Tag Archives: Type 2 Diabetes

Insulin: Type 1 & Type 2 Diabetes Differences

When we think about insulin, we know that all of our bodies have a pancreas that sits in the middle of it and, within the pancreas, there specialized cells that go ahead and release insulin. The way I like to think about it is it’s a key that unlocks ourselves so that the food and nutrients we eat are able to be metabolized and used for fuel by our body.

In Type 1 diabetes, we always tell families it’s an autoimmune process. So for some reason, your body sees those insulin producing cells within your pancreas as being foreign, so it starts attacking those cells. So going back to that key analogy, we think about, all of a sudden there’s not a lot of keys available.

Youth with Type 2 diabetes have a different situation going on. In that situation., it’s an issue with insulin resistance and so the way that I think about it is that you still have keys, but the keys are the wrong shape now. The difference between Type 1 and Type 2 diabetes is really the fact that, in Type 1 diabetes, you are relying on exogenously administered insulin for survival.

In Type 2 diabetes, you have insulin that your body’s making. However, you cannot use it appropriately and so youth present with high blood sugars, but in conjunction with that, they often have high insulin levels and so we need to initiate insulin therapy. So giving injections, but over time we may be able to transition to alternative means to manage their glucose levels and I have to say, Yale is at the cutting edge of developing new treatments for kids diagnosed with diabetes.

When using injected insulin therapy or pumping insulin, what we’re trying to do is closely match what your body should be making and so there’s lots of different insulin therapies out there and the amazing thing to think is, you know, 100 years ago this was just discovered, it was one of the initial presentations on insulin therapy. It was here at Yale. People started on insulin therapy in 1922 and it’s come such a long way.

As somebody living with Type 1 diabetes, I can share with you that in 1987 when I was diagnosed, I was on purified pork insulin and so I don’t feel very old, but saying that I took a purified pork insulin therapy makes me feel very, very old and very grateful for how these therapies have improved and how we’re better able to match the physiologic profiles of what your body should make.

Insights: The Lucrative Business Of Diabetes (2022)

In our modern consumer society, Type 2 diabetes has become a widespread disease. Companies are developing drugs that are increasingly expensive, but not necessarily more effective. Health authorities are powerless. Diabetes is spreading rapidly, all over the world.

The disease destroys lives and puts a strain on public budgets. The UN is calling on governments to take action. Diabetes is proof that modern societies are incapable of adequately treating chronic disease. It affects around 430 million people worldwide, with two main metabolic disorders falling under the name diabetes.

Type 1 is an autoimmune disease that must be treated with lifelong doses of insulin, while type 2 can develop when a person’s diet is too high in fat and sugar and they do not engage in enough physical activity. With turnover of $46 billion, diabetes is a massive and extremely lucrative market. Constantly promised miracle cures have not led to satisfactory treatment, with patients either taking too many drugs or no longer being able to afford them.

It’s a desperate situation, and the only ones benefiting seem to be pharmaceutical companies. A medical focus on blood glucose levels has led to an overreliance on medication, sometimes without due concern for dangerous side effects. Patients become trapped in a cycle of treatment, which in many cases still does not halt the disease’s progression. This can lead to amputations, blindness and heart attacks.

And yet there are alternatives that could flatten the curve of the type 2 diabetes epidemic, while reducing health care spending. Improved diet can be a preventative measure, and a strict adherence to diet can also bring about remission in the case of Type 2 diabetes. But these solutions require effort, as well as a complete rethinking of chronic disease management. Filmed on three continents, this documentary features industry whistleblowers, patients, researchers and medical professionals. It also confronts pharmaceutical companies about their responsibility for the situation.

Studies: Covid Increases Type 2 Diabetes Risk By 40%

The true disability cost of the COVID-19 pandemic is still unknown, but more and more studies are adding to the list of potential fallout from even mild COVID 19 infection. 

