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Gallbladder Problems and Diabetes

Diabetes and Gallbladder Problems: What’s the Connection?

The evidence that people with diabetes are at greater risk of gallstones is clear, but “we still don’t know why,” says Armand A. Krikorian, MD, an endocrinologist at University Hospitals Case Medical Center and an assistant professor of medicine at Case Western Reserve University School of Medicine in Cleveland.

Perhaps it’s because people with diabetes are generally overweight, and obesity is linked to gallstone disease. People with diabetes have higher levels of triglycerides — a type of fat — and it’s theorized that the triglycerides themselves encourage gallstone formation.

Another theory is that stones form because of what is called autonomic neuropathy, or damage from diabetes to the involuntary nerves that control movement of the bowels and gallbladder. According to this line of thought, the bile stored in the gallbladder is not released efficiently because the nerves are damaged, and gallstones form from the resulting sludge.

Also, recent research on insulin-resistant mice shows that FOXO1, a specific protein involved with diabetes, increases the amount of cholesterol that enters the bile, which may lead to the formation of gallstones. Cholesterol is a major component of most gallstones.

Diabetes and Gallbladder Problems: Know the Symptoms

Dr. Krikorian says that for a person living with diabetes, controlling the diabetes is the way to head off gallbladder problems.

When diabetes is under control, it’s much less likely that autonomic neuropathy will become an issue, and your triglyceride levels will be lower — thus decreasing your odds of developing gallstones, according to Krikorian.

Diabetes and Gallbladder Problems: Gallstone Symptoms

This common-sense approach means that people with diabetes should be aware of gallstone symptoms, Krikorian says.

Some gallstones, called silent stones, cause no symptoms and do not require treatment. However, in many people, gallbladder “attacks” may occur, especially after consuming a fat-laden meal.

Symptoms of a gallbladder attack may include:

  • Sudden pain in the right upper abdomen that can last several hours
  • Pain between the shoulder blades or under the right shoulder
  • Abdominal pain centered on the right side that gets worse after eating
  • Unexplained nausea or vomiting

Diabetes and Gallbladder Problems: Managing Diabetes

Most people with diabetes who are under a doctor’s care have a plan in place to manage and treat their disease. A management plan should address food intake, exercise, medications, and daily monitoring of blood sugar levels.

Controlling blood glucose levels should not only help you feel better in general, but it may also delay the onset of complications often associated with diabetes, including gallbladder problems.

Diabetes and Gallbladder Problems: Treatment

People with diabetes are usually considered high-risk for any surgery, including gallbladder surgery, says Krikorian. But, in most cases, when gallstones are problematic, the best course of action is to remove the gallbladder. According to Krikorian, controlling the diabetes doesn’t change after the gallbladder is removed.

In general, whether they have diabetes or not, most people can avoid gallbladder problems by eating a consistently balanced diet, getting enough exercise, and managing their overall health.

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8 Triggers That Make Restless Legs Worse

 

 

Identifying Restless Legs Triggers

Medications may be most effective for severe RLS, but identifying and avoiding things that aggravate your symptoms can also help, especially in mild or moderate cases. Here are some common restless legs triggers, plus tips to help you overcome them and get some sleep:

