Infection, Diabetes and Septic Shock

Sepsis should be one of the most feared diseases facing individuals with diabetes.  I’m not sure that it is, probably because it is generally not well understood and is not reported in the same dramatic manner as other illnesses.

However, those diagnosed with sepsis have up to a ~16% mortality rate.  This rises 40% for those with severe sepsis and to over 60% for those with septic shock.  Unlike cancer, which is significantly less deadly (see the figure), sepsis can strike in a matter of days and takes its toll on the young and old alike.  To make matters worse, there is apparently not a clear diagnostic criteria until the disease has progressed.  Until then, clinicians look for two or three indication that are often qualitative.  And, every hour that treatment is delayed carries a 7% increase in mortality.

What is sepsis?  It is the overwhelming response of the body to an infection.  It is the body’s deady response to infection or injury.

I once attended a talk in which the presenter described the body’s immune system as a booby-trap that is set to self-destruct when an intruder enters its premises.  The infection is the intruder and the response of the body’s immune system is what actually causes the deadly blast.

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Sad Case of Hypoglycemia

The dangers are all too real:

A NORTH-WEST man died within hours of being discharged from the North West Regional Hospital in what a coroner has labelled a “regrettable misjudgment”.
The diabetic man, known as Mr H, was taken to the emergency department of the North West Regional Hospital in Burnie suffering a low blood-sugar level about 5.30pm on January 10, 2009.
An investigation by Coroner Rod Chandler found the 46-year-old was discharged at 7pm and died at home about 1.45am the next day.
“In these circumstances the decision to permit Mr H to go home about 7pm on 10 January, 2009, was a regrettable misjudgment,” he said.
“Had he remained in hospital for a longer period and been subject to close monitoring and to more intensive investigations then it is likely in my view that the seriousness of his condition would have become evident and life-saving treatment put in place.
“These matters give rise to the question whether the decision to permit Mr H to go home without further monitoring and/or investigation was, in all the circumstances, a reasonable one.”
Health authorities implemented new procedures after the man’s death.
The man, a self-employed electrical technician, weighed 150kg and was taken by ambulance to the hospital with a very low blood sugar level of 1.5 millimoles per litre.

For those in the United States, the man weight 330lbs and his glucose was measured below 25 mg/dL.

Diabetes may lead to mild cognitive impairment

We often focus on the physical problems that stem from diabetes such as neuropathy, heart disease and blindness. Considering the ever increasing incidence of the disease, and in particular Type 2 Diabetes, the consequences of not making obvious lifestyle changes on individuals, families, and society is quite staggering.
Unfortunately, the complications related to diabetes are not limited to the body but may also impact the mind. According to a report in the April issue of Archives of Neurology, individuals with diabetes may have a higher risk of developing mild cognitive impairment, a condition that involves difficulties with thinking and learning and may be an intermediate step toward Alzheimer’s disease.
The time to change is now, prior to the development or maturation of complications, if not for yourself, for the people you love.

High Blood Sugars: a Surprising Culprit in the Search for Causes of Diabetic Birth Defects

Over the past several years, Joslin Investigator Mary R. Loeken, Ph.D., and her colleagues at Joslin Diabetes Center have unlocked several mysteries behind what puts women with diabetes more at risk of having a child with birth defects.

Even though those risks have decreased significantly over the years, thanks in part to advancements at Joslin, women with diabetes still are two to five times more likely than the general population to have a baby with birth defects, especially of the heart and spinal cord, organs that form within the first few weeks of pregnancy.

In past work, Dr. Loeken and her research team were able to establish through their studies in mice that the mother’s high blood glucose levels are the cause of these defects. This is one of the reasons why women with diabetes who are planning a pregnancy are encouraged to have their blood glucose levels under good control prior to conception. The Joslin researchers also have shown that the damage occurs because the extra glucose in the mother’s blood inhibits the expression of embryonic genes that control essential developmental processes.
Now, in this latest study done in mice, Dr. Loeken and her colleagues have discovered that the protein called glucose transporter 2 (Glut2) makes it possible for the high concentrations of glucose to get into the embryonic cells efficiently when the mother’s blood glucose concentrations are high. Also involved in the study was Rulin Li, Ph.D., a former postdoctoral fellow at Joslin. The study, supported by the National Institutes of Health, will appear in the March print edition of Diabetologia and was published online by the journal on Jan. 18.

