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News from the American Diabetes Association’s 71st Scientific Sessions

An A1C goal of less than 7 % may be unhealthy for some high-risk people with diabetes. A study confirmed that older people may benefit from a higher A1C target. (The A1C test measures blood glucose over two to three months.) In assessing the consequences of raising the target for seniors, researchers calculated that as many as 4.3 million Americans 65 years and older would be able to take fewer diabetes medications if the A1C target for older adults was bumped up to 8% or less. Taking fewer medications would reduce the risk of dangerous drug interactions. However, higher blood glucose levels can also have negative health effects. People with diabetes should discuss appropriate individual A1C targets with their doctors

Medication used to treat patients with type II diabetes activates sensors on brain cells that increase hunger, causing people taking this drug to gain more body fat, according to researchers at Georgia State University, Oregon Health and Science University, Georgia Regents University and Charlie Norwood Veterans Administration Medical Center.
The study, published on March 18, 2015 in The Journal of Neuroscience, describes a new way to affect hunger in the brain and helps to explain why people taking a class of drugs for type II diabetes gain more body fat.
Type II diabetes, the most common form of diabetes, affects 95 percent of diabetes sufferers. People with type I or type II diabetes have too much glucose, or sugar, in their blood. Type II diabetes develops most often in middle-aged and older adults and people who are overweight and inactive, according to the National Institute of Diabetes and Digestive and Kidney Diseases.
The research team found that sensors in the brain that detect free circulating energy and help use sugars are located on brain cells that control eating behavior. This is important because many people with type II diabetes are taking antidiabetics, known as thiazolidinediones (TZDs), which specifically activate these sensors, said Johnny Garretson, study author and doctoral student in the Neuroscience Institute and Center for Obesity Reversal at Georgia State.
The study found peroxisome proliferator-activated receptor ϒ (PPARϒ) sensors on hunger-stimulating cells, known as agouti-related protein (AgRP) cells, at the base of the brain in the hypothalamus. Activating these PPARϒ sensors triggers food hoarding, food intake and the production of more AgRP. When AgRP cells are activated, animals become immediately hungry. These cells are so potent they will wake a rodent up from slumber to go eat, Garretson said.
TZDs help to treat insulin resistance, in which the body doesn’t use insulin the way that it should. They help the body’s insulin work properly, making blood glucose levels stay on target and allowing cells to get the energy they need, according to the National Institute of Diabetes and Digestive and Kidney Diseases.
“People taking these TZDs are hungrier, and they do gain more weight. This may be a reason why,” Garretson said. “When they’re taking these drugs, it’s activating these receptors, which we believe are controlling feeding through this mechanism that we found. We discovered that activating these receptors makes our rodent animal model eat more and store more food for later, while blocking these receptors makes them eat less and store less food for later, even after they’ve been food deprived and they’re at their hungriest.”
The research team includes Dr. Timothy Bartness, director of the Center for Obesity Reversal at Georgia State; Johnny Garretson and Drs. Brett J. W. Teubner and Vitaly Ryu of Georgia State; Dr. Kevin L. Grove of Oregon Health and Science University; and Dr. Almira Vazdarjanova of Georgia Regents. The study was funded by the National Institutes of Health and National Science Foundation.
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Story Source:
The above story is based on materials provided by Georgia State University. Note: Materials may be edited for content and length.
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Journal Reference:
J. T. Garretson, B. J. W. Teubner, K. L. Grove, A. Vazdarjanova, V. Ryu, T. J. Bartness. Peroxisome Proliferator-Activated Receptor Controls Ingestive Behavior, Agouti-Related Protein, and Neuropeptide Y mRNA in the Arcuate Hypothalamus. Journal of Neuroscience, 2015; 35 (11): 4571 DOI:10.1523/JNEUROSCI.2129-14.2015

