Category Archives: Diabetes Complications

September 25, 2013 · 11:59 PM

Longevity of Type 1 Diabetics Much Improved, But Still Far From Ideal

When I started my medical career three decades ago, it was uncommon to see a type 1 diabetic exceed 60 years of age. Thank God that has been changing for the better. A recent Scottish study found life expectancy in type 1 diabetics, compared to the general population, was 11 years shorter for men and 14 years shorter for women. In 1975, the gap was 27 years. One of the investigators was quoted by the article at MedPageToday:

“There is absolutely no doubt that glucose control is important for long-term outcomes in people with type 1 diabetes.”

From the Framingham Heart Study: Compared to those without diabetes, women and men with diabetes at age 50 died 7 or 8 years earlier, on average. This study population was a mix of type 2 and type 2 diabetes, with type 2 predominating, I’m sure.

Steve Parker, M.D.

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June 29, 2013 · 5:08 PM

Upper Normal Blood Sugars Linked To Brain Shrinkage

MRI scan of brain

MRI scan of brain

Healthy bodies keep blood sugar levels in a fairly narrow range.  You might think you’re fine if you’re anywhere within the defined normal range.  Think again.  Australian researchers found that folks with fasting blood sugars toward the upper end of the normal range had more degeneration (atrophy) in parts of the brain called the hippocampus and amygdala, compared to those in the low normal range.  Degeneration in those areas is often manifested as dementia.

The hippocampus is critical for learning and memory formation and retention.  The amygdala is also involved in memory as well as emotion.  The two areas are intimately connected, literally.

How Was the Study Done?

Over 250 study participants aged 60 to 64 years had normal brains at baseline and were free of prediabetes and diabetes.  They were mostly caucasian.  MRI brain scans were done at baseline and again four years later.  Significant atrophy (shrinkage) was seen in the hippocampus and amygdala over time, with greater atrophy seen in those with higher baseline fasting glucose levels.

Fasting blood sugar was measured only once, at the start, and ranged from 58 to 108 mg/dl (3.2 to 6.0 mmol/l).  (Fasting glucose of 108 would be prediabetes according to the American Diabetes Association, but not by the World Health Organization.)  Participants weren’t tested for deterioration of cognition (actual thinking).

So What?

The results of the study at hand are consistent with others that link higher rates of dementia with diabetes.  Diabetics, even when under treatment, usually have higher average blood sugars than non-diabetics.  The study authors speculate that damage from higher blood sugars may be mediated by inflammation and abnormal blood clotting (prothrombotic factors and platelet activation).

The Mayo Clinic recently reported that diets high in carbohydrates and sugar increase the odds of developing cognitive impairment in the elderly years.

It’s interesting to contemplate whether non-diabetics and diabetics would have less risk of developing dementia if blood sugars could be kept in the lower end of the normal range.  How could you do that?  Possibilities include:

  • avoid sugars and other refined carbohydrates
  • limit all carbohydrates
  • favor low-glycemic-index foods over high
  • regular exercise, which helps maintain insulin sensitivity (insulin is a major blood sugar regulator)
  • avoid overweight and obesity, which helps maintain insulin sensitivity
  • for diabetics: all of the above plus drugs that control blood sugar

Steve Parker, M.D.

Reference:  Cherbuin, Nicolas, et al.  Higher normal fasting plasma glucose is associated with hippocampal atrophy: The PATH Study.  Neurology, September 4, 2012, vol. 79, No. 10, pp: 1,010-1,026.  doi:10.1212/WNL.0b013e31826846de

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April 13, 2013 · 2:00 AM

Periodic Tests, Treatments, and Goals for PWDs (Persons With Diabetes)

If you don't like your physician, find a new one

If you don’t like your physician, find a new one

So, you’ve got diabetes. You’re trying to deal with it or you wouldn’t be here. You’ve got a heck of a lot of medical information to master.

Unless you have a good diabetes specialist physician on your team, you may not be getting optimal care. Below are some guidelines you may find helpful. The goal is to prevent diabetes complications. Many primary care physicians will not be up-to-date on the guidelines. Don’t hesitate to discuss them with your doctor. Nobody cares as much about your health as you do.

Annual Tests

The American Diabetes Association (ADA) recommends the following items be done yearly (except as noted) in non-pregnant adults with diabetes. (Incidentally, I don’t necessarily agree with all ADA guidelines.) The complete ADA guidelines are available on the Internet.