In this episode of Coronapod we discuss a massive association study which links COVID-19 cases with an increase in the risk of developing type 2 diabetes. We delve into the numbers to ask how big the risk might be? Whether any casual relationship can be drawn from this association? And what might be in store from future research into COVID and chronic disease?

News: Diabetes risk rises after COVID, massive study finds

Medicine: Is Metformin A Wonder Drug? (Harvard)

DIABETES: THE ROLE OF INSULIN AND ISLETS (VIDEO)

Type 1 and type 2 diabetes are characterized by increased blood glucose levels. They affect almost half a billion people around the globe, and this number is projected to rise as we reach the middle of the century. In most individuals, blood glucose levels are kept within a healthy range by a hormone called insulin, which is secreted by the pancreas, but this fine-tuned regulation can go wrong in type 1 and type 2 diabetes. In this animation, we lay out our current understanding of these diseases and explore active areas of research that aim to restore the body’s blood glucose control.

MEDICINE: ‘DIABETES’ – RISKS & DIAGNOSIS (BMJ PODCAST)

In this episode of the JIM Podcast, Editor-in-Chief Richard McCallum speaks with David Cistola of Texas Tech University Health Sciences Center El Paso about American Diabetes Month.

HEALTH: ‘DIABETES AND CHRONIC KIDNEY DISEASE’ – NEW GUIDELINES (OCT 2020)

Comprehensive care in patients with diabetes and CKD

Management of CKD in diabetes can be challenging and complex, and a multidisciplinary team should be involved (doctors, nurses, dietitians, educators, etc). Patient participation is important for self-management and to participate in shared decision-making regarding the management plan. (Practice point).

We recommend that treatment with an angiotensin-converting enzyme inhibitor (ACEi) or an angiotensin II receptor blocker (ARB) be initiated in patients with diabetes, hypertension, and albuminuria, and that these medications be titrated to the highest approved dose that is tolerated (1B).

Lifestyle interventions in patients with diabetes and CKD

We suggest maintaining a protein intake of 0.8 g protein/kg)/d for those with diabetes and CKD not treated with dialysis (2C).

On the amount of proteins recommended in these guidelines, they suggest (‘recommend’ becomes a ‘suggest’ at this level of evidence) a very precise  intake of 0.8g/kg/d in patients with diabetes and CKD. Lower dietary protein intake has been hypothesized but never proven to reduce glomerular hyperfiltration and slow progression of CKD, however in patients with diabetes, limiting protein intake below 0.8g/kg/d can be translated into a decreased caloric content, significant weight loss and quality of life. Malnutrition from protein and calorie deficit is possible.

Physical activity

We recommend that patients with diabetes and CKD be advised to undertake moderate-intensity physical activity for a cumulative duration of at least 150 minutes per week, or to a level compatible with their cardiovascular and physical tolerance (1D).

Read full guidelines

STUDIES: “INSOMNIA / SHORT SLEEP DURATION” IS A TYPE 2 DIABETES “RISK FACTOR”

Diabetologia  (Sept 8, 2020) – Insomnia with objective short sleep duration has been associated with an increased risk of type 2 diabetes in observational studies [2728]. The present MR study found strong and suggestive evidence of a causal association of insomnia and short sleep duration, respectively, with increased risk of type 2 diabetes.

Conclusions/interpretation

The present study verified several previously reported risk factors and identified novel potential risk factors for type 2 diabetes. Prevention strategies for type 2 diabetes should be considered from multiple perspectives on obesity, mental health, sleep quality, education level, birthweight and smoking.

Read full study

COMMENTARY

This was a laborious and apparently objective study.

The discovery of insomnia as a unique risk factor is no surprise, and reinforces the restorative IMPORTANCE of SLEEP.

I was surprised to see docosohexanoic and Eicosapentanoic acids in the risk column and LDL in the good column. However they were studying type 2 diabetes, and not vascular health. I will continue to take my fish oil, and enjoy my HDL, which is in the good column.

—Dr. C.