type 2 diabetes
Information and questions about Type 2 diabetes.
I’m so excited to introduce you to Gabi Richter, a Type 1 diabetic and counsellor, and a new member on our Panel of Experts who’s going to be dealing specifically with the emotional side of diabetes with a monthly column. Let us know if you have any specific questions for her! Today she’s talking about stress and diabetes.
It does not matter how long you have been diabetic, for whether it is years or if you are newly diagnosed, living with a chronic condition comes with a certain amount of stress. How you manage that stress will determine the effects it can have on your sugar levels. To much stress or mismanaged stress can affect control of your levels, however having diabetes with its constant control and management can cause stress. Therefore we need to find a workable and manageable balance between the two.
There are many definitions of stress but simply put: stress happens when pressure exceeds your perceived ability to cope. It is an emotional strain or tension that occurs when we feel that we can’t cope with pressure.
Research shows a physiological difference between pressure and stress,
People experiencing stress have higher levels of various stress hormones in their blood stream then those that merely feel challenged. When we are stressed, the body releases hormones that give cells access to stored energy known as fat and glucose to help you get away from perceived danger. This instinctive response is known as the Fight, Flight or Freeze response.
When we are confronted by a threat, a hormone called cortisol are released to help us get ready to either Fight, Flight or Freeze. This hormone allows for the increase in blood sugar for energy and an increase in blood pressure for fresh oxygen to flow to the working muscles and the release of adrenaline for heightened vigilance and alertness. However, in diabetics this instinctive response does not work well since insulin is needed to get the stored energy (glucose) to the cells and we either do not produce insulin or we produce too much of it. We are then left with an excess build-up of glucose in the blood, which results in higher levels and one more thing we need to manage and worry about.
In today’s world, it is impossible to fully avoid stress even in small doses and since the body is still programmed to release this hormone whenever it detects a threat, we as diabetics are at a bit of a disadvantage and therefore need to have a good stress management plan in place that we can fall back on when we feel stressed.
Stress can be brought on by a number of factors: a higher Hba1c or a new treatment plan or even being late and getting stuck in traffic. And then of course work and family expectations – all of these situations will lead to some level of stress. It is never a good idea to ignore stress and to think that emotions like anger and sadness don’t affect our levels, because unfortunately that is wrong and as we know everything can affect us. Ongoing stress can wear you down and lead to poor management of levels: this in turn can then lead to depression.
As diabetics we need to always look at the bigger picture and have many management programmes in place. The simplest one I have found for stress so far is to rate my stress on a scale of 1 to 10 when testing my levels and to make a note next to each reading. This will allow you to see if your high or low reading could possibly coincide with stress of any kind.
When dealing with everyday situations in life, we need to try and remember that stress of any kind is not good. Our bodies are wired to cope with a small amount of stress and for a short period, however if we continue to stress for a long period this will have negative effects on our heath. It will not only lead to depression but has also been known to lower the immune system which in turn will make us more prone to colds and illness. Therefore, we need to try and take many deep breaths when we feel overwhelmed, and to try and find ways that we can relax. Even if that means having coffee with a friend and simply talking about our problems.
– Gabi Richter
The latest diabetes-related research suggests that those who have Type 2 diabetes may reap more benefit from eating two large meals a day, rather than the traditional view of six smaller meals. Pippa Stephens from the BBC, reports that the new research from Prague was conducted using two samples sets of 27 people. One group was fed two meals a day – breakfast and lunch – and the other group was fed six smaller meals. The number of calories contained in both groups’ meals were equal. At the end of the study, the volunteers who had been eating two meals a day were found to have lost more weight and have lower blood sugar levels. Previous diabetic diet regimes were based on the assumption that eating small amounts of food regularly would be more beneficial in controlling levels of blood sugar. The Czech research calls this into question.
