Regardless of the type, diabetes is a frustrating and inconvenient disease to live with. But the complications can be extremely detrimental, and some are even fatal. Some of these symptoms are kidney and heart disease, nerve disease, blindness, impotence, and diabetic neuropathy. Under the worst conditions, some patients even have lower limbs amputated. While the effects of oxygen therapy and hyperbaric chambers for diabetic patients may not be preventative for diabetes itself, it can reduce the likelihood of the complications.

Internal wounds to the organs are most helped by hyperbaric oxygen therapy (HBOT). HBOT replenishes the oxygen supply in the blood, so that the blood and plasma can carry more blood to the muscles and organs. Oxygen can heal almost any kind of wound by building up healthy new tissue at the wound site, and the pressurized oxygen inters the body to do just that. Some “topical” hyperbaric chambers are so small that they are meant to concentrate the pressurized oxygen on only one limb; others are traditional and meant for the patient to climb in, but are portable and can be used in the patient’s own home; others can only be used at a hospital, and some of these can accommodate up to four people at a time.

With increased oxygen levels, blood vessels function better as well. This, along with faster-healing tissue, is beneficial for a diabetic patient because some people are at risk for irradiated tissue and skin graft or flap compromise. Hyperbaric chambers also enable diabetics to be much less subject to infection of the tissue or wounds, which in turn makes any further complications much less likely. Infections can occur from street drugs or surgery, and people with diabetes are more susceptible because of weakened antibodies.

Results from tests on the reaction of diabetic patients with foot ulcers to hyperbaric chambers were very positive; the therapy was given for two weeks, and during that time the rate of healing was significantly improved. Hyperbaric chambers may also help diabetics with hypoglycemia, a common side effect that occurs when there is not enough glucose in the blood. Because the blood cannot deliver enough glucose to the brain, hypoglycemia can result in temporary unconsciousness or seizures. If these persist, a patient could suffer brain damage.

But hyperbaric chambers have been found to help people with autism and cerebral palsy, so why not those who have lasting brain damage from hypoglycemia? Most sources also say that HBOT can regulate blood flow in the cerebrum, which is weakened in patients with diabetes.

If left untreated for too long, diabetes and its connected complications can worsen and even be linked to subsequent stroke. However, hyperbaric oxygen therapy has been able to prevent stroke and even significantly help people recovering from stroke. Though anyone interested in using a hyperbaric chamber for diabetes and any other ailment is encouraged to consult a doctor first, most hard studies have shown that the therapy is helpful in any stage of a disease.

Apart from dietary management and treatment of diabetes, another good way diabetes condition can be treated is through the use of roots and herbs. In treating diabetes with herbs, the aims are:

* To repair the pancreas

* To strengthen the kidney

* To eradicate the symptoms attributed to diabetes

* To prevent sugar or glucose from escaping in the urine.

* To help the body to find its natural balance

Points to Note in Herbal Treatment of Diabetes

The following points should be kept in mind when treating diabetes with help:

1. Juvenile diabetes or insulin dependent diabetes is more difficult to cure than non-insulin dependent diabetes.

2. Those that develop maturity onset diabetes at age fifty or above respond more quickly to herbal treatment than those who develop the disease at age thirty or forty

3. It is not recommended that insulin-dependent diabetics stop injecting themselves as soon as they begin herbal treatment. They will need to combine both medications for two weeks after which they will then reduce the volume of insulin they inject to half its usual volume while they still continue with the herbs. It is only after four weeks that they can leave aside that they check their urine and blood from time to time, so as to monitor their sugar levels. It is strongly advised that diabetic patients should always consult a competent herbal scientist.

Herbal Treatment of Diabetes Formula 1

Materials:

A. Cashew stem-bark (half small bucket)

B. 7 green pawpaw leaves

C. 1 medium size pot of bitter leaf

D. 10 bulbs of garlic

E. 10 pieces of ginger

F. 5 bulbs of onions

G. 10 pods of Capsicum frutescens

English - African red pepper or bird’s pepper (The tiniest pepper you find around. Very peppery)

H. 15 pieces of Xylopia Aethiopica

I. 15 litres of water

J. 2 bottles of honey

Recipe : Boil A to H together in I for 40 minutes. Allow it to stand for 24 hours before adding J. Stir well. Sieve and store in a container.

