It is estimated that 50 million Americans suffer from metabolic syndrome. By definition, metabolic syndrome is having any three of these ailments: insulin resistance, low hdl, waste circumference greater than 40 for men and 35 for women, elevated blood pressure and elevated c reactive protein. Alone each of these poses a great risk of mortality in people who suffer from them. The risk of cardiovascular death by tho afflicted with the metabolic syndrome is 3-4 times higher than just having one ailment alone.

The American Diabetes Association recommends diet and exercise as a measure to improve some of these conditions. As of 2009, there are no pharmaceutical products approved for treatment of insulin resistance or metabolic syndrome also known as metabolic syndrome x or insulin resistance syndrome. DHEA derived products have designed a global health platform which not only attacks the root of the problem but also assist patients by designing exercise tips, routines and diet plans for consumers. The conditions that make up metabolic syndrome all most derived from patients being overweight and worst of all being overweight in the visceral are. People who have visceral fat also known as belly fat have a much higher rate of death due to cardiovascular disease than those who carry weight in other parts of the body.

DHEA is very popular due to the vast amount of clinical research that has been completed for uses such as major depression as well as reduction of abdominal fat. Other natural products such as green tea and vitamin c are also linked to assist in reduction of abdominal fat.. Although there is no magic pill on the market, Biopharm Nutraceuticals recommends natural alternatives to prescription drugs. I do not support any specific brand as a medical professional, but what I do recommenced are the components mentioned above. One can buy them individually at any health food store or find a product as mentioned above that has all ingredients in one capsule in order to simply dosing. Although supplementation can assist in treating insulin resistance, there is not substitute for proper diet and exercise. I encourage readers o read the data on Google scholar on Green Tea, Dhea and L arginine and make an educated choice.For those of you with metabolic syndrome or any of the components, keep in mind that even a modest reduction in weight such as 5-6kg would reduce mortality in some cases by half.

Diabetes is a dangerous disease when it is left undiagnosed and untreated. For such an easy disease to detect and to screen for, it is amazing the number of people whose diabetes goes undetected and so untreated.

First of all, there are two different types of diabetes that affect many things concerning treatment. Type 1 diabetes involves failure of the pancreas to produce insulin. Insulin is an important hormone that allows the body to convert sugars and starches into energy for the cells. Without it, the sugars stay in the blood stream and accomplish nothing. Type 2 diabetes, on the other hand, is much more common than Type 1 diabetes. It is the type of diabetes in which a person’s pancreas cannot produce enough insulin to keep up with demand or the body is no longer able to use the insulin produced by the body. Type 1 patients are much less common (roughly 10% of all cases) but are completely insulin injection dependent. Type 2 patients can generally control the disease through diet and lifestyle changes.

Diabetes is a very serious health condition. It is such a serious condition that the life expectancy of diabetics is approximately 10 years less than that of non-diabetics. This is because of the numerous complications that go hand in hand with diabetes. Coronary artery disease, peripheral vascular disease, blindness or vision loss, kidney problems, circulation issues, and loss of circulation in both the hands and feet are all common side effects of diabetes that has not been treated or managed properly.

Considering the dangers of not controlling diabetes, it is scary how many have diabetes undiagnosed. An individual with undiagnosed diabetes is an individual who has not been diagnosed by a doctor or physician but whose plasma glucose levels are well within the accepted criteria for diabetes. The United States is estimated to have an undiagnosed diabetes population of 2.7% of the entire adult population over the age of 20.

This percentage means that nearly 3% of the adult population are putting their bodies at risk by not having control of their diabetes because they have not had it diagnosed. A simple blood test is really all that is needed to determine if a person is diabetic or not. This is generally part of any general physical conducted on an adult, since blood tests can tell so much about a person’s overall health. The level of undiagnosed diabetics suggests that at least some blood tests are not being interpreted appropriately.

TGR5, a G protein-coupled receptor expressed in brown adipose tissue and muscle, may be a novel therapeutic target for Type 2 diabetes and obesity or “diabesity,” research indicates.

