Type 2 diabetes and associated complications are not independent risk factors for incident venous thromboembolism (VTE), report researchers in the journal Arteriosclerosis, Thrombosis and Vascular Biology.

Diabetes has previously been reported to be a risk factor for VTE, but John Heit (Mayo Clinic, Rochester, Minnesota, USA) and colleagues hypothesized that this could be because “persons with diabetes are frequently hospitalized for major surgery or acute medical illness, or confined to a nursing home or chronic rehabilitation facility, all of which are major risk factors for incident VTE.”

To test this, the researchers identified all residents of Olmsted County in Minnesota who met criteria for incident VTE over a 25-year period from 1976 to 2000, of whom 1922, aged 64.8 years on average at baseline, were included in the analysis. A group of 2115 controls matched for age, gender, and length of medical history were used for comparison purposes.

Heit and team assessed whether Type 2 diabetes or associated complications such as retinopathy, nephropathy, neuropathy, or ketoacidosis were independent predictors of VTE.

They found that 231 VTE cases and 199 controls had a diagnosis of Type 2 diabetes. Results from univariate analysis showed that, overall, a diagnosis of diabetes was associated with a 32% increased relative risk for incident VTE.

But after adjusting for factors such as hospitalization (including for surgery), acute medical illness, and nursing home confinement, the association disappeared completely.

The researchers therefore conclude that “diabetes mellitus and diabetes microvascular complications are not associated with overall or idiopathic incident VTE.”

They add: “Our findings suggest that the more direct path to reducing VTE incidence is to reduce the need for surgery, hospitalization for acute medical illness, or nursing home confinement among persons with diabetes.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

Free abstract

Urinary adiponectin excretion in patients with Type 2 diabetes is an independent predictor of vascular damage, potentially identifying an increased risk for vascular events, report researchers in the journal Diabetes.

Experimental studies indicate that adiponectin is involved in glomerular homeostasis leading to suggestions that damage to the glomerular capillary wall in diabetes may result in loss of endothelial binding sites for adiponectin.

“We hypothesized that adiponectin appears in urine consequently reflecting early glomerular vascular damage in Type 2 diabetes rather than the metabolic changes associated with serum adiponectin,” write Maximilian von Eynatten (Munich Technical University, Germany) and co-workers.

They recruited 156 patients with Type 2 diabetes and a documented history of microalbuminuria being referred to a diabetes outpatient clinic for specialist treatment, and 40 healthy controls.

The researchers measured patients’ total urinary adiponectin excretion rate by enzyme-linked immunosorbent assay (ELISA), characterized their urinary adiponectin isoforms by western blot analysis, and assessed their level of pre-clinical atherosclerosis by measuring common carotid artery intima-media thickness (IMT). In all individuals, 24-hour urine samples were collected on three consecutive days.

In six patients with Type 2 diabetes who had undergone kidney biopsy, adiponectin distribution was assessed by immunohistochemistry. Noncancerous regions of resected kidneys distant from a tumor in patients without diabetes were used as control tissue.

The authors observed strong staining for adiponectin on the endothelial surface of glomerular capillaries and intrarenal arterioles in all non-diabetic kidneys, whereas staining was decreased in patients with diabetic nephropathy.

Urinary adiponectin levels were significantly increased in patients with Type 2 diabetes compared with controls at 7.68 versus 2.91 µg/g creatinine, respectively.

“Excretion could be a pathophysiological marker of vascular stress and may precede the onset of microalbuminuria and renal failure in Type 2 diabetes,” suggest the authors.

In this study, urinary adiponectin was superior to urinary albumin excretion in the prediction of increased carotid IMT and was a powerful independent predictor of carotid IMT in multivariable regression analyses.

“Measurement of urinary adiponectin may emerge as a novel and easy to obtain method for the clinical assessment of vascular stress and cardiovascular disease risk in Type 2 diabetes,” conclude the authors.

They caution that this should be validated in larger prospective studies and different samples including diabetes patients without a history of microalbuminuria.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

Free abstract

Up to ten years before type 2 diabetes is diagnosed, there are signs of your body resisting insulin. This is why researchers now refer to this as the “silent” epidemic or the “silent” killer. And it is usually the accompanying heart disease they have the most concern with.

1. Hypertension or high blood pressure. This may be the result of the high amount of insulin required to keep your blood sugars normal. What often shows is that as the insulin-level rises so does your blood pressure reading.

2. Elevated triglycerides levels. These levels are often high if you are overweight. It is not just the result of excessive fat intake; refined carbohydrates such as sugar and white flour are the culprits also. Existing body fat is also responsible.

3. Low HDL levels. The way fat is carried on the inside affects your risk of heart disease.

4. Increased abdominal fat. The culprit is a particular type of body fat centered around your abdomen, particularly around the intestines. Usually the male who has this type of fat has a waist much larger than his hips. The females’ waist is at least 80% of her hip measurement.