Dosage: One glass 3 times daily for two months.

Herbal Treatment of Diabetes Formula 2

Materials:

A. Leaves of Mormodica Charantia (balsam pear)

B. Leaves of Basil Ocinum

C. 10 litres of water

Recipe:: squeeze an equal amount of the leaves of A and B together in C. Do not worry about the precise quantity of leaves. What matters is to squeeze equal amount of both leaves and to make the preparation as thick and concentrated as possible.

Dosag: 1 glass 3 times daily for 2 months.

Type 2 diabetes patients with prostate cancer who undergo radical prostatectomy are more likely to have advanced grade disease at final pathology than nondiabetics, say researchers.

Furthermore, positive diabetes mellitus status can predict a subsequent finding of high-grade prostate cancer - Gleason score 8 or higher - earlier than treatment, at initial prostate biopsy, says the Italian research team.

“Our findings should be considered when counseling diabetic patients,” suggest Firas Abdollah and colleagues from Vita-Salute University in Milan.

“In view of these patients’ predisposition to develop a high-grade tumor, regular prostate-specific antigen (PSA) screening may be advised in order to detect prostate cancer at early stages,” they add in the journal Prostate Cancer and Prostatic Diseases.

The prevalence of Type 2 diabetes mellitus in a cohort of 2060 patients who underwent prostatectomy between 2001 and 2009 was 7.1%. The researchers tested the hypothesis that these diabetic patients would have a higher incidence of high-grade tumors than their non-diabetic counterparts.

Indeed, after adjustment for potential confounding factors including clinical stage, PSA level, body mass index, and year of treatment, Abdollah and team observed that Type 2 diabetic patients had a 2.7-fold increased risk for having high-grade prostate cancer at initial biopsy.

This trend was mirrored in the final pathology findings at prostatectomy: after adjustment for the same factors, diabetic patients were 2.4 times more likely to have high-grade disease compared with non-diabetic patients.

These risk differences are highlighted by the finding of significantly more disease with a Gleason score of 8 or higher among men with Type 2 diabetes at biopsy (16.3% vs 7.6%) and after prostatectomy (21.1% vs 11.7%) compared with non-diabetic men.

Abdollah et al recommend that their results be verified in a prospective manner before being applied to clinical practice, but they do maintain that theirs is the first analysis of Type 2 diabetes mellitus status and prostatectomy findings in a non-Northern American cohort.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

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UK researchers report that glycated hemoglobin (HbA1C) levels do not accurately reflect the glycemic control of diabetic patients who receive intravenous (iv) iron and erythropoietin-stimulating agents (ESAs) for co-existing chronic kidney disease (CKD).

Indeed, HbA1C levels can fall during treatment with these agents, therefore health professionals should seek out additional methods “for measuring glycemic control such as capillary glucose testing and continuous glucose monitoring (CGM),” say the researchers.

They suggest glycated albumin as a suitable alternative to HbA1C as it reflects glycemic control with similar accuracy in patients with iron deficiency and pre-ESA compared with patients post-therapy.

Jen Ng, from Hull York Medical School, and team studied 30 diabetic patients with moderate to end-stage CKD who underwent iv iron therapy alone (n=15) or with ESA (n=15).

HbA1C levels were measured at baseline and after a mean follow-up period of 16.4 weeks. Seven-point daily glucose was also measured three times a week during the study period along with CGM lasting at least 48 hours on each occasion.

As reported in the journal Diabetes Care, Ng and team found that mean HbA1C levels fell significantly among patients receiving iron alone and among those receiving both agents, from 7.40% and 7.31% at baseline to 6.96% and 6.63% at study end, respectively.

Mean blood glucose, however, did not change significantly among either patient group. Patients taking iron alone had mean blood glucose levels of 9.55 mmol/l at baseline and 9.71 mmol/l at study end, and those taking iron and ESA had blood glucose levels of 8.72 mmol/l at baseline and 8.78 mmol/l at study end.

Both iron and ESA treatment led to significant increases in hemoglobin and hematocrit levels, but this was not associated with the fall in HbA1C levels noted during treatment.

The researchers conclude: “At a time when self-monitoring of blood glucose is being discouraged, especially in non-insulin-treated patients, regular capillary glucose measurements, and the concurrent use of CGM if available, seems essential in order to accurately assess glycemic control in this group of patients.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

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The relationship between carotid intima-media thickness (IMT) and three measures of arterial stiffness differs between diabetics and nondiabetics, suggest study results.

