Study: Self-monitoring of Blood Sugar Had No Effect on Long-term Glucose Levels in Those Not Taking Insulin

Steven Reinberg wrote . . . . . .

People with type 2 diabetes who aren’t taking insulin don’t necessarily need to check their blood sugar levels, a new study contends.

Many of these patients use “finger prick” blood sugar monitors, but “testing blood sugar didn’t have any impact on their blood sugar,” said study author Dr. Laura Young, an assistant professor of medicine at the University of North Carolina.

“The best way to control blood sugar is to take your medication the way your doctor asks you to and to take good care of yourself,” she said. “The key is really taking your medications.”

Monitoring might be helpful when starting a new medication or changing doses, Young said.

“But if someone is on insulin, they absolutely need to be tested regularly,” she said. Insulin predisposes people to have blood sugar that’s too low, a condition called hypoglycemia. Hypoglycemia can cause dizziness and weakness and, if not treated, lead to coma, Young said.

“Patients should have a conversation with their doctor about whether or not they should be checking blood sugar,” she said.

For the study, Young and her colleagues randomly assigned 450 patients with type 2 diabetes who weren’t taking insulin to monitor their blood sugar once a day with a typical blood sugar meter, once a day with a monitor that gave them a feedback message, or to not monitor blood sugar at all.

The participants in the study were from 15 primary care practices in North Carolina. Their average age was 61, and they’d had diabetes for an average of eight years. About three-quarters were monitoring their blood sugar at the start of the study.

After a year, the researchers found no differences between the groups in how well their blood sugar was controlled or in their quality of life.

It’s possible that these results were skewed by people who dropped out of the trial. An improvement in blood sugar seen in hemoglobin A1c levels was seen in the early months of the trial, but wasn’t significant at the end of the trial, the researchers reported. Hemoglobin A1c is a blood test (usually done at the doctor’s office) that provides an average of about two to three months of blood sugar levels.

One diabetes expert agreed that routine blood sugar checks may not be necessary for these patients.

“The value of self-monitoring of blood sugar levels in patients not treated with insulin is minimal,” said Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center in New York City.

“In my practice, I advocate that every patient with diabetes needs to have a monitor, needs to know how to check blood sugars, and needs to check blood sugars from time to time, when they are sick and when treatment is changed,” he said.

Zonszein agreed that the main reason to check blood sugar is not to see if it’s too high, but to check if it’s too low.

This is especially true for patients taking sulfonylureas, such as chlorpropamide (Diabinese), he said.

“These agents can cause hypoglycemia, and low blood sugar is something we want to diagnose and treat. Those patients on hypoglycemic agents such as sulfonylureas need to monitor more often, as they can have a low blood sugar and not even know about it,” Zonszein said.

The majority of his type 2 diabetes patients are treated with metformin and one of the newer medications, such as a liraglutide (Victoza) or canagliflozin (Invokana) or combinations of those drugs.

“These patients tend to have a normal A1c and they rarely need to check their blood sugars, as these agents don’t cause significant hypoglycemia,” he said.

In other studies, frequent blood sugar monitoring has been found to not be beneficial, and might also lead to depression, Zonszein said.

“The authors proved what I have been telling my patients,” he said. “Monitoring blood sugar is somewhat painful and very costly, and when it is done, it has to have a reason.”

The findings were published in the journal JAMA Internal Medicine, to coincide with a presentation of the study at the American Diabetes Association’s annual meeting, in San Diego.

Source: HealthDay


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Is Coconut Palm Sugar a Better Sweetener for People with Diabetes?

Lana Barhum wrote . . . . . .

What is coconut palm sugar?

Coconut palm sugar is made from the sap of the coconut palm. The sugar is extracted from the palm by heating it until the moisture evaporates. After processing, the sugar has a caramel color and tastes like brown sugar, making it an easy substitution in any recipe.

Coconut palm sugar is considered a healthier option for people with diabetes because it contains less pure fructose than other sweeteners.

The digestive tract does not absorb fructose as it does other sugars, which means that the excess fructose finds its way to the liver. Too much fructose in the liver can lead to a host of metabolic problems, including type 2 diabetes.

Can people with diabetes eat coconut palm sugar?