  • Stress and anxiety.Rachel Salas, MD, an assistant professor of neurology at the Johns Hopkins University School of Medicine in Baltimore, says that stress and anxiety are big restless legs triggers. Stress reduction techniques like deep breathing or yoga may help.
  • Nicotine.If you need another reason to stop smoking,calming your restless legs is a good one. Talk with your doctor if you think you need help quitting.
  • Alcohol.Many people with RLS report that drinking can lead to more restless legs symptoms. Although alcohol can help people fall asleep quickly, it interferes with the quality of sleep and can make sleep apnea worse , says Alon Avidan, MD, MPH, an associate professor of neurology and director of the Sleep Disorders Clinic at UCLA. Try omitting alcohol to see whether your restless legs improve and whether you feel more rested in the morning.
  • Vigorous exercise.Getting moderate exercise during the day can help ease restlessness at night. Butvigorousexercise, especially close to bedtime, can have the opposite effect in some people.
  • Medications.A number of medications can make RLS worse. In particular, anti-nausea drugs and sedating antihistamines (like Benadryl) block the brain’s dopamine receptors, causing restless legs symptoms. Antidepressants that increase serotonin and antipsychotic medications can also aggravate the condition. Let your doctor know if your restless legs symptoms worsen after you take a new medication. A change in dosage or to a different medication may do the trick.
  • Caffeine.Because caffeine is a stimulant, it can interfere with sleep if it’s consumed too close to bedtime. It’s long been on the list of restless legs triggers, but Dr. Salas says recent research shows it may not be that big of a problem. In fact, she says, it may be beneficial in some people. Try cutting out coffee, tea, colas, sports drinks, and even chocolate to see if your symptoms improve or worsen.

 

Other health conditions can also cause restless legs. This is what’s called secondary restless legs syndrome :

  • Pregnancy.According to Dr. Avidan, about 20 percent of pregnant women report restless legs symptoms. This is more likely in the last three months of pregnancy, and iron deficiency is usually the culprit. If symptoms crop up when you’re expecting, your doctor will probably test the level of iron in your blood and prescribe iron supplements if it’s too low. The good news is that your restless legs symptoms will probably go away soon after you have your baby.
  • Medical conditions.Restless legs symptoms are also seen in some people with kidney failure and diabetes. Treating these conditions will often calm the restless legs.

The Restless Legs Syndrome Foundation suggests using a sleep diary to pinpoint your personal triggers and gauge the severity of your symptoms. Always tell your doctor if your symptoms get noticeably worse.

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Diabetes and Impotence

Over the long term, diabetes can cause various degrees of erectile dysfunction, including impotence. Diabetes interferes with oxygen delivery and the production of the chemical nitrous oxide, which is crucial to having and maintaining an erection. Poor glucose control, along with other diabetes-related complications, such as neuropathy in the feet and retinopathy in the eyes, increases the odds of erectile dysfunction.

Up to 52 percent of diabetic men between the ages of 55 and 59 have erectile dysfunction, or ED. Having said this, there are many other problems that, either in combination with diabetes or on their own, can cause it — these include advancing age, dementia, stroke, spinal cord or back injury, multiple sclerosis, heart disease, injury to the prostate, smoking, and the use of certain types of medicines. Most antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), are known to cause erectile dysfunction. Thiazide diuretics, a class of medicines typically given to treat hypertension, are also associated with erectile dysfunction, though their benefits outweigh this risk. Other drugs linked to ED include spironolactone (a diuretic), clonidine (a hypertension medication), cimetidine (an antacid), and ketoconazole (an antifungal medication). It is also important to consider psychological causes of impotence, such as depression and performance anxiety.

Improving glucose control and losing weight, if you need to, might help resolve the problem. There are also various treatments, depending on the cause of the dysfunction. Medications, including sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis), are commonly prescribed and can be effective. These medicines have disturbing side effects, however, including headache, flushing, and light-headedness. Additionally, they are not recommended for individuals taking heart medicines such as nitrates. Other treatments — depending on the cause of the erectile dysfunction — include psychotherapy, prostaglandin injections, vacuum-assisted devices, surgical implantations, and testosterone injections.

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Low Crab: The Role of Insulin

There are three basic units the body uses for energy:

1. Fats

2. Proteins

3. Carbohydrates

All three can be converted to blood glucose. However, while fats and proteins are converted slowly, carbohydrates are converted quickly causing quick spikes in the body’s blood sugar levels. These spikes in blood sugar levels cause the pancreas to create and release insulin until the blood sugar level returns to normal.

