Updated Treatment Approach for Type-2 Diabetes

A new stepped-up approach to the care of diabetes was recently created by the American Diabetes Association and the European Association for the Study of Diabetes. These updated treatment recommendations includes phases for initial treatment, as well as progressive steps to treat Type 2 diabetes.

Type 2 diabetes is a lifelong disease that occurs when the cells of the body can not use insulin in the correct way or when the pancreas can not make enough insulin for correct bodily function. The insulin lets our blood sugar, also called glucose, enter the body’s cells to be used to create energy. When insulin is not able to perform its job, the cells can’t get the amount of sugar they need, and too much sugar builds up in the blood. Over time, the extra sugar in the blood can cause damage to your blood vessels, eyes, nerves, heart, and kidneys.

More and more children and adults are getting type  2 diabetes. This is largely in part because of our bad eating habits and the lack of physical activity. It is very important to know if you or your children have the risk for getting type 2 diabetes and also to know what you can do to help prevent the disease.

Some people don’t even know that they have diabetes because if it diagnosed early, they may not have any symptoms. This is because the level of blood sugar may rise so slowly that a person may not know that is anything is wrong with them. Other people may experience symptoms such as:

•    Losing weight when they are not trying
•    Being very thirsty all the time
•    Urinating more than usual
•    Feeling hungrier and more tired than normal
•    Experiencing blurry vision

Sometimes a person may find out that she or he has type 2 diabetes during a regular physical examination. Or they may find out that they have this disease during an appointment for another health problem such as a wound that is slow to heal, high blood pressure, or an infection. Some people do not find out until they experience complications from the disease such as nerve disease, vision problems, kidney disease, or heart and blood vessel problems.

According to the experts who composed the updated guidelines, the changes are suggested to help control levels of blood glucose and A1C, which is a measure of average glucose levels during the previous three months. If these fail to help the patients achieve target glucose/A1C levels, there are two alternate treatment choices. One, which is the more preferred and well-validated, involves the addition of basal insulin or a sulfonylurea to the initial stage treatment which typically includes lifestyle changes and metformin. The second choice will involve the addition of the prescription pioglitazone or a GLP-1 to the lifestyle changes and metformin.

If neither of these step 2 options work, the experts suggest that the use of basal insulin, if it has not already been started, and then transition to intensive insulin, only if needed. As in the original guidelines, all of these transitions in therapy usually occur within three month intervals, with the end result of achieving rapid and continuous maintenance of levels of glucose and A1C levels that are near normal.

Dr. David M. Nathan, who is the panel chairman, stated, “Excellent glycemic control is critical to prevent the long-term complications associated with diabetes, which can lead to loss of vision, kidney failure, and amputation…. After much deliberation, we intentionally chose therapies we highly recommend as safe, effective, and that have much evidence supporting their use. The second-tier drugs are valuable if hypoglycemia [low blood sugar] is a major concern, but the use of these drugs is less validated.

Common Cold, Uncommon Nasal Remedy

Entering the coldest months of the year and the favored months of the common cold, prevention methods are back in full swing. Flu shots are being offered at drug stores and pharmacies across the country, cold medicines are going on sale, orange juice is ready to be plucked off grocery store shelves and tissues are being grabbed by the handful. One of the most overlooked methods however, is using saline nasal solutions to help with allergies, congestion, and sinus troubles. Whenever I was getting a sore throat my mom always tells me to gargle with salt water; turns out it works with your nose, too, just in a different form.

Contrary to popular belief, nasal congestion isn’t caused by a buildup of mucus. Common colds and allergens increase swelling of the blood vessels of the nasal passages causing congestion by blocking air flow through the nostrils. University of Wisconsin researchers studied the effects of salt water on the sinuses through irrigation and concluded that their volunteers had little need for sinus infection medications after using this method. By flushing salt water through your nose, the bad bacteria that could be accumulating have a way of being naturally processed out, and the more often it is used, makes it harder to get an infection or large amount of congestion.