5. Obesity. Everyone who is obese, or has a high proportion of fat in their body, is insulin-resistant.

6. Fatigue. This is the most common feature; for no apparent reason your spark is no longer there. Some people are tired in the morning, some in the afternoon and some all day. This is because your body’s cells are not getting enough of the glucose they need. Even though there is plenty of insulin, your body is resistant to it’s action

7. Unable to concentrate. Your memory is not so sharp; your brain needs a constant supply of glucose to work properly and fluctuations are sending your blood sugar levels too high, or too low, quickly. This results in disordered memory and foggy thoughts.

To prevent long term complications:

• there are a variety of drugs available to help treat elevated triglycerides and low HDLs
• it is really important to concentrate on controlling your type 2 diabetes by losing weight and reducing your resistance to insulin

Weigh loss is not always easy but it is doable. Often losing just ten or twenty pounds, (5 or 10 kilograms), is enough to reduce your insulin resistance and blood sugar levels, and therefore your type 2 diabetes. You will also have less worry about heart disease.

Diet for diabetes is essential in the regulation of blood sugar levels. It’s been said many times that the right diet, along with exercise and medication, is key in controlling diabetes.

Why is there a need to control diabetes in the first place? Although diabetes itself is not life-threatening, control measures are necessary so as to prevent complications like kidney problems and heart failure either which can ultimately lead to death. Such being the case, regulating blood sugar levels should therefore be the primary goal of every diabetic treatment plan.

You must know that certain foods trigger abnormal spikes of your blood sugar levels. Thus, it may be necessary to embark on the right diet for diabetes. There are foods that are highly recommended for diabetics to eat; at the same time there are also those that they must avoid.

Ideally, diet for diabetes should comprise of the following:

fiber-rich foods

whole grains, bran, brown rice

vegetables

fresh fruits

nuts, seeds, legumes

fish

Whereas, the following foods should be avoided or at least limited:

foods rich in fat

salty foods

sweets

There is what is called the diabetes food pyramid that clearly illustrates the ideal diet for diabetes. The bottom of the pyramid represents foods that you must eat plenty of, and this includes starches or whole grain starches in the form of bread, cereals, pasta, corn, and potatoes. The next level of the pyramid are vegetables and fruits; next in line are milk, meat and meat substitutes, while at the top of the pyramid are fat and sweets, and these you should very well limit your intake of.

This diet for diabetes also requires that 45% - 65% of the total daily calories should come from carbohydrates, 25-35% from fat, while 12-20% should come from proteins.

Aside from knowing the right foods to eat, it is also important that you know exactly when to eat and how much to eat. Always keep in mind that anything in excess can have negative repercussions to your health.

As you must know not every diet for diabetes works effectively for all diabetics. Each one has different sets of needs and requirements, the reason why it is highly recommended that you see a diabetic dietician to help you come up with the right meal plan based on your body weight and needs. This way, you will not have to eat too much of anything that you shouldn’t, and not too little of those that you should.

If you think that this diet for diabetes seems rather boring, more so if you have a sweet tooth, think again, because with some bits of creativity, you can easily whip up a great meal that is just as delicious as any other meal you have been used to. A glass of fruit shake, a bowl of vegetable soup, and a toast of wheat bread can be a great way to start your day.

Indeed, a diet for diabetes can certainly be palatable, too, and since you are basically using natural products, you can be sure that it will give you loads of health benefits.

You’ll be surprised that this dietary regimen not only regulates your blood sugar levels naturally but makes you feel a lot healthier in the process. So even if you are not a diabetic, you can most certainly achieve better health with this diet for diabetes.

The typical American lifestyle reads like the ADA’s list of risk factors. We’re obese and inactive. We eat foods that give us high blood glucose and high cholesterol. We stress ourselves out and raise our blood pressure. It’s not surprising, then, that there are over one and a half million people with type 2 diabetes in California alone.

Here are some of the most common symptoms of diabetes. If you find yourself experiencing them, it may be a good idea to check with your doctor.

• Frequent urination
• Extreme hunger
• Excessive thirst
• Unexplained weight loss
• Blurry vision
• Increased fatigue
• Irritability

Some people get “pre-diabetes,” a condition characterized by high blood glucose levels, but nothing high enough to diagnose as diabetes. This can still be harmful to the body, but if you are aware of the possibility, you can prevent it from ever becoming full-blown diabetes.

The best way to avoid diabetes is to keep your blood glucose levels healthy now. This means eating right - plenty of fruits and vegetables, whole grains over Wonderbread, fish, dried beans, lean meats, diet drinks over sugar-laden ones, liquid oils over solid fats. This also means cutting back on the desserts and generally watching portion sizes. Really, it’s the wonder diet you’ve been looking for.