  • Lipid profile (every two years if results are fine and stable)
  • Comprehensive foot exam
  • Screening test for distal symmetric polyneuropathy: pinprick, vibration, monofilament pressure sense
  • Serum creatinine and estimate of glomerular filtration rate (MDRD equation)
  • Test for albumin in the urine, such as measurement of albumin-to-creatinine ratio in a random spot urine specimen
  • Comprehensive eye exam by an ophthalmologist or optometrist (if exam is normal, every two or three years is acceptable)
  • Hemoglobin A1c at least twice a year, but every three months if therapy has changed or glucose control is not at goal
  • Flu shots

Other Vaccinations, Weight Loss, Diabetic Diet, Prediabetes, Alcohol, Exercise, Etc.

Additionally, the 2013 ADA guidelines recommend:

  • Pneumococcal vaccination. “A one time re-vaccination is recommended for individuals >64 years of age previously immunized when they were <65 years of age if the vaccine was administered >5 years ago.” Also repeat the vaccination after five years for patients with nephrotic syndrome, chronic kidney disease, other immunocompromised states (poor ability to fight infection), or transplantation.
  • Hepatitis B vaccination to unvaccinated adults who are 19 through 59 years of age.
  • Weight loss for all overweight diabetics. “For weight loss, either low-carbohydrate, low-fat calorie-restricted, or Mediterranean diets may be effective in the short-term (up to two years).” For those on low-carb diets, monitor lipids, kidney function, and protein consumption, and adjust diabetic drugs as needed. The optimal macronutrient composition of weight loss diets has not been established. (Macronutrients are carbohydrates, proteins, and fats.)
  • “The mix of carbohydrate, protein, and fat may be adjusted to meet the metabolic goals and individual preferences of the person with diabetes.” “It must be clearly recognized that regardless of the macronutrient mix, total caloric intake must be appropriate to weight management goal.”
  • “A variety of dietary meal patterns are likely effective in managing diabetes including Mediterranean-style, plant-based (vegan or vegetarian), low-fat and lower-carbohydrate eating patterns.”
  • “Monitoring carbohydrate, whether by carbohydrate counting, choices, or experience-based estimation, remains a key strategy in achieving glycemic control.”
  • Limit alcohol to one (women) or two (men) drinks a day.
  • Limit saturated fat to less than seven percent of calories.
  • During the initial diabetic exam, screen for peripheral arterial disease (poor circulation). Strongly consider calculation of the ankle-brachial index for those over 50 years of age; consider it for younger patients if they have risk factors for poor circulation.
  • Those at risk for diabetes, including prediabetics, should aim for moderate weight loss (about seven percent of body weight) if overweight. Either low-carbohydrate, low-fat calorie-restricted, or Mediterranean diets may be effective in the short-term (up to 2 years). Also important is exercise: at least 150 minutes per week of moderate-intensity aerobic activity. “Individuals at risk for type 2 diabetes should be encouraged to achieve the U.S. Department of Agriculture (USDA) recommendation for dietary fiber (14 g fiber/1,000 kcal) and foods containing whole grains (one-half of grain intake).” Limit intake of sugar-sweetened beverages.
  • “Adults with diabetes should be advised to perform at least 150 min/week of moderate-intensity aerobic physical activity (50–70% of maximum heart rate), spread over at least 3 days/week with no more than two consecutive days without exercise. In the absence of contraindications, adults with type 2 diabetes should be encouraged to perform resistance training at least twice per week.”
  • Screening for coronary artery disease before an exercise program is depends on the physician judgment on a case-by-case basis. Routine screening is not recommended.
Steve Parker MD, low-carb diet, diabetic diet

Olive, olive oil, and vinegar: classic Mediterranean foods

Obviously, some of my dietary recommendations conflict with ADA guidelines. The experts assembled by the ADA to compose guidelines were well-intentioned, intelligent, and hard-working. The guidelines are supported by 528 scientific journal references. I greatly appreciate the expert panel’s work. We’ve simply reached some different conclusions. By the same token, I’m sure the expert panel didn’t have unanimous agreement on all the final recommendations. I invite you to review the dietary guidelines yourself, discuss with your personal physician, then decide where you stand.