Meanwhile, insulin, a hormone produced in the pancreas that lowers our blood’s glucose levels is released into the blood as soon as the body detects that blood sugar levels have risen above its optimal level.

Insulin is a very efficient hormone that runs the body’s fuel storage systems. If there is excess sugar or fat in the blood insulin will signal the body to store it in the body’s fat cells. Insulin also tells these cells not to release their stored fat, making that fat unavailable for use by the body as energy.

Since this stored fat cannot be released for use as energy, insulin very effectively prevents weight loss. The higher the body’s insulin levels, the more effectively it prevents fat cells from releasing their stores, and the harder it becomes to lose weight. According to many authorities, over the long term, high insulin levels can lead to insulin resistanceand cause serious health problems like the ones listed below:

1. Raised insulin levels and insulin resistance

2. Lower metabolism leading to weight gain

3. An increase in fatty tissue and reduction in muscle tissue

4. Accelerated aging

5. Increased food allergies and intolerances

6. Overworked immune system

7. Increased risk of heart disease, obesity, diabetes and cancer

Carbohydrates, especially simple carbs like sugar and starch, are quickly turned into sucrose by the body entering the blood stream quicker thereby causing the release of large amounts of insulin. The fewer carbs are eaten, the less insulin is produced by the body, and the fewer calories are stored as fat. Less fat storage equals less weight gain and fewer carbs eaten equals less insulin in the blood and the body using its fat stores for fuel.

The premise behind every low-carb diet plan is that a body that produces less insulin burns more fat than a body that produces lots of insulin. Some plans encourage a period of extremely low carbohydrate intake so that the body will enter a state of ketosis and more quickly burn fat stores – These are usually called induction periods.

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PROTEIN PRINCIPLE OF DIABETES

Dietary considerations can present a Hobson’s choice in diabetes. Even when the intake is nutritious, assimilating it can be another matter. Then there is the problem of progression of diabetic complications if one ends up with excess glucose or fat in the system. Excess carbohydrates in a meal, and the resulting uncontrolled blood sugar levels can be detrimental to any number of tissues, from the lens of the eye, to the neurons, small blood vessels and the kidneys. Fat is also a problem with increase incidences of atherosclerosis, large vessel disease and cardiac complications. What, then is the appropriate macronutrient for the diabetic population? Enough medical literature exists to suggest that in diabetes, proteins are probably the best bet.

Proteins are the natural choice of the body when faced with diabetes. In uncontrolled diabetes, muscle protein is broken down into amino acids to be converted into glucose by the liver. If left to fend for itself, this can create a commotion within the body. Since proteins have to supply enough energy to substitute for carbohydrates, proteins are broken down faster than they are made. The body ends up with a protein deficit, a situation with subtle, yet far-reaching effects on normal body functions. Importantly, for diabetics, a protein deficit has been shown to impair resistance to infections (Ganong WF). Replenishing the depleting protein stores is a vital requirement of all diabetic diets.

Importance of proteins in a diabetic has been well documented. The American Associations of Clinical Endocrinologists have made it clear that not much evidence exists to indicate that the patients with diabetes need to reduce their intake of dietary proteins. The AACE recommends that 10-20% of the calorie intake in diabetes should come from proteins (AACE Diabetes Guidelines). It is in fact believed that this is one nutrient that does not increase blood glucose levels in both diabetics and healthy subjects (Gannon et al).

