Nerves help orchestrate this digestive tour de force, says Bragg, by telling the muscles what to do. Uncontrolled diabetes, though, can damage the nerves, leading to some GI missteps. “It has to do with hyperglycemia [high blood glucose],” says Bragg. “We don’t know the exact mechanism.” We do know that blood glucose control can both prevent and improve GI dysfunction.
One of the most studied programs in the National Institutes of Health’s Diabetes Prevention Program (DPP). This program helps people who have pre-diabetes or a high risk of developing type 2 diabetes lose weight. Studies of the program have found that those who lost about seven percent of their initial weight, kept some of it off, and maintained an exercise program delayed the onset of type 2 diabetes for three years in 58% of cases.
The other way to make such things accessible is to inundate attendees with advertising—which can undermine the concept by making us feel inadequate without this product or that, rather than by affirming our wholeness. Poolside, Hoess told me that he believes there can still be profit in a less consumerist direction, but that it’s necessary to “redefine capitalism to where it’s not just about pure profit, it’s also about social profit. If we can merge those things, I think business becomes a force for good.”
The consumption of commodified connection doesn’t need to require a small fortune, though. In fact, it can’t, by any of the new, woke definitions of wellness. Hoess would like to get Wellspring up to 4,000 people or so, he tells me, in order to keep the price down. I met two seekers who were there on scholarship, and four who had won a ticket through an Instagram giveaway (people actually do win those things). Hoess contrasted his model with smaller events like the Aspen Ideas Festival (which The Atlantic has long been a partner in producing), which tend to be more expensive at least partly due to scale.
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.
Chronic pain can reflect injury that hasn’t completely healed. More often, it is caused by nerves that have become oversensitive or by a brain that is misreading the signals it receives. If acute pain goes on too long, nerves and brain can tire of the constant signals and just decide the injury is permanent. That’s why it’s important to treat acute pain seriously. For example, if you injure your foot or your back and don’t treat it promptly — with adequate rest, other first-aid measures, and seeing a doctor if the pain is severe or persists — mild pain can become severe, and acute pain can become chronic.
Though not routinely used any longer, the oral glucose tolerance test (OGTT) is a gold standard for making the diagnosis of type 2 diabetes. It is still commonly used for diagnosing gestational diabetes and in conditions of pre-diabetes, such as polycystic ovary syndrome. With an oral glucose tolerance test, the person fasts overnight (at least eight but not more than 16 hours). Then first, the fasting plasma glucose is tested. After this test, the person receives an oral dose (75 grams) of glucose. There are several methods employed by obstetricians to do this test, but the one described here is standard. Usually, the glucose is in a sweet-tasting liquid that the person drinks. Blood samples are taken at specific intervals to measure the blood glucose.
Monitoring your caloric intake may be helpful if you’re overweight, but everyone with type 2 diabetes should track how many carbs they’re taking in. That can be tricky because carbs are in many of the common foods you may already eat, but there are both good and bad sources of carbs. Fruits and vegetables, for example, are good sources, while pretzels and cookies are bad sources. (29)
According to Jack D. Bragg, DO, associate professor of clinical medicine at the University of Missouri, most diabetes-related GI issues stem from a problem with one thing: motion. The digestive tract is a finely tuned muscular machine. It pulls and pushes, expands and contracts, relaxes and squeezes to carry food from your mouth, down the esophagus, into the stomach, and, finally, through 25 feet of nutrient- and water-extracting intestine that ends in, well, your exit.
One of the biggest hits in type 2 diabetes treatment is glucagon-like peptide (GLP)-1 receptor agonists, which induce insulin production in beta-pancreatic cells while suppressing the secretion of glucagon. All big pharma have GLP-1 drugs on the market or their pipelines, including Sanofi, Eli Lilly, Roche, AstraZeneca and Boehringer Ingelheim. But Novo Nordisk is going a step further with the first oral version of a GLP-1 drug, which is now close to the market.
Wellspring is produced by a quickly growing company called Wanderlust, “a global wellness platform” and “a multi-channel company focused around mindful living” by way of “renowned festival events, a full-service media company, and several permanent yoga centers.” Wanderlust was founded in Brooklyn 10 years ago and has since been putting on small, music-and-yoga-based festivals. But Wellspring is a new and much grander undertaking, lasting multiple days and based mostly on workshops and high-profile panels and lectures.