General Blood Glucose Treatment Goals

The ADA in 2013 suggests these therapeutic goals for non-pregnant adults:

  • Fasting blood glucoses: 70 to 130 mg/dl (3.9 to 7.2 mmol/l)
  • Peak glucoses one to two hours after start of meals: under 180 mg/dl (10 mmol/l)
  • Hemoglobin A1C: under 7%
  • Blood pressure: under 140/80 mmHg
  • LDL cholesterol: under 100 mg/dl (2.6 mmol/l). (In established cardiovascular disease: <70 mg/dl or 1.8 mmol/l may be a better goal.)
  • HDL cholesterol: over 40 mg/dl (1.0 mmol/l) for men and over 50 mg/dl (1.3 mmol/l) for women
  • Triglycerides: under 150 mg/dl (1.7 mmol/l)

The American Association of Clinical Endocrinologists (AACE) in 2011 proposed somewhat “tighter” blood sugar goals for non-pregnant adults:

  • Fasting blood glucoses: under 110 mg/dl (6.11 mmol/l)
  • Peak glucoses 2 hours after start of meals: under 140 mg/dl (7.78 mmol/l)
  • Hemoglobin A1C: 6.5% or less

The ADA reminds clinicians, and I’m sure the AACE guys agree, that diabetes control goals should be individualized, based on age and life expectancy of the patient, duration of diabetes, other diseases that are present, individual patient preferences, and whether the patient is able to easily recognize and deal with hypoglycemia. I agree completely.

Steve Parker, M.D.

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March 24, 2013 · 7:22 AM

Diabetes: Scope of the Problem

97 mg/dl. Yippee!

Type 2 diabetes is arguably the most important public health problem in the U.S. and most of the developed world. The U.S. Centers for Disease Control and Prevention predicts that one of every three Americans born in the year 2000 will develop diabetes.

The most common form of diabetes by far is type 2, which describes about 85% of cases. It’s less serious than type 1 diabetes. Type 1 diabetics have an immune system abnormality that destroys the pancreas’s ability to make insulin. Type 1’s will not last long without insulin injections. On the other hand, many type 2 diabetics live well without insulin shots.

“Prediabetes” is what you’d expect: a precursor that may become full-blown type 2 diabetes over time. Blood sugar levels are above average, but not yet into the diabetic range. One in four people with prediabetes develops type 2 diabetes over the course of three to five years. Researchers estimate that 35% of the adult U.S. population had prediabetes in 2008. That’s one out of every three adults, or 79 million. Only 7% of them (less than one in 10) were aware they had it.

In the U.S. as of 2010, 26 million folks have diabetes. That includes 11% of all adults.

The rise of diabetes parallels the increase in overweight and obesity, which in turn mirrors the prominence of refined sugars and starches throughout our food supply. These trends are intimately related. Public health authorities 40 years ago convinced us to cut down our fat consumption in a mistaken effort to help our hearts. We replaced fats with body-fattening carbohydrates that test the limits of our pancreas to handle them. Diabetics and prediabetics fail that test.

Dr. Richard K. Bernstein, notable diabetologist, wrote that, “Americans are fat largely because of sugar, starches, and other high-carbohydrate foods.”

We’re even starting to see type 2 diabetes in children, which was rare just thirty years ago. It’s undoubtedly related to overweight and obesity. Childhood obesity in the U.S. tripled from the early 1980s to 2000, ending with a 17% obesity rate.  Overweight and obesity together describe 32% of U.S. children.

Diabetes is important because it has the potential to damage many different organ systems, deteriorating quality of life. It can damage nerves (neuropathy), eyes (retinopathy), kidneys (nephropathy),  and stomach function (gastroparesis), just to name a few.

Just as important, diabetes can cut life short. Compared to those who are free of diabetes, having diabetes at age 50 more than doubles the risk of developing cardiovascular disease—heart attacks, strokes, and high blood pressure. Compared to those without diabetes, having both cardiovascular disease and diabetes approximately doubles the risk of dying. Compared to those without diabetes, women and men with diabetes at age 50 die seven or eight years earlier, on average.

Diabetic complications and survival rates will undoubtedly improve over the coming decades as we learn how to better treat this ancient disease.

Steve Parker, M.D.

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March 13, 2013 · 3:07 AM

Have You Heard of “Dawn Phenomenon”?

"You gotta consider that free fatty acids may be causing insulin resistance....blah, blah, blah...which if it occurs in the liver, they may both be right!"

“You gotta consider that free fatty acids may be causing insulin resistance….blah, blah, blah…which if it occurs in the liver, they may both be right!”

It refers to somewhat mysterious higher-than-expected blood sugars in the early morning hours, as between 6 an 9 AM.  Even if you don’t eat breakfast; that’s why it seems mysterious.  Assuming you slept all night, why would your blood sugars be too high, even before breakfast?

