Monthly Archives: May 2014

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LADA and GAD: Diagnosing Type 1.5 Diabetes

Alex O’Meara | April 24, 2014 

Researchers in Germany have further endorsed the effectiveness of a blood test that helps determine whether some adult diabetics diagnosed as type 2 diabetes are actually in the early stages of having type 1 diabetes.

Latent Autoimmune Diabetes of Adults (LADA) like type 1 diabetes, is an autoimmune response that that destroys insulin-producing beta cells in the pancreas. It is often misdiagnosed as type 2 diabetes because it looks and acts a lot like type 2– arising usually in adulthood and progressing slowly­– but, unlike type 2 diabetes, LADA results from the autoimmune destruction of insulin-producing beta cells.

A test for glutamic acid decarboxylase, or GAD, antibodies, has long been used as a method of differentiating between LADA (which is sometimes referred to at type 1.5 diabetes) and type 2 diabetes in people over age 30. With LADA as well as type 1 diabetes, the body’s immune system begins to attack its own beta cells. When the immune system attacks pathogens, one weapon in its arsenal is the creation of antibodies that bind to the foreign objects and mark them as invaders. In the case of autoimmune diabetes, the body begins to create antibodies against parts of proteins that are not foreign, but rather are associated with its own beta cells. GAD is one of the earliest proteins to be targeted by antibodies, and so by testing for the presence of GAD antibodies, doctors can determine whether there is an autoimmune reaction to beta cells taking place.

“At diagnosis, people with LADA usually do not require insulin right away because they are still producing some insulin,” according to Christy L. Parkin, MSN, RN, CDE, Associate Editor of Diabetes Forecast. “Because of their older age, they are often misdiagnosed as type 2 and started on oral medications. They may be normal weight or slightly overweight (not typical in type 2). LADA has characteristics of type 1 and may include insulin resistance, like type 2 diabetes. The main difference between LADA and type 2 is the autoimmune response, which is similar to type 1. The loss of beta cells is much more gradual in LADA than in type 1, though. It can take several years before blood glucose control starts to worsen.”

Given the differences between the necessary treatments for LADA and type 2 diabetes, a good diagnostic tool is clearly needed. However, up until now, the effectiveness of GAD antibody testing as a diagnostic has not been completely endorsed by the scientific community. Researchers at the Institute of Diabetes Research at the Helmholtz Zentrum München, partners in the Deutsches Zentrum für Diabetesforschung (DZD – German Center for Diabetes Research) however, have concluded a study that recommends use of the test in diagnosing LADA.

The study looked at reactions to injections of the GAD antibody in 46 LADA patients over 30 months. The subjects in the study were injected under the skin with different doses of GAD, or a placebo, producing an immune system reaction that impacted the insulin making beta cells. It was found that subjects with a strong reaction to the GAD antibody had correlating low insulin production.

“Our findings show that the GAD antibody affinity is a valuable … diagnostic marker in LADA patients,” according to lead investigator Dr. Peter Achenbach. “As with childhood type 1 diabetes, we can forecast the progression of the disease and adapt the therapeutic measures accordingly. The antibody affinity should now also be taken into consideration in clinical studies involving LADA patients.”

Other testing for type 1.5 diabetes that may be used in conjunction with the GAD test to determine if a person has LADA include determining c-peptide levels to measure insulin production levels, and tests for islet cell antibodies.

The supportive vote on GAD antibody testing is good news– it’s estimated that 10 percent of people diagnosed with type 2 diabetes have LADA (type 1.5), according to Dr. Jeff Unger, in the journal, American Family Physician.

In many cases, people who are diagnosed with type 2 but who have LADA will experience higher and higher blood sugars as insulin producing cells die off and oral medications do little or nothing to properly control their levels. High blood sugars might also be accompanied with weight loss, a classic symptom of untreated type 1 diabetes.

There are no formally established treatment procedures for LADA, according to the Mayo Clinic. Typically, however, patients diagnosed with LADA take insulin rather than oral diabetes medications, and otherwise treat their condition similarly to how they would be treated if they were diagnosed with type 1 diabetes. Once a diagnosis is made, the best option moving forward is to work with a physician to tailor a specific treatment plan.

For some people, such as Caraline McLeod, the diagnosis makes a world of difference in how they care for themselves.

Diagnosed with type 2, McLeod followed her doctor’s advice on exercising to lose weight, taking oral medication, and testing her blood sugars on a regular basis. Even though she reached her target weight and got in better shape, her blood sugars inexplicably continued to rise.