Nutrition therapy for diabetes has progressed from prevention of obesity or weight gain to improving insulin’s effectiveness and contributing to improved metabolic control (Franz MJ). In this new role, a high protein diet (30% of total food energy) forms a very pertinent part of nutrition therapy. One of the most important causes for type II diabetes is obesity. Excess body fat raises insulin resistance and higher levels of insulin are required to bring down blood sugars as the weight increases (Ganong WF). Another problem with excess fat is the clogging of arteries with atherosclerotic plaques that is responsible for a wide range of diabetic complications. Any mechanism that reduces body fat decreases insulin resistance and improves blood glucose control. Parker et al have also shown that a high protein diet decreased abdominal and total fat mass in women with type II diabetes. Other studies by Gannon et al. and Nuttall et al have verified that blood glucose levels and glycosylated hemoglobin (a marker of long term diabetic control) reduce after 5 weeks on a diet containing 30% of the total food energy in the form of proteins and low carbohydrate content. It is speculated that a high protein diet has a favorable effect in diabetes due to the ability of proteins and amino acids to stimulate insulin release from the pancreas. Thus, a high protein diet is not only safe in diabetes, but can also be therapeutic, resulting in improved glycemic control, and decreased risk of complications related to diabetes.

The benefits of a high protein diet do not end here. Individual protein components of such a diet, when aptly chosen, can have other advantages as well. Dietary supplements containing proteins like whey and casein come highly recommended. Casein is a milk protein and has the ability to form a gel or clot in the stomach. The ability to form this clot makes it very efficient in nutrient supply. The clot is able to provide a sustained, slow release of amino acids into the blood stream, sometimes lasting for several hours (Boirie et al. 1997). A slow sustained release of nutrients matches well with the limited amount of insulin that can be produced by the pancreas in diabetes. A protein supplement containing casein can thus increase the amount of energy assimilated from every meal and, at the same time, reduce the need for pharmacological interventions to control blood sugar.

Whey proteins and caseins also contain “casokinins” and “lactokinins’, (FitzGerald) which have been found to decrease both systolic and diastolic blood pressure in hypertensive humans (Seppo). In addition, whey protein forms bioactive amine in the gut that promotes immunity. Whey protein contains an ample supply of the amino acid cysteine. Cysteine appears to enhance glutathione levels, which has been shown to have strong antioxidant properties — antioxidants mop up free radicals that induce cell death and play a role in aging.

Thus, development of a protein supplement containing casein and whey can provide an apt high protein diet and its health benefits to individuals suffering from diabetes, obesity and hypercholesterolemia.

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Kids and teens at risk for type 2 diabetes.

 

One of my favorite things to do is speak to our kids and youth about the affects of type 2 diabetes. I also love telling them how to avoid getting type 2 diabetes through healthy eating and getting more exercise.

Type 2 diabetes is becoming increasingly common in the Indian Kids and teens especially those who are overweight. There are some studies that report between 8% and 45 % of children who’ve been diagnose with diabetes have the form known as type 2.

Diabetes is a chronic condition and needs close attention, with some piratical knowledge, you can become your child’s most important ally when it comes to learning to live with this disease.

Most people who develop type 2 diabetes are overweight. Excess fat makes it harder for the cells to respond to insulin. Being inactive makes the body’s ability to respond to insulin. Once only known as adult- onset diabetes because it almost exclusively affected adults that were overweight. Today that description is not accurate. Kids and teens are being diagnosed with type 2 diabetes, unfortunately most of these kids are overweight.

Have hope!! With better diet and exercise you can help your child avoid having your child ever hear the words you have type 2 diabetes.

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Do You Have Type 2 Diabetes Burnout?

 

If you’re living with type 2 diabetes, you know how frustrating some days can be. Learn to recognize the signs of burnout and when to seek advice and help.

Type 2 diabetes is a chronic condition, and for people with diabetes, that means having to manage it every day. If you have type 2 diabetes, you need to constantly monitor not only your blood glucose (sugar) levels and medication doses, but also what you eat, how much you exercise, and how to cope in various situations, such as when you travel or catch the flu. Following a daily management plan is the best way to keep your diabetes in check, but it can take its toll on you emotionally.
Type 2 Diabetes Burnout: Why It Happens

Burnout means being overwhelmed or exhausted by physical or emotional stresses, and a chronic condition like diabetes can cause both.

“Living with diabetes can be challenging,” says Jenny De Jesus, RN, CDE, a diabetes educator at The Friedman Diabetes Institute at Beth Israel Medical Center in New York City. “It’s easy to become overwhelmed by diabetes and all that comes with it.”

