical injection of the streptozotocin (STZ) to induce diabetes. Those rats that did not receive STZ (vehicle injected) served as controls. The experiments began on each of the rats four weeks after the injections.
Four experiments were conducted. Experiment one examined the effect of L-NMMA on NMDA mediated behavioral responses in normal rats; experiment two measured behavioral responses to NMDA or sodium nitroprusside (SNP), an NO donor in both control and diabetic rats; the third experiment observed the effect of diabetes on nNOS protein in the PVN; the fourth experiment measured NMDA mediated behavioral responses in diabetic rats after restoring the nNOS protein in the PVN using viral gene transfer.
Results
The researchers found that:
Conclusion
The researchers conclude that erectile dysfunction in diabetes is due to a selective defect in the NO mechanisms within the PVN. This defect is a loss in the synthetic enzyme for the production of NO within the neurons of the PVN. Restoring this synthetic enzyme may have a significant therapeutic value for diabetic patients with ED.
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JOURNAL PUBLICATION INFORMATION: American Journal of Physiology – Regulatory, Integrative and Comprehensive Physiology – March 2007.
A review of published studies shows a clear and consistent relationship between drinking sugary (non-diet) soft drinks and poor nutrition, increased risk for obesity — and increased risk for diabetes.
There is no denying that sugar-loaded soft drinks are having “a negative impact on health,” Dr. Kelly Brownell, director of the Rudd Center for Food Policy and Obesity at Yale University in New Haven, Connecticut, said in a telephone interview with Reuters Health.
Having analyzed and reviewed 88 studies on the issue, Brownell and his colleagues conclude that recommendations to curb soft drink consumption on a population level are strongly supported by the available scientific evidence.
Results of a study of more than 91,000 women followed for 8 years provides one of the “most striking” links between soft drinks and health outcomes, the investigators note in the American Journal of Public Health.
In the study, women who drank one or more sodas per day — an amount less than the US national average — were twice as likely as those who drank less than one soda per month to develop diabetes over the course of the study.
When diet soda replaced regular soda in the analysis, there was no increased risk, “suggesting that the risk was specific to sugar-sweetened soft drinks,” note the authors.
“This result alone,” they assert, “warrants serious concern about soft drink intake, particularly in light of the unprecedented rise in type 2 diabetes in children.”
The data reviewed by Brownell’s team also show that higher intake of ?ugary sodas goes hand-in-hand with lower intake of milk, calcium and other essential nutrients, fruit and fiber, and higher intake of carbohydrates.
Furthermore, there was a “remarkable difference” in results from industry-funded and non-industry-funded studies on soft drink consumption and health outcomes, Brownell said, “with the industry-funded studies much more likely to find the results favorable to industry.”
“The bigger issue here, in this arena in particular but in science in general,” Brownell said, “is how you can get a distorted view of reality if industry-funded studies are considered in the mix — and usually they are — especially, when industry uses these studies in advertising, lobbying, and in talking to the press.”
When it comes to soft drink consumption among America’s youth, Brownell added, “the decisions parents make are one thing, but the relentless marketing to children is another.”
He supports the growing trend toward banning soda sales in schools. “I believe schools should be a commercial-free zone and that beverages that are contributing to ill health should not be sold there,” Brownell said.
SOURCE: American Journal of Public Health, April 2007.
A study of type 2 diabetics with depression confirms that depression has a negative impact on glycemic (blood sugar) control, researchers report, and “affirms the importance of depression management in diabetic patients in its potential to improve glycemic control.”
Researchers from Missouri treated 93 patients with type 2 diabetes and depression with the antidepressant bupropion (Wellbutrin).
“We selected bupropion because it is capable of reducing depression and weight simultaneously and hypothesized that these effects would be accompanied by improved glycemic control in diabetic patients with major depressive disorder,” the team explains in the journal Diabetes Care.
In support of their hypothesis, “antidepressant treatment produced benefits beyond just mood improvement,” first author Dr. Patrick J. Lustman from Washington University School of Medicine, St. Louis, told Reuters Health. “Patients also lost weight, improved self-management of their diabetes, and improved their glucose control (A1C levels).”
Of these short-term improvements, only depression improvement predicted maintenance of improved blood sugar control in the subsequent 6 months, the researchers found.
“This confirms our hypothesis that depressio? improvement can produce better glycemic control, independent of favorable changes in weight and diabetes self care,” Lustman noted. “Improvement in depression was the key to achieving longer term improvements in glucose control.”
Lustman concludes that the data “point to the importance of weight-independent physiological factors (insulin sensitivity, inflammation) that improve during depression relief and contribute to better long-term control of diabetes.”
SOURCE: Diabetes Care, March 2007.