“I carried a deep sense that part of the puzzle was missing,” McLeod says in an interview with ABC Health and Wellbeing. “I became paranoid that some aspect of my lifestyle had contributed to this rapid progression, wondering if diet tonic water or my shampoo could be the hidden enemy. While I told myself that denial is one of the phases of grief and perhaps normal under the circumstances, I continued to obsess.”

When she learned about LADA, McLeod immediately went to her doctor for a GAD antibody test.

“Two weeks later the results came back strongly positive. Perhaps most people would have been unsettled with such a result, but I simply felt relief. In one fell swoop, my questions had been answered. I now knew why there had been no pre-diabetes and why exercise and diet had not spared me.

“I was referred to an endocrinologist who confirmed type 1 diabetes, and who encouraged me to be proactive in my own treatment. Indeed, he confirmed what I’d already read – that starting insulin early might spare my remaining beta cells.”

Like McLeod, for many diabetics diagnosed with a condition they don’t, in fact, suffer from, the correct diagnosis made though a GAD test provides the best chance for achieving improved long term health and happiness.

 

Alex O’Meara is a regular contributor to ASweetLife. He writes the blog The Other Side of Diabetes.

Source: Click

5 Trendy Diets and T1

Published on May 13th, 2014 | by Allison Nimlos

Recently, I stopped by a bookstore to browse. As a budding dietitian and someone who also has a bit of a weight problem, it didn’t take me long to find my way to the diet and fitness section. Although I shouldn’t have been surprised, I was taken aback by the overflowing wall of books on various diets and schemes to lose weight. With so many choices in reading material, it’s no wonder people have such a difficult time figuring out what to eat! It seems like everyone and their brother has an idea of what you should do.

But T1 people like me have a lot to consider when it comes to choosing a different diet. It’s not just weight management that we want, but also good BG. So how do today’s trendiest diets stack up for managing Type 1 diabetes? At Insulin Nation, we’ve examined 5 of the most popular diets out there and asked Certified Diabetes Educators and Registered Dietitians to give us their take on what fits for T1 and what doesn’t:

Veganism

shutterstock_180083381_Veganism_200pxWhat it is:
Veganism eschews eating any and all animal products, including dairy and eggs, as well as using animal-based products like leather. It’s possible to get enough protein through the right combinations in a plant-based diet, but it requires research and planning, especially when it comes to getting all the amino acids you need. Veganism has gotten easier in recent years with the growing availability of supplements and fortified products to help practitioners get all the nutrition they need. However, it’s important for vegans to keep to a diversified diet, and not rely on easy carbohydrates in meals, which not only can raise blood sugar but also can pack on the pounds.

What experts say:
“Anyone pursuing veganism, whether Type 1 or not, would need to make sure they are getting a balance of nutrients, particularly iron, Vitamin B12, protein, zinc, omega 3′s, and calcium,” says Lise Gloede, RDN, CDE, who specializes in vegan and vegetarian diets at her private practice in Virginia.

“There are so many places to get protein in a plant-based diet that it’s not a concern that a vegan would be protein-deficient if they are eating from all the food groups in a balanced way,” says Jennifer Smith, RD, CDE at Integrated Diabetes Services in Pennsylvania; Smith also is T1. “Getting rid of all of the animal-based fats and protein can also decrease inflammation in the body, which in itself can help to decrease BG levels.”

Raw

shutterstock_121727104_Rawism_200pxWhat it is:
Raw foodism is the belief that the healthiest foods are uncooked and unprocessed foods, mostly consisting of fruits, uncooked vegetables, eggs, raw dairy, and raw fish. Raw foodists believe that cooking food destroys important enzymes when heated over 115 degrees Fahrenheit. Many people who follow raw foodism are also vegan, but it’s not necessarily required, since some fish, like sashimi, is eaten raw.

However, it’s not nutritionally better to eat all foods in their raw form. Protein can be difficult to get, since legumes and meat usually should be cooked to be safe and digestible. Also, some vegetables, like asparagus, spinach, and mushrooms, are healthier when they are cooked because the heat activates the health-promoting nutrients. But others, like broccoli, onions, and red peppers, really are better eaten raw.

What experts say:
“It’s high in fruits and veggies, since these are easily eaten in their raw form, so from the standpoint of blood sugar control it can be gentle on management,” says Smith. “The only processed foods allowed are those that have been processed through fermentation, such as kimchi, or those processed in vinegar. However, It can be an expensive and time-consuming diet to follow, and it’s best for those who have or can easily use kitchen gadgets.”

Macrobiotic

shutterstock_105876668_Macrobiotic_200pxWhat it is:
The macrobiotic diet involves eating grains as a staple food, supplemented with other healthy foods, such as local vegetables. It also requires avoiding the use of highly processed or refined foods and most animal products; some people on the macrobiotic diet will still eat seafood. Macrobiotic enthusiasts also believe the manner in which you eat is important; they believe it’s best to focus on slow, thoughtful chewing — which can actually be a boon for people who overeat, since it can take up to 20 minutes to register fullness.

