Type 2 Diabetes has adverse effect on the sugar levels of our body. The sugar levels need to be kept within a certain range and a condition where it is well above the permissible limit or below it can become a cause of worry. Eating healthy snacks can minimize the risk of Type 2 diabetes.

In this form of diabetes, the insulin generated in the body is either insufficient or is rejected by the cells. Insulin helps in utilizing the glucose for producing energy. Insulin helps to carry the glucose to the cells. If it does not reach the cells, then the body cannot make use of it for generating energy. In case, the cells cannot utilize the glucose, it remains in the blood. An excessive amount of glucose in the blood can cause diabetes. Type 2 Diabetes occurs as a result of insulin resistance and obesity.

The conditions, which lead to the occurrence of Type 2 Diabetes, include snacking, excessive eating, consumption of high calorie drinks, and foods high on carbohydrate content. All these shoot up the sugar levels in the body. Since the sugar cannot reach the tissues, its levels rise in the blood. Obese people are more prone to insulin resistance as the fat in the body acts as a barrier to the optimum utilization of the insulin. In the United States of America almost one-third of the total population are obese and it is expected that 30% of the children who are born after 2000 are prone to get diabetes.

When it comes to kids it is necessary to inculcate in them correct food habits. They are not aware of what is good and nutritional food for them. The onus here lies with the schools and the parents of the kids. In the past schools organized fundraising events and the selling of chocolate bars was an integral part of them. With the introduction of California SB 12 and other similar laws in other US states, chocolate fundraising was banned.

Searching for healthy fundraising solutions can solve this problem. Schools can now order healthy fundraising snacks that are low on calories. To be healthy, they would comprise less that 35% fat, 10% less saturated fats, 25% less sugar. All in all, your child can have all these sumptuous snacks and even then consume less that 250 calories. If the snacks are healthy, there will be no harmful trans-fats as these need to be completely avoided by obese people.

Healthy fundraising does not mean that the food served is bland. They are equally tasty as fries, burgers and pizzas and the kids are definitely going to love them. It is important to make decisions to look for healthy fundraising alternatives, and contribute to better health in America.

Patients with Type 2 diabetes have an altered fatty acid pattern compared with individuals with normal glucose tolerance, research shows.

In particular, diabetics had diminished ?”5-desaturase activity that was inversely correlated with the homeostatic model assessment of insulin resistance (HOMA-IR), suggesting that “changes in fatty acid metabolism play a role in the etiology of Type 2 diabetes,” say Geertruida van Woudenbergh (Wageningen University, The Netherlands) and colleagues.

Plasma or serum fatty acid profiles reflect endogenous conversion of ingested fatty acids by desaturation, elongation, or both.

The association between the proportion of individual fatty acids within fatty acid profiles and Type 2 diabetes and related markers have been investigated in several cross-sectional and longitudinal studies with varying results.

Proportions of trans-fatty acids (TFA) are of particular interest because they may increase inflammatory cytokines that could affect the process leading to Type 2 diabetes.

To investigate, the researchers reviewed data on 471 participants from the Dutch Cohort study on Diabetes and Atherosclerosis Maastricht (CoDAM).

Individual fatty acids in serum cholesteryl esters were determined and endogenous conversions by desaturases were estimated from product-to-precursor ratios. Proportions of fatty acids were compared among participants with normal glucose tolerance (n=279), impaired glucose metabolism (n=115), and newly diagnosed Type 2 diabetes (n=77).

The proportions of total monounsaturated fatty acids (MUFA), polyunsaturated fatty acids (PUFA), and TFA did not differ significantly among the three groups, but proportions of several individual MUFA and PUFA did. The proportion of C18:1n7 was lower in participants with Type 2 diabetes (0.97%) than in those with normal glucose tolerance (1.07%) orimpaired glucose metabolism (1.05%).

The proportion of C20:3n6 was higher in those with Type 2 diabetes (0.86%) and impaired glucose metabolism (0.85%) than in those with normal glucose tolerance (0.80%).

Activity of ?”5-desaturase, that is, the ratio of C20:4n6 to C20:3n6, was lower in participants with Type 2 diabetes (7.4) than in those with normal glucose tolerance (8.4). HOMA-IR correlated positively with ?”9-desaturase activity and inversely with ?”5-desaturase activity.

“The major strength of this study was that information on serum cholesteryl fatty acids and diet was available,” van Woudenbergh et al comment.

“Adjustment for energy, fiber, and alcohol hardly influenced mean proportions, which may suggest that the association between proportions of fatty acids and glucose tolerance status is not affected by these dietary factors.”

The research is published in the journal Nutrition, Metabolism & Cardiovascular Diseases.

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

Consumption of trans-palmitoleate, a component of dairy products not produced by the body, reduces insulin resistance and incidence of diabetes, report US researchers.