In preclinical and in vitro studies, a pharmacologic selective TGR5 activator brought about an increase in muscle energy expenditure, a property with “therapeutic potential,” according to the study authors.

The work was undertaken by Johan Auwerx (Ecole Polytechnique Federale de Lausanne, Switzerland) and international collaborators and focused on the protein TGR5, which upon activation by bile acids triggers an increase in energy expenditure and attenuates diet-induced obesity.

Through a combination of pharmacological and genetic gain- and loss-of-function studies, the researchers found that TGR5 controls the secretion of glucagon-like peptide (GLP)-1 from enteroendocrine cells in the gut.

The therapeutic relevance of GLP-1 is well-established, say the researchers, and several drugs exploiting the properties of this hormone are already in advanced clinical development.

When administered to obesity-prone mice, TGR5 resulted in improved liver and pancreatic function as well as enhanced glucose tolerance, Auwerx et al report in Cell Metabolism.

Most importantly, administration of a specific TGR5 agonist, INT-777, induced GLP-1 release as well as leading to an increase in the intracellular ADP/ATP ratio and a rise in intracellular calcium mobilization.

Taken together, the results indicate that TGR5 activation “counteracts the metabolic dysfunction associated with diabesity,” say the researchers, through an increase in energy expenditure and incretin secretion.

“This leads us to conclude that TGR5 agonists could represent potential promising agents for the management of diabesity, along with associated disorders such as nonalcoholic steatohepatitis.” MedWire Diabetes, lipidology AstraZeneca Global v2 - Cardiovascular News Medical Disease_group: diabetes mellitus, dyslipidemia Drug provider: none Baylor: lipid

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

The addition of exenatide to insulin-based therapy is associated with improved glycemic control, less weight gain, and reduced prandial insulin requirements for treatment periods of up to 27 months, researchers report.

Only limited published data exist on the off-label use of exenatide in conjunction with insulin for the treatment of Type 2 diabetes, explain Paris Roach (Indiana University School of Medicine, Indianapolis, USA) and co-workers.

In a retrospective review of data from an outpatient setting collected between June 2005 ??” the date when exenatide became commercially available in the USA ??” and November 2007, the team examined the effects of exenatide on glycemic control, weight, and insulin dose in 188 patients with Type 2 diabetes treated with insulin.

Information on clinical parameters was obtained by retrospective review of medical records for four specified time intervals (0 to 6, 6 to 12, 12 to 18, and 18 to 27 months).

Compared with baseline values obtained before initiation of exenatide, the authors observed mean reductions in glycated hemoglobin (HbA1c) of 0.66% at 0 to 6 months, 0.55% at 6 to 12 months, 0.54% at 12 to 18 months, and 0.54% at 18 to 27 months. However, they note that there was considerable heterogeneity in patient responses.

There was also a significant decline in mean weight with increasing treatment duration with additional exenatide up to 18 months. After this time point an increase in weight was observed, but this remained lower than baseline values.

“The present study is notable in that patients were able to lose weight despite ongoing treatment with insulin,” write the authors.

Prandial insulin dose was significantly reduced compared with baseline, with mean reductions of 33.5% at 0 to 6 months, 25.9% at 6 to 12 months, 29.7% at 12 to 18 months, and 55.7% at 18 to 27 months. Total insulin requirements were also reduced but only for treatment periods of up to 12 months.

Adverse events were generally mild; those most frequently reported were nausea (22.6% of patients), vomiting (19.7%), and hypoglycemia (4.0%).

Based on these results, the authors suggest that insulin therapy does not preclude therapeutic benefit from the addition of incretin mimetics in patients with Type 2 diabetes.

“Prospective controlled trials are needed to further characterize the efficacy and safety of incretin-based therapy in insulin-treated patients with Type 2 diabetes,” they conclude in the journal Clinical Therapeutics.

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

Add-on treatment with pioglitazone or bedtime insulin has a similar impact on intra-abdominal fat mass and systemic low-grade inflammation ??” two well known cardiovascular risk factors ??” in patients with Type 2 diabetes, research shows.