Dr. Richard Bernstein talks about it at DiabetesHealth.  Dr Bernstein is a great resource for folks with diabetes, and to physicians who treat diabetes.

Peter at Hyperlipid suggests that dawn phenomenon isn’t as simple and straightforward as Dr. Bernstein says.  In fact, Peter seriously questions, Dr. Bernstein’s explanation that it’s caused by the liver removing too much insulin from circulation. For those who don’t click through, I’ll summarize by saying Peter found evidence that nighttime growth hormone elevations (this is normal) lead to lipolysis (breakdown of body fats into free fatty acids to be used by various tissues for energy) and the FFA’s cause a degree of insulin resistance, leading to higher blood sugar levels in the early morning.

As a practical side note, some people with diabetes (should I start using PWD’s?) seem to suppress Dawn Phenom by drinking alcohol at bedtime.

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February 4, 2013 · 2:00 AM

How To Recognize and Treat Hypoglycemia (Low Blood Sugar)

Insulin and sulfonylurea drugs are common causes of hypoglycemia

Insulin and sulfonylurea drugs are common causes of hypoglycemia

Hypoglycemia is the biggest immediate risk for a diabetic on drugs starting a carbohydrate-restricted diet such as the Low-Carb Mediterranean Diet. Traditional calorie-restricted diets also have the potential to cause hypoglycemia.

SYMPTOMS

Your personal physician and other healthcare team members should teach you how to recognize and manage hypoglycemia.  Hypoglycemial means an abnormally low blood sugar (under 60–70 mg/dl or 3.33–3.89 mmol/l) associated with symptoms such as weakness, malaise, anxiety, irritability, shaking, sweating, hunger, fast heart rate, blurry vision, difficulty concentrating, or dizziness. Symptoms often start suddenly and without obvious explanation. If not recognized and treated, hypoglycemia can lead to incoordination, altered mental status (fuzzy thinking, disorientation, confusion, odd behavior, lethargy), loss of consciousness, seizures, and even death (rare).

You can imagine the consequences if you develop fuzzy thinking or lose consciousness while driving a car, operating dangerous machinery, or scuba diving.

TREATMENT

Immediate early stage treatment involves ingestion of glucose as the preferred treatment—15 to 20 grams. You can get glucose tablets or paste at your local pharmacy without a prescription. Other carbohydrates will also work: six fl oz (180 ml) sweetened fruit juice, 12 fl oz (360 ml) milk, four tsp (20 ml) table sugar mixed in water, four fl oz (120 ml) soda pop, candy, etc. Fifteen to 30 grams of glucose or other carbohydrate should do the trick. Hypoglycemic symptoms respond within 20 minutes.

If level of consciousness is diminished such that the person cannot safely swallow, he will need a glucagon injection. Non-medical people can be trained to give the injection under the skin or into a muscle. Ask your doctor if you are at risk for severe hypoglycemia. If so, ask him for a prescription so you can get an emergency glucagon kit from a pharmacy.

Some people with diabetes, particularly after having the condition for many years, lose the ability to detect hypoglycemia just by the way they feel. This “hypoglycemia unawareness” is obviously more dangerous than being able to detect and treat hypoglycemia early on. Blood sugar levels may continue to fall and reach a life-threatening degree. Hypoglycemia unawareness can be caused by impairment of the nervous system (autonomic neuropathy) or by beta blocker drugs prescribed for high blood pressure or heart disease. People with hypoglycemia unawareness need to check blood sugars more frequently, particularly if driving a car or operating dangerous machinery.

Do not assume your sugar is low every time you feel a little hungry, weak, or anxious. Use your home glucose monitor for confirmation when able.

If you do experience hypoglycemia, discuss management options with your doctor: downward medication adjustment, shifting meal quantities or times, adjustment of exercise routine, eating more carbohydrates, etc. If you’re trying to lose weight or control high blood sugars, reducing certain diabetic drugs makes more sense than eating more carbs. Eating at regular intervals three or four times daily may help prevent hypoglycemia. Spreading carbohydrate consumption evenly throughout the day may help. Someone most active during daylight hours as opposed to nighttime will generally do better eating carbs at breakfast and lunch rather than concentrating them at bedtime.

DRUG  ADJUSTMENTS  TO  AVOID  HYPOGLYCEMIA

Diabetics considering or following a low-carb or very-low-carb ketogenic diet must work closely with their personal physician and dietitian, especially to avoid hypoglycemia caused by certain classes of diabetic drugs. Two common diabetes drug classes that cause hypoglycemia are the insulins and sulfonylureas. More are listed below. Those who don’t know the class of their diabetic medication should ask their physician or pharmacist.