“There has been no clear biologic explanation for the lower risk of diabetes seen with higher dairy consumption in prior studies,” said lead author Dariush Mozaffarian (Harvard School of Public Health, Boston, Massachusetts).

“We wonder whether this naturally occurring trans fatty acid in dairy fats may partly mimic the normal biologic role of its cis counterpart, cis-palmitoleic acid, a fatty acid that is produced in the body. In animal experiments, cis-palmitoleic acid protects against diabetes.”

Mozaffarian and team carried out a prospective cohort study between 1992 and 2006 including 3736 adults from the Cardiovascular Health Study from four US communities. They investigated whether circulating levels of trans-palmitoleate at baseline influence metabolic risk and incident Type 2 diabetes.

Individuals who consumed whole-fat dairy were most likely to have high circulating levels of trans-palmitoleate.

Comparing the highest with the lowest quintile for trans-palmitoleate, the researchers found that high-density lipoprotein (HDL) levels were 1.9% higher, and triglycerides, total cholesterol-to-HDL cholesterol ratio, C-reactive protein levels, and insulin resistance were 19.0%, 4.7%, 13.8%, and 16.7% lower, respectively.

Overall, 304 individuals developed incident Type 2 diabetes during the study. Those in quintiles four and five, had a 59% and 62% reduction in risk for incident diabetes compared with quintile one, respectively.

“Our findings support a role of this fatty acid in previously observed metabolic benefits of dairy consumption, with pathways potentially related to insulin resistance, atherogenic dyslipidemia, and regulation of hepatic fat synthesis,” write the authors in the Annals of Internal Medicine.

“These results support the need for additional detailed experimental and clinical investigation, including animal experiments and metabolic feeding studies, to assess the potential health effects of trans palmitoleate.”

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

Overweight or obesity in the absence of the metabolic syndrome can significantly raise a man’s risk for developing Type 2 diabetes, show study findings.

Presence of the metabolic syndrome, for which obesity is a common component, has been linked to increased risk for developing diabetes, but it is less clear whether overweight or obesity alone can increase such risk. Indeed, it has been proposed that there may be an obese subgroup who are metabolically healthy and at low risk for diabetes.

Writing in the journal Diabetes Care, Johan Ärnlov (Uppsala University, Sweden) and colleagues report results from the Uppsala Longitudinal Study of Adult Men (ULSAM) from 1675 men without diabetes at baseline.

The participants were followed up for 20 years for incident diabetes, and associations with body mass index (BMI) or presence of the metabolic syndrome (modified National Cholesterol Education Panel Adult Treatment Panel III definition) at baseline were also evaluated.

At 20 years, 160 of the men had developed Type 2 diabetes. As expected, men who were normal weight (BMI 18.5-24.9 kg/m²), overweight (BMI 25-29.9 kg/m²), or obese (BMI 30 kg/m² or above) and had the metabolic syndrome were at increased risk for developing diabetes during follow up. They had a 3.28-, 7.77-, and 10.06-fold increased risk, respectively, compared with men of normal weight without the metabolic syndrome at baseline.

However, men without the metabolic syndrome who were overweight or obese at baseline also had significantly increased risk for developing Type 2 diabetes, with a respective 3.49- and 11.72-fold increased risk compared with normal-weight men without the syndrome.

The authors conclude that “the increased risk for Type 2 diabetes in overweight/obese men without the metabolic syndrome or insulin resistance in the present study provides additional evidence that opposes the existence of a healthy obese phenotype based on the definition of absence of the metabolic syndrome or insulin resistance.”

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

Free abstract

Increased levels of leptin are associated with raised bone mineral density (BMD) in men with Type 2 diabetes, report researchers.

Leptin is thought to stimulate bone formation and inhibit osteoclastogenesis, thus having an overall positive effect on BMD, but the exact mechanism for this is unknown.

As patients with diabetes are commonly leptin-resistant and thought to be at increased risk for fractures, Noboru Takamura (University of Nagasaki, Japan) and colleagues investigated links between leptin concentration and BMD in 168 Belarusian men with Type 2 diabetes aged 45-65 years.

The participants had a mean leptin level of 7.8 g/l, ranging from 3.4-16.1 g/l. BMD of the femur was measured using X-ray absorptiometry.

After adjusting for possible confounding factors, such as body mass index, waist-to-hip ratio, insulin resistance, and triglycerides, the researchers found that BMD significantly and positively correlated with (log) leptin levels.

Takamura and co-workers suggest that leptin may stimulate bone formation by “acting on human marrow stromal cells to enhance osteoblasts and inhibit adipocyte differentiation,” and may inhibit osteoclastogenesis by “decreasing the receptor activator of nuclear factor-jB and its ligand and increasing the production of osteoprotegerin, a mediator of mineral metabolism.”