Pioglitazone and bedtime insulin similarly improve glycemic control in combination with sulfonylurea and metformin, but both are associated with significant weight gain.

Agnès Hartemann-Heurtier (Pitie-Salpêtrière Hospital, Paris, France) and co-workers compared the impact of the two regimens on abdominal fat accumulation and inflammatory markers.

They randomized 28 patients with Type 2 diabetes inadequately controlled with maximal tolerated doses of metformin and sulfonylurea to receive add-on therapy with pioglitazone or bedtime neutral protein hagedorn (NPH) insulin for 24 weeks.

Intra-abdominal and subcutaneous fat content; serum levels of adiponectin, interleukin-6, high-sensitivity C-reactive protein (CRP), and ferritin; and mRNA expression of inflammation-related genes in subcutaneous fat, were determined before and after 24 weeks of treatment.

Presenting the results in the journal Diabetes Research and Clinical Practice, the authors report that both insulin and pioglitazone resulted in a significant decrease in glycated hemoglobin (HbA1c) (??”1.6% and ??”1.2%, respectively) and a significant increase in total body fat mass (1.0 and 3.3 kg, respectively).

Neither bedtime insulin nor pioglitazone induced a significant and constant change in intra-abdominal fat content following 24 weeks of treatment, but pioglitazone was associated with a significant increase in subcutaneous fat content. “This suggests that fat mass gain under insulin therapy is probably diffuse,” write the authors.

Levels of the serum inflammatory marker interleukin-6 were unchanged in both groups compared with baseline, whereas pioglitazone was associated with a significant decrease in CRP. Only insulin induced a significant decrease in the acute-phase reactant ferritin.

The authors observed no change in mRNA expression of inflammation-related genes after either treatment.

“Our study shows that 6-month pioglitazone or bedtime NPH insulin treatments do not have a highly different impact on intra-abdominal fat content and low-grade inflammation level,” conclude the authors.

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

A saxagliptin phase III dose-ranging study shows clinically significant reductions in glycated hemoglobin (HbA1c) when the drug is added to metformin in patients with Type 2 diabetes inadequately controlled with metformin alone, researchers report in the journal Diabetes Care.

Saxagliptin is the latest dipeptidyl peptidase-4 (DPP-4) inhibitor to be approved by the US Food and Drug Administration for the treatment of Type 2 diabetes.

As part of the saxagliptin phase III program, Ralph DeFronzo (University of Texas Health Science Center at San Antonio, Texas, USA) and colleagues assessed the efficacy of saxagliptin as add-on therapy.

The 24-week, double-blind, placebo-controlled trial, randomized 743 patients with an HbA1c level of 7??”10% on a stable dose of metformin (1500??”2500 mg) to one of three doses of saxagliptin (2.5, 5.0, 10.0 mg once daily) or placebo. The primary endpoint was change from baseline in HbA1c levels.

Patients receiving saxagliptin plus metformin achieved statistically significant decreases in HbA1c of 0.59%, 0.69%, and 0.58%, and in fasting plasma glucose (FPG) of 14 mg/dl, 22 mg/dl, and 21 mg/dl for the 2.5-, 5.0-, and 10.0-mg doses, respectively, compared with placebo plus metformin.

In addition, at least twice as many patients achieved an HbA1c less than 7.0% with saxagliptin 2.5, 5.0, and 10 mg compared with placebo (37%, 44%, and 44% versus 17%).

Saxagliptin was also associated with statistically significant reductions in postprandial glucose (PPG) 3-hour area under the curve during a 75-g oral glucose tolerance test compared with placebo.

Maximal HbA1c, FPG, and PPG reductions were observed with the 5-mg saxagliptin dose, with no evidence of a dose-response relationship at 10 mg (presumably!).

The overall frequency of confirmed hypoglycemia during the 24-week treatment period was similar for saxagliptin-treated patients (0.5%) and those treated with metformin plus placebo (0.6%); no dose-dependent relationship was observed among the three saxagliptin groups.