Manuel Angel Gómez-Marcos (La Alamedilla Health Center, Salamanca, Spain) and colleagues carried out a study of 366 individuals, of whom 105 were diabetic and 261 nondiabetic.

Carotid IMT was associated with measures of arterial stiffness in both diabetics and nondiabetics. For each unit increase in the ambulatory arterial stiffness index, augmentation index, and pulse wave velocity (PWV), carotid IMT increased by 0.40, 0.24, and 0.36 mm in diabetic patients, and 0.48, 0.17, and 0.55 mm in nondiabetics.

The team found that, following adjustment for age, gender, and heart rate, PWV was no longer associated with carotid IMT in patients with diabetes. In those without diabetes, the association between carotid IMT and the augmentation index was lost following adjustment for these variables.

Therefore, in diabetics, carotid IMT variability was mostly explained by the ambulatory arterial stiffness index, the augmentation index, and gender, and in nondiabetics by age, gender, PWV, and the ambulatory arterial stiffness index.

“The present study demonstrates that the three measures taken to assess arterial stiffness in clinical practice are not interchangeable, nor do they behave equally in all subjects,” say the authors.

“We consider that follow-up studies are necessary to establish the relationship between carotid IMT and each of these three measures, and to determine whether their joint determination offers additional benefits,” they conclude in the journal Cardiovascular Diabetology.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

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Patients with diabetes who observe the practice of fasting during the Muslim month of Ramadan, must know when to break the fast, should symptoms such as shaking, tremor, sweating, anxious, dizziness, hunger, palpitation, impaired vision, fatigue, weakness, headache, poor concentration and irritability occur. They should be alert towards these symptoms as these are the symptoms of a hypoglycemic attack.

They are advised to constantly self-monitor their blood glucose levels at home. If the blood glucose level falls below 3.5 mmol/l, they should stop the fast immediately. On the other hand, if they suffer from hyperglycemia (blood glucose level more than 16 mmol/l), they should also break fast without delay.

The meals during Ramadan should consist of a balanced and healthy diet. It should aim at maintaining a constant body mass. According to research, 50-60% of patients who fast maintain their body weight during the month, while 20-25% either gain or lose weight. Occasionally, the weight loss may be excessive (more than 3 kg). It is not advisable to consume large amounts of food rich in carbohydrate and fat, especially at the sunset meal. Predawn meal may include food containing “complex” carbohydrate, while foods with more simple carbohydrates may be more appropriate at the sunset meal. Such allocation is made in view of the delay in digestion and absorption.

Excessive physical activity may lead to higher risk of hypoglycemia and should be avoided, particularly during the few hours before breaking the fast. However, normal level of physical activities may still be carried out. If Tarawaih prayer (multiple prayers after the sunset meal) is performed, then it should be considered a part of the daily exercise program. In certain patients with poorly controlled type 1 diabetes, exercise may lead to severe hyperglycemia.

Clearly there are many issues to be addressed with regards to patients on the management of diabetes during the Ramadan month. When patients fail to adhere to the oral hypoglycemic agent or insulin regime in the past 11 months, chances are they may be at risk to develop complications of diabetes if they insist to fast.

Diabetes is more than just high blood glucose but it is a complex metabolic disorder affecting multiple organs and small vessels as well. Drugs and Insulin are just part of the management of diabetes as it requires much self-discipline and lifestyle modification for the better control of blood glucose.

Patients and healthcare providers should look beyond the numbers that appear on the glucometer and associate these numbers with the co-morbid conditions (like heart diseases, renal insufficiency, stroke) to stratify the risk of diabetes associated complications.

Management of diabetes also call for support from patients and family members, as doctors and healthcare providers are not able to make much difference if there is no co-operation from all parties as a team. For that matter, there are many NGOs that have been set up to help diabetic patients support each other and share their knowledge and experience on living with diabetes.

Drug-eluting stents (DES) are associated with half the risk for restenosis and an equivalent risk for death and myocardial infarction (MI) compared with bare-metal stents (BMS) in patients with diabetes and coronary artery disease (CAD), a Swedish registry study suggests.

