Snacking often gets a bad rap, but if you make intelligent choices about what you eat, you can actually benefit your health and longevity. Read on to find out how!
Why Snacks?
Most of us are used to eating three times a day, but it is much healthier to eat smaller meals more frequently -f ive small meals a day, for instance. Eating in this way delivers a steady stream of nutrients, blood sugar, and energy to your body throughout the day and is also much less taxing on the digestive and metabolic systems.
And when you eat more small meals throughout the day, you will most likely avoid the pitfalls of overindulging at your next meal and may actually consume fewer total calories for the day.
Keep healthy "grab-and-go" snacks on hand all the time to avoid the tempting lure of high-calorie snacks. Here are my top five snack choices:
1. Nuts and Seeds Keep You Young
Healthy and appetizing, nuts and seeds are absolutely the best snack of the bunch. Helping yourself to a handful of nuts and seeds every day can improve circulation and muscle tone.
And nuts and seeds are especially full of arginine, an amino acid that helps to combat heart disease, impotence, infertility, and high blood pressure, and it also facilitates the healing process. Additionally, arginine can stimulate the pituitary gland at the base of the brain.
The pituitary releases growth hormones, which begin to decline quickly in humans after age 35. This means that after 35, your hormones start to plunge and you experience some aging symptoms. The skin loses elasticity, the muscle loses mass and strength, the lean body tissue decreases, fertility and virility decrease, and other signs of aging start to set in.
Many nuts and seeds are rich sources of vitamin E, lignants and omega-3 fatty acids, which protect you from heart disease and also from the ravages of aging.
Almonds, pine nuts, sesame seeds, Brazil nuts, walnuts, pumpkin seeds, sunflower seeds, flax seeds, peanuts, and pistachios: mix them in any combination and enjoy! Keep in mind that there are more nutrients in the raw form than roasted. Make sure that the nuts and seeds are fresh and not old and rancid.
2. An Apple a Day for Heart Health
There are many reasons to eat an apple - or two or three - every day. One study discovered that subjects who ate five apples or more a week had a healthier lung function than those who ate no apples.
And scientists have confirmed that apples also contribute to a healthy heart. Thanks to the fruit's rich pectin content, eating two to three apples per day leads to decreased cholesterol levels. Pectin also helps prevent colon cancer, one of the top causes of death in adults over age sixty.
3. Bring On the Berries
In season again, berries are bursting with antioxidants. The enticing red, purple, and blue skins of berries contain bioflavonoids, antioxidant compounds that reduce free radical damage.
These flavonoids are more potent antioxidants than vitamins C and E, and they also help to reduce inflammation - more effectively even than aspirin!
• Blueberries are your best pick because not only do they have the highest level of antioxidant activity, but they also possess powerful neuroprotective properties that shield brain cells from damage , helping to slow down the age-related onset of memory loss, Alzheimer's, and senility.
• Cherries also contain these beneficial anthocyanin compounds, which stimulate your pancreas to produce insulin. In fact, Chinese researchers have observed that cherries help keep diabetics healthy. These compounds also protect you against cancer, arthritis, and heart disease because they lower cholesterol.
To learn more about the health benefits of berries, click here.
4. Avocado: Packed with Nutrients
Among the many antioxidant nutrients, glutathione is known as the "master antioxidant." This naturally occurring compound, found in avocados (as well as asparagus, walnuts, and fish), is made up of the three amino acids glycine, glutamic acid, and cysteine. Glutathione regulates immune cells, protects against cancer, and assists in detoxifying.
A deficiency in glutathione can play a part in diabetes, liver disease, heart disease, low sperm count, and premature aging. Avocados are also a source of L-cysteine, which helps protect your body from the harmful effects of pollution, chemicals, radiation, alcohol, and smoke. L-cysteine may also help boost immunity, protect you from heart disease, and build muscle. It is also useful for combating inflammation and encouraging healthy hair and nail growth.
Pair your avocado with whole-grain crackers or whole-grain crisp breads for a fiber-rich tasty treat.
5. Apricots for Anti-Aging
One of the staple foods of the famously long-lived centenarians in the Hunza valley of the Himalayas is the apricot. Research has discovered that apricots have the highest levels and widest variety of carotenoids of any food.