Clinical experience with thousands of patients has led to generally accepted guidelines that help avoid hypoglycemia in diabetics on medications.

Diabetics and prediabetics not being treated with pills or insulin rarely need to worry about hypoglycemia.

Similarly, diabetics treated only with diet, metformin, colesevalam, and/or an alpha-glucosidase inhibitor (acarbose, miglitol) should not have much, if any, trouble with hypoglycemia. The DPP4-inhibitors (sitagliptan and saxagliptin) do not seem to cause low glucose levels, whether used alone or combined with metformin or a thiazoladinedione.

Thiazolidinediones by themselves cause hypoglycemia in only 1 to 3% of users, but might cause a higher percentage in people on a reduced calorie diet. Bromocriptine may slightly increase the risk of hypoglycemia.

THESE DRUGS MAY CAUSE HYPOGLYCEMIA

Type 2 diabetics are at risk for hypoglycemia if they use the following drug classes. Also listed are a few of the individual drugs in some classes:

■  insulin

■  sulfonylureas: glipizide, glyburide, glimiperide, chlorpropamide, acetohexamide, tolbutamide

■  meglitinides: repaglinide, nateglinide

■  pramlintide plus insulin

■  exenatide plus sulfonylurea

■  possibly thiazolidinediones: pioglitazone, rosiglitazone

■  possibly bromocriptine

Open wide!

Open wide!

Remember, drugs have both generic and brand names. The names vary from country to country, as well as by manufacturer. If you have any doubt about whether your diabetic drug has the potential to cause hypoglycemia, ask your physician or pharmacist.

MANAGEMENT STRATEGIES TO AVOID HYPOGLYCEMIA

Common management strategies for diabetics on the preceding drugs and starting a very-low-carb diet include:

■  reduce the insulin dose by half

■  change short-acting insulin to long-acting (such as glargine)

■  stop the sulfonylurea, or reduce dose by half

■  reduce the thiazolidinedione by half

■  stop the meglitinide, or reduce the dose by half

■  monitor blood sugars frequently, such as four times daily, at least until a stable pattern is established

■  spread what few carbohydrates are eaten evenly throughout the day

Management also includes frequent monitoring of glucose levels with a home glucose monitor, often four to six times daily. Common measurement times are before meals and at bedtime. It may be helpful to occasionally wake at 3 AM and check a sugar level. To see the effect of a particular food or meal on glucose level, check it one or two hours after eating. Keep a record. When eating patterns are stable, and blood sugar levels are reasonable and stable, monitoring can be done less often. When food consumption or exercise habits change significantly, check sugar levels more often.

If you’re thinking that many type 2 diabetics on low-carb and very-low-carb ketogenic diets use fewer diabetic medications, you’re right. That’s probably a good thing since the long-term side effects of many of the drugs we use are unknown. Remember Rezulin (troglitazone)? Introduced in 1997, it was pulled off the U.S. market in 2001 because of fatal liver toxicity. More recently, rosiglitazone usage has been highly restricted due to concern for heart toxicity.

Steve Parker, M.D.

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January 25, 2013 · 2:17 AM

Hypoglycemia: A Few Causes

Insulin and sulfonylurea drugs are common causes of hypoglycemia

Insulin and sulfonylurea drugs are common causes of hypoglycemia

Low-carbohydrate diets are often so effective at controlling blood sugars that low blood sugar (hypoglycemia) becomes a serious risk for some diabetics. It’s rarely a problem for prediabetics. But people with diabetes using particular drugs could develop life-threatening hypoglycemia, particularly when switching to a reduced-calorie or low-carb style of eating.

CARBOHYDRATES AND BLOOD SUGAR

Never forget that carbohydrate consumption has a major effect on blood sugar (glucose) levels—often causing a rise—in many people with type 2 diabetes and prediabetes. Most folks with diabetes are taking medications to lower their glucose levels.

Remember that the main components of food—called macronutrients—are proteins, fats, and carbohydrates. Common carbohydrate sources are:

■  grains

■  fruits

■  starchy vegetables (e.g., potatoes, corn, peas, beans)

■  milk products

■  candy

■  sweetened beverages

■  other added sugars (e.g., table sugar, high fructose corn syrup, honey)

Low-carb and very-low-carb diets restrict the dieter’s carbohydrate consumption rather dramatically. The standard American diet, for instance, provides 250–300 grams of carbohydrate daily, or 50–60% of total energy (calories). A low-carb diet may provide in the range of 50–130 grams daily, or 10 to 25% of total calories. A very-low-carb diet provides under 50 grams of carb daily (under 10% of all calories), often starting at 20–30 grams. With very-low-carb diets, our bodies must use fats instead of carbohydrates as an energy source, and a result of this fat metabolism is the generation of ketone bodies in the bloodstream. So very-low-carb diets are often called ketogenic diets.