While the American Diabetes Association (ADA) do find coconut palm sugar to be an acceptable sugar substitute, they do not appear to endorse its use.

Coconut palm sugar and glycemic index

Some people believe coconut palm sugar is more healthful because it is lower on the glycemic index (GI).

People with diabetes are encouraged to consume foods with a low GI because they will not raise blood sugar levels as much as foods with a high GI level. Any GI value of 55 or less is considered low, and anything above 70 is high on the GI.

Both honey and cane sugar have GIs of around 50, while the GI of coconut palm sugar, as reported by the Food and Nutrition Research Institute of the Philippines, is 35.

However, the University of Sydney have measured the GI of coconut palm sugar at 54. Based on its chemical makeup, this is thought to be the most likely value. Despite the difference in opinion, coconut palm sugar is still considered to be a low GI food.

Issues with looking at GI

There are several factors that contribute to blood sugar levels after eating, including how the food is prepared.

In the United States, there is no official GI rating system. The ADA note, however, that GI numbers for specific foods differ based on their source, and this would likely apply to coconut palm sugar.

According to the Joslin Diabetes Center, the GI is not the best guideline for what happens to blood sugar levels after eating.

There are many factors that influence the process, including:

  • the individual
  • the content of the food
  • how food is prepared
  • what other foods are consumed
  • the rate of digestion

Therefore, the ADA advise people to treat coconut palm sugar as they would any other sweetener, including pure cane sugar. It is also important to include the number of calories and carbohydrates it contains when planning meals.

People should always check the nutritional labels on coconut palm sugar. This is because coconut palm sugar may contain other ingredients, including cane sugar, which means its GI will be much higher than noted in a rating system.

Coconut palm sugar contains inulin

Inulin is a fermentable prebiotic fiber, beneficial to gut bacteria that may help with controlling sugar levels in type 2 diabetics.

At least one research study finds coconut palm sugar contains significant amounts of inulin.

A study from 2016 found that fermentable carbohydrates might help to improve insulin sensitivity. They may also have unique metabolic effects for those who are at high risk for diabetes.

Benefits for women with type 2 diabetes

Another study finds that inulin provides some benefits for women with type 2 diabetes, including blood glycemic control and antioxidant status. Antioxidants protect the body from disease and damage.

More research is needed to further identify and understand these findings to extend to other populations with type 2 diabetes.

Nutritional value of coconut palm sugar

Coconut palm sugar contains the same number of calories and carbohydrates as regular cane sugar.

In addition, coconut palm sugar and cane sugar both contain:

  • fructose, which is a monosaccharide, or single sugar
  • glucose, which is a monosaccharide
  • sucrose, which is a disaccharide that is made up of two sugars: half fructose, half glucose

However, the proportion of these sugars is different in cane sugar and palm sugar.

Other nutrients found in coconut palm sugar

Coconut palm sugar may be considered a better option, as it has more nutritional value than some other sugars.

Unlike cane sugar, it contains:

  • iron
  • calcium
  • magnesium
  • potassium
  • other important minerals

However, people should bear in mind that cane sugar contains tiny amounts of these nutrients. Most people only consume a few teaspoons of coconut palm sugar at a time, which actually contains less than 2 percent of all nutrients.

Healthful whole foods will provide dramatically more of these same nutrients for fewer calories.

Conclusion

There is not enough sufficient research to back up claims coconut palm sugar is more healthful, better, or different than any other sugar for blood sugar.

While coconut sugar contains inulin, it may not contain enough to significantly affect blood sugar levels. In addition, coconut palm sugar is also just as high in calories as regular cane sugar.

Coconut palm sugar seems to be slightly more beneficial than regular sugar but is still best consumed in moderation. Therefore, individuals with type 2 diabetes should treat it the same as other sugars and use it sparingly, as it still might raise blood glucose levels, despite its possibly lower GI.

Source: Medical News Today


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Type 2 Diabetes: The Basics

Diabetes is a life-long disease that affects the way your body handles glucose, a kind of sugar, in your blood.

Most people with the condition have type 2. There are about 27 million people in the U.S. with it. Another 86 million have prediabetes: Their blood glucose is not normal, but not high enough to be diabetes yet.

