Answer: In recent years, intermittent fasting has emerged as a novel way of treating patients with type 2 diabetes. There are anecdotal reports of patients who have lost weight, their blood sugar levels have improved significantly, and they no longer need to take their diabetes medications. Their disease appears to be in remission – if not exactly cured.
The symptoms may relate to fluid loss and polyuria, but the course may also be insidious. Diabetic animals are more prone to infections. The long-term complications recognized in humans are much rarer in animals. The principles of treatment (weight loss, oral antidiabetics, subcutaneous insulin) and management of emergencies (e.g. ketoacidosis) are similar to those in humans.
Although the promises are big, these technologies are still far from the market. First, clinical trials will have to show they do work. Then, the price could be steep, as cell therapy precedents for other applications, such as oncology, come with price tags that reach the six figures and are finding difficulties to get reimbursed. Considering that compared to cancer, diabetes is not an immediately life-threatening disease, health insurers in some countries might be reluctant to cover the treatment.
Pain affects millions of people with diabetes. For most of these people, the pain is chronic, defined as pain persisting for more than six months, experienced almost every day, and of moderate to severe intensity, or that significantly interferes with daily activities. In some cases, a person’s pain is clearly related to complications of diabetes; in other cases, it is not. Regardless of the cause, however, studies show that chronic pain makes diabetes self-management much more difficult and often leads to higher blood glucose levels.
The last time I was in Palm Springs was a year ago for the TEDMED conference (relational platform?), and at the time I was mystified. It was a full house at the price of $4,950 a ticket, even though TED Talks are available for free online. The videos can be sped up if the speaker is boring, segments can be skipped, and tabs can be opened to keep the talk running in the background while getting some email done or shopping for shoes. There would seem, then, very little reason to need to go to the actual conference, to sit through marathon sessions where a fair number of speakers mess up or forget their lines (as I did).
^ Sarwar N, Gao P, Seshasai SR, Gobin R, Kaptoge S, Di Angelantonio E, Ingelsson E, Lawlor DA, Selvin E, Stampfer M, Stehouwer CD, Lewington S, Pennells L, Thompson A, Sattar N, White IR, Ray KK, Danesh J (June 2010). "Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies". Lancet. 375 (9733): 2215–22. doi:10.1016/S0140-6736(10)60484-9. PMC 2904878. PMID 20609967.
Benari doesn’t want to remain an outlier, though. And perhaps surprisingly, many doctors and surgeons are starting to agree that surgery should be considered more than a last-resort remedy for weight loss. Instead, it should be seen as a crucial aspect of diabetes care, and quite possibly the best tool we have against the chronic, often worsening condition.
For a wellness festival, there was an unexpected amount of talk about the importance of suffering and pain. In one panel about addiction, the ultramarathoner Charlie Engle, who ran 30 marathons in his first three years of sobriety, told the story of his first son being born. “He was gonna save me,” Engle recalled, “and then six days later, after a crack binge, the police are searching my car, and I had to choose between living and dying. And I chose running ... I wanted to pound that part of me out and never visit it again.”
Findings from the Diabetes Control and Complications Trial (DCCT) and the United Kingdom Prospective Diabetes Study (UKPDS) have clearly shown that aggressive and intensive control of elevated levels of blood sugar in patients with type 1 and type 2 diabetes decreases the complications of nephropathy, neuropathy, retinopathy, and may reduce the occurrence and severity of large blood vessel diseases. Aggressive control with intensive therapy means achieving fasting glucose levels between 70-120 mg/dl; glucose levels of less than 160 mg/dl after meals; and a near normal hemoglobin A1c levels (see below).
A 2018 study suggested that three types should be abandoned as too simplistic. It classified diabetes into five subgroups, with what is typically described as type 1 and autoimmune late-onset diabetes categorized as one group, whereas type 2 encompasses four categories. This is hoped to improve diabetes treatment by tailoring it more specifically to the subgroups.
What this means is the exact opposite of saying that pain is “all in your head.” It means that pain is a summary of all the data that come into your brain from your whole body, your environment, your relationships, feelings, and beliefs. If the summary says, “Things are not well,” you will likely feel pain. Chronic pain is a whole body–mind experience. It always has a physical component, and it always has an emotional component, and there may be other factors as well.
Family or personal history. Your risk increases if you have prediabetes — a precursor to type 2 diabetes — or if a close family member, such as a parent or sibling, has type 2 diabetes. You're also at greater risk if you had gestational diabetes during a previous pregnancy, if you delivered a very large baby or if you had an unexplained stillbirth.