Carotenoids are antioxidants that help prevent heart disease, reduce "bad cholesterol" levels, and protect against cancer.
I hope you find the ways to nourish your body with healthy snacks! I invite you to visit often and share your own personal health and longevity tips with me.
May you live long, live strong, and live happy!
Tuesday, June 10, 2008
The High Fructose Corn Syrup Myth - Nutrition
It's getting hard to find a product in the supermarket these days that doesn't contain at least a small dollop of the infamous high fructose corn syrup (HFCS).
You've long known that HFCS is a commonly used sweetener in drinks like sodas, but did you realize it's also hiding in breads, salad dressings, yogurt, crackers, and soups — just for starters? Avoiding HFCS altogether might be possible (with a lot of work and label reading), but do we really need to steer clear of the stuff entirely?
One myth about HFCS is that it alters your metabolism in such a way that promotes fat storage and increases your appetite. The thought behind this is that, unlike glucose, fructose somehow keeps the body from releasing enough of the satiety hormones we need to feel full.
But this is nonsense: The makeup of HFCS (55 percent fructose and 45 percent glucose) is close to that of white sugar (50 percent fructose and 50 percent glucose), which means that our bodies digest HFCS and sugar in very similar ways.
The other big myth about high fructose corn syrup is that it's responsible for America's current obesity epidemic. Since HFCS entered our food supply in the 1970s, and the rates of obesity started to rise about then, many blame HFCS for our fat plague. It's true of course that the calories HFCS contributes can be linked to our nation's obesity problems, but its calories are no different from those in refined white sugar.
If you're casting about for the culprit behind our obesity crisis, think, too, about the huge portion sizes we are served, about how we eat out more than we eat at home nowadays, and about how our more sedentary jobs and our great love affair with the TV and computer screen have slashed our ever-dwindling exercise timetables.
So what should you do about those ubiquitous HFCS? First, reduce your intake of both HFCS and plain old sugar; decreasing your calories will in turn decrease your weight. Then think about eating more whole fruits, vegetables, and unprocessed whole grains such as rice, barley, and corn.
And realize that many other nutrition goals are more vital to your health that striving to attain a diet that's 100-percent HFCS-free.
You've long known that HFCS is a commonly used sweetener in drinks like sodas, but did you realize it's also hiding in breads, salad dressings, yogurt, crackers, and soups — just for starters? Avoiding HFCS altogether might be possible (with a lot of work and label reading), but do we really need to steer clear of the stuff entirely?
One myth about HFCS is that it alters your metabolism in such a way that promotes fat storage and increases your appetite. The thought behind this is that, unlike glucose, fructose somehow keeps the body from releasing enough of the satiety hormones we need to feel full.
But this is nonsense: The makeup of HFCS (55 percent fructose and 45 percent glucose) is close to that of white sugar (50 percent fructose and 50 percent glucose), which means that our bodies digest HFCS and sugar in very similar ways.
The other big myth about high fructose corn syrup is that it's responsible for America's current obesity epidemic. Since HFCS entered our food supply in the 1970s, and the rates of obesity started to rise about then, many blame HFCS for our fat plague. It's true of course that the calories HFCS contributes can be linked to our nation's obesity problems, but its calories are no different from those in refined white sugar.
If you're casting about for the culprit behind our obesity crisis, think, too, about the huge portion sizes we are served, about how we eat out more than we eat at home nowadays, and about how our more sedentary jobs and our great love affair with the TV and computer screen have slashed our ever-dwindling exercise timetables.
So what should you do about those ubiquitous HFCS? First, reduce your intake of both HFCS and plain old sugar; decreasing your calories will in turn decrease your weight. Then think about eating more whole fruits, vegetables, and unprocessed whole grains such as rice, barley, and corn.
And realize that many other nutrition goals are more vital to your health that striving to attain a diet that's 100-percent HFCS-free.
Saturday, May 31, 2008
Diabetes Mellitus - Did you know?