You may feel at times that sticking with a diabetes care plan is more than you can or want to handle. You may get frustrated with monitoring blood glucose or having to watch your diet. Know that these are normal feelings, and that you can take steps to regain a positive outlook.

Type 2 Diabetes Burnout: Heading It Off

According to the National Diabetes Education Program, you may be able to prevent negative feelings from escalating by finding ways to ease stress. Here are a few suggestions:

  • Take a few minutes each day to spend time on a hobby you enjoy, meditate, or practice deep breathing.
  • Keep a journal to record not just what you eat and your glucose levels, but also to note how you feel — what bothers you and what makes you feel better.
  • Ask yourself how you can divide your management plan into smaller steps that will make it seem easier to master.

Type 2 Diabetes Burnout: Coping Strategies

Unlike a job that’s sent you over the edge or a relationship that just isn’t right for you any longer, type 2 diabetes is with you for the long term. And there may be times when you experience burnout despite all your best efforts. Often the first step is accepting that you may not be able to handle every aspect of diabetes care without some help. Try to figure out which aspects of diabetes led to your feelings of burnout and get help to address those issues and restore your quality of life.

Reaching out for support from friends and family is essential to relieve diabetes burnout. “They can help you put things into perspective and get back on track,” says De Jesus.

Randy Pike, a reporter in Grande Prairie, Alberta, Canada, who has had type 2 diabetes for the past 15 years, knows how helpful family can be. “My wife generally notices signs that I need to eat better than I do,” Pike says.

The more your family and friends know and understand about type 2 diabetes, the greater a resource they can be for you. They can attend classes with you or get information through sources like the American Diabetes Association Web site.

Your health care team is another important resource. Doctors, nurses, and dietitians who specialize in diabetes care understand the problems that type 2 diabetes can cause. If you discuss your situation with them, they will be able to offer you insights to better manage whatever is troubling you.

Doctors are also learning to be more aware of diabetes-related stress. By anticipating problems, they may be able to show you how to reduce stress before you reach the burnout stage. And if a member of your medical team brings up the subject with you, be sure to answer honestly. Bottling up stress or denying it exists can make it worse.

Diabetes is something that you have to live with, but how you live with it depends on you. The most important things you can do are take care of yourself and seek help when you need it.

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Fructose Consumption Impairs Insulin Sensitivity

Fructose and sucrose worsen lipid profiles compared with similar amount of glucose….
High levels of fructose can affect hepatic insulin sensitivity, while even moderate consumption of fructose and sucrose can significantly alter lipid profiles in healthy young men, according to published research.

Isabelle Aeberli, Ph.D., of University Hospital Zurich, and colleagues assessed the effect of moderate amounts of fructose and sucrose compared with glucose on glucose and lipid metabolism in a randomized, double-blind, cross-over study involving nine healthy normal-weight male volunteers. The volunteers, aged 21 to 25 years, were given four different beverages (600 mL/day) sweetened with medium or high fructose, high glucose, or high sucrose for three weeks each.

After high fructose, the researchers found that hepatic suppression of glucose production was significantly lower than after high glucose (59.4 ± 11.0 percent versus 70.3 ± 10.5 percent). Fasting glucose, insulin, and C-peptide were not affected after high fructose. Low-density lipoprotein cholesterol and total cholesterol were significantly higher after medium fructose, high fructose, and high sucrose, compared with high glucose. Free fatty acids were significantly higher after medium fructose, but not after high fructose or high sucrose, compared with high glucose.

“In conclusion, this study shows that, with regard to glucose metabolism and, specifically, hepatic insulin sensitivity, fructose, even in moderate amounts, seems to be more harmful than the same amount of glucose,” the authors write. “Furthermore, all fructose-containing drinks (including sucrose) showed significant effects on the lipid profile compared with glucose.”
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Diabetes and Your Emotions: Staying Positive

 

Here’s how to get the diabetes support you need to manage your health and avoid diabetes burnout.