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Promising New Anti-cancer Treatment Approved For HER2-Positive Breast Cancer

The FDA has approved Tykerb (lapatinib), a new targeted anti-cancer treatment that is significantly more effective than current medicines in fighting advanced stage of breast cancer, for use in combination with capectabine (Xeloda), another cancer drug, for patients with advanced, metastatic breast cancer that is HER2 positive (tumors that exhibit HER2 protein): The combination treatment is indicated for women who have received prior therapy with other cancer drugs, including an anthracycline, a taxane, and trastuzumab (Herceptin). According to the American Cancer Society, about 180,000 new cases of breast cancer are diagnosed each year. Approximately 8,000 to 10,000 women die from metastatic HER2 positive breast cancer each year.
more at Hyscience

Burning or Tingling Feet May Be Warning of Pre-diabetes

Adult onset, or type 2 diabetes, is a growing problem in the United States. Researchers estimate that about 10 percent of Americans will develop diabetes during their lifetime and about twice that number will develop a milder form of diabetes called impaired glucose tolerance, or pre-diabetes. Diabetes and pre-diabetes often do not present any symptoms until a complication arises, making the disease difficult for patients to detect.

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Sleep Apnea

We have reason to be concerned about sleep apnea because it affects an estimated 12 million Americans, according to the U.S. Department of Health and Human Services. The condition can contribute to heart attack, stroke, irregular heartbeat, high blood pressure, impotence and other conditions. While there are three classes of sleep apnea–obstructive, central and mixed–obstructive sleep apnea is by far the most common form. This article gives the report of Ron Mason, a cabinet worker who in 2002 experienced a significant drop in his energy:

Mason’s doctor referred him to a Santa Cruz sleep disorder clinic, where a diagnostic test of his sleep patterns showed he was constantly moving between unconscious and semiconscious states, meaning that he “woke up” an average of 47 times per hour.

“I hadn’t had any dreams in years,” Mason says. “To get into a dream state, you really have to fall into a deeper sleep.”

As it turns out, sleep apnea also increases the risk of developing type 2 diabetes. Not to beat a dead horse, but the common factor between the two appears to be obesity:

“The unifying factor between sleep apnea and diabetes is obesity in the vast number of cases,” says Arthur H. Friedlander, MD, director of graduate medical education and associate chief of staff at Veterans Affairs West Los Angeles Healthcare Center.

Interestingly, seelp apnea often leads to a decrease in blood oxygen levels which often triggers the body’s “fight or flight” instinct. Sympathetic stimulation causes the heart to race and a burst of adrenaline is released.

Read the rest here .

Diabetes-related Complications On The Rise

cy2a.jpg Most would know diabetes as a disease arising out of inadequate production or inappropriate action of insulin.
But not many are aware that inflammation is a characteristic feature of the disease. Recent researches in the field of diabetes confirm that an excess production of some hormones and toxic substances in the body cause inflammation and several toxic reactions as well.
An implication of this could be seen in the form of diabetes related complications.
This was revealed by head, medicine, King George’s Medical University (KGMU), Prof CG Agarwal during a lecture on ‘current trends in the management of type II diabetes mellitus’ at a Continuing Medical Education (CME) programme organised by Indian Medical Association (IMA) on Monday.
“The role of free fatty acids, tumour necrosis factors and leptin was known to have been contributing to diabetes.
Related:
Inflamation Linked to Heart Disease and Diabetes

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Diabetes may also be a risk indicator for pancreatic cancer

This article caught my attention because by grandfather, who was also a diabetic, died as a result of pancreatic cancer:

High insulin levels normally associated with diabetes may also be a risk indicator for pancreatic cancer, new research has suggested.
A team from the US National Cancer Institute said high levels of the hormone insulin in the body and increased resistance to it were found to be linked to an increased cancer risk.
The team say the findings suggest that a healthy lifestyle could help reduce the risk of pancreatic cancer.

more here.
One of the most interesting aspects of the article is the potential impact of elevated insulin levels. Although they are related, this argues for management that not only keeps glucose levels stable and at normal levels but also increases insulin sensitivity.

