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Diabetic Neuropathy

>> Monday, January 16, 2017

One of the main reasons why long term blood sugar control is so important in diabetes is the prevention of diabetes complications.   Diabetic neuropathy, which is damage to nerves caused by chronic elevation in blood sugars, is one of the complications we are trying to prevent.   Diabetic neuropathy affects a lot of people (you may be surprised by just how many - read on!), can be present in people who don't even have diabetes yet, can take many different forms, and can have a profound impact on the quality of life of people living with diabetes.

The American Diabetes Association has recently released a Position Statement (download is free) to help guide clinicians in understanding, diagnosing, preventing, and managing this complication of diabetes.

Some key points from this article:

1.  Diabetic neuropathy (DN) is a diagnosis of exclusion.  In other words, just because a patient with diabetes has findings of neuropathy, doesn't mean that the diabetes is necessarily the cause.  Other causes of neuropathy (discussed in the article) need to be ruled out before the nerve problem is attributed to diabetes as the cause.

2.  There are many types of diabetic neuropathy.  Distal symmetric polyneuropathy usually starts with symptoms in the feet, including numbness, tingling, pain, and burning, especially at night.  Autonomic neuropathies can affect/include the heart, ability to maintain blood pressure when standing up (orthostatic hypotension), the gastrointestinal tract, urinary tract, sexual dysfunction, or dysfunction in sweating. There are also forms of diabetic neuropathy that can affect specific nerves (cranial or peripheral), or bundles of nerves as they exit the spinal column.

3.  Diabetic neuropathy is common. Distal symmetric polyneuropathy affects 50% of people with type 2 diabetes after 10 years, and 20% of people with type 1 diabetes after 20 years.  Autonomic neuropathy involving the heart may affect up to 60% of people with type 2 diabetes after 15 years, and up to 30% of people with type 1 diabetes after 20 years.

4.  Diabetic neuropathy can be present in people with prediabetes.  Distal symmetric polyneuropathy may be present in 10-30% of people with impaired glucose tolerance, and autonomic neuropathy affecting the heart has been found in people with impaired glucose tolerance as well.

5.  Prevention of diabetic neuropathy is key, as there is no effective treatment available for established nerve damage.  Prevention is achieved primarily through optimizing blood sugar control. Lifestyle interventions are recommended for prevention in people with prediabetes or type 2 diabetes, and a multifaceted approach including targeting of cardiovascular risk factors is recommended for prevention of cardiac autonomic neuropathy in people with type 2 diabetes.

6.  Management of established diabetic neuropathy is directed towards the particular type of neuropathy each patient has.  This can include pain control medication, fall prevention, and specific treatments to manage symptoms of the autonomic neuropathies.

Follow me on twitter! @drsuepedersen © 2017


Mediterranean Diet May Slow Brain 'Shrinkage' With Age

>> Monday, January 9, 2017

The Mediterranean style of eating seems to be rising above most other dietary plans for its health benefits.  Studies have shown that the Mediterranean diet may reduce the risk of cardiovascular events, and may also decrease the risk of breast cancer. A new study shows that the Med diet may also slow age related brain atrophy (natural 'shrinkage' of the brain with aging).

(Pictured above is the brain of a person in their 20s, compared to a person in their 80s, showing the natural atrophy that happens in the brain over time.)

The study, published in the journal Neurology, examined brain volumes and brain cortical thickness in Scottish people age 73, and followed them for three years until age 76.  They assessed eating patterns using questionnaires at age 70 (three years before the start of the study).   They found that people who reported less adherence to a Mediterranean style of eating had a greater reduction in total brain volume from age 73 to age 76, than those who reported eating in the Mediterranean style.

While this study is of lower quality than the randomized controlled clinical trial showing the cardiovascular and breast cancer benefit, it is another arrow pointing towards the benefits of the Mediterranean style of eating.   While no diet has been shown to be superior to another for weight loss, the health benefits of the Mediterranean diet continue to impress.

Follow me on twitter! @drsuepedersen © 2017


The Bugs In Your Gut - Could They Cause Obesity or Diabetes?

>> Monday, January 2, 2017

Did you know that you have more bacterial cells inside your intestines than you have human cells in your entire body?  Not only that, but they house somewhere between 250 to 800 times more genes than we have human genes in our body.   Perhaps it's not so far out, then, for us to learn that these bacteria (called the 'microbiome') play an important role in our metabolism, and are very likely to contribute to the risk of both obesity and type 2 diabetes.

A wonderful Viewpoint article in JAMA (free to read online here) outlines what we know about this topic so far.