Learning you have diabetes can lead to a flood of emotions, both when you’re first diagnosed and as you manage your condition over time — all of which can lead to diabetes burnout — unless you have the right outlook and strong diabetes support.

Denial is a common reaction to being diagnosed with diabetes, explains Barbara Borcik, RD, LDN, CDE, of the Diabetes & Nutrition Center at Northwest Hospital in Randallstown, Md. “You might think of a host of reasons why the test results can’t be accurate,” she says. The problem with denial, Borcik says, is that it can get in the way of taking care of yourself. When test results show you have diabetes, your doctor may perform a second test on a different day to confirm. If the results are the same, she notes, “you may be a little more accepting and start to change how you take care of yourself.”

Guilt is another common reaction. “You might say to yourself, ‘If I hadn’t had a soda every day or a candy bar every afternoon, I wouldn’t have diabetes’” Borcik says. The truth is, diet isn’t the only risk factor, and feeling guilty shouldn’t be part of your get-better equation. You need to stay positive and face living with diabetes with an “I can do this” attitude.

Living With Diabetes: Building Diabetes Support

Living with diabetes isn’t as difficult as you might think, even if you need to make permanent lifestyle changes. Your doctor will work with you to develop a management plan to improve your health. Key components are a nutritious diet to reach and maintain a healthy weight, regular exercise, and possibly medication to keep your blood sugar under control. It’s also important to check your blood sugar often and visit your doctor regularly to monitor your condition and prevent complications. Think of all these steps as positive changes you’re making for better health.

Other strategies can also make living with diabetes easier to manage, both physically and emotionally:

Get educated. Learn all you can about living with diabetes, Borcik says. The more you know, the better you’ll cope. For instance, knowing trouble signs to watch for will take away some of the panic and confusion you might be feeling. If you use the Internet to research diabetes, she suggests accessing only sites that you know are reliable and up-to-date, such as the American Diabetes Association. Ask your doctor or diabetes educator for ways to keep up with treatment advances.

Get diabetes support. According to the National Institutes of Health and the Centers for Disease Control and Prevention, nearly 26 million Americans have diabetes. Networking with other people who are also managing diabetes can be both reassuring and helpful. “Realizing you’re not alone can help you stay positive,” Borcik says. Find support groups online or through your doctor or a diabetes educator.

Create a family network, too. Your family and friends often want to help you manage diabetes, but may not know how. Be specific about your needs — you might want a loved one to be with you at doctor appointments, or you might want to share nutritious recipes for healthier meals. “Friends and caregivers can help you problem-solve if you share your challenges with them,” says Laura Rooney, DNP, RN, CDE, who runs the Healthy Eating and Lifestyles Program, a self-management and education program for people with diabetes, for the School of Nursing at the University of Texas Health Science Center at Houston. Surround yourself with those who support you and minimize exposure to those who negatively impact your health.

Stick to your diabetes management plan. If you watch your diet, exercise regularly, and take any prescribed medications, you can control your diabetes. “When you control your blood sugar, you’ll feel better, and feeling better is a great motivator and mood lifter,” Borcik says. You’ll also sleep better, and that in turn can help you deal better with whatever life throws your way, she adds. Stay in touch with your doctor so you know your numbers — your glucose level, your A1C, your blood pressure, and your cholesterol count. Should they go above the levels that are right for you, look for possible causes and see what happens if you make changes. Your doctor may have additional suggestions for how to get your numbers back where they should be. Don’t delay — if you allow diabetes to get too far out of control, you may start to feel overwhelmed.

Don’t be too hard on yourself. Living with diabetes is a ‘round-the-clock reality, and you’re bound to slip up once in awhile. “Just get right back on track the next day,” Borcik says. Don’t let guilt get you down.