It is a syndrome characterized by disordered metabolism and abnormally high blood sugar (hyperglycaemia) resulting from insufficient levels of the hormone insulin.[2] The characteristic symptoms are excessive urine production (polyuria) due to high blood glucose levels, excessive thirst and increased fluid intake (polydipsia) attempting to compensate for increased urination, blurred vision due to high blood glucose effects on the eye's optics, unexplained weight loss, and lethargy. These symptoms are likely to be less apparent if the blood sugar is only mildly elevated.
The World Health Organization recognizes three main forms of diabetes mellitus: type 1, type 2, and gestational diabetes (occurring during pregnancy),[3] which have different causes and population distributions. While, ultimately, all forms are due to the beta cells of the pancreas being unable to produce sufficient insulin to prevent hyperglycemia, the causes are different.[4] Type 1 diabetes is usually due to autoimmune destruction of the pancreatic beta cells. Type 2 diabetes is characterized by insulin resistance in target tissues. This causes a need for abnormally high amounts of insulin and diabetes develops when the beta cells cannot meet this demand. Gestational diabetes is similar to type 2 diabetes in that it involves insulin resistance; the hormones of pregnancy can cause insulin resistance in women genetically predisposed to developing this condition.
Gestational diabetes typically resolves with delivery of the child, however types 1 and 2 diabetes are chronic conditions.[2] All types have been treatable since insulin became medically available in 1921. Type 1 diabetes, in which insulin is not secreted by the pancreas, is directly treatable only with injected insulin, although dietary and other lifestyle adjustments are part of management. Type 2 may be managed with a combination of dietary treatment, tablets and injections and, frequently, insulin supplementation. While insulin was originally produced from natural sources such as porcine pancreas, most insulin used today is produced through genetic engineering, either as a direct copy of human insulin, or human insulin with modified molecules that provide different onset and duration of action. Insulin can also be delivered continuously by a specialized pump which subcutaneously provides insulin through a changeable catheter.
Diabetes can cause many complications. Acute complications (hypoglycemia, ketoacidosis or nonketotic hyperosmolar coma) may occur if the disease is not adequately controlled. Serious long-term complications include cardiovascular disease (doubled risk), chronic renal failure, retinal damage (which can lead to blindness), nerve damage (of several kinds), and microvascular damage, which may cause impotence and poor healing. Poor healing of wounds, particularly of the feet, can lead to gangrene, which may require amputation. Adequate treatment of diabetes, as well as increased emphasis on blood pressure control and lifestyle factors (such as not smoking and keeping a healthy body weight), may improve the risk profile of most aforementioned complications. In the developed world, diabetes is the most significant cause of adult blindness in the non-elderly and the leading cause of non-traumatic amputation in adults, and diabetic nephropathy is the main illness requiring renal dialysis in the United States.
is a syndrome characterized by disordered metabolism and abnormally high blood sugar (hyperglycaemia) resulting from insufficient levels of the hormone insulin.[2] The characteristic symptoms are excessive urine production (polyuria) due to high blood glucose levels, excessive thirst and increased fluid intake (polydipsia) attempting to compensate for increased urination, blurred vision due to high blood glucose effects on the eye's optics, unexplained weight loss, and lethargy. These symptoms are likely to be less apparent if the blood sugar is only mildly elevated.
The World Health Organization recognizes three main forms of diabetes mellitus: type 1, type 2, and gestational diabetes (occurring during pregnancy),[3] which have different causes and population distributions. While, ultimately, all forms are due to the beta cells of the pancreas being unable to produce sufficient insulin to prevent hyperglycemia, the causes are different.[4] Type 1 diabetes is usually due to autoimmune destruction of the pancreatic beta cells. Type 2 diabetes is characterized by insulin resistance in target tissues. This causes a need for abnormally high amounts of insulin and diabetes develops when the beta cells cannot meet this demand. Gestational diabetes is similar to type 2 diabetes in that it involves insulin resistance; the hormones of pregnancy can cause insulin resistance in women genetically predisposed to developing this condition.
