By: Scott M. King
I have been sifting through the pages of several diabetes medical journals from all over the world over. My impressions are mixed. A very few articles are clear and significant for people with diabetes, while most are written only for a select few. These have titles so complicated, I have to get out the medical dictionary even to read them. I don’t question their validity, but with titles such as “Anglotensin-converting enzyme polymorphism and development of diabetic nephropathy in non-insulin-dependent diabetes mellitus,” it makes it difficult to know whether I’m looking at the next cure or maybe a stepping-stone for someone to get their next grant. I read through over 300 articles and selected the seven which follow. I felt these had relevant information to help people with diabetes make better informed choices.
We Told You This Five Year Ago
In 1991, DIABETES HEALTH presented an article quoting Alan Marcus, MD on the subject of blood sugars. He said, “We now know that it is the high blood sugars after meals that are the prime cause of diseases such as hardening of the arteries, hypertension, eye disease and other (complications). Hence, it is vital to test 90 minutes after you eat.”
Now the New England Journal of Medicine has presented evidence in November 1995 that proves Dr. Marcus is right. A study headed by M. deVeciana, found that women with gestational diabetes had fewer complications when they tested their blood glucose after meals, rather than before.
They followed two groups of women, one based their insulin injections on before-meal blood sugar readings, and the other based their injections of tests taken after-meals.
The women who monitored after-meals experienced a lowering of their HbA1c levels of 3.0% compared to 0.6% raise in those who monitored before-meals.
Babies born to women with diabetes are often very large, the result of the infant producing more insulin (a growth hormone) in response to the high glucose levels in the mother’s body. The large babies often must be delivered by cesarean section and then may suffer from neonatal hypoglycemia.
Those who monitored after-meals benefited all around: their infants had lower birth weight-about 6.5 pounds to 8.5 pounds. Only 3% of the after-meal babies had neonatal hypoglycemia, compared to 21% of those whose mothers monitored before meals. Just 12% of the after-meal babies were born cesarean section, compared to 36% of the pre-meal babies.
The researchers concluded that women with gestational diabetes should adjust their insulin needs according to after-meal measurements in order to fully understand how food influences blood glucose levels.
This study only dealt with gestational diabetes, but I think that the lessons are applicable to me and others with diabetes. We might greatly benefit by getting the training necessary to adjust our insulin doses with the after meal glucose reading. In other news:
More Good News About Vitamin E
A study presented in the October 28, 1995 issue of the British Medical Journal showed study participants who had low blood levels of vitamin E were 400% more likely to develop type 2 diabetes. The authors of the study conclude that “this data supports the theory that free radical stress has a role in the causation of non-insulin dependent (type 2) diabetes.” Take home lesson: take vitamin E if type 2 diabetes runs in you family.
Learning About Trigger Finger
A recent issue, September 1995, of the Journal of Hand Therapy reported that type I patients experience twice as much multiple finger trigger finger as do type 2 patients. Type I’s also require double the number of surgeries to relieve pain from trigger finger symptoms. They also found that cortisone shots were half as effective for diabetics as a group when compared to the general population.
It’s Not Your Fault
Research presented in the Journal of Pediatric Endocrinology, July-September 1995, highlighted the experience of a 15 year-old girl, who has had type I diabetes for 11 years. She developed severe neuropathy even though her mean HbA1c was only 7.4%-which for a young person takes a lot of work! This young girl’s case brings to light that there are other factors involved in developing complications than a low (or high) HbA1c.
Support Group for Everyone
The September 1995 issue of Patient Education and Counseling presented some sobering news: with 100 million diabetics in the known world, it is not possible to educate them one by one. It can be best accomplished educating in groups.
Kids on Pumps
In the March 1995 issue of Diabetes Research and Clinical Practice a retrospective was done with six young type I patients between the ages of 12 and 16. Each was instructed to use an insulin pump, and the results were looked at over a calendar year. Prior to pump therapy, four of the patients were labeled “non-adherent,” and two were called brittle. Before pump therapy they spent an average of 20 days/year in the hospital because of problems related to their diabetes. After initiation of pump therapy, hospitalizations were reduced to 5 day/year. However,there was no change in A1c-it held constant at 9%. This study from the Childrens Hospital in LA is the first time I’ve seen to put the “non-adherent” kids on pumps. It sounds like it worked!
More on Kids
Research published in the July 1995 issue of Diabetic Medicine is trying to predict who will develop diabetes complications by using psychosocial predictors. The goal would be to develop early intervention strategies, to protect the health of the individual. The results: boys were 14 times more likely than girls to experience recurrent hypoglycemia as opposed to ketoacidosis. Girls with recurrent ketoacidosis had more behavioral problems and lower social competence. They reported higher levels of family conflict, and their parents reported lower levels of family cohesion, expressiveness and organization in year one. These relationships were independent of any association with poor glycemic control. Recurrent hypoglycemia in boys was generally unrelated to individual and family functioning or glycohemoglobin.
Everything I read shows that girls have a particularly difficult time with diabetes. Everything should be done to understand and support these struggling children. We hope that our articles on diabetes and children are helpful in illuminating these issues, and helping to foster solutions.