How the study quantifies the new claim
Kathleen Lees details the specific nature of the tests. The study was undertaken by researchers at the Diabetes Centre, at the Institute for Experimental and Clinical Medicine in Prague. Researchers selected “54 patients between the ages of 30 and 70. Participants were initially divided into two equal groups, and followed a diet that either consisted of six smaller meals or two larger ones, both containing around 1,700 calories, to include 50-55% of energy from carbohydrate and under 30% of energy from fat. Three months later, the groups switched their diet regimens.” Diabetes.co.uk noted that although all participants lost some weight, “the 2 meal diet was more effective, resulting in an average 3.7kg weight loss compared with a 2.3kg weight loss on the 6 meal diet.” Those on the two meal diet also experienced greater improvement in fasting plasma glucose levels. The study also noted that “reductions in HbA1c were modestly improved in both groups by around 0.25% (3 mmol/mol).”
In South Africa, this new research could be used to great effect following last year’s announcement that the canagliflozin drug would be made available to treat those suffering from Type 2 diabetes. Jo Willey reports that the drug, also known as Invokana, “cuts blood sugar levels in people for who diet and lifestyle measures or other blood sugar-lowering medicines do not work well enough” and “blocks the re-absorption of glucose in the kidneys, which is instead passed in the urine.” Whilst the drug’s availability in Africa, America and Asia was confirmed last year, it has only just recently been approved for use in the European Union, where it is being hailed as an important and welcome announcement for those with Type 2 diabetes. Center Watch reports that research is underway in multiple global locations, including several in South Africa, “assess the effectiveness of the co-administration of canagliflozin and metformin extended release (XR) compared with canagliflozin alone, and metformin XR alone in patients with Type 2 diabetes.” This study is sponsored by the drug’s manufacturer, Janssen, and aims to be completed in 11 months.
According to Diabetes.co.uk, “people who are diagnosed with a chronic physical health problem such as diabetes are 3 times more likely to be diagnosed with depression than people without it.” Prescribed anti-depressants are a common treatment for depression, but can have negative effects, including addiction. There is plenty of guidance available online to help friends and family find the right support and treatment for a loved one. Rehabilitation organisation, We Do Recover, run a number of rehabilitation centres across South Africa, including Johannesburg, Cape Town and Pretoria.
Whilst the new developments in the treatment of Type 2 diabetes is undoubtedly welcome news to those with the condition, as well as their friends and family. It should be borne in mind, however, that the research in Prague was undertaken with a relatively small sample set. A great deal of further study needs to be undertaken to refine what has been learned from that study. Likewise, although canagliflozin has been made available, research into its use, and its use as combined with other drugs is ongoing. Despite this, there is no doubt that treatment for Type 2 diatbetes is most definitely looking up.
– by Lily McCann
“2 larger meals beats 6 much smaller meals for type 2 diabetes.” Diabetes.co.uk. http://www.diabetes.co.uk/news/2014/may/2-larger-meals-beats-6-much-smaller-meals-for-type-2-diabetes-95702186.html (accessed May 17, 2014).
“Addiction, Durban.” Johannesburg Rehab Centre. http://wedorecover.com/sa-rehab-centres/johannesburg.html (accessed May 17, 2014).
“Clinical Trial Details.” A clinical trial to evaluate treatments using Canagliflozin 100 mg, Canagliflozin 300 mg and Metformin XR for patients with Diabetes Mellitus, Type 2. http://www.centerwatch.com/clinical-trials/listings (accessed May 17, 2014).
“Diabetes and Depression.” Diabetes.co.uk. http://www.diabetes.co.uk/diabetes-and-depression.html (accessed May 17, 2014).
Lees, Kathleen. “Could Two Large Meals Help Better Manage Type 2 Diabetes than Six Snacks?.” Science World Report. http://www.scienceworldreport.com/articles/14765/20140516/could-two-large-meals-help-better-manage-type-2-diabetes-than-six-snacks.htm (accessed May 17, 2014).
“News.” Latest Data for Type 2 Diabetes Treatment INVOKANA (canagliflozin) to be Presented at American Diabetes Association Annual Meeting. https://www.jnj.com/news/all/latest-data-for-type-2-diabetes-treatment-invokana-canagliflozin-to-be-presented-at-american-diabetes-association-annual-meeting (accessed May 17, 2014).