Gestational diabetes typically resolves with delivery of the child, however types 1 and 2 diabetes are chronic conditions.[2] All types have been treatable since insulin became medically available in 1921. Type 1 diabetes, in which insulin is not secreted by the pancreas, is directly treatable only with injected insulin, although dietary and other lifestyle adjustments are part of management. Type 2 may be managed with a combination of dietary treatment, tablets and injections and, frequently, insulin supplementation. While insulin was originally produced from natural sources such as porcine pancreas, most insulin used today is produced through genetic engineering, either as a direct copy of human insulin, or human insulin with modified molecules that provide different onset and duration of action. Insulin can also be delivered continuously by a specialized pump which subcutaneously provides insulin through a changeable catheter.
Diabetes can cause many complications. Acute complications (hypoglycemia, ketoacidosis or nonketotic hyperosmolar coma) may occur if the disease is not adequately controlled. Serious long-term complications include cardiovascular disease (doubled risk), chronic renal failure, retinal damage (which can lead to blindness), nerve damage (of several kinds), and microvascular damage, which may cause impotence and poor healing. Poor healing of wounds, particularly of the feet, can lead to gangrene, which may require amputation. Adequate treatment of diabetes, as well as increased emphasis on blood pressure control and lifestyle factors (such as not smoking and keeping a healthy body weight), may improve the risk profile of most aforementioned complications. In the developed world, diabetes is the most significant cause of adult blindness in the non-elderly and the leading cause of non-traumatic amputation in adults, and diabetic nephropathy is the main illness requiring renal dialysis in the United States.
Diagnosis
The diagnosis of type 1 diabetes, and many cases of type 2, is usually prompted by recent-onset symptoms of excessive urination (polyuria) and excessive thirst (polydipsia), often accompanied by weight loss. These symptoms typically worsen over days to weeks; about a quarter of people with new type 1 diabetes have developed some degree of diabetic ketoacidosis by the time the diabetes is recognized. The diagnosis of other types of diabetes is usually made in other ways. These include ordinary health screening; detection of hyperglycemia during other medical investigations; and secondary symptoms such as vision changes or unexplainable fatigue. Diabetes is often detected when a person suffers a problem that is frequently caused by diabetes, such as a heart attack, stroke, neuropathy,
poor wound healing or a foot ulcer, certain eye problems, certain fungal infections, or delivering a baby with macrosomia or hypoglycemia.
Diabetes mellitus is characterized by recurrent or persistent hyperglycemia, and is diagnosed by demonstrating any one of the following:[3]
fasting plasma glucose level at or above 126 mg/dL (7.0 mmol/l).
plasma glucose at or above 200 mg/dL (11.1 mmol/l) two hours after a 75 g oral glucose load as in a glucose tolerance test.
random plasma glucose at or above 200 mg/dL (11.1 mmol/l).
A positive result, in the absence of clinical symptoms of diabetes, should be confirmed by another of the above-listed methods on a different day. Most physicians prefer to measure a fasting glucose level because of the ease of measurement and the considerable time commitment of formal glucose tolerance testing, which takes two hours to complete. According to the current definition, two fasting glucose measurements above 126 mg/dL (7.0 mmol/l) is considered diagnostic for diabetes mellitus.
Patients with fasting glucose levels between 110 and 125 mg/dL (6.1 and 7.0 mmol/l) are considered to have impaired fasting glycemia. Patients with plasma glucose at or above 140 mg/dL or 7.8 mmol/l two hours after a 75 g oral glucose load are considered to have impaired glucose tolerance. Of these two pre-diabetic states, the latter in particular is a major risk factor for progression to full-blown diabetes mellitus as well as cardiovascular disease.