There are two main ways to “irrigate” your nose with a saline solution: using a neti-pot or a nasal spray. Saline nasal sprays are more common and can be found at any major drug store or cold section of your local grocer, but watch out for those that carry preservatives as they can be harmful to the inside of your nose over time. The best kind of saline nasal spray to look for is one that is a natural sea water rinse with minerals and one that doesn’t contain preservatives if possible, such as Breathe Again Seawater Saliine Nasal Spray. Saline sprays usually come in a squirt bottle or as an injection and can be used every day to prevent symptoms that can lead to the common cold, congestion, chronic sinusitis, asthma due to sinusitis, seasonal allergies, irritation and soreness due to lack of moisture, and snoring.

The neti pot is the alternative medicine approach, an Ayurvedic method of cleansing the sinuses. An ancient branch of the yoga practice, using a neti pot is a way of washing out the nasal canals without stuffing them with foreign objects or resorting to decongestion medication. Neti pots come in all different sizes and styles, most are narrow pots similar to a travel-sized tea pot with a small spout like a thin watering can opening and usually come in metal, ceramic, or unbreakable plastic.

Neti pots can be purchased at many health food and drug stores. Prices run from $10 to $30 depending on the material and where you buy them. Some neti pots come with pre-packaged saline solutions and others recommend you buy non-iodized salt to dissolve in them. Once you fill the pot and dissolve the salt you stand over a sink or tub and tilt your head while positioning the spout just inside your nostril so the solution is poured right up one nostril and out the other for about thirty seconds on both sides. Practicing this daily helps to keep your sinuses flowing and can help prevent your nose from being a target the next time cold season comes calling, although if you are prone to chronic nosebleeds, have a deviated septum, or if you already have a sinus infection or another serious nasal condition, please consult your doctor before use.

Dr. Ketan C. Mehta, M.D., is a physician specializing in pulmonary medicine and critical care and before creating his own nasal saline solution, he used this practice to treat his patients as well as himself, "Of all the treatments tried for controlling and curing the symptoms of sinus disease, the one I found to work the best is a saline nasal rinse," he says, "An effective nasal rinse would significantly reduce or permanently cure the symptoms of nasal allergies and sinus disease.”

October is already well underway and school children will start coming home with the sniffles, co-workers will be calling in sick more frequently, and holiday shoppers will no doubt forget to cover their mouths to cough, sneeze, or breathe in your direction so start the prevention now and look into finding the best saline rinse for your healthy nasal needs.

New Evidence of The Brain’s Role in Obesity

People are obese because they love to eat, right? Not according to a recent brain study. Researchers found that obese people actually enjoy the food they eat less than lean people do, and therein lies the problem. In order to compensate for the missing pleasure, obese people eat more high-calorie food. In turn, overeating further dulls the enjoyment and begins a vicious cycle. They also found that people who carry a variant gene are more likely to gain weight.

To better understand the biology of obesity, Eric Stice, PhD, of the Oregon Research Institute and colleagues from Yale University and the University of Texas at Austin recruited volunteers, 43 female college students aged from 18 to 22 and 33 adolescent girls, ages 14 to 18. The young women ranged from very skinny to obese, according to body mass index calculations. Each participant was also tested for a gene variant known as Taq1A1, which is linked with a lower number of dopamine receptors in the brain. Dopamine is the primary neurotransmitter involved in the brain’s reward pathways and is released in response to eating. The amount released depends on the degree of pleasure the food brings.

First, the researchers showed both groups a picture of a chocolate milkshake and a picture of a glass of water. Their brain responses were monitored using a technique called functional Magnetic Resonance Imaging (fMRI). The heaviest women had the most activity in the dorsal striatum region of the brain, which is dopamine rich. But when the women actually tasted a chocolate milkshake or a tasteless liquid, the heavier women had less activity in their brains’ pleasure centers. The women with the gene variant had the lowest pleasure response when tasting the milkshake. They had to consume more of the shake to get the same pleasure response. Over the following year, these women were more likely to gain weight than the women with a stronger response. “The research reveals obese people may have fewer dopamine receptors, so they overeat to compensate for this reward deficit,” said Dr. Stice, who has studied eating disorders and obesity for almost twenty years.