Mean reductions from baseline in body weight at week 24 were 1.43 kg, 0.87 kg, and 0.53 kg for saxagliptin plus metformin 2.5, 5.0, and 10.0 mg versus 0.92 kg for metformin plus placebo.

The overall frequency of adverse events was comparable across all treatment groups and placebo and did not appear to be dose related.

“These results suggest that saxagliptin represents a valuable therapeutic option for the management of patients with Type 2 diabetes inadequately controlled with metformin monotherapy,” conclude the authors.

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

Research indicates that measuring levels of osteocalcin and bone-specific alkaline phosphatase (BAP) may help identify men with Type 2 diabetes at risk for vertebral fracture.

Although bone mineral density (BMD) is not reduced in patients with Type 2 diabetes, the disease is associated with a higher risk for fractures, including vertebral fracture in Japanese patients, independent of BMD, explain Ippei Kanazawa and co-authors, from Shimane University in Japan.

To determine whether BMD and bone markers are useful for assessing risk for vertebral fracture, the team recruited 248 Japanese men with Type 2 diabetes and examined the relationships among bone markers, BMD, hemoglobin A_1c (a marker of plasma glucose), insulin-like growth factor (IGF)-I, parathyroid hormone, and vitamin D.

In all, 76 (30.6%) of the men had suffered a vertebral fracture. Analysis showed that serum osteocalcin and the ratio of osteocalcin to BAP were significantly and negatively correlated with plasma hemoglobin A_1c and positively correlated with IGF-I, after adjusting for age, height, weight, duration of diabetes, and serum creatinine.

Furthermore, the serum osteoclacin??”BAP ratio was negatively associated with the likelihood of vertebral fracture, with an odds ratio of 0.7, even after adjusting for lumbar or femoral neck BMD, hemoglobin A_1c, and IGF-I.

Writing in the journal Calcified Tissue International, Kanazawa et al say: “Our results suggest that poor diabetic control and lower IGF-I level are linked to impaired bone formation and resultant reduction in OC/BAP ratio in men with Type 2 diabetes.”

Finding that the serum OC??”BAP ratio was a better predictor for vertebral fracture than BMD and other bone markers in men with Type 2 diabetes, the researchers suggest that “the OC??”BAP ratio could be clinically useful for assessing the risk for vertebral fractures independent of BMD in diabetic men.”

They conclude that further research is required to determine the optimal cut-off values for serum OC/BAP ratio for vertebral fracture detection in this population.

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

Insulin is a hormone produced by your pancreas whose primary function is to lower blood sugar. It does this by binding to insulin receptors on the cell wall which open glucose transporters. Once the glucose transporters are opened by the action of insulin, glucose can flow freely from the blood into the cell.

If you are insulin dependent your body relies on insulin injections in order to function correctly. This is either because your pancreas is not secreting any insulin, as in type 1 diabetes), or else the insulin that your pancreas is making is not doing its job properly, as in type 2 diabetes.

Insulin Basics

Before we jump into discussing the various insulin regimens, I need to first explain two terms which you will come across frequently:

Basal insulin - This is the injection of a long-acting insulin which mimics the insulin secretion of the pancreas. A single basal shot of insulin continues to act slowly throughout the day, therefore you only need to inject it once or twice daily. These long-acting insulins are “peakless” which means that they try and maintain the same glucose level throughout the day, unlike the fast acting insulins which result in a rapid decrease in blood sugar.

Bolus insulin - A bolus is a medical term for a single dose. Bolus insulin is given when you eat food in order to counteract the rapid increase in blood glucose after a meal. Bolus insulins are typically fast-acting, some of which start bringing down blood glucose in a matter of minutes. They do not remain in your system for long, being metabolized and excreted out of the body usually within a few hours.

So, to summarise… basal insulin keeps your blood sugar stable in the absence of food, but when you eat you need to take a bolus of fast acting insulin in order to counteract the sudden increase in blood sugar which comes from the breakdown of carbohydrate into glucose.

When Is Insulin Needed?