The other key to avoiding diabetes is lots of exercise. If you can walk instead of driving, do it. Anything that gets you moving will help, whether its running or climbing or swimming or playing tennis. If you feel that you may be at risk, talk to your doctor about safe exercise for people who may have trouble maintaining healthy glucose levels during exercise.

Diabetes has become an epidemic in America, but if we can wise up, it doesn’t have to continue to be one.

We know that Diabetes is a silent killer, being able to inflict damage because we’re looking somewhere else. We thought we were okay by avoiding sweets. We thought we were okay because no one in the family had it. We thought we were okay because we were negative for urine sugar. We thought we were okay because our wounds healed easily. We now know why it’s a silent killer. But we don’t know how.

Diabetes is a serial killer. But it is a SILENT serial killer because it stays behind the scenes. It doesn’t directly participate in the murder of its not-so-innocent victims. It has many guns-for-hire under its payroll. It is the MASTERMIND. Some of its crimes remain unsolved, pointing only to the one who pulled the trigger but not the one who paid the triggerman.

Let us go into a forensic analysis of how the Mastermind works, what his weapons are, and how we can detect his presence even before we can see him.

1. Stroke

I have mentioned that in Diabetics, cholesterol rises years before the blood sugar goes up. Since diabetics lose the capacity to utilize sugar, tissue fat is mobilized as alternative fuel. So fat in the tissues will have to travel via the arteries. The blood carries too much fat, much of which will be imbibed into the arterial walls. By the time the rising blood sugar is uncovered, the tightened cerebral arteries have already choked off the blood that carries oxygen to the brain. And since the brain cannot last more than 6 minutes without oxygen, the area deprived of it dies. If the patient lives, he is found to have Diabetes. But if he dies, he is diagnosed as a stroke, and the diagnosis of Diabetes dies with him. The triggerman is convicted, with the mastermind scot-free.

2. Heart Attack

In the same process it takes for the cerebral arteries to harden and narrow, the blood supply to the heart declines, giving the patient shortness of breathing and easy fatigability. If the patient seeks medical attention, his Diabetes would be uncovered and treated accordingly. But if the blockage is abrupt, the heart stops beating. Blood will stop going to the brain. And the patient will die of a heart attack. The triggerman is convicted, with the mastermind scot-free.

3. Retinopathy

While the brain and heart suffer because of blockage of the large vessels supplying blood, the small arteries bringing needed oxygen to the eye can more easily get clogged. Those with white collared jobs that require frequent reading and writing easily notice the blurring of vision, but put off a visit to the ophthalmologist thinking that glasses would be a burden to their work. But those who have no use of reading skills, or have not even learned to do so, may not even notice the change until they are no longer able to find their way around the house. It is not, however, the lens of the eye that gets damaged in diabetes, but the retina which is the inside of the eyeball that catches the image thrown by the lens. With retinopathy, it would be like focusing a projector onto a cobblestone wall instead of a white screen. Trying to change the focus with corrective lenses would do nothing to improve the image on the cobblestone. Again the triggerman is convicted, with the mastermind scot-free.

4. Kidney Failure

In my 20 years of medical practice, I might have heard this statement more than twenty thousand times. And as if the misconception of “kidney” being an illness was not enough, those claiming to have “kidney” associate it with urine dribbling. So, patients having this problem are unconcerned, thinking they do not have kidney problems. If the bladder is uninvolved, patients do not complain of dribbling. So the damage that diabetes inflicts on the kidney is so subtle that you don’t feel a thing until you start to bloat because the kidney is no longer able to excrete your excess body water. (The low back pain present in kidney infections is absent in Diabetic Nephropathy.) At this point, your only recourse would either be dialysis or a kidney transplant. The triggerman is convicted, with the mastermind scot-free.

There are subtle and not-so-subtle clues that point to Diabetes as the mastermind. If only we would care to notice before the triggermen do their job.

1) Frequent urination.

-sugar in the urine attracts more water into the kidneys

2) Excessive thirst.

-due to frequent urination

3) Big, big appetite.

-hunger because of under-utilization of sugar in the blood

4) Weight loss.

-due to fat mobilization

5) Tingling sensation or numbness over extremities.

-decreased circulation and nerve swelling

These clues can spell the difference between catching the triggerman or catching the mastermind. Between alleviating the symptoms, or treating the cause.

It’s hard to say for certain how many Americans have diabetes, since it’s been estimated that as many as 6.3 million people are undiagnosed. You might be a diabetic if you are excessively thirsty and hungry all the time, urinate frequently (as often as every hour), encounter unusual weight gain or weight loss, feel exhausted for no real reason, commonly suffer nausea, have blurred vision, develop vaginal or yeast infections, have dry mouth, take a long time to heal sores or cuts and suffer itchy skin. Diabetes is not contagious, but people who are older, overweight and sedentary are more likely to develop this disease.