Emmanuel Pothos, Ph.D., a neuroscientist at Tufts University has seen the same thing in mouse studies. He was not involved in the Stice study. “Obesity is not only a function of brain systems that regulate body weight, but a function of brain systems that regulate eating for pleasure,” Pothos says. “In mice, the central dopamine system—the system that underlies pleasure from eating—is defective. The animals have a very low response to stimuli that release dopamine and food is one of those stimuli.”

Past research has shown that biological factors play a major part in obesity, but this study is one of the first to identify factors that increase people’s weight gain risk in the future. Dr. Stice says that while this study may not provide the “magic bullet” to cure obesity, the results are key for understanding weight gain and to helping at-risk individuals. He says if doctors could determine who carries the at-risk gene, children especially could be steered toward “recreational sports or other things that give them satisfaction and pleasure and dopamine that aren’t food…and not get their brains used to having crappy food. You want to change people’s behaviors before they become entrenched.”

Dr. Stice is now looking at whether the pleasure circuitry in obese people can be reset by switching to a healthy diet. He has found that when obese people stop eating energy-dense foods, their craving for those foods goes down, not up. “If we can get obese people to improve the quality of their diets and stay the course for a long time, eventually they do much better in craving and their pleasure circuits should go back to their old balance,” he says.

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Parents Not Recognizing Children’s Weight Issues

Over 40 percent of parents of both underweight and overweight children are misguided in their belief that their children are within the average weight range. In what is becoming a common problem—the misconception about a child’s real weight—parents allow unhealthy habits to continue, which can lead to life-long issues.

Research conducted at the University of Melbourne in Australia found that 4 in 10 parents mis-identified their child’s body size, and that various methods in assessing the weight of children, such as the Body Mass Index (BMI) or waist circumference (WC), results in different standards for recognizing children as being either overweight or underweight. With the use of BMI, which estimates the percentage of body fat by comparing a person’s height and weight in a statistical formula, more children were categorized as being overweight than when using the WC method, which generally deems a waistline of 18.5 to 24.9 inches as normal.

Doctoral researcher Dr. Pene Schmidt conducted the study which  also showed that children not falling within the average weight range are more likely to over or underestimate their body size and that even a few parents believe their underweight children are overweight or that their overweight children are underweight. Dr. Schmidt acknowledges that the results of the research suggest a need to revamp the methods by which the weight of children is classified and offer better information to parents about appropriate weight at both ends of the tape measure. She stated, “Parents are unlikely to take the necessary preventative actions if the perception of their child’s weight, whether underweight or overweight, is incorrect.”

The study was conducted in the University of Melbourne’s School of Behavioral Science and data used for the analysis came from a survey of over 2,100 children, ages 4 to 12, as well as their parents. Previous research has only examined the perceptions of parents of overweight children whereas Dr. Schmidt’s study is the first to examine parental perceptions of underweight children as well when using both BMI and WC.

The outcome was that 43 percent of parents of underweight children considered their children to be an average weight and that 49 percent of parents of overweight children believed their children to be an average weight. Over 80 percent of parents were correct in identifying average weight children as being average weight. Additionally, 1.4 percent of parents felt that their underweight children were overweight and 2.5 percent correctly identified their overweight children as overweight.

Interestingly, parents were found to be more likely to report their sons as underweight and their daughters as overweight. Parents of girls were less likely to accurately identify that their child was underweight while parents of boys were less likely to accurately identify their child as being overweight. In fact, only 4 out of 10 parents of underweight girls and half of underweight boys correctly assessed their weight. Double the number of parents were concerned about their overweight children compared to those concerned about underweight children.

Dr. Schmidt says the study showed that parents and children were both struggling to determine whether or not they were the correct weight. The results of the analysis have concluded that there is need for more research to determine how to best define children’s weight status as well as how to communicate the information to children and parents.