While not used for diagnosis, an elevated level of glucose irreversibly bound to hemoglobin (termed glycosylated hemoglobin or HbA1c) of 6.0% or higher (the 2003 revised U.S. standard) is considered abnormal by most labs; HbA1c is primarily used as a treatment-tracking test reflecting average blood glucose levels over the preceding 90 days (approximately). However, some physicians may order this test at the time of diagnosis to track changes over time. The current recommended goal for HbA1c in patients with diabetes is <7.0%,>glycemic control, although some guidelines are stricter (<6.5%).>retinopathy and diabetic nephropathy.[15][16]
Screening
Diabetes screening is recommended for many people at various stages of life, and for those with any of several risk factors. The screening test varies according to circumstances and local policy, and may be a random blood glucose test, a fasting blood glucose test, a blood glucose test two hours after 75 g of glucose, or an even more formal glucose tolerance test. Many healthcare providers recommend universal screening for adults at age 40 or 50, and often periodically thereafter. Earlier screening is typically recommended for those with risk factors such as obesity, family history of diabetes, high-risk ethnicity (Hispanic, Native American, Afro-Caribbean, Pacific Island, and South Asian ancestry).[17][18]
Many medical conditions are associated with diabetes and warrant screening. A partial list includes: high blood pressure, elevated cholesterol levels, coronary artery disease, past gestational diabetes, polycystic ovary syndrome, chronic pancreatitis, fatty liver, hemochromatosis, cystic fibrosis, several mitochondrial neuropathies and myopathies, myotonic dystrophy, Friedreich's ataxia, some of the inherited forms of neonatal hyperinsulinism. The risk of diabetes is higher with chronic use of several medications, including high-dose glucocorticoids, some chemotherapy agents (especially L-asparaginase), as well as some of the antipsychotics and mood stabilizers (especially phenothiazines and some atypical antipsychotics).
People with a confirmed diagnosis of diabetes are screened routinely for complications. This includes yearly urine testing for microalbuminuria and examination of the retina (retinal photography) for retinopathy. In the UK, screening for diabetic retinopathy has helped reduce the incidence of legal blindness since its implementation.[citation needed]
Prevention
Type 1 diabetes risk is known to depend upon a genetic predisposition based on HLA types (particularly types DR3 and DR4), an unknown environmental trigger (suspected to be an infection, although none has proven definitive in all cases), and an uncontrolled autoimmune response that attacks the insulin producing beta cells.[19] Some research has suggested that breastfeeding decreased the risk; [20][21] various other nutritional risk factors are being studied, but no firm evidence has been found. [22] Giving children 2000 IU of Vitamin D during their first year of life is associated with reduced risk of type 1 diabetes. [23]
Children with antibodies but no overt diabetes treated with vitamin B-3 (niacin) had less than half the onset of diabetes incidence in a 7-year time span as the general population and even lower incidence relative to those with antibodies as above, but no vitamin B3.[24]
Type 2 diabetes risk can be reduced in many cases by making changes in diet and increasing physical activity.[25][26] The American Diabetes Association (ADA) recommends maintaining a healthy weight, getting at least 2½ hours of exercise per week (a brisk sustained walk appears sufficient), having a modest fat intake, and eating a good amount of fiber and whole grains. The ADA does not recommend alcohol consumption as a preventative, but it is interesting to note that moderate alcohol intake may reduce the risk (though heavy consumption clearly increases damage to body systems significantly). There is inadequate evidence that eating foods of low glycemic index is clinically helpful.[27]
Some studies have shown delayed progression to diabetes in predisposed patients through prophylactic use of metformin,[26] rosiglitazone,[28] or valsartan.[29] In patients on hydroxychloroquine for rheumatoid arthritis, incidence of diabetes was reduced by 77%.[30] Breastfeeding might also be associated with the prevention of type 2 of the disease in mothers.[31]
Treatment and management
Main article: Diabetes management
Diabetes mellitus is currently a chronic disease, without a cure, and medical emphasis must necessarily be on managing/avoiding possible short-term as well as long-term diabetes-related problems. There is an exceptionally important role for patient education, dietetic support, sensible exercise, self glucose monitoring, with the goal of keeping both short-term blood glucose levels, and long term levels as well, within acceptable bounds. Careful control is needed to reduce the risk of long term complications. This is theoretically achievable with combinations of diet, exercise and weight loss (type 2), various oral diabetic drugs (type 2 only), and insulin use (type 1 and increasingly for type 2 not responding to oral medications). In addition, given the associated higher risks of cardiovascular disease, lifestyle modifications should be undertaken to control blood pressure[32] and cholesterol by exercising more, smoking cessation, consuming an appropriate diet, wearing diabetic socks, and if necessary, taking any of several drugs to reduce pressure. Many Type 1 treatments include the combination use of regular or NPH insulin, and/or synthetic insulin analogs such as Humalog, Novolog or Apidra; the combination of Lantus/Levemir and Humalog, Novolog or Apidra. Another Type 1 treatment option is the use of the insulin pump with some of the most popular pump brands being: Cozmo, Animas, Medtronic Minimed, and Omnipod.[5]
The World Health Organization recognizes three main forms of diabetes mellitus: type 1, type 2, and gestational diabetes (occurring during pregnancy),[3] which have different causes and population distributions. While, ultimately, all forms are due to the beta cells of the pancreas being unable to produce sufficient insulin to prevent hyperglycemia, the causes are different.[4] Type 1 diabetes is usually due to autoimmune destruction of the pancreatic beta cells. Type 2 diabetes is characterized by insulin resistance in target tissues. This causes a need for abnormally high amounts of insulin and diabetes develops when the beta cells cannot meet this demand. Gestational diabetes is similar to type 2 diabetes in that it involves insulin resistance; the hormones of pregnancy can cause insulin resistance in women genetically predisposed to developing this condition.