The researchers concede that the study size was small and that they did not measure specific body composition values such as waist-to-thigh ratio or fat mass.

However, they say that “BMD of the femur was positively associated with leptin in male patients with Type 2 diabetes mellitus.”

Takamura et al conclude in the journal Acta Diabetologia: “Further research is necessary to confirm this association and to develop ways to correct abnormalities of bone metabolism in patients with Type 2 diabetes mellitus.”

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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US researchers have discovered that leptin therapy can significantly improve the symptoms of patients with different forms of lipodystrophy.

Lipodystrophy is a rare condition that can be genetic or acquired and is characterized by loss of adipose tissue, low levels of leptin, dyslipidemia, severe insulin resistance, and diabetes.

In this study, Phillip Gordon and fellow researchers, from the National Institutes of Health in Bethesda, Maryland, carried out a prospective open-label study of leptin replacement therapy in 48 patients with acquired and inherited forms of lipodystrophy.

The median baseline age of the participants was 18 years, but ranged from 8 to 68 years, and 81% of the participants were female.

Recombinant methionyl human leptin was used to treat the patients at doses ranging from 0.04??”0.24 mg/kg/day. The participants were treated for varying periods of time, with 43 patients continuing therapy for at least 4 months, and 35 patients for at least 12 months.

Writing in the journal Diabetologia, the authors report that 12 months treatment with leptin lead to significant improvements in serum triglycerides, total cholesterol, and glycated hemoglobin (HbA1c) levels. There was also a nonsignificant trend for improvement in low-density lipoprotein cholesterol concentration, but high-density lipoprotein cholesterol levels were unaffected.

In patients who were treated for 12 months or more, triglyceride levels fell by 6.02 mmol/l (533.19 mg/dl), total cholesterol by 1.78 mmol/l (68.83 mg/dl), and HbA1c decreased by 1.5% from baseline.

Of note, proteinuria was also reduced with leptin replacement, the researchers report.

“Lipodystrophy is a complex condition with many different etiologies, but the primary metabolic derangement in this condition appears to be caused by leptin deficiency,” comment Gordon et al.

“We confirm that leptin administration is effective in ameliorating the major metabolic abnormalities seen in lipodystrophy,” they conclude.

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

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Metformin treatment is moderately effective at reducing body mass index (BMI) and insulin resistance in obese children and adolescents, show results from a systematic review and meta-analysis.

“Metformin has been shown to reduce weight gain, hyperinsulinemia, and hyperglycemia in adults with Type 2 diabetes and to reduce progression from impaired glucose tolerance to diabetes in those without diabetes,” say Russell Viner (University College London, UK) and colleagues.

“These benefits have led to an increase in the use of metformin in obese children with hyperinsulinemia,” they add. This is concerning as obesity is not currently a licensed indication for metformin in either the USA or the UK, but use of metformin in these children has increased faster than the evidence of clinical benefit.

In this study, Viner and team carried out a systematic review and meta-analysis of five trials containing data on metformin use in obese children with a total of 320 participants.

Studies were included if they were double blind randomized controlled trials of 6 months or longer in duration and included obese individuals aged 19 years or younger who did not have diabetes or secondary syndromic obesity.

The researchers report in the journal Diabetes Care that, treatment with metformin reduced BMI by an average of 1.42 kg/m² and homeostasis model assessment insulin of resistance (HOMA-IR) score by 2.01 compared with placebo.

“Metformin may be efficacious in reducing BMI and insulin resistance among obese hyperinsulinemic children and adolescents in the short term,” say the authors.

However, they conclude: “Larger, long term studies across different populations are needed to establish the role of metformin as therapy for obesity and cardiometabolic risk in young people.”

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

When you were first diagnosed with type 2 diabetes you learned the extra weight you put on over many years, played a large role in you developing type 2. Carrying fat around your abdominal area led to your insulin becoming less effective … this is known as insulin resistance, meaning your body had to produce more and more insulin to control your blood sugar levels.

Eventually your pancreas could not produce enough insulin and your blood sugar levels started to rise. This is the point at which your type 2 diabetes occurred. Whilst sweet foods did not in themselves cause this condition, excess calories of any kind, sweets, cake, potatoes, sugary drinks and alcohol, or maybe not enough physical activity together with eating too much food, is clearly related to being overweight or obese. Add to this a genetic flaw and obesity makes you more likely to develop type 2.

Now you are at this stage you find you need to watch what you eat. Most people like fruit, and yes, you can eat fruit but you need to watch the amount and type you eat.

Eating fruits that contain high fructose or high fruit sugar levels, can lead to problems. This would be like eating pure sugar and pure sugar has a GI value of 100 and eating carbohydrates with a GI value that high would certainly negatively affect your blood sugar levels.