Insulin is always necessary for the treatment of type 1 diabetes, because there is a complete lack of the hormone in these patients. Type 2 diabetics do not usually require insulin until the disease has progressed to a point where the patient has become highly resistant to insulin, or when oral antidiabetic medications are no longer enough to keep blood glucose levels down.

A patient with insulin dependent type 2 diabetes has to use insulin in the same way as type 1 diabetics. However, there is a difference in that type 2 diabetics usually have to take much larger doses of insulin than type 1 patients because they have become so resistant to the effects of insulin.

For many type 2 diabetics, the addition of a long acting (basal) insulin such as Lantus or Levemir is usually enough to provide enough help to assist the body’s own insulin in doing its job. If this is still not effective enough, a basal dose can be taken in addition to fast acting boluses of insulin at mealtimes.

Insulin Mixtures

These come premixed under certain brand names, a popular one is a 70/30 mix (70% long acting, 30% fast acting) called humulin or mixtard. These are usually taken before breakfast and supper.

However, the combination of basal and bolus injections provides much tighter glucose control and is a more flexible system than taking premixed insulin. This is because you can vary the amount and timing of the bolus to match what type of food you eat and when you eat it.

With mixtures of insulin such as the 70/30 mix, you have to take it on a rigid schedule, and you can only eat a certain number of carbohydrates each day and at a scheduled time. You are not able to vary the timing of the injections because they contain both slow acting and fast acting insulin, and you are not able to eat more or less food depending on how hungry you are that day.

How to Inject Insulin

Depending on the insulin regime prescribed by your doctor, you may have to inject insulin via a traditional syringe. However, the majority of patients now are using injection pens which come pre-filled with insulin as they are much easier to use. In either case, the following basics apply:

Step 1: If using a syringe, roll the insulin vial (or the syringe itself if it has been pre-filled) between the palms of your hands a number of times before filling the syringe to redistribute any particles that may have settled to the bottom. This ensures an even concentration of insulin in each dose. The same applies to insulin pens, but they should also be shaken as most pens have a small glass ball inside which can move around and mix the insulin thoroughly.

Step 2: Choose an injection site and pinch the skin slightly. Position the syringe or pen so that the insulin is injected under the fatty layer of the skin. Note that a 45 degree angle is best for children and adults who are very thin, otherwise a 90 degree angle may be more appropriate.

Step 3: You should rotate your injection site regularly. Insulin is best absorbed through the abdominal area so rotating injection sites in this area is ideal. You could visualize your abdomen as a grid of 8 squares. Assign to each square a particular day and change to a new one each day of the week.

Insulin Injection Tips

1. Subsequent injections should be delivered at least 1 inch away from the previous injection site.

2. It is not necessary to disinfect the injection site with an alcohol swab as long as your skin is clean.

3. If necessary, insulin may be injected through clothing, but this is not recommended.

4. Never shake a vial of insulin as this creates air bubbles which can clog the syringe.

5. Never mix one type of insulin with another in a single syringe. This can make it’s effects erratic.

6. Try not to inject insulin into muscle tissue. It is painful and the insulin is absorbed too quickly and cause hypoglycemia.

Insulin Pumps

Insulin pumps are normally used in type 1 diabetes however they can work as effectively for insulin dependent type 2 diabetics also.

Some advantages of using an insulin pump include:

You change your infusion site once every 3 days, so if you have a dislike of needles, insulin pumping is better than having to inject yourself times a day.

You will use less insulin with a pump than on injections. Insulin pumps only use fast acting insulin which is more efficient than the slow acting types. Typically you use 20% less insulin when using a pump.

Because you have more control of the amount of insulin you take, if you are motivated, you can achieve much lower HbA1c (glucose average) than with injections. This improved control is due to the fact you can take doses that are not whole units, but fractions of a unit.

A new development in the area of insulin pumps is the advent of the artificial pancreas. This device combines an insulin pump with a continuous blood glucose meter, and automatically calculates how much insulin you need, minute by minute. This device is not currently on the market, but foundations such as the JDRF have invested a lot of money into it’s R&D. Human trials are currently underway.

Is an Insulin Pump Right For Me?