Gestational diabetes typically resolves with delivery of the child, however types 1 and 2 diabetes are chronic conditions.[2] All types have been treatable since insulin became medically available in 1921. Type 1 diabetes, in which insulin is not secreted by the pancreas, is directly treatable only with injected insulin, although dietary and other lifestyle adjustments are part of management. Type 2 may be managed with a combination of dietary treatment, tablets and injections and, frequently, insulin supplementation. While insulin was originally produced from natural sources such as porcine pancreas, most insulin used today is produced through genetic engineering, either as a direct copy of human insulin, or human insulin with modified molecules that provide different onset and duration of action. Insulin can also be delivered continuously by a specialized pump which subcutaneously provides insulin through a changeable catheter.
Diabetes can cause many complications. Acute complications (hypoglycemia, ketoacidosis or nonketotic hyperosmolar coma) may occur if the disease is not adequately controlled. Serious long-term complications include cardiovascular disease (doubled risk), chronic renal failure, retinal damage (which can lead to blindness), nerve damage (of several kinds), and microvascular damage, which may cause impotence and poor healing. Poor healing of wounds, particularly of the feet, can lead to gangrene, which may require amputation. Adequate treatment of diabetes, as well as increased emphasis on blood pressure control and lifestyle factors (such as not smoking and keeping a healthy body weight), may improve the risk profile of most aforementioned complications. In the developed world, diabetes is the most significant cause of adult blindness in the non-elderly and the leading cause of non-traumatic amputation in adults, and diabetic nephropathy is the main illness requiring renal dialysis in the United States.
is a syndrome characterized by disordered metabolism and abnormally high blood sugar (hyperglycaemia) resulting from insufficient levels of the hormone insulin.[2] The characteristic symptoms are excessive urine production (polyuria) due to high blood glucose levels, excessive thirst and increased fluid intake (polydipsia) attempting to compensate for increased urination, blurred vision due to high blood glucose effects on the eye's optics, unexplained weight loss, and lethargy. These symptoms are likely to be less apparent if the blood sugar is only mildly elevated.
The World Health Organization recognizes three main forms of diabetes mellitus: type 1, type 2, and gestational diabetes (occurring during pregnancy),[3] which have different causes and population distributions. While, ultimately, all forms are due to the beta cells of the pancreas being unable to produce sufficient insulin to prevent hyperglycemia, the causes are different.[4] Type 1 diabetes is usually due to autoimmune destruction of the pancreatic beta cells. Type 2 diabetes is characterized by insulin resistance in target tissues. This causes a need for abnormally high amounts of insulin and diabetes develops when the beta cells cannot meet this demand. Gestational diabetes is similar to type 2 diabetes in that it involves insulin resistance; the hormones of pregnancy can cause insulin resistance in women genetically predisposed to developing this condition.
Gestational diabetes typically resolves with delivery of the child, however types 1 and 2 diabetes are chronic conditions.[2] All types have been treatable since insulin became medically available in 1921. Type 1 diabetes, in which insulin is not secreted by the pancreas, is directly treatable only with injected insulin, although dietary and other lifestyle adjustments are part of management. Type 2 may be managed with a combination of dietary treatment, tablets and injections and, frequently, insulin supplementation. While insulin was originally produced from natural sources such as porcine pancreas, most insulin used today is produced through genetic engineering, either as a direct copy of human insulin, or human insulin with modified molecules that provide different onset and duration of action. Insulin can also be delivered continuously by a specialized pump which subcutaneously provides insulin through a changeable catheter.