The results support the long-term safety and efficacy of DES in diabetic patients, who tend to have more extensive CAD and higher rates of disease progression and restenosis than their nondiabetic counterparts.

The national Swedish Coronary Angiography and Angioplasty Registry (SCAAR) records data on all patients undergoing coronary angiography and percutaneous coronary intervention. It also allows analysis of patient outcomes through linkage with other national databases.

For the present study, Stefan James (Uppsala Clinical Research Center) and fellow members of the SCAAR/SWEDEHEART study group evaluated long-term outcomes in patients with diabetes undergoing coronary angiography and stenting with either DES or BMS.

A total of 9710 diabetic patients underwent coronary stenting between 2003 and 2006, and were followed-up for a median of 2.5 years.

Analysis revealed that the composite outcome of death or MI was similar irrespective of the type of stent used, with a relative risk (RR) of 0.91 for DES versus BMS.

However, rates of both MI and restenosis were significantly lower in patients who received a DES, with RRs of 0.80 and 0.50, respectively, versus BMS. The reduction in restenosis was observed in patients with either stable or unstable CAD, and was most pronounced in those with a stent diameter of less than 3 mm or a stent length of more than 20 mm.

Importantly, the presence of restenosis was associated with a five-fold increased risk for MI (RR=50.3), irrespective of type of stent received.

“The use of DES in diabetic patients is considered off-label by the US Food and Drug Administration , because adequate numbers of diabetic patients have not been evaluated in clinical trials,” remark the authors.

“Despite this categorization, our real-life study shows that DES is safe and effective in reducing clinical restenosis in patients with diabetes mellitus.”

The study is reported in the European Heart Journal.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2009

Free abstract

Treating diabetic patients with the
thiazolidinedione pioglitazone significantly decreases triglyceride
content in the liver and reduces cholesteryl ester transfer protein
(CETP) mass, research shows.

In addition, treatment with pioglitazone was also associated
with an accompanying increase in high-density lipoprotein (HDL)
cholesterol levels.

The findings, report Jacqueline Jonker (Leiden University
Medical Center, The Netherlands) and colleagues in the journal
Diabetes Care, are “in full agreement with our recent
findings in apolipoprotein (APO)E*3-Leiden CETP mice and support
the validity of these mice as a model for human-like lipoprotein
metabolism.”

Patients with diabetes are often characterized by marked
dyslipidemia, with high levels of apoB-lipoproteins and
triglycerides, and low HDL cholesterol levels.

Previous research has suggested that hepatic steatosis, a common
condition in patients with Type 2 diabetes, is associated with more
severe dyslipidemia.

The purpose of this study was to confirm the previous findings
from the mouse model showing that pioglitazone favorably reduces
triglycerides in the liver.

In total, 78 men with Type 2 diabetes mellitus were randomly
assigned to receive pioglitazone 30 mg/day, metformin 2000 mg/day,
or matching placebo, all in addition to treatment with
glimepiride.

After 24 weeks, hepatic triglyceride content decreased from 5.9%
to 4.1% in patients taking pioglitazone. Accompanying the change,
CETP mass declined from 2.33 µg/ml to 2.06 µg/ml, while
HDL cholesterol levels increased from 1.22 mmol/l to 1.34
mmol/l.

Treatment with metformin had no significant effect on hepatic
triglyceride content, CETP mass, or HDL cholesterol levels.

In an analysis stratified according to statin use at baseline,
the researchers note that pioglitazone had an additional effect on
liver triglyceride content, reducing it from 8.0% to 3.7% at 24
weeks in 19 patients taking both drugs, compared with a decrease
from 6.4% to 4.9% in non-statin users.

However, pioglitazone did not further decrease CETP mass or HDL
cholesterol in patients taking statins at baseline.

“We hypothesize that statins specifically decrease hepatic
cholesterol content and downregulate CETP mRNA expression,” explain
Jonker and colleagues. “Therefore, additional lowering of hepatic
triglyceride content will not result in an additional decrease in
CETP expression.”

They conclude: “These results in patients with Type 2 diabetes
fully confirm recent findings in mice.”