Electrical stimulation can sometimes block pain signals from traveling up the nerves. The most commonly used system is called TENS, which stands for transcutaneous electrical nerve stimulation. TENS works by sending electrical pulses across the surface of the skin into the nerves. The stimulating pulses help prevent pain signals from reaching the brain. They also help stimulate your body to produce higher levels of its own natural painkillers, called endorphins.
Studies in type 1 patients have shown that in intensively treated patients, diabetic eye disease decreased by 76%, kidney disease decreased by 54%, and nerve disease decreased by 60%. More recently the EDIC trial has shown that type 1 diabetes is also associated with increased heart disease, similar to type 2 diabetes. However, the price for aggressive blood sugar control is a two to three fold increase in the incidence of abnormally low blood sugar levels (caused by the diabetes medications). For this reason, tight control of diabetes to achieve glucose levels between 70 to120 mg/dl is not recommended for children under 13 years of age, patients with severe recurrent hypoglycemia, patients unaware of their hypoglycemia, and patients with far advanced diabetes complications. To achieve optimal glucose control without an undue risk of abnormally lowering blood sugar levels, patients with type 1 diabetes must monitor their blood glucose at least four times a day and administer insulin at least three times per day. In patients with type 2 diabetes, aggressive blood sugar control has similar beneficial effects on the eyes, kidneys, nerves and blood vessels.
Many people may not want to divulge their bathroom dramas to a doctor, or anyone, or may think that heartburn is common and no big deal. Everyone gets a tummy ache now and again, but if you have diabetes, GI symptoms may indicate that something is chronically wrong. “If it bothers you, it’s worth getting checked out,” says Bragg. With a proper diagnosis, you and your health care provider can come up with a plan to make your whole body feel a whole lot better.
There are some interesting developments in blood glucose monitoring including continuous glucose sensors. The new continuous glucose sensor systems involve an implantable cannula placed just under the skin in the abdomen or in the arm. This cannula allows for frequent sampling of blood glucose levels. Attached to this is a transmitter that sends the data to a pager-like device. This device has a visual screen that allows the wearer to see, not only the current glucose reading, but also the graphic trends. In some devices, the rate of change of blood sugar is also shown. There are alarms for low and high sugar levels. Certain models will alarm if the rate of change indicates the wearer is at risk for dropping or rising blood glucose too rapidly. One version is specifically designed to interface with their insulin pumps. In most cases the patient still must manually approve any insulin dose (the pump cannot blindly respond to the glucose information it receives, it can only give a calculated suggestion as to whether the wearer should give insulin, and if so, how much). However, in 2013 the US FDA approved the first artificial pancreas type device, meaning an implanted sensor and pump combination that stops insulin delivery when glucose levels reach a certain low point. All of these devices need to be correlated to fingersticks measurements for a few hours before they can function independently. The devices can then provide readings for 3 to 5 days.
Metformin is generally recommended as a first line treatment for type 2 diabetes, as there is good evidence that it decreases mortality. It works by decreasing the liver's production of glucose. Several other groups of drugs, mostly given by mouth, may also decrease blood sugar in type II DM. These include agents that increase insulin release, agents that decrease absorption of sugar from the intestines, and agents that make the body more sensitive to insulin. When insulin is used in type 2 diabetes, a long-acting formulation is usually added initially, while continuing oral medications. Doses of insulin are then increased to effect.
The prognosis of diabetes is related to the extent to which the condition is kept under control to prevent the development of the complications described in the preceding sections. Some of the more serious complications of diabetes such as kidney failure and cardiovascular disease, can be life-threatening. Acute complications such as diabetic ketoacidosis can also be life-threatening. As mentioned above, aggressive control of blood sugar levels can prevent or delay the onset of complications, and many people with diabetes lead long and full lives.
Insulin is vital to patients with type 1 diabetes - they cannot live without a source of exogenous insulin. Without insulin, patients with type 1 diabetes develop severely elevated blood sugar levels. This leads to increased urine glucose, which in turn leads to excessive loss of fluid and electrolytes in the urine. Lack of insulin also causes the inability to store fat and protein along with breakdown of existing fat and protein stores. This dysregulation, results in the process of ketosis and the release of ketones into the blood. Ketones turn the blood acidic, a condition called diabetic ketoacidosis (DKA). Symptoms of diabetic ketoacidosis include nausea, vomiting, and abdominal pain. Without prompt medical treatment, patients with diabetic ketoacidosis can rapidly go into shock, coma, and even death may result.