Diabetes can cause many complications. Acute complications (hypoglycemia, ketoacidosis or nonketotic hyperosmolar coma) may occur if the disease is not adequately controlled. Serious long-term complications include cardiovascular disease (doubled risk), chronic renal failure, retinal damage (which can lead to blindness), nerve damage (of several kinds), and microvascular damage, which may cause impotence and poor healing. Poor healing of wounds, particularly of the feet, can lead to gangrene, which may require amputation. Adequate treatment of diabetes, as well as increased emphasis on blood pressure control and lifestyle factors (such as not smoking and keeping a healthy body weight), may improve the risk profile of most aforementioned complications. In the developed world, diabetes is the most significant cause of adult blindness in the non-elderly and the leading cause of non-traumatic amputation in adults, and diabetic nephropathy is the main illness requiring renal dialysis in the United States.
Diagnosis
The diagnosis of type 1 diabetes, and many cases of type 2, is usually prompted by recent-onset symptoms of excessive urination (polyuria) and excessive thirst (polydipsia), often accompanied by weight loss. These symptoms typically worsen over days to weeks; about a quarter of people with new type 1 diabetes have developed some degree of diabetic ketoacidosis by the time the diabetes is recognized. The diagnosis of other types of diabetes is usually made in other ways. These include ordinary health screening; detection of hyperglycemia during other medical investigations; and secondary symptoms such as vision changes or unexplainable fatigue. Diabetes is often detected when a person suffers a problem that is frequently caused by diabetes, such as a heart attack, stroke, neuropathy,
poor wound healing or a foot ulcer, certain eye problems, certain fungal infections, or delivering a baby with macrosomia or hypoglycemia.
Diabetes mellitus is characterized by recurrent or persistent hyperglycemia, and is diagnosed by demonstrating any one of the following:[3]
fasting plasma glucose level at or above 126 mg/dL (7.0 mmol/l).
plasma glucose at or above 200 mg/dL (11.1 mmol/l) two hours after a 75 g oral glucose load as in a glucose tolerance test.
random plasma glucose at or above 200 mg/dL (11.1 mmol/l).
A positive result, in the absence of clinical symptoms of diabetes, should be confirmed by another of the above-listed methods on a different day. Most physicians prefer to measure a fasting glucose level because of the ease of measurement and the considerable time commitment of formal glucose tolerance testing, which takes two hours to complete. According to the current definition, two fasting glucose measurements above 126 mg/dL (7.0 mmol/l) is considered diagnostic for diabetes mellitus.
Patients with fasting glucose levels between 110 and 125 mg/dL (6.1 and 7.0 mmol/l) are considered to have impaired fasting glycemia. Patients with plasma glucose at or above 140 mg/dL or 7.8 mmol/l two hours after a 75 g oral glucose load are considered to have impaired glucose tolerance. Of these two pre-diabetic states, the latter in particular is a major risk factor for progression to full-blown diabetes mellitus as well as cardiovascular disease.
While not used for diagnosis, an elevated level of glucose irreversibly bound to hemoglobin (termed glycosylated hemoglobin or HbA1c) of 6.0% or higher (the 2003 revised U.S. standard) is considered abnormal by most labs; HbA1c is primarily used as a treatment-tracking test reflecting average blood glucose levels over the preceding 90 days (approximately). However, some physicians may order this test at the time of diagnosis to track changes over time. The current recommended goal for HbA1c in patients with diabetes is <7.0%,>glycemic control, although some guidelines are stricter (<6.5%).>retinopathy and diabetic nephropathy.[15][16]
Screening
Diabetes screening is recommended for many people at various stages of life, and for those with any of several risk factors. The screening test varies according to circumstances and local policy, and may be a random blood glucose test, a fasting blood glucose test, a blood glucose test two hours after 75 g of glucose, or an even more formal glucose tolerance test. Many healthcare providers recommend universal screening for adults at age 40 or 50, and often periodically thereafter. Earlier screening is typically recommended for those with risk factors such as obesity, family history of diabetes, high-risk ethnicity (Hispanic, Native American, Afro-Caribbean, Pacific Island, and South Asian ancestry).[17][18]
Many medical conditions are associated with diabetes and warrant screening. A partial list includes: high blood pressure, elevated cholesterol levels, coronary artery disease, past gestational diabetes, polycystic ovary syndrome, chronic pancreatitis, fatty liver, hemochromatosis, cystic fibrosis, several mitochondrial neuropathies and myopathies, myotonic dystrophy, Friedreich's ataxia, some of the inherited forms of neonatal hyperinsulinism. The risk of diabetes is higher with chronic use of several medications, including high-dose glucocorticoids, some chemotherapy agents (especially L-asparaginase), as well as some of the antipsychotics and mood stabilizers (especially phenothiazines and some atypical antipsychotics).