MedWire (www.medwire-news.md) is an independent clinical news
service provided by Current Medicine Group, a trading division of
Springer Healthcare Limited. © Springer Healthcare Ltd;
2010

Free abstract

Patients afflicted with diabetes (or people who know of a diabetic patient) are always asking what’s the best fruit to indulge in if you have this degenerative disease. There are a lot of diabetic patients too worried that fruit intake may increase their blood sugar levels since fruits are primary sources of fructose. Good news, there are fruits that a diabetic patient can enjoy and indulge in that will not significantly alter their glucose levels at an all time high.

Foods that are rich in fiber are good choices for diabetic patients. They have a lower glycemic index and are trusted not to cause a major spike in their blood sugar levels compared to other foods that are high in GI level. The reason for such is because fiber slows down the sugar breakdown in the bloodstream. Fruits that have skins and peels you can eat (even the seeds) are good sources of the fiber that diabetics need. These include apples, apricots, blueberries, pears, kiwifruit, pomegranates, and pears.

Fructose high fruits, on the contrary, are not bad for diabetics. This is because fructose does not need insulin to metabolize and these can be very well enjoyed by patients suffering from insulin resistance. These fruits include are still apples, pears, mangoes, and guavas - these fruits have glucose ratios higher than 2. Apples have additional benefits for diabetics. They contain a good amount of pectin which is medically proven to have improved glycemic level control and are therefore good in reducing insulin dependence to more than 50%. Grapefruits are good for diabetics too. These can help achieve weight loss which is guaranteed to reduce insulin resistance. Grapefruit has also been proven to stabilize insulin levels when eaten during breakfast, lunch, or dinner.

What are bad fruits to avoid if you have diabetes?

Dates, bananas, oranges, and watermelons are bad fruits for a diabetic. They all contain a high amount of glucose and can surely spike blood sugar levels, but this does not mean an entire resistance to these fruits. Small amounts are okay, just not in indulgent amounts and can still be enjoyed in a healthy meal.

Fruit juices which are processed and removed of their pulpy fibers are high in sugar content while giving low fiber content. There are juice manufacturers that are adding so much sugar in their product juices that these tend to have higher sugar levels than in sodas.

A diabetic may also do well to avoid dried fruits because of its high sugar content. The process of drying fruits involve a lot of sugar as a preservative, so it should be a big no if you’d like to maintain normal levels of your blood sugar. Canned fruits too are no-no’s since the major preservative content is sugar which, during the manufacturing process, is provided at very high levels for a canned fruit to endure long shelf life. Small bites are not so bad, just make sure to drain the sugary syrup or rinse it with a bit of drinking water.

Exposure to metformin may inadvertently cause worsening of peripheral neuropathy in patients with Type 2 diabetes, say researchers.

“Long-term use of metformin is associated with malabsorption of vitamin B12 (cobalamin [Cbl]), and elevated homocysteine (Hcy) and methylmalonic acid (MMA) levels, which may have deleterious effects on peripheral nerves,” explain Daryl Wile and Cory Toth from the University of Calgary in Alberta, Canada.

To clarify the effect of long-term metformin treatment on the symptoms of diabetic peripheral neuropathy, the team carried out a prospective case-control study involving 59 Type 2 diabetic patients with peripheral neuropathy who had been treated with metformin for over 6 months and 63 similar patients who had not been treated with metformin (controls).

The authors used the Toronto Clinical Scoring System and Neuropathy Impairment Score (TCSS), as well as electrophysiological measures to assess the degree of neuropathy. They also measured concentrations of Cbl, Hcy, and MMA to assess their potential impact.

Writing in the journal Diabetes Care, Wile and Toth report that the metformin-treated patients had significantly lower concentrations of Cbl than controls, at a median of 231 versus 486 pmol/l.

In contrast, median Hcy and MMA were significantly higher in the metformin-treated group compared with controls, at 11.6 versus 8.4 µmol/l and 0.18 versus 0.11 µmol/l, respectively.

The TCSS and electrophysiological measures used to assess the degree of neuropathy showed that metformin-treated patients had significantly more severe peripheral neuropathy than controls (TCSS score of 10 vs 5).

The authors note that “the cumulative metformin dose correlated strongly with these clinical and paraclinical group differences.”

They conclude: “The current findings suggest an association among metformin, elevated Cbl metabolites, and exacerbation of diabetic peripheral neuropathy, but further work is needed to prove a direct causal relationship and its mechanism.”

The researchers add: “Recognition of this readily identifiable and potentially treatable component of disease might improve quality of life for this large population of diabetic patients.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

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