In 1991, the National Institutes of Health issued a consensus statement, cautiously recommending surgery as a treatment for people living with morbid obesity, meaning they have a body mass index, or BMI, over 40. For people who have health complications connected to obesity, such as type 2 diabetes, the limit goes down to a BMI of 35. Relying on these guidelines, insurance companies and public payers like Medicaid and Medicare typically only cover surgery for people living with diabetes who fall into that category.
Insulin serves as a “key” to open your cells, to allow the glucose to enter -- and allow you to use the glucose for energy. Without insulin, there is no “key.” So, the sugar stays -- and builds up-- in the blood. The result: the body’s cells starve from the lack of glucose. And, if left untreated, the high level of “blood sugar” can damage eyes, kidneys, nerves, and the heart, and can also lead to coma and death.
Efforts to cure or stop type 1 diabetes are still in the early stages, and these approaches will also not be suitable for people that have already lost their insulin-producing cells. A solution could be the creation of an “artificial pancreas” — a fully automated system that can measure glucose levels and inject the right amount of insulin into the bloodstream, just like a healthy pancreas would.
Poxel (PP:POXEL) is a French pharmaceutical company that recently received $30.1 million in post-IPO equity in 2016. The company has developed an orally active medication called Imeglimin, which targets all three organs and body systems that are affected by diabetes simultaneously: the pancreas, liver, and muscles. The drug is currently undergoing phase 3 clinical work in Japan, and will commence phase 3 trials in the European Union and the United States that will be completed by 2019. The company is also concurrently working on several other pharmaceutical agents in various stages of the development pipeline.
Let’s face it, when you’re a college-educated 57-year-old slinging parcels for a living, something in your life has not gone according to plan. That said, my moments of chagrin are far outnumbered by the upsides of the job, which include windfall connections with grateful strangers. There’s a certain novelty, after decades at a legacy media company—Time Inc.—in playing for the team that’s winning big, that’s not considered a dinosaur, even if that team is paying me $17 an hour (plus OT!). It’s been healthy for me, a fair-haired Anglo-Saxon with a Roman numeral in my name (John Austin Murphy III), to be a minority in my workplace, and in some of the neighborhoods where I deliver. As Amazon reaches maximum ubiquity in our lives (“Alexa, play Led Zeppelin”), as online shopping turns malls into mausoleums, it’s been illuminating to see exactly how a package makes the final leg of its journey.
The primary complications of diabetes due to damage in small blood vessels include damage to the eyes, kidneys, and nerves. Damage to the eyes, known as diabetic retinopathy, is caused by damage to the blood vessels in the retina of the eye, and can result in gradual vision loss and eventual blindness. Diabetes also increases the risk of having glaucoma, cataracts, and other eye problems. It is recommended that diabetics visit an eye doctor once a year. Damage to the kidneys, known as diabetic nephropathy, can lead to tissue scarring, urine protein loss, and eventually chronic kidney disease, sometimes requiring dialysis or kidney transplantation. Damage to the nerves of the body, known as diabetic neuropathy, is the most common complication of diabetes. The symptoms can include numbness, tingling, pain, and altered pain sensation, which can lead to damage to the skin. Diabetes-related foot problems (such as diabetic foot ulcers) may occur, and can be difficult to treat, occasionally requiring amputation. Additionally, proximal diabetic neuropathy causes painful muscle atrophy and weakness.
Some risks of the keto diet include low blood sugar, negative medication interactions, and nutrient deficiencies. (People who should avoid the keto diet include those with kidney damage or disease, women who are pregnant or breast-feeding, and those with or at a heightened risk for heart disease due to high blood pressure, high cholesterol, or family history. (40)
Wellness is in many ways a counterpoint to the inefficient and inaccessible and alienating elements of the U.S. health-care system. While it may have antiestablishment origins, the industry is now subject to criticism as a new elite establishment, and one that profits off of serious insecurities and medical problems. Marketing for the festival alludes to the opioid epidemic that killed 72,000 Americans last year: “With our world being affected by addiction and mental-health issues, the Wellspring festival couldn’t come at a better time.” At a time when millions of Americans bear medical debt or are doing jobs they would otherwise quit, because they need health insurance, Wanderlust offers monthly payment plans (“rates from 10–30 percent APR”) to afford a ticket.
As many doctors watch their diabetic patients slowly decline while implementing traditional methods of care, it’s only natural for them to pursue therapies that actually work to stall and even reverse many of the debilitating comorbidities associated with diabetes. In challenging economic times, it’s difficult for physicians to be able to afford specialized treatment protocols, but they’re constantly on the lookout for ways to provide additional services that have been proven effective.
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.
One easy way to increase your fat content and quit snacking is to begin your meal by eating an avocado. I and others I know have used this trick to easily quit snacking. Avocados protect you from one of the reasons some dietary research wrongly claims that high-fat diets are bad for you: the danger of gorging yourself on delicious, fatty foods. With plain avocados, there is little danger of gorging. Another danger is clogging your arteries and giving yourself heart disease. But it’s been amply shown that the blame for that falls squarely on trans fats, like margarine. If you see any product with the words “partially hydrogenated” or “hydrogenated” in the list of ingredients, put it back, it’s a trans fat. On the other hand, any fat that comes directly from an animal or plant is not a trans fat and can be safely consumed.
Replacing humans with computers could make patients better control their sugar levels and suffer less complications in the long term. The French company Cellnovo has already shown that just a partially automated system, where blood sugar levels can be monitored wirelessly but patients still select insulin amounts, can reduce the chances of reaching life-threatening low sugar levels up to 39%. The company is now working towards developing a fully automated artificial pancreas in collaboration with Imperial College, the Diabeloop consortium and the Horizon2020 program.
Type 2 DM begins with insulin resistance, a condition in which cells fail to respond to insulin properly. As the disease progresses, a lack of insulin may also develop. This form was previously referred to as "non insulin-dependent diabetes mellitus" (NIDDM) or "adult-onset diabetes". The most common cause is a combination of excessive body weight and insufficient exercise.
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To explain what hemoglobin A1c is, think in simple terms. Sugar sticks, and when it's around for a long time, it's harder to get it off. In the body, sugar sticks too, particularly to proteins. The red blood cells that circulate in the body live for about three months before they die off. When sugar sticks to these hemoglobin proteins in these cells, it is known as glycosylated hemoglobin or hemoglobin A1c (HBA1c). Measurement of HBA1c gives us an idea of how much sugar is present in the bloodstream for the preceding three months. In most labs, the normal range is 4%-5.9 %. In poorly controlled diabetes, its 8.0% or above, and in well controlled patients it's less than 7.0% (optimal is <6.5%). The benefits of measuring A1c is that is gives a more reasonable and stable view of what's happening over the course of time (three months), and the value does not vary as much as finger stick blood sugar measurements. There is a direct correlation between A1c levels and average blood sugar levels as follows.
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