Stephens, Pippa. “Two meals a day ‘effective’ to treat type 2 diabetes.” BBC News. http://www.bbc.co.uk/news/health-27422547 (accessed May 17, 2014).
“Your Guide to Xanax Detox Centers and Programs” Detox.net. http://www.detox.net/articles/xanax-detox/ (accessed May 17, 2014).
I am using Lantus Solostar and due to medical aid restraints have to change. I have been given a Lilly Humapen Savvio and would like to use the Lilly equivalent cartridge to Lantus, but don’t know which one to use.
My Hba1C is 6.5 and I inject Lantus once a day in the morning and take Glucophage XR 500mg, 1 x morning and 1 x evening.
Your help will be appreciated. I know what you are going to say: “See your doctor!” but I need more answers as the doctor does not know too much about diabetes. He wants my Hba1C much lower and so doubled up on my glucophage a month ago to the present dosage, which I find a bit strange.
Thanks for your help,
I am overweight and diabetic
I have tried Metformin 500mg and Glucophage, but I get very sick with that so now I am taking Galvus 50mg but I don’t see any change to my weight even though I exercise and follow a diet. My sugar is stable and I don’t feel any side effects with Galvus.
I have been told that Victosa is a drug that assists diabetes and in weight loss but the side effects for the first two weeks are terrible, it is also very expensive, is there a drug similar to Victosa that has less side effects I can take?
Looking for a change in your Type 2 diabetic life? Take a look at this diabetic retreat that one of our Sweet Life diabetes community members is running!
The Klein Karoo Diabetic Retreat is where newly diagnosed and veteran Type 2 diabetics come together in a nurturing and diabetic friendly environment, to learn and experience the skills necessary to manage, control and live with diabetes.
Usually when a patient is diagnosed with Type 2 diabetes, they are given a rundown of the dos and don’ts, a prescription and then left very much to their own devices, to make sense of their new condition and how to put it all together.
As diabetes is a chronic (lifelong), lifestyle disease, without assistance the adjustments required often prove too daunting for the average person. In addition there is little or no support system, so necessary to assist the patient during the transition. With the result that old, inappropriate habits are not changed and the patient, very much continues as before, making only minor adjustments for medication.
Newly diagnosed and to some extent, veteran diabetics’ need an environment in which to implement and experience their new lifestyle in order to adapt and better understand, manage and control the disease. At The Klein Karoo Diabetic Retreat patients acquire all the necessary skills to manage their condition though a multi disciplined approach of correct eating habits, best exercise practices and medication management.
Ideally situated in the Klein Karoo, The Klein Karoo Diabetic Retreat is sufficiently secluded to enable the attendees to focus almost exclusively on the program, without compromising the need for expert medical care should the need arise.
At The Klein Karoo Diabetic Retreat we provide a holistic environment in which the patient can adopt a sustainable blue print around which to model their new diabetic lifestyle.
To this end we offer the following as part of our wellness program.
- · Diet and meal plan consultation.*
- · Physical assessment.*
- · Personalised exercise plan.*
- · Foot and wound care workshop.
- · Ophthalmic (Eye care) evaluation.*
- · Professional medication and blood testing management.
- · Exercise routines (walks/gym).
- · Food preparation classes.
- · Group support and networking.
- · Psychology of Diabetes lecture and discussion
- · Facilitated Group discussions by qualified councillors
- · Daily Program workbook.
Find out more at www.diabeticretreat.co.za
My 14 year old son was diagnosed with Type 1 Diabetes last year. I want to bring to your attention an initiative that I believe will greatly facilitate awareness and fundraising for T1D. A fellow mom of a T1 child, Jeanette Collier, and I have filed a petition to revise the type classification names of both T1 and T2 Diabetes to more accurately reflect the nature of onset of each condition. We believe this will benefit both the T1 and T2 communities and help protect our T1 children from dangers caused by prevalent misconceptions. We believe that clarity in the names given to these two types of Diabetes will enhance educational campaigns for all types; which in turn will benefit fundraising towards better treatments and a cure.