Pancreatic cancer and diabetes

Pancreatic cancer kills virtually all of the 32,000 people who are diagnosed with the disease in the United States, making it the fourth leading cause of cancer death. This is in part because it shows few symptoms before it becomes advanced.
Reported by Reuters International, Dr/ Suresh Chari and colleagues, writing in the Journal Of Gastroenterology, said they studied 2,122 patients from Rochester, Minnesota, aged 50 and older who were diagnosed with diabetes between 1950 and 1995.
Middle-aged and older Americans who are newly diagnosed with diabetes also appear to have a higher risk of deadly pancreatic cancer, according to a study published on Tuesday, and for three years after their diagnosis with diabetes, patients have eight times the risk of developing pancreatic cancer.
Source: Hyscience

Tight Glucose Control Lowers CVD by About 50 Percent in Diabetes

A significantly lower risk of heart disease can now be added to the list of proven long-term benefits of tight glucose control in people with type 1 diabetes. Researchers announced this finding today at the annual scientific meeting of the American Diabetes Association after analyzing cardiovascular (CVD) events such as heart attack, stroke, and angina in patients who took part in the Diabetes Control and Complications Trial (DCCT) years ago.
“The longer we follow patients, the more we’re impressed by the lasting benefits of tight glucose control,” said Saul Genuth, M.D., of Case Western University. Dr. Genuth chairs the follow-up study of DCCT participants, called the Epidemiology of Diabetes Interventions and Complications (EDIC) study, which has been looking at the long-term effects of prior intensive versus conventional blood glucose control. “The earlier intensive therapy begins and the longer it is maintained, the better the chances of reducing the debilitating complications of diabetes.”
The DCCT was a multicenter study that compared intensive management of blood glucose to conventional control in 1,441 people with type 1 diabetes. Patients 13 to 39 years of age were enrolled in the trial between 1983 and 1989. Those randomly assigned to intensive treatment kept glucose levels as close to normal as possible with at least three insulin injections a day or an insulin pump, guided by frequent self-monitoring of blood glucose. Intensive treatment meant keeping hemoglobin A1c (HbA1c) levels as close as possible to the normal value of 6 percent or less. (The HbA1c blood test reflects a person’s average blood sugar over the past 2 to 3 months.) Conventional treatment at the time consisted of one or two insulin injections a day with daily urine or blood glucose testing.
In 1993, researchers announced the DCCT’s main findings: intensive glucose control greatly reduces the eye, nerve, and kidney damage of type 1 diabetes. Tight control also lowers the risk of atherosclerosis, according to a study of DCCT participants published in 2003. But what’s most remarkable about intensive control, the researchers say, is its long-lasting value.
After 61/2 years of the DCCT, HbA1c levels averaged 7 percent in the intensively treated group and 9 percent in the conventionally treated group. When the study ended, the conventionally treated group was encouraged to adopt intensive control and shown how to do it, and researchers began the long-term follow-up of participants. To the researchers’ surprise, the benefits of the original 6 years of intensive control have persisted despite the fact that both groups’ HbA1c values have leveled off at about 8 percent after a rise in blood glucose in the intensively treated group and a drop in blood glucose in those formerly on conventional treatment.
In results announced today, among the 1,375 volunteers continuing to participate in the study, the intensively treated patients had less than half the number of CVD events than the conventionally treated group (46 compared to 98 events). Such events included heart attacks, stroke, angina, and coronary artery disease requiring angioplasty or coronary bypass surgery. Thirty-one intensively treated patients (4 percent) and 52 conventionally treated patients (7 percent) had at least one CVD event during the 17 years of follow- up. The average age of participants is 45 years; 53 percent are male.