What Causes Diabetes?

Your pancreas makes a hormone called insulin. It’s what lets your cells turn glucose from the food you eat into energy. People with type 2 diabetes make insulin, but their cells don’t use it as well as they should. Doctors call this insulin resistance.

At first, the pancreas makes more insulin to try to get glucose into the cells. But eventually it can’t keep up, and the sugar builds up in your blood instead.

Usually a combination of things cause type 2 diabetes, including:

Genes: Scientists have found different bits of DNA that affect how your body makes insulin.

Extra weight: Being overweight or obese can cause insulin resistance, especially if you carry your extra pounds around the middle. Now type 2 diabetes affects kids and teens as well as adults, mainly because of childhood obesity.

Metabolic syndrome: People with insulin resistance often have a group of conditions including high blood glucose, extra fat around the waist, high blood pressure, and high cholesterol and triglycerides.

Too much glucose from your liver: When your blood sugar is low, your liver makes and sends out glucose. After you eat, your blood sugar goes up, and usually the liver will slow down and store its glucose for later. But some people’s livers don’t. They keep cranking out sugar.

Bad communication between cells: Sometimes cells send the wrong signals or don’t pick up messages correctly. When these problems affect how your cells make and use insulin or glucose, a chain reaction can lead to diabetes.

Broken beta cells: If the cells that make the insulin send out the wrong amount of insulin at the wrong time, your blood sugar gets thrown off. High blood glucose can damage these cells, too.

Risk Factors and Prevention

While certain things make getting diabetes more likely, they won’t give you the disease. But the more that apply to you, the higher your chances of getting it are.

Some things you can’t control.

  • Age: 45 or older
  • Family: A parent, sister, or brother with diabetes
  • Ethnicity: African-American, Alaska Native, Native American, Asian-American, Hispanic or Latino, or Pacific Islander-American

Some things are related to your health and medical history. Your doctor may be able to help.

  • Prediabetes
  • Heart and blood vessel disease
  • High blood pressure, even if it’s treated and under control
  • Low HDL (“good”) cholesterol
  • High triglycerides
  • Being overweight or obese
  • Having a baby that weighed more than 9 pounds
  • Having gestational diabetes while you were pregnant
  • Polycystic ovary syndrome (PCOS)
  • Acanthosis nigricans, a skin condition with dark rashes around your neck or armpits
  • Depression

Other risk factors have to do with your daily habits and lifestyle. These are the ones you can really do something about.

  • Getting little or no exercise
  • Smoking
  • Stress
  • Sleeping too little or too much

Because you can’t change what happened in the past, focus on what you can do now and going forward. Take medications and follow your doctor’s suggestions to be healthy. Simple changes at home can make a big difference, too.

Lose weight: Dropping just 7% to 10% of your weight can cut your risk of type 2 diabetes in half.

Get active: Moving muscles use insulin. Thirty minutes of brisk walking a day will cut your risk by almost a third.

Eat right: Avoid highly processed carbs, sugary drinks, and trans and saturated fats. Limit red and processed meats.

Quit smoking: Work with your doctor to avoid gaining weight, so you don’t create one problem by solving another.

Symptoms

The symptoms of type 2 diabetes can be so mild you don’t notice them. In fact, about 8 million people who have it don’t know it.

  • Being very thirsty
  • Peeing a lot
  • Blurry vision
  • Being irritable
  • Tingling or numbness in your hands or feet
  • Feeling worn out
  • Wounds that don’t heal
  • Yeast infections that keep coming back
  • Getting a Diagnosis

Your doctor can test your blood for signs of diabetes. Usually doctors will test you on two different days to confirm the diagnosis. But if your blood glucose is very high or you have a lot of symptoms, one test may be all you need.

A1C: It’s like an average of your blood glucose over the past 2 or 3 months.

Fasting plasma glucose: This measures your blood sugar on an empty stomach. You won’t be able to eat or drink anything except water for 8 hours before the test.

Oral glucose tolerance test (OGTT): This checks your blood glucose before and 2 hours after you drink a sweet drink to see how your body handles the sugar.