What experts say:
“Choosing carbs that are low on the glycemic index will help with control of diabetes, but the diet tends to be heavier in carbs than other ‘diet plans’…due to heavy emphasis on grains and fruit and veggies,” says Smith.

Gluten-Free

shutterstock_142037104_GlutenFree_200pxWhat it is:
A gluten-free diet eliminates the protein gluten that is found in wheat, rye, and barley. There has been an upward swing in the diagnosis of celiac disease, gluten intolerance, and wheat intolerance in people around the world. The number of cases of celiac disease has doubled in the last 20 years. Because celiac disease is an autoimmune disease, approximately 10% of people with T1 will find themselves going gluten-free, whether they like it or not.

What experts say:
The official word from registered dietitians is that there is no reason to be gluten-free unless you have an identified intolerance to gluten, whether it’s an allergy or celiac disease. It’s also important to recognize that not all gluten-containing products are created equal. Gluten is found both in healthier items, like whole grain bread, and in processed junk food, like donuts and cookies. Cutting out cookies is probably going to do more for your blood sugar management than cutting out all gluten.

“It’s not commonly understood that many gluten-free products are just as refined as those commonly made with gluten-containing grains,” says Smith. “Something made with rice flour may be free of gluten, but it will not be kind for post-consumption BG control.”

Many people find themselves feeling better when cutting out gluten, but it may have more to do with the improvement in the overall quality of their diet, says Lori Zanini, RD, CDE, who works at a private practice in Los Angeles. “When people cut out gluten and wheat and feel results, it could be because they are cutting out the processed, high sugar foods that contain the wheat, but not the wheat itself,” she says.

Paleo

shutterstock_120137452_Paleo_200pxWhat it is:
Nicknamed the “caveman diet,” Paleo is best described by what you can’t eat: no grains (naturally gluten-free), no legumes (including peanuts), no dairy, and no artificial sweeteners or refined products. With an emphasis on protein, vegetables, and fruit, it can be a healthy diet to try, but some find it difficult to maintain.

What experts say:
This diet falls at the bottom of U.S. World & News’ annual list of best diets because it eliminates whole food groups, but it can help manage blood sugar. Many people on the Paleo diet start eating more protein and less carbohydrates, which can help stabilize blood sugars.

“I like Paleo in that it promotes protein and fiber from vegetables and avoids processed foods,” says Wishnick. “I would never push someone to eat bread or pasta, but lentils and quinoa are good for you. They have beneficial nutrients.”

Smith adds that it’s important to remember that the liver will convert protein into glucose when it’s deprived of carbohydrates, so people with diabetes will often find themselves needing some insulin for a low-to-no carb meal.

“Often people with diabetes will experience improved blood sugars from the drop in carb content,” says Smith. “But they may also experience odd swings in blood sugars hours after a meal due to the lower carb and higher protein and fat nature of the meals.”

 

Insulin Nation recommends consulting with a dietician, a certified diabetes educator, and/or your medical professional before making any significant dietary changes.

Source: Click

Is Glucagon Ready for Primetime?