“The risk of heart disease is about 10 times higher in people with type 1 diabetes than in people without diabetes. It’s now clear that high blood glucose levels contribute to the development of heart disease,” said David Nathan, M.D., of Massachusetts General Hospital, who co-chaired the DCCT/EDIC research group and presented the results. “The good news is that intensively controlling glucose significantly reduces heart disease as well as damage to the eyes, nerves, and kidneys in people with type 1 diabetes. Tight control is difficult to achieve and maintain, but its advantages are huge.”
“The take-home message is that good glucose control should be started as early as possible to delay or prevent serious diabetes-related complications,” said Alan D. Cherrington, PhD, president, American Diabetes Association.
Is glucose control just as important for people with type 2 diabetes? “There is a strong and growing body of evidence that everyone with diabetes gains from strict blood glucose control,” said Catherine Cowie, PhD, who oversees EDIC for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
DCCT and EDIC were funded by the NIDDK and other parts of the National Institutes of Health (NIH) under the Department of Health and Human Services. Genentech, Inc., also supported the studies through a Cooperative Research and Development Agreement with the NIDDK. The NIH also funds a great deal of research aimed at developing new approaches to help patients control diabetes, which is difficult for many people.
About 18.2 million people in the United States have diabetes, the most common cause of blindness, kidney failure, and amputations in adults and a major cause of heart disease and stroke. At least 65 percent of people with diabetes will die from a heart attack or stroke, yet two out of every three people with diabetes are unaware of their increased risk.
Type 1 diabetes accounts for up to 10 percent of diagnosed cases of diabetes in the United States (up to 1 million people). This form of diabetes usually strikes children and young adults, who need several insulin injections a day or an insulin pump to survive. Insulin, though critical for controlling blood glucose, is no cure. Most people with type 1 diabetes eventually develop one or more complications, including damage to the heart and blood vessels, eyes, nerves, and kidneys.
In its “Be Smart About Your Heart: Control the ABCs of Diabetes” campaign, the National Diabetes Education Program (http://www.ndep.nih.gov/), jointly sponsored by the NIH, the Centers for Disease Control and Prevention, and 200 partner organizations including the American Diabetes Association (ADA), encourages people with diabetes to control their blood glucose as well as their blood pressure and cholesterol. By keeping all three as close to normal as possible, people with diabetes can live long, healthy lives.
“Make the Link! Diabetes, Heart Disease and Stroke,” is a joint initiative of the American Diabetes Association (http://www.diabetes.org/makethelink) and the American College of Cardiology (http://www.acc.org), which works to increase awareness of the link between diabetes and heart disease and help educate physicians and people with diabetes about how to reduce those risks.
Source: American Diabetes Association

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Most Diabetics Unaware of Serious Complications

NEW YORK (Reuters Health) – The majority of people with diabetes have never heard of diabetic neuropathy — nerve damage that causes pain, numbness, or tingling in the feet and hands — researchers report.
Furthermore, only one in four people with symptoms of diabetic neuropathy had ever been diagnosed by their doctors.

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American Kidney Fund Warns of Link Between Diabetes, High Blood Pressure and Kidney Failure

ROCKVILLE, Md., March 4 /U.S. Newswire/ — In observance of National Kidney Month, the American Kidney Fund today urged individuals with diabetes or high blood pressure to be screened for chronic kidney disease.
Both diabetes and high blood pressure can damage the kidneys, and this damage can result in chronic kidney disease-a condition in which a person’s kidneys are not working as well as they should. Left undiagnosed and untreated, chronic kidney disease can lead to kidney failure, and then an individual can survive only with dialysis treatment or a kidney transplant.

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