Plenty of carbs in this bread!

Plenty of carbs in this bread!

Many dietitians have been taught that you must eat at least 130 grams of carbohydrate daily to provide a rich, readily available source of energy—glucose, specifically—to your brain in particular, and other tissues. Millions of “low-carbers”—people with a low-carb way of eating—know that isn’t right, having proven it to themselves by experience. I personally lived on 30 grams (or less) daily for four months without problems with my brain or other organs. (Well, my wife might argue about the brain issue.) I felt fine and had plenty of energy.

In healthy people, prediabetics, and mild diabetics not treated with medication, carbohydrate restriction rarely causes low blood sugar problems. But in other diabetics, carbohydrate restriction can lead to serious, even life-threatening, symptoms of hypoglycemia.

DRUGS, DIET, AND HYPOGLYCEMIA

Traditional balanced diets for diabetics typically provide 50 to 60% of all calories as carbohydrates. Low-carb diets, remember, provide 25% or less of calories as carbohydrates. A diabetic trying to lose excess weight with a traditional balanced diet is told also to reduce total calories, which necessarily means lowering carbohydrate grams. So, hypoglycemia is also a potential problem for diabetics on these traditional reduced-calorie diets if they are taking particular diabetic medications.

Hypoglycemia, however, is an even greater risk for diabetics taking certain diabetic drugs while on a low-carb or very-low-carb diet. Serious, even life-threatening, symptoms of hypoglycemia may arise.

For diabetics taking certain diabetic drugs, carbohydrate restriction can lead to serious, even life-threatening, symptoms of hypoglycemia.

I hope I’ve made my point. This is dangerous territory. Review your diabetes drugs to see if they can cause hypoglycemia.

Steve Parker, M.D.

 

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November 25, 2012 · 2:00 AM

This Is the Best Time Ever to Have Diabetes

Here’s a quote from a recent Diabetes Care:

Improved therapeutics and health care delivery have brought remarkable declines in the incidence of … complications, with a 50% reduction in amputations from their peak in 1997 and ∼35% reduction in the incidence of end-stage renal disease. Similarly, 10-year coronary heart disease risk dropped from 21% in 2000 to 16% in 2008.

Nevertheless, diabetes remains the leading cause of blindness, renal failure, nontraumatic lower-limb amputation, in adults 18 to 65 years of age.  We gotta stay after it!

The essay by Dr. Robert Ratner also notes 79 million Americans with prediabetes.  They need my Conquer Diabetes and Prediabetes book.  It’s only $9.99 (USD), a drop in the ocean compared to the $174 billion spent on diabetes in 2007 in the U.S.

—Steve

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August 24, 2012 · 8:39 AM

“Doc, How Long Will I Live With My Type 1 Diabetes?”

Type 1 diabetics diagnosed in childhood and born between 1965 and 1980 have an average life expectancy of 68.8 years.  That compares to a lifespan average of 53.4 years for those born between 1950 and 1964.  The figures are based on Pittsburgh, PA, residents and published in a recent issue of Diabetes.

Elizabeth Hughes, one of the very first users of insulin injections, lived to be 73.  She started on insulin around 1922.

Average overall life expectancy in the U.S. is 78.2 years—roughly 76 for men and 81 for women.

Don’t be too discouraged if you have diabetes: you have roughly a 50:50 chance of beating the averages, and medical advances will continue to lengthen lifespan.

Steve Parker, M.D.

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August 1, 2012 · 2:00 AM

Women With Diabetes Can’t Get No Satisfaction

“I’ll be OK if my sugar doesn’t drop too low”

Well, that’s not entirely accurate.

MedPageToday reported on a study of sexual satisfaction in women.

“While many diabetic women are interested and engaged in sexual activity, diabetes is associated with a markedly decreased sexual quality of life in women,” they wrote.

Complications of diabetes — including heart disease, stroke, renal dysfunction, and peripheral neuropathy — were associated with diminished sexual function among diabetic women, suggesting that “prevention of diabetic complications may be helpful in preventing sexual dysfunction,” in these patients, the researchers wrote.

Steve Parker, M.D.

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