Published on May 18th, 2014 | by Craig Idlebrook

Xeris_GPen_Mini_300pxIf you’ve ever been given glucagon, chances are you weren’t focused enough to see how it was reconstituted. Considered the counterweight hormone to insulin, glucagon is typically only given in emergency situations to quickly treat extreme lows. It’s an invaluable tool to help people with diabetes, but not a convenient one. Glucagon quickly degrades with water, so it usually is kept in powder form and must be quickly mixed with water during an emergency, says Doug Baum, CEO of Xeris Pharmaceuticals. “Glucagon is a poster child of a drug that does not do well with water,” says Baum. Because glucagon delivery is not user friendly, few people with diabetes even keep a glucagon rescue kit in the house. Even when the drug is kept in the house, it’s often up to a non-medically trained individual to administer it, and most people instead reach for the phone to dial 911. The delay can be disastrous. The steps involved in administering glucagon have made a potentially life-saving treatment about as popular as an orphan drug. But what if glucagon could instead be as easily administered as insulin and utilized by people with diabetes to treat even mild lows? Better yet, what if glucagon could even flow through your body as part of a pump system for an artificial pancreas? That’s the quest of Xeris, a company that is focusing on biologically friendly ways to make drug mixtures in liquid forms. And if Xeris’ recent media push is any indication, they may have cracked the code for how to do it. Pharmaceutical companies typically have learned to be careful to manage expectations before releasing study results, but Baum was noticeably chipper in a phone interview withInsulin Nation about the results of a recent Phase II trial of Xeris’s G-Pump glucagon infusion formula. While Baum wouldn’t give specifics on how Xeris’ glucagon formula performed, he did sound more than a little optimistic. “When we administered our glucagon, we saw the desired or intended effect occur,” Baum says. “We’re very excited that our glucagon performs very well in the study compared to Lily’s glucagon.” In other words, Xeris believes it has a created a liquid-based glucagon with a stable shelf life that does just as well as the powdered stuff found in the standard glucagon rescue kit. Xeris will officially be announcing the results of the study at the American Diabetes Association Scientific Sessions, being held June 13th – 17th, 2014 in San Francisco. What we know so far is that researchers at the Oregon Health and Science University have been analyzing a Xeris glucagon that’s administered through an OmniPod pump to see how quickly it can be absorbed into the bloodstream and bring up blood sugar levels in human study participants. Previously, a Xeris G-Pen glucagon product did well in a similar Phase II study. While people with diabetes have grown accustomed to knowing the ins and outs of insulin, the value of an everyday glucagon might not be as readily apparent. But many researchers believe room temperature stable glucagon could be the “missing link” to make a truly closed-loop artificial pancreas system that continuously regulates blood glucose levels. Easy-to-use glucagon could also expand the use of the treatment and prevent extreme lows before they happen by allowing people with diabetes to administer it themselves. Although the Xeris formulation is being tested with an OmniPod pump, Baum says Xeris would like to make the glucagon available for any pump manufacturer who wishes to create a chamber for it. Company officials also are hoping to develop glucagon auto-injectors and pens. In short, Xeris wants glucagon to be the new insulin. “We want to be like an insulin manufacturer,” Baum says. “We want to make it ubiquitous.” Diabetes researchers will eagerly await the results of the Phase II pump trials to see if Xeris’ claims signal that glucagon can come out of the emergency room and into everyday life.

Source: Click

Have You Been Thinking About An Insulin Pump?

Tyler Stevenson
May 13, 2014

OmniPod IM 455

Is your blood sugar on a rollercoaster ride every single day? Do you feel unsure about what to do or how to bring your blood glucose levels down? Are you scared to go out and do things with friends or family because of the fear that diabetes brings you on a daily basis? If you answered yes to any of these questions, then it is time to think about using an insulin pump to control your blood glucose levels. 

I have been wearing aninsulin pump for many years and am here to weigh in on why I feel it is a good option for type 1 diabetics. To some, this option may seem to be overly extreme or a last resort to an unsolvable problem. However, it shouldn’t be viewed this way. I am here to clear the air and answer a few questions about some of the common fears and concerns that scare people away from using an insulin pump.

Question: What makes an insulin pump a great option?

¬ An insulin pump can provide you with the convenience of being able to adjust yourself with insulin wherever you go and without the hassle of having to carry needles, a vial of insulin, etc. Instead, you can simply give yourself the exact amount of insulin you need at any moment.

Question: Is wearing an insulin pump uncomfortable?

¬ No, actually once you get in a routine of where you like to put your pump on your body, you hardly even know it is there. Plus, when you wear a pump you do not have to give yourself shots all the time, which are never comfortable.

Question: What are the benefits of an insulin pump?

¬ Fist of all, it gives you peace of mind that the insulin pump is on you at all times, along with a sense of independence and confidence about your diabetes control. This freedom allows you to not worry about your blood glucose levels or insulin when you go out with friends and family.

¬ By having an insulin pump you are able to set your hourly insulin rate (basal rates) to fit your individual needs, giving you a far greater ability to regulate blood glucose levels as a regular pancreas would.

¬ An insulin pump allows you to conveniently store basal rates and lets you track when you give yourself insulin making it easier to track your daily usage. Also, this information can be downloaded and given to your doctor in a hard copy format giving them an even better overall view of how you are doing.


Choosing to use an insulin pump is a major decision that needs to be discussed with your doctor, family, and yourself. It is not a decision that should be made on a whim because it impacts your health every single day. Hopefully, what I have shared has given you some things to think about. I wish everyone the best of luck with their type 1 diabetes.

Happy pumping!

Source: Have You Been Thinking About An Insulin Pump? – Diabetes Health.

NEW website!

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Hello everyone,

We know it’s been a while since we have posted something, but we have got some great news! We have been very busy with creating a new website. The new website is now online and of course, we are still offering the same high quality insulin pump cases and accessories. Click here to check out our new website! 

Wit the new website we have fixed some issues that we have had with the previous website. Besides that, it is now easier than ever to navigate through the website and order products.

In order to celebrate the new website, we have set up a promotion! :)

Like our Facebook page and get a chance at 
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