Each year, an average of 200,000 Americans are hospitalized because of flu complications, but people with type 1 or type 2 diabetes are three times more likely to face complications that may be fatal, according to the Centers for Disease Control and Prevention. The best step is prevention, and anyone with diabetes should seriously consider getting a flu shot in the fall.
But for those who do get sick, it’s important that people with diabetes be prepared. The following sick-day plan is designed to help diabetic patients suffering from a cough, a cold or the flu.
Get plenty of sleep, and even when awake, do resting activities (reading, watching TV, online shopping) as long as you don’t find it stressful.
“Feed a cold, starve a fever” is not advice you should follow. Eat plenty of healthy items that are also easy to digest, like soups, sugar-free Jell-O and fruit juice mixed with water and yogurt. Dehydration will cause your blood sugar to drop, so drink one cup of sugar-free, caffeine-free liquid per hour.
Medicine cabinets must go beyond a glucose meter and thermometer. You should also have ketone-testing supplies and appropriate medications for cold and flu symptoms. “When suffering from a cough, cold or flu, it’s important for people with diabetes to treat their symptoms with medicine that doesn’t have a negative effect on their diabetes,” says Debra Spector, registered dietitian and certified nutritionist.
“Most people don’t realize that cough syrups can contain up to 50 percent sugar, and cold and flu medicines may contain alcohol, both of which can raise one’s glucose, possibly to dangerous levels. Diabetic Tussin has been trusted by the medical community for years because it is sugar and alcohol-free, so it’s 100 percent safe for diabetics. It’s even recommended for those on a sodium or gluten-free diet,” says Spector.
Take your insulin and diabetes medicine on schedule, even if you experience nausea or haven’t eaten. Check your blood glucose at least four times a day.
If your symptoms worsen, contact your doctor.
Distributed by Internet Broadcasting. This material may not be published, broadcast, rewritten or redistributed.

Diabetes can destroy small blood vessels, which in turn can damage the nervous system, and these damaged nerves can cause pain.
The most common forms of diabetes, juvenile and adult onset, can damage many organs and systems. Diabetes can make it hard to digest food, cause heart disease, and destroy small blood vessels, while the nervous system becomes an innocent, injured bystander. The disease’s most common pain syndrome is diabetic neuropathy.
The pain arises from nerves that are injured or malfunctioning. These crippled fibers can be found anywhere along their path, from the tip of the toe to the brain. Diabetes eats away at the thread-thin blood vessels that feed delicate nerve cells.
This is why diabetes pain usually strikes first in the hands and feet. A common pain syndrome from diabetes is described as “stocking and glove” pain because it appears in the hands and feet and usually makes it painful to wear gloves or socks.
Diabetes alters sensation in the smallest nerves, which happen to lie at the end of the peripheral nervous system, in the hands and feet. Diabetes starves these tiny nerves. As a result, the nervous system becomes confused about what is and isn’t painful. Stockings, gloves – anything that touches skin served by these tiny, hypersensitive nerves – is going to send signals to the spinal cord, where they may be mistaken for pain.
Author: Scott Fishman, M. D., Pain Management Specialist

Patients with type 2 diabetes treated with insulin could be exposed to a greater risk of health complications including heart attack, stroke, cancer and eye complications a new study has found.

Examining the UK Clinical Practice Research Datalink (CPRD) – data that characterizes about 10 percent of the UK population – a team of researchers from Cardiff University’s School of Medicine looked at the risk of death for patients taking insulin compared with other treatments designed to lower blood glucose levels in people with type 2 diabetes.

The team’s epidemiological study found people have greater risk of individual complications associated with diabetes such as heart attack, stroke, eye complications and renal disease when compared with patients treated with alternative glucose-lowering treatments.

“Insulin treatment remains the most longstanding blood-glucose-lowering therapies for people with type 2 diabetes, with its use growing markedly in recent years,” according to Professor Craig Currie from Cardiff University’s School of Medicine, who led the study.