Our petition is approaching 5,000 signatures from all over the globe. It is supported by many well-respected individuals within the Diabetes community including:
- Dr. Camillo Ricordi, Scientific Director and Chief Academic Officer- Diabetes Research Institute (DRI)
- Robert A. Pearlman, President & CEO, Diabetes Research Institute Foundation (DRIF)
- Dr. G. Prakasam, Pediatric Endocrinologist, Founder/President Center of Excellence in Diabetes & Endocrinology (CEDE), past Chapter President and Board Member of ADA
- Dr. Mingder Yang, JDRF nPod Investigator Relationship Coordinator
- Moira McCarthy, Journalist/Author and JDRF National Volunteer, Chairperson and Outreach Speaker
- Della Matheson, RN, CDE; Research Coordinator, University of Miami Type 1 Diabetes TrialNet Clinical Center
- Brenda Novak, Best Selling Author and Diabetes Advocate
- Scott R. King, President, CEO and Founder, Islet Sheet Medical LLC, in association with Hanuman Medical Foundation
- Dr. Stephen Ponder, Pediatric Endocrinologist, Medical Director Texas Lions Camp
- Dr. David L. Katz, Founder and Director of The Yale University Prevention Center
- Riva Greenberg, Speaker, Author and Health Coach
- Theresa Garnero, Diabetes Nurse Educator, Author, and Speaker
- Barbara J. Anderson, Ph.D., Professor of Pediatrics, Associate Head, Psychology Section, Baylor College of Medicine; Diabetes Nurse Educator/Social Worker (Joslin, Barbara Davis, and Texas Children’s)
- Bret Michaels, via Life Rocks Foundation
- Miguel Paludo, NASCAR Driver and Diabetes Advocate
- Nikki Lang, Singer/Songwriter and Diabetes Advocate
The petition can be accessed via a link on our website, DiabetesTypeConfusion.org. The response we have received so far has been amazing, but additional support is still needed to bring our efforts to the forefront. We hope that you will review our petition and consider signing and promoting our cause.
Please sign the petition here if you are interested: http://www.change.org/petitions/revise-names-of-type-1-2-diabetes-to-reflect-the-nature-of-each-disease
Thank you for your consideration!
– Jamie Perez
I wonder if anyone can advise me. I’m 27 (soon to be 28) and was diagnosed as a Type 2 diabetic in 2010. When I lived in South Africa, my average blood glucose would read between 5-7 and I would have occasional episodes of hypoglycemia.
Since I moved to South Korea, I have had the opposite problem. My reading first thing in the morning before breakfast is 10-14! I eat special K cereal with skimmed milk diluted with water for breakfast, a garden salad with no dressing for lunch and an average meal for dinner (I try to keep it low fat as I had my gallbladder removed recently and low carb for my diabetes). Dinner is usually something like a salad, curry, pasta (about 100 g), etc. I take Metformin 500 twice a day (I’ve been on that dose since I was diagnosed) and exercise regularly but I can’t seem to drop my blood glucose to within healthy levels.
The climate in South Korea is very different to the climate in South Africa, with the winter temperatures dropping as low as -20’C. There was also a lot of snow and I was pretty much sick constantly from late November 2012 through to March this year.
At first I thought my machine was broken but when I got a new one, my readings are still high. I can’t really seek medical help because with my job, I can be deported if they find out I’m diabetic.
How can I get my blood sugar down?
I guess this question should have been forwarded to a Dietician but I am sure you will pass it on.
Being a Type 2 diabetic my usual breakfast consists of two slices of low G.I. bread turned into toast with butter and Bovril, only after a Glucophage tablet has been taken. Lunch is also a two slice sarmie with ham and cheese or tomato.
What I want to know is it considered safe to have these carbs during the day or should I cut down and rather eat a protein meal as Prof.Tom Noakes says?
Thanks for your advice.