The microbiome has many important functions, including the production of important amino acids (protein building blocks) and vitamins, and they also help to degrade toxins.  The genes in these bacteria also produce hormones and inflammatory molecules that enter our circulation and effect our health.

These bacteria also play a role in how many calories we absorb from food, because they make enzymes that help us to digest polysaccharides, a type of carbohydrate.  Some types of gut bacteria are better at this than others, and studies have shown that people with obesity carry more of the carb-digesting bacteria (called Firmicutes) than people without obesity.  Interestingly, some studies have shown that when a person with obesity loses weight, particularly after bariatric surgery, the proportion of 'good' bacteria (called Bacterioides) increases relative to the 'bad' Firmicutes. Overall, the studies suggest that the gut bacteria may be both a cause and a consequence of obesity.

Along with the increased capacity to absorb carbs in people who carry more Firmicutes bacteria, so comes an increased risk of having not only obesity, but also type 2 diabetes.  Altered production of short chain fatty acids by gut bacteria, as well as low grade gut inflammation caused by chemicals made by the microbiome, also contribute to insulin resistance and diabetes risk.

So how does this play out in terms of treatment of obesity or diabetes? Well, some studies (mostly done in rodents, but some in humans too) have shown that manipulation of the gut microbiome by way of stool transplants (yep, transplanting poo), or perhaps by other modalities such as change in diet or probiotics, may be able to have an effect on the type of bacteria we have, but we are far from developing concrete treatment approaches.   However, as we learn more about our gut bugs and the genes they carry, we come steps closer to learning how we may ultimately be able to incorporate microbiome modification into our treatment options for obesity and metabolic syndrome.

Follow me on twitter! @drsuepedersen © 2017


Practicing Mindfulness - Survival Tips For The Holidays

>> Saturday, December 24, 2016

I hope everyone is enjoying a wonderful holiday season, with some time to relax and have fun with family and friends!  With the abundance of food and drink that often accompanies the merriment,  it can be particularly tough to stick to our healthy lifestyle plans - let's be honest, it's hard to say no.

So - don't say no.  Just engage in a few practices that will help get you through!  The theme here is eating mindfully - give purposeful thought to the choices you make.  Here are a few suggestions:

1.  Make sure it's worthy of splurging: If you are going to treat yourself, make sure it is awesome enough to deserve it.  If it's not delightful with the first bite, stop.

2.  Portions, portions, portions.  If it's not a healthy choice, have a small portion.

3.  Take your time: remember that it takes about 15 minutes for the fullness hormones to kick in and tell your brain that you feel full.

4.  Fill your plate wisely:  Fill half of your plates with vegetables (avoiding dressing/butter/sauces); choose lean proteins; minimize portions of foods where it's very hard to know what's in it (eg mashed potatoes and stuffing can hide a lot of extra calories); and minimize gravies and sauces.  Eat the vegetables first.

5.  Don't starve yourself all day before a big meal or party: you'll end up very hungry and likely to eat more than your full day of calories.

6.  Be aware of liquid calories, especially alcohol.  Alcohol is empty calories that does not give any fullness sensation.  Your body essentially puts the brakes on burning anything else until the alcohol is out of your system.

Happy Holidays to all!

Follow me on twitter! @drsuepedersen © 2016


An Inspirational Kid with Diabetes!

>> Monday, December 19, 2016

This youngster has grabbed my heart, and this week I'm sharing him with you.

Meet Carter: He's 2 years old and has type 1 diabetes.  He has learned to test his own blood sugars and is doing it here for the first time.

Many people living with diabetes struggle with commitment to testing their own sugars - hopefully Carter serves as an inspiration!

If you're looking for a cause to support this holiday season, consider the Juvenile Diabetes Research Foundation. 

Follow me on twitter! @drsuepedersen © 2016



I am excited that you have arrived at my site, and I hope you are too - consider this the first step towards a Healthier New You!! As a medical doctor, Endocrinologist, and obesity specialist, I am absolutely passionate about helping people with weight management. Though there is certainly no magic cure for obesity, there IS a successful treatment plan out there for you - it is all about understanding the elements that contribute to your personal weight struggle, and then finding the treatment plan that suits your needs and your lifestyle. The way to finding your personal solution is to learn as much as you can about obesity: how our toxic environment has shaped us into an overweight society; the diversity of contributors to obesity; and what the treatment options out there are really all about. Knowledge Is Power!!

Are you ready to change your life? Let's begin our journey together, towards a healthier, happier you!!

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