Actually health care practitioners who once believed all fruit was good for the body, have reconsidered that idea and can now see it’s the glycemic index of the fruit that matters most. Fruits that rank high on the GI scale include:

• raisins, they are? even higher than grapes
• pineapple
• very ripe peaches and nectarines
• cantaloupe and watermelon (but because they are primarily water you can eat one cup of them without having to worry about spiking blood sugar levels)

Lower ranking fruits include:

• cherries
• grapefruit
• prunes
• dried apricots
• apple
• pears
• plums
• strawberries
• oranges

The key is simply select the best carbohydrate fruits … low-GI, which are equal to fifty-five per cent or less on a carbohydrate ranking. Know which fruits have a high glycemic index and which ones it would be wise to eat in moderation:

• half cup pineapple,
• 10 grapes,
• 2 tablespoons raisins,
• a half a large peach or ripe nectarine

This is one of the ways you start to gain control over your blood sugar levels.

The pathologic changes that lead to myocardial insulin resistance in Type 2 diabetes and left-ventricular dysfunction (LVD) are distinctly different, report researchers in the European Heart Journal.

“Whole body insulin resistance is a predominant feature of non-insulin-dependent diabetes mellitus and, although less well recognized, it is also a feature of LVD and congestive heart failure,” write Paolo Camici (Imperial College, London, UK) and co-workers.

Despite the increasing global burden of diabetes, the pathophysiology of tissue- and disease-specific insulin resistance remains unclear.

Camici and colleagues therefore studied skeletal and cardiac muscle biopsies from nine patients with Type 2 diabetes and eight patients with LVD, and seven control volunteers who had neither of these conditions, all of whom were waiting for routine cardiac surgery. Glycemic control and myocardial glucose uptake were also studied using euglycemic-hyperglycemic clamping techniques and positron emission tomography.

Analysis revealed that the expression of insulin receptor substrate (IRS)-1 was significantly decreased compared with normal in skeletal muscle tissue from patients with LVD, while the activity of cardiac IRS-1 P13K was significantly increased both in patients with LVD and those with Type 2 diabetes.

In addition, expression of the glucose transporter (GLUT)-4 was significantly decreased in the sarcolemma of patients with Type 2 diabetes and significantly increased in the sarcolemma of patients with LVD. Despite this, insulin-stimulated glucose uptake was lower than usual in those with LVD.

“The results of the present study provide some novel findings of the mechanisms underlying whole body and myocardial insulin resistance in patients with Type 2 diabetes or LVD,” conclude the authors.

However, the researchers say that their study is limited by the fact that they “compared glucose utilization measured during euglycaemic??”hyperinsulinaemic clamp in vivo, with molecular analysis carried out ex vivo on samples obtained at the time of surgery.”

The investigators say they cannot explain why the increased GLUT-4 expression observed in patients with LVD was accompanied by decreased insulin-stimulated glucose uptake, but hypothesise that this may be due to “elevated adrenergic signaling in the failing heart, which is been shown to affect some components of insulin signaling.”

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

There is no magic answer to losing weight or keeping it stable … unfortunately. Weight loss or weight gain really depends on balancing the calories you eat against the calories you use in your day to day activities. So, if you eat more than you use, you will definitely put on weight.

When you received your type 2 diabetes diagnosis, I am sure you were told about a healthy lifestyle program which included an eating plan with reduced amounts of refined carbohydrate or sugar, and better dietary choices. I also feel certain you were encouraged to add exercise to your program to help bring your weight under control and as an aid in reducing your blood sugar levels.

Any increase in physical activity increases your insulin sensitivity and reduces your risk of heart attack. How much exercise do you need to do to get good results? Various reports have led the US Surgeon General and the American College of Sports Medicine to suggest thirty minutes of vigorous exercise almost every day, preferably every day. If you find this doesn’t work for you, simply walking briskly each day for approximately forty-five minutes can lower your insulin resistance and help greatly with your weight loss.

Before increasing the amount of exercise you are doing at present check with your health care provider. Have a thorough physical examination if you:

• are more than thirty years of age
• have not exercised for the past six or more months
• have any cardiovascular condition, eg. heart disease, high blood pressure, or have experienced fainting or weakness of any description
• have had a heart attack
• have asthma or any lung disease
• have arthritis
• have insulin-dependent diabetes … your insulin dose will need to be adjusted

Exercise is great but you can’t just do it for a bit, then stop and expect your type 2 diabetes and insulin resistance to be cured. Once you stop exercising on a regular basis, your insulin levels will go right back up to their old levels. There are studies that show the beneficial effects of exercise only last for about sixty hours.

Any exercise is better than none though … a single exercise session can increase the efficiency of your insulin both during exercise and for as much as two days afterward, even if you are not physically fit. If you are fit and exercise on a regular basis, your results will be better still.