There are three main types of diabetes: type 1, type 2 and gestational. Type 1 diabetes is an autoimmune disease, where the body’s immune system turns against itself, attacking insulin-producing beta cells in the pancreas. Scientists believe viral and genetic factors are at play here, with most people receiving a diagnosis when they are younger. This type of diabetes occurs evenly in males and females, but is more common in Caucasian sectors of the population, particularly in northern European countries like Sweden and Finland.

The onset is sudden for a type 1 diabetic, who has blurry vision, feels constantly hungry, thirsty and fatigued, and loses weight rapidly. If they do not receive insulin everyday, they can lapse into a coma. You may need immediate medical attention if you’re always thirsty, you urinate frequently, if your breathing becomes more rapid, if your abdomen hurts or if your breath smells like nail polish remover.

Type 2 diabetes accounts for 90-95% of all diabetics and is most commonly found in older Hispanics, African Americans and Native Americans, as well as Native Alaskans and Pacific Islander Americans. The onset for a type 2 diabetic is more gradual, but 80% of those who have it are overweight and physically inactive.

Symptoms include slow healing wounds, frequent infections, unusual thirst, frequent urination, nausea and fatigue. Just like type 1 diabetes, glucose builds up in the blood, which prevents the body from using it as fuel. Yet, unlike type 1, the body is usually producing enough insulin, although for unknown reasons, the body lacks the ability to make use of it.

Learning that you are a diabetic can feel overwhelming at first, but you can control your symptoms through lifestyle changes and careful monitoring. Diabetes care includes dieting and exercise. Diets should be diverse, high in fiber and low in fat and salt. Each day, you’ll need to monitor your cholesterol, blood glucose levels, blood pressure, triglycerides and weight.

You’ll need to talk to your healthcare practitioner about a plan for physical activity and meals, as well as medications and self-monitoring. Often your body will be less resilient, so you’ll need annual flu shots, eye exams, foot exams, kidney function tests and dental exams to stay healthy.

Wrapping one’s mind around diet nutrition can sometimes be confusing. For instance, a 120-pound fifteen-year-old girl will not need as many calories as a 220-pound twenty-five-year-old man. To further confuse matters, that 120-pound fifteen-year-old girl’s 150-pound peer of the same age will need more calories. A fifteen-year-old girl with juvenile diabetes will have an entirely different set of nutritional needs as well. Online, there are many resources and tools to help the average American figure out what his or her dietary needs are, depending on height, weight and level of physical activity.

The “2005 Dietary Guidelines for Americans” are the most current recommendations for diet nutrition, at least until the 2010 edition comes out. According to the guidelines, a “healthy diet” is one that is full of fruits, vegetables, whole grains and low-fat dairy products, including lean protein like poultry and fish, beans, eggs and nuts, and is low in saturated fats, trans fats, cholesterol, sodium and sugar.

Consumers are encouraged to make smart choices and eat a wide variety of foods, while staying within the caloric needs for their height and weight. Each day, Americans should be consuming calories, amino acids, essential fatty acids, minerals and vitamins. While requirements change for people depending upon their size and level of physical activity, the average person consumes around 50 grams of fat and 2,000 calories per day to remain at a stable weight.

For someone with type 1 or type 2 diabetes, the normal dietary rules may not apply. Generally, most diabetics will need to reduce the amount of fat consumed (particularly saturated fat), quit smoking and reduce alcohol consumption to no more than 3 or 4 per day. Diets should be rich in mono-unsaturated fats (like olive oil), oily fish, starchy whole grain carbohydrates (bread, pasta, potatoes, rice, cereal), and fresh fruits and vegetables.

A diabetic will need to check his or her blood sugar level before eating to see that it’s 70 to 130 and then again a few hours after eating to make sure it’s below 180. People with low blood sugar will need to have certain snacks handy, like fruit juice, hard candy, sugar or honey, soft drinks and milk. Small or medium sized women should eat 1,200 to 1,600 calories per day (6 starch, 3 vegetables, 2 fruits, 2 milks, 4-6 ounces protein and up to 3 fats). Larger women or small to medium sized men should have 1,600 to 2,000 calories (8 starch, 4 vegetables, 3 fruits, 2 milks, 4-6 ounces protein and up to 4 fats). For more information, check out the Diabetes Food Pyramid at Nih.

Americans seeking counseling on their dietary habits, whether they wish to gain or lose weight, can find assistance online. Websites like Shapeup or Eatright focus on consumer education centered on diet and weight loss. The National Institute of Health offers information on the 2005 guidelines and Food Pyramid at Nutrition website. Several nation-wide programs can help dieters find greater online support and practical resources at Fitday, Weightwatchers, Sparkpeople, Ediets, Mywebmd Nutrition, Nutricise, Changeone, Cyberdiet or Caloriescount.