Not everyone is suited to pump therapy, and it usually reserved for cases of type 1 diabetes or insulin dependent type 2 diabetes. In order to be successful at using an insulin pump:

• You need to be good at counting carbohydrates. You have to manually program the pump with the number of carbohydrates you are going to eat. It then calculates the dose of insulin to give you.
• You need to be comfortable working with technology. If you are unable to basic devices such as a cell phone, then the insulin pump is not for you. However, as you are reading this information on your computer, this is likely not the case.
• You need to be patient in order to give the pump a chance to impress you. It usually takes at least a week or two before your glucose levels reach a healthy level. It will also be at least several more weeks after that before you become confidant with adjusting the device.
• You need to have a cool head rather than anxiety prone. When your glucose level starts to seem a little scary you have to quickly figure out what changes you need to make. Your doctor will be able to assist you with the learning curve at first, but you will eventually have to cope with the device on your own as the lag time between seeing a problem and getting help is too long for another person to control your pump for you.
• Finally, you must be willing to test your blood glucose level with a glucometer about 8 times per day and more often when you are making adjustments to your routine.

Regardless of whether you have type 1 or type 2 diabetes, it is important that you now realize that you have a problem in your hands, you have an illness to take care of and if you do not do anything about it and keep the same lifestyle that you have been having up until today, you can pretty much kiss your life goodbye! Yes, I know these are harsh words and at more than one person may even get upset about it, but when it comes to diabetes the truth can be very upsetting and that is that if you do not take care of your body now that you know if your condition consequences can be dire.

After you have been diagnosed with diabetes you will get several medications as well testing supplies so you can be on top of your health condition at all times. However, the best medication doesn’t cost a thing and it’s something that you should’ve been doing in the first place, such medication/treatment is called exercise.

Diabetics don’t like to hear about the “E” word because it implies physical activity, movement, sweating and some might not be comfortable about the whole idea but exercise is just part of your treatment and you need to get used to be a deity you need to move around and keep your body not only in shape but healthy if you want to be around for those important moments in life such as your children graduation, their wedding and such.

Exercise it doesn’t necessarily have to involve weight lifting or running for hours at the local gym, in fact you can start with very small changes around your house that will also count as an exercise as much as weight lifting at the gym do. For instance:

1. Try to vacuum four times per week, even if your house is not that dirty. Vacuuming can be a great exercise that will help you move around, sweat a little and achieve your main goal which is to remain healthy and keep your diabetes and check.

2. Walk, walk, walk and then walk some more. Lots of people often come up with very ingenious excuses about the many reasons they have for not walking, maybe it is raining, maybe they work a lot of hours and don’t have enough time throughout the day to walk, well you need to get over those excuses and find or better yet make some time throughout your busy day so you can dedicate at least five to 10 minutes to this exercise.

3. Go to your local mall and walk around.

4. Whenever you go out shopping try to make many trips from the car to your house instead of making just one trip with all the things you have purchased.

5. Play around with your kids, pets or try to get yourself a workout buddy that can encourage you to reach your goals.

If you or someone that you know has just been diagnosed with type 2 diabetes then you need to know that the first step to treat this disease is a special diabetes meal plan. It is a known fact that the most effective way to treat diabetes is with a diabetic meal plan. The medications that were given to you by your doctor will not cure your diabetes, only the meal plan will do that.

There are now companies that are releasing the plans online. Every weight loss diet is based on the meal plan. This plan will allow you to lose weight and reverse your diabetes.

Type 2 diabetes causes elevated blood sugar and when your blood sugar goes up then you become hungry. This will be a never ending cycle unless you use the plan to curb your appetite, lose weight and bring your blood sugars to normal.

Diabetes is a disease that affects millions of Americans because of our poor diet. However all this can change in one day if you know how to eat right. But we have found that most Americans are not aware of how to control their blood sugar levels.

If you are suffering from diabetes then you need to compare your diet against the online plan to assure the right amount of nutrients and limiting your calories. The dieticians that have created these meal plans have placed the proper level of nutrients so you have energy to work and do what you need to do each day and the proper level of calories so you can lose weight.