Be kind to yourself. “I always tell people, ‘Give yourself a break,’ ” Rooney says. Once in awhile it’s okay to have a small slice of birthday cake or some of Mom’s homemade candy — as long as it’s not a daily habit. Having a small, favorite indulgence every now and then will help you stay on track the rest of the time and prevent diabetes burnout. Also, reward yourself for small victories with treats other than food. Go to the movies, get a massage or facial, or meet a friend for a walk around the neighborhood or a game of golf.

Focus on the positive. “Lots of people with type 2 diabetes focus on what they can’t have rather than all the wonderful things they can have,” Rooney says. Adjusting your outlook can help you stay positive. When you see only the negatives, you sabotage your efforts to manage your condition. Focus on the control you do have over your health and the actions you can take to feel better.

A Note on Diabetes and Depression

Despite your best efforts, you might feel overwhelmed by your diabetes diagnosis and upset about the lifestyle changes you need to make. You may even become depressed. It’s important to get help for depression right away because it can start a dangerous downward spiral. People with diabetes who become depressed are less likely to take their medications regularly, putting them at increased risk for complications.

A study by researchers from the University of Pennsylvania published in the Annals of Family Medicine found that treating people for diabetes and depression simultaneously improved their ability to not only control their diabetes, but also their mood. When people received treatment for both diabetes and depression, the rate at which they had improved blood sugar tests almost doubled (61 percent for those who received combined care versus 36 percent for those who didn’t). The same was true for reduced symptoms of depression (58 percent showed improvement with combined care versus 31 percent without combined care).

Watch for the warning signs of depression. If you feel sad much of the time, overeat or don’t eat enough, notice changes in your sleep habits, or can’t concentrate at work, you may need counseling. Talk to your doctor about getting professional help.

Living with diabetes requires daily commitment, but educating yourself about this common condition and building a solid support network will help keep you healthy and emotionally strong.

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Teens Manage Diabetes Better with Family Problem-solving Sessions

A clinic-based program for adolescents with type 1 diabetes and their families helped the teens develop the healthy behaviors needed to control their blood sugar levels….
The researchers found that 12- to 15-year-olds benefited from a two-year program of three to four meetings each year with parents and a health advisor to discuss shared responsibilities, goals and strategies for solving diabetes management problems that arose. 
Many adolescents have difficulty managing their diabetes. Hormonal changes may affect insulin levels. Moreover, adolescents may find it difficult to adhere to their daily treatment plan.  When caring for their diabetes, adults often follow the patterns they established in adolescence, Dr. Nansel (who collaborated on the study with NICHD colleagues Ronald J. Iannotti, Ph.D., and Aiyi Liu, Ph.D.) explained. If they fail to learn how to care for the disease properly during this time, they may develop poor habits that increase the chances for health problems later on. 

In the study, the researchers evaluated WE-CAN Manage Diabetes, a two-year behavioral intervention program they developed. The study included about 300 preteens and young adolescents with type 1 diabetes (ages 9 to 15) and their families. Half the families received the WE-CAN intervention and half received standard care. 

Standard care consisted of regular visits with their diabetes care physician. In addition to the physician visits, the WE-CAN program included meetings in which the health advisor discussed with the family any difficulties they were having with the child’s diabetes management or areas they would like to improve. The health advisor then helped the families work out a plan for solving the problems. For example, in their sessions with the health advisor, young people with diabetes and their families frequently set goals such as checking blood sugar more often or eating more healthfully.

At each visit, researchers also recorded hemoglobin A1C (HbA1C) measurements, a standard indicator of a person’s long-term blood sugar control.

At the study’s conclusion, the 12- to 15-year-olds in the intervention group had markedly better HbA1c levels than those who received standard care. The intervention did not appear to improve blood sugar control among 9- to 11-year-olds. 

“The approach appears to be better suited for the behavioral issues that the older kids were facing,” said Dr. Nansel. “The findings show us that the children who needed it most are the ones for whom this approach worked.”