At present, the American Diabetes Association does not recommend general screening of the population for type 1 diabetes, though screening of high risk individuals, such as those with a first degree relative (sibling or parent) with type 1 diabetes should be encouraged. Type 1 diabetes tends to occur in young, lean individuals, usually before 30 years of age; however, older patients do present with this form of diabetes on occasion. This subgroup is referred to as latent autoimmune diabetes in adults (LADA). LADA is a slow, progressive form of type 1 diabetes. Of all the people with diabetes, only approximately 10% have type 1 diabetes and the remaining 90% have type 2 diabetes.
Some cases of diabetes are caused by the body's tissue receptors not responding to insulin (even when insulin levels are normal, which is what separates it from type 2 diabetes); this form is very uncommon. Genetic mutations (autosomal or mitochondrial) can lead to defects in beta cell function. Abnormal insulin action may also have been genetically determined in some cases. Any disease that causes extensive damage to the pancreas may lead to diabetes (for example, chronic pancreatitis and cystic fibrosis). Diseases associated with excessive secretion of insulin-antagonistic hormones can cause diabetes (which is typically resolved once the hormone excess is removed). Many drugs impair insulin secretion and some toxins damage pancreatic beta cells. The ICD-10 (1992) diagnostic entity, malnutrition-related diabetes mellitus (MRDM or MMDM, ICD-10 code E12), was deprecated by the World Health Organization (WHO) when the current taxonomy was introduced in 1999.
I was diagnosed as a Type I diabetic in October 1993. I was traveling at the time, and I felt lethargic, I was always thirsty, and I was having trouble concentrating. When I returned home, I went for a checkup, and the doctor confirmed my condition. From that day forward, I’ve been injecting myself with insulin every day. Before I switched to an insulin pump in 2011, I calculated that I had given myself about 30,000 needles. That’s a lot of jabbing.
One participant in an online discussion on the Diabetes Self-Management blog wrote, “I noticed that when I was doing something like reading an interesting book, or walking and talking with a friend, I was not consciously feeling pain.” Another wrote, “I keep my mind busy with genealogy [family history] during the day. I play sudoku and crosswords at night until I can fall asleep.”
In another study, albeit including only 30 people, those who were recently diagnosed and went on a very low-calorie diet for eight weeks experienced remission. That remission continued more than six months after their low-calorie diet ended. In people who have had type 2 diabetes for a long time, unfortunately, weight loss has a much more limited impact.
Environmental wellness inspires us to live a lifestyle that is respectful of our surroundings. This realm encourages us to live in harmony with the Earth by taking action to protect it. Environmental well-being promotes interaction with nature and your personal environment. Everyone can have a strong environmental conscious simply by raising their awareness.
In gastroesophageal reflux disease (GERD), sometimes called heartburn, stomach acid and partially undigested food move backward through the esophagus, escaping from the stomach and through the esophageal sphincter that normally prevents such backsliding. This can occur as a symptom of gastroparesis, says Hiroshi Mashimo, MD, PhD, a gastroenterologist at Harvard Medical School. “If the stomach doesn’t empty, it’s likely to reflux up,” he says. GERD may also result from diabetes-related nerve damage affecting the esophageal sphincter, Mashimo adds. One caution: Some diseases, such as a yeast infection in the esophagus, can masquerade as GERD, so don’t brush off symptoms. We can’t treat the gastroparesis or esophageal sphincter problems that contribute to GERD, but antacids and other medications can help to reduce or neutralize stomach acids (see “PPIs the Right Way,” below).
Diabetes is a serious disease requiring professional medical attention. The information and recipes on this site, although as accurate and timely as feasibly possible, should not be considered as medical advice, nor as a substitute for the same. All recipes and menus are provided with the implied understanding that directions for exchange sizes will be strictly adhered to, and that blood glucose levels can be affected by not following individualized dietary guidelines as directed by your physician and/or healthcare team.
This is the advice that diabetics received a hundred years ago. Even in Sweden, with the high fat-Petrén diet that included fatty pork cuts, butter and green cabbage. And when diabetics start eating this way today the same thing happens as it did in the past. Their blood sugar levels improve dramatically from day one. This makes sense, as they avoid eating what raises blood sugar.