Long-Term Effects

Over time, high blood sugar can damage and cause problems with your:

  • Heart and blood vessels
  • Kidneys
  • Eyes
  • Nerves, which can lead to trouble with digestion, the feeling in your feet, and your sexual response
  • Wound healing
  • Pregnancy

The best way to avoid these complications is to manage your diabetes well.

  • Take your diabetes medications or insulin on time.
  • Check your blood glucose.
  • Eat right, and don’t skip meals.
  • See your doctor regularly to check for early signs of trouble.

Source: WebMD

Type 1 Diabetes: Causes, Symptoms, and Treatments

Rose Kivi and Elizabeth Boskey, PhD wrote . . . . . . .

What Is Type 1 Diabetes?

Type 1 diabetes is a chronic disease. In type 1 diabetes, the cells in the pancreas that make insulin are destroyed, and the body is unable to make insulin. While the exact cause of type 1 diabetes is unknown, it is thought to be an autoimmune response; something, such as a virus, triggers the body’s immune system to create an antibody that kills the cells in the pancreas responsible for making insulin.

Insulin is a hormone that helps to lower blood sugar by allowing sugar to pass from the blood into the cells. When there is no insulin, blood sugar, called glucose, builds up in the blood. Glucose is a natural sugar that your body uses as a source of energy. It is obtained from food. Extra glucose is stored in the liver and muscle tissues. It is released when extra energy is needed, such as between meals or when sleeping. Normal levels of blood sugar are helpful, but when it builds up, it can cause both short term and long term problems.

What Causes Type 1 Diabetes?

Type 1 diabetes is an autoimmune disease. It occurs when the body’s immune system attacks the beta cells of the pancreas. These are the cells that create insulin. People with type 1 diabetes cannot make enough insulin to control their blood sugar.

The reasons why the immune system attacks beta cells are unknown.

Who Is at Risk for Type 1 Diabetes?

Risk factors for type 1 diabetes are poorly understood. However, some factors have been tentatively identified.

Heredity may be important in some cases of type 1 diabetes. If you have a family member with the condition, your risk of developing it is increased. Several genes have been tentatively linked to this condition. However, not everyone who is at risk for type 1 diabetes develops the condition. It is believed that there must be some type of trigger that causes type 1 diabetes to develop.

Younger people are more likely to be diagnosed with type 1 diabetes. The most common age of diagnosis is between 11 and 14 years old. It is rarely diagnosed after age 40.

Cold weather may increase risk for type 1 diabetes, so those who live in cold climates may have a higher risk. People in Finland are approximately 300 times more likely to develop type 1 diabetes than those in the United States.

People with certain antibodies may also have a higher risk of developing type 1 diabetes. These antibodies, which are made by the body in response to certain viruses, are found in some people years before the diagnosis of type 1 diabetes. It is also thought that viruses may play a role in developing diabetes.

Race may be a risk factor for type 1 diabetes. It is more common in Caucasians than in those of Asian and African descent.

Finally, early diet may play a role, since those who are breastfed and introduced to solids foods later show a lower risk of type 1 diabetes.

What Are the Symptoms of Type 1 Diabetes?

Type 1 diabetes usually develops more quickly than type 2 diabetes, which can take years. The following symptoms may be signs of type 1 diabetes:

  • hunger
  • thirst
  • blurry vision
  • fatigue
  • excessive urination
  • dramatic weight loss in a short period of time
  • numbness or lack of sensation in the feet
  • Symptoms of ketoacidosis (rapid breathing, dry skin and mouth, flushed face, fruity breath odor, nausea, vomiting or stomach pain)

If you have one or more of these symptoms, you should visit your doctor.

How Is Type 1 Diabetes Diagnosed?

Type 1 diabetes is usually diagnosed through a series of tests. Because type 1 diabetes often develops quickly, people are diagnosed when they have signs and symptoms of high blood sugar and their blood glucose level is over 200 mg/dL.

A fasting blood test can be used to diagnose type 1 diabetes.

In this test, you fast overnight before having your blood sugar tested. It is more reliable than a random test. A value of less than 100 mg/dL is considered normal. A value of 100 mg/dL to 125 mg/dL indicates pre-diabetes. Someone with a value of 126 mg/dL or a higher is diagnostic for diabetes.