People with a confirmed diagnosis of diabetes are screened routinely for complications. This includes yearly urine testing for microalbuminuria and examination of the retina (retinal photography) for retinopathy. In the UK, screening for diabetic retinopathy has helped reduce the incidence of legal blindness since its implementation.[citation needed]
Prevention
Type 1 diabetes risk is known to depend upon a genetic predisposition based on HLA types (particularly types DR3 and DR4), an unknown environmental trigger (suspected to be an infection, although none has proven definitive in all cases), and an uncontrolled autoimmune response that attacks the insulin producing beta cells.[19] Some research has suggested that breastfeeding decreased the risk; [20][21] various other nutritional risk factors are being studied, but no firm evidence has been found. [22] Giving children 2000 IU of Vitamin D during their first year of life is associated with reduced risk of type 1 diabetes. [23]
Children with antibodies but no overt diabetes treated with vitamin B-3 (niacin) had less than half the onset of diabetes incidence in a 7-year time span as the general population and even lower incidence relative to those with antibodies as above, but no vitamin B3.[24]
Type 2 diabetes risk can be reduced in many cases by making changes in diet and increasing physical activity.[25][26] The American Diabetes Association (ADA) recommends maintaining a healthy weight, getting at least 2½ hours of exercise per week (a brisk sustained walk appears sufficient), having a modest fat intake, and eating a good amount of fiber and whole grains. The ADA does not recommend alcohol consumption as a preventative, but it is interesting to note that moderate alcohol intake may reduce the risk (though heavy consumption clearly increases damage to body systems significantly). There is inadequate evidence that eating foods of low glycemic index is clinically helpful.[27]
Some studies have shown delayed progression to diabetes in predisposed patients through prophylactic use of metformin,[26] rosiglitazone,[28] or valsartan.[29] In patients on hydroxychloroquine for rheumatoid arthritis, incidence of diabetes was reduced by 77%.[30] Breastfeeding might also be associated with the prevention of type 2 of the disease in mothers.[31]
Treatment and management
Main article: Diabetes management
Diabetes mellitus is currently a chronic disease, without a cure, and medical emphasis must necessarily be on managing/avoiding possible short-term as well as long-term diabetes-related problems. There is an exceptionally important role for patient education, dietetic support, sensible exercise, self glucose monitoring, with the goal of keeping both short-term blood glucose levels, and long term levels as well, within acceptable bounds. Careful control is needed to reduce the risk of long term complications. This is theoretically achievable with combinations of diet, exercise and weight loss (type 2), various oral diabetic drugs (type 2 only), and insulin use (type 1 and increasingly for type 2 not responding to oral medications). In addition, given the associated higher risks of cardiovascular disease, lifestyle modifications should be undertaken to control blood pressure[32] and cholesterol by exercising more, smoking cessation, consuming an appropriate diet, wearing diabetic socks, and if necessary, taking any of several drugs to reduce pressure. Many Type 1 treatments include the combination use of regular or NPH insulin, and/or synthetic insulin analogs such as Humalog, Novolog or Apidra; the combination of Lantus/Levemir and Humalog, Novolog or Apidra. Another Type 1 treatment option is the use of the insulin pump with some of the most popular pump brands being: Cozmo, Animas, Medtronic Minimed, and Omnipod.[5]
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