“However, with new diabetes therapies and treatments emerging there has been a new spotlight on treatments to ensure what the best and safest form of diabetes treatment is.

“By reviewing data from CPRD between 1999 and 2011 we’ve confirmed there are increased health risks for patients with type 2 diabetes who take insulin to manage their condition,” he adds.

The study adds to previous findings which identified potential health risks of insulin in this specific group of people.

Initial concerns were first raised regarding the use of insulin in type 2 diabetes from a population-based study in Canada, which reported a three-fold increase in mortality.

A similar study of people in UK primary care with type 2 diabetes treated with insulin also reported a 50 percent risk of increased mortality compared with another common treatment regimen.

Professor Currie adds: “Patients currently being treated with insulin should not, under any circumstances, stop taking their medications, and it is important to emphasize that this report related to only type 2 diabetes which typically starts in older people who are overweight.

“Each patient’s individual circumstances are different and treatment decisions are managed by their clinician with all of their medical history fully considered.

“The vast majority of people who take insulin will experience no adverse effects and it remains a reliable and common form of treatment worldwide but this study shows that we need to investigate this matter urgently and the drug regulatory authorities should take interest in this issue.

“Anyone who is concerned should speak to their GP first before taking any action on managing their condition.”

Source: http://jcem.endojournals.org/content/98/2/668.abstract?sid=e5e8ec61-0997-43bd-934b-d4894998abb9

Medicine tied to lower thyroid-stimulating hormone levels in those with underactive thyroid
WebMD News from HealthDay , By Mary Elizabeth Dallas, HealthDay Reporter

MONDAY, Sept. 22, 2014 (HealthDay News) –Insulin sensitizers commonly used to treat diabetes, may raise the risk of low levels of thyroid-stimulating hormone (TSH) among patients with an under active thyroid, a new study suggests.

The researchers cautioned that low TSH levels may be associated withheartproblems and broken bones, although a cause-and-effect link was not established in this study.

Among those in the study with an underactive thyroid (hypothyroidism), there were 495 incidences of low levels of thyroid-stimulating hormone per year compared with 322 in the normal thyroid group, the report published Sept. 22 in the CMAJ concluded.

Among patients treated for an underactive thyroid, insulin sensitizers were linked with a 55 percent higher risk for low TSH levels, compared to those who were taking sulfonyl urea for their diabetes.

“The results of this longitudinal study confirmed that the use of insulin sensitizers was associated with an increased risk of low TSH levels in patients with treated hypothyroidism,” Dr. Laurent Azoulay, with the department of oncology at McGill University in Montreal, said in a journal news release.

“Given the relatively high incidence of low TSH levels in patients taking insulin sensitizers, it is imperative that future studies assess the clinical consequences of this effect,” Azoulay added.

Two experts agreed that the finding requires further research.

“The question this study poses is: does the suppressed TSH have clinical significance?” said Dr. Gerald Bernstein, director of the diabetes management program at the Friedman Diabetes Institute at Mount Sinai Beth Israel, in New York City.

“The answer is as follows, millions of people have type 2 diabetes and millions of people have low thyroidand take thyroid pills. And given the multiple millions of people who take both drugs there has been no mass clinical issue,” Bernstein said. Also, “this study did not contain any measurements of the two forms of thyroid hormone in the blood. That data might help clarify why the TSH is suppressed.”

Dr. Minisha Sood, an endocrinologist at Lenox Hill Hospital in New York City, added that “the reason for insulin sensitizer’s effect on TSH levels is not clear at present. It is also unclear whether the low TSH levels associated with insulin sensitizers in this study put patients at risk for developing other complications such as cardiovascular diseases.”

Insulin sensitizers are used to lower blood sugar (glucose) levels. It works by reducing glucose production in the liver. To examine the drug’s effect on TSH, the researchers examined data compiled on over 74,000 people who took insulin sensitizers, along with another diabetes drug known as sulfonylurea, over a 25-year period.