The progression of nephropathy in patients can be significantly slowed by controlling high blood pressure, and by aggressively treating high blood sugar levels. Angiotensin converting enzyme inhibitors (ACE inhibitors) or angiotensin receptor blockers (ARBs) used in treating high blood pressure may also benefit kidney disease in patients with diabetes.
Chronic pain creates several vicious cycles. For one, people tend to tense their muscles in response to pain, which often makes the pain worse. Pain also leads people to stop moving, which leads to increasing stiffness and more pain. Pain can interfere with sleep, and restless nights can increase pain. Pain also can contribute to depression and painful emotions such as anger, grief, fear, and frustration, which in turn contribute to pain.
The diabetes market is expected to reach a massively big €86Bn by 2025 combining both type 1 (€32Bn) and type 2 (€54Bn) treatments, and we can expect all sort of revolutionary technologies to come forward and claim their market share. Researchers are already speculating about microchips that can diagnose diabetes type 1 before the symptoms appear or nanorobots traveling in the bloodstream while they measure glucose and deliver insulin.
It's unclear how people get the disease — genetics plays a big role, though unknown environmental factors may also trigger the disease. Either way, the disease causes the immune system to mistakenly attack and kill insulin-producing cells, called beta cells, in the pancreas. (This differs from type 2 diabetes, in which the body initially makes sufficient insulin but the cells cannot properly use it.) Without enough insulin working to remove glucose from the blood stream, and allowing glucose to enter the body's cells, blood sugar levels spike. Left untreated, this insulin deficiency leads to a deadly complication called diabetic ketoacidosis. What's more, having high blood sugar over the long term can cause life-threatening complications such as kidney damage or heart disease, according to the Mayo Clinic.
Over the last century, advancements in new treatments aided by the remarkable developments in computer technology have helped many people better manage the disease, but achieving optimal glucose control remains an unattainable goal for the vast majority of those with diabetes, and particularly among young people. Despite patients' best attempts, managing diabetes remains a challenging, daily balancing act that requires constant vigilance. That's because insulin therapy cannot ideally mimic the exquisite biological function of a healthy pancreas. And that's why the Diabetes Research Institute and Foundation remain passionately committed to achieving this singular goal. Learn more about our progress toward a cure and the steps we are taking to turn our vision into reality.
^ Jump up to: a b Picot J, Jones J, Colquitt JL, Gospodarevskaya E, Loveman E, Baxter L, Clegg AJ (September 2009). "The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation". Health Technology Assessment. 13 (41): 1–190, 215–357, iii–iv. doi:10.3310/hta13410. PMID 19726018.
"Advocacy Month was appropriately themed “Midterms Matter: Add your voice,” in light of the Nov. 6 election. ASDA members across the country made sure their fellow students went to the polls to represent the dental profession. It was an especially exciting election season since five dentists were elected to Congress." Read more on ASDA's blog, Mouthing Off
The term was partly inspired by the preamble to the World Health Organization’s 1948 constitution which said: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” It was initially brought to use in the US by Halbert L. Dunn, M.D. in the 1950s; Dunn was the chief of the National Office of Vital Statistics and discussed “high-level wellness,” which he defined as “an integrated method of functioning, which is oriented toward maximizing the potential of which the individual is capable.” The term "wellness" was then adopted by John Travis who opened a "Wellness Resource Center" in Mill Valley, California in the mid-1970s, which was seen by mainstream culture as part of the hedonistic culture of Northern California at that time and typical of the Me generation. Travis marketed the center as alternative medicine, opposed to what he said was the disease-oriented approach of medicine. The concept was further popularized by Robert Rodale through Prevention magazine, Bill Hetler, a doctor at University of Wisconsin–Stevens Point, who set up an annual academic conference on wellness, and Tom Dickey, who established the Berkeley Wellness Letter in the 1980s. The term had become accepted as standard usage in the 1990s.
“Diabetes type 1 is very different from your standard disease. Insulin requirements vary greatly from one day to another and there is no way patients can know what they need,” Roman Hovorka, Professor at the University of Cambridge, explained to me during an interview. His research group is working on the development of an algorithm that can accurately predict insulin requirements for a specific patient at any moment.
These days, American children on average receive about $800 per year in allowance, according to the American Institute of Certified Public Accountants. Kids, though, are usually not receiving money for nothing—the vast majority of American parents who pay allowance (who themselves are a majority of American parents) tie it to the completion of work around the house.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.