How Is Type 1 Diabetes Treated?

Because the body no longer makes insulin, people with type 1 diabetes will need to take insulin and manage their diet and exercise to keep blood sugars within a healthy range.

Insulin

People with type 1 diabetes must take insulin everyday. The insulin is usually administered by injection. However, some people use an insulin pump. The pump injects insulin through a port in their skin. It can be easier for some people than sticking themselves with a needle. It may also level out blood sugar highs and lows.

Insulin needs vary throughout the day. People with type 1 diabetes regularly measure their blood sugar to figure out how much insulin they need. Both diet and exercise can affect blood sugar levels.

Diet and Exercise

People with type 1 diabetes should eat regular meals and snacks to keep blood sugar stable. A dietitian familiar with diabetes can help to establish a healthy, balanced eating plan. Exercise also affects blood sugar and insulin amounts may need to be adjusted to account for this.

Foot Care

Type 1 diabetes can damage the nerves, especially in the feet. Small cuts can quickly turn into severe ulcers and infections. Therefore, diabetes treatment should include regular foot checks. Injuries should be brought to the attention of a doctor.

What Are Complications of Type 1 Diabetes?

High blood sugar levels can cause damage to various parts of the body. Poorly managed diabetes increases the risk of these complications, which include:

  • increased heart attack risk
  • eye problems, including blindness
  • nerve pain
  • infections on the skin, especially the feet, that could require amputation in serious cases
  • kidney damage
  • high blood pressure
  • high cholesterol

What is the Prognosis for Type 1 Diabetes?

Type 1 diabetes can be managed with proper treatment. People who manage their diabetes can live a healthy life.

Source: healthline


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Daily Diet of Fresh Fruit Linked to Lower Diabetes Risk

“Eating fresh fruit daily could cut risk of diabetes by 12%,” the Mail Online reports.

A study of half a million people in China found those who ate fruit daily were 12% less likely to get type 2 diabetes than those who never or rarely ate it.

It was also found that people with diabetes at the start of the study who ate fruit regularly were slightly less likely to die, or to get complications of diabetes, such as eye problems (diabetic retinopathy), during the study than those who ate fruit rarely or never.

Many people with diabetes in China avoid eating fruit, because they are told it raises blood sugar. However, the study suggests fresh fruit may actually be beneficial for people with and without diabetes.

Fruits which release sugars more slowly into the blood, such as apples, pears and oranges, are the most popular in China, according to the researchers. So this may be the preferred option if you are worried about diabetes risk, or have been diagnosed with diabetes.

The study doesn’t show that fruit directly prevents diabetes or diabetes complications, as an inherent limitation of this type of study is that other factors could be involved. And it doesn’t tell us how much fruit might be too much.

Overall, the research suggests fresh fruit can be part of a healthy diet for everyone.

Where did the story come from?

The study was carried out by researchers from the University of Oxford, and Peking University, Chinese Academy of Medical Sciences, China National Center for Food Safety Risk Assessment, Non-communicable Disease Prevention and Control Department, and Pengzhou Center for Disease Control and Prevention, all in China. It was funded by the Kadoorie Charitable Foundation.

The study was published in the peer-reviewed journal PLOS Medicine on an open-access basis, so it’s free to read online.

The Mail’s report was basically accurate, although it did not point out that this type of study cannot prove cause and effect. The report confused some readers by saying that fruit does not raise blood sugar because it is metabolised differently to refined sugar.

However, what the study found was that fruit-eaters’ blood sugar was not on average higher than that of non-fruit eaters. Like most food, the rise in sugar levels after eating fruit is usually temporary.

The Sun’s report was poorly written and contained some basic grammatical errors.

What kind of research was this?

This was a large-scale prospective cohort study. Researchers wanted to look for associations between fruit eating, diabetes and complications of diabetes.

However, while this type of study is good for spotting links, it cannot prove that one factor causes another.

What did the research involve?

Researchers used information from a big ongoing cohort study called the China Kadoorie Biobank Study, which recruited half a million adults aged 30 to 79 between 2004 and 2008.

Participants filled in questionnaires about their health, diet and lifestyle and had measurements taken of their blood sugar, blood pressure, cholesterol and other health-related factors. The diet questionnaires were repeated over the course of the study. After an average seven years of follow-up, researchers looked to see how fruit consumption related to diabetes.

Some people in the study (almost 6%) had diabetes at the start of the study. While not actually specified in the study, we assume the majority of these cases were type 2 diabetes. Type 1 diabetes usually begins in childhood and is less common than type 2.

About half of them had previously been diagnosed, and half were diagnosed due to their blood sugar readings taken during the study. China’s Disease Surveillance Points system was used to identify any deaths and cause of death during the study. Disease registries and health insurance claims were used to look into diabetes-related health complications.

The researchers took the average responses from the diet questionnaires to establish how regularly people ate fruit, to account for possible changes in dietary habits.

They adjusted the figures to take account of potential confounding factors including age, age at diabetes diagnosis, gender, smoking, alcohol consumption, physical activity and body mass index.

What were the basic results?

Only 18.8% of people surveyed reported eating fruit daily, and 6.4% said they never or rarely ate fruit. Some 30,300 people had diabetes at the start of the study, and there were 9,504 new cases of diabetes in the seven years of follow up, or 2.8 for each 1,000 people each year.

  • People who ate fresh fruit daily were 12% less likely to develop diabetes than those who never or rarely ate fresh fruit (hazard ratio (HR) 0.88, 95% confidence interval (CI) 0.83 to 0.93).
  • Of the people with diabetes at the start of the study, 11.2% died during follow up (16.5 for every 1,000 people each year).
  • People with diabetes who ate fresh fruit on three days a week or more were 14% less likely to die of any cause, compared to those who ate fresh fruit less than one day a week (HR 0.86, 95% CI 0.80 to 0.94). They were also less likely to die from diabetes-related causes or cardiovascular disease, specifically.
  • People with diabetes who ate fresh fruit daily were also 14% less likely to have complications of damage to their large blood vessels (such as heart attack or stroke) than those who ate fresh fruit never or rarely (HR 0.86, 95% CI 0.82 to 0.90). They were also 28% less likely to have small blood vessel complications, such as eye or kidney disease (HR 0.72, 95% CI 0.63 to 0.83).

How did the researchers interpret the results?

The researchers say their results “provide strong evidence in support of current dietary guidelines that fresh fruit consumption should be recommended for all, including those with diabetes.”

They say that people with diabetes in China eat much less fruit than people without diabetes, because of concerns about sugar in fruit. They say the study shows that better health education is “urgently needed” in China and other Asian countries where diabetes is common, and many people misunderstand the effects of eating fresh fruit.

They speculate that “natural sugars in fruit may not be metabolised in the same way as refined sugars,” although their paper did not investigate this.

Conclusion

The study findings – that eating fresh fruit every day does not raise the risk of diabetes, and may reduce it – are reassuring and in line with dietary advice in the UK. It’s also helpful to see evidence that people who already have diabetes are likely to benefit from fresh fruit as well, because there has not been much research into fruit-eating for people with diabetes.

However, it’s a step too far to say that fresh fruit prevents diabetes or diabetes complications. Fresh fruit is just one part of a healthy diet, and diet is just one of the things that may affect someone’s risk of getting diabetes. This type of study can’t tell us whether fresh fruit actually protects against diabetes, because it can’t account for all the other health and lifestyle factors involved.

Though it would be expected that the results of this large scale study should be applicable to other populations, there may be differences between people from China and other populations. This could include differences in prevalence of diabetes and its risk factors, differences in healthcare (for example, diagnostic criteria and methods for coding health outcomes in databases), and other environmental and lifestyle differences, including fruit consumption.

The study didn’t ask people which types of fruit they ate, but the researchers say the most commonly eaten fruits in China are apples, pears and oranges, which release sugars more slowly into the blood stream than bananas, grapes and tropical fruits.

It’s important to make a distinction between whole fresh fruit, which contains lots of fibre, and fruit juice, which is very high in sugar. Previous research that we reported on in 2013 found that fruit may lower diabetes risk, but fruit juice may raise it.

The most effective method of reducing your diabetes risk is to achieve or maintain a healthy weight, through a combination of regular exercise and healthy eating.

Source: NHS Choices


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