Quarterback Jay Cutler Talks About His Diabetes

Eli Lilly recently hired Chicago Bears quarterback Jay Cutler to star in a series of videos where he talks openly about his diabetes - how it was diagnosed and how he manages it. You can watch the videos on Lilly's "Touchdowns for Diabetes" site. Clicking the photo to the right will also take you there.

Culter was diagnosed with type 1 diabetes in April 2008, after losing 33 pounds. The transition to daily diabetes management has been challenging for him:

"Whenever you have to jab yourself with a needle, that's, ah, that's where it gets a little iffy."

"You're 24 years old, you don't expect things like that to happen in life."

"It's tough, you wake up with it and you go to sleep with it."

"I miss a lot of foods. I used to love desserts. I miss sweet tea. I miss lemonade. Do I ever cheat? Yes, I do. Reese's peanut-butter cups is my cheat-food."

"I'm still struggling with this, still trying to overcome stuff. I think, over time, you just get used to it and it becomes part of you. And, I'm not to that point yet."

Related: Chicago Tribune article:
Jay Cutler Discusses His Diabetes In Webisodes, Offers Encouragement To Others
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November 14 is World Diabetes Day

Diabetes education and prevention is the World Diabetes Day theme for the period 2009-2013:

• For people with diabetes, this is a message about empowerment through education.
  
• For governments, it is a call to implement effective strategies and policies for the prevention and management of diabetes to safeguard the health of their citizens with and at risk of diabetes.
  
• For healthcare professionals, it is a call to improve knowledge so that evidence-based recommendations are put into practice.
  
• For the general public, it is a call to understand the serious impact of diabetes and know, where possible, how to avoid or delay diabetes and its complications.

This is a great time to review the warning signs of diabetes:

• Frequent urination
  
• Excessive thirst
  
• Increased hunger
  
• Weight loss
  
• Tiredness
  
• Lack of interest and concentration
  
• Vomiting and stomach pain (often mistaken as the flu)
  
• A tingling sensation or numbness in the hands or feet
  
• Blurred vision
  
• Frequent infections
  
• Slow-healing wounds

Any of these signs should be discussed with your health care provider.
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November is American Diabetes Month

The American Diabetes Association gives these statistics on diabetes prevalence:

• 24 million children and adults in the US live with diabetes.
  
• 57 million Americans have prediabetes, putting them at risk for developing type 2 diabetes.
  
• 1 out of every 3 children born today will face a future with diabetes if current trends continue.

And these figures on the impact of diabetes on health:

• 60-70% of people with diabetes have mild to severe forms of nerve damage.
  
• The rate of amputation for people with diabetes is 10 times higher than for people
  without diabetes.
  
• 2 out of 3 people with diabetes die from heart disease or stroke.
  
• Diabetes is the leading cause of new cases of blindness among adults.
  
• Diabetes is the leading cause of kidney failure.

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Clues That Inflammation Is At The Heart Of Type 2 Diabetes, Part 2

This is a continuation from my last post, Clues That Inflammation Is At The Heart Of Type 2 Diabetes, Part 1.

Last year, Joslin researchers reported that the inexpensive, non-steroidal anti-inflammatory drug (NSAID) salsalate reduced blood glucose in overweight adults:

Salsalate Improves Glycemia And Inflammatory Parameters In Obese Young Adults, Diabetes Care, February 2008

• Fasting glucose was reduced by 13%
  
• Response to an oral glucose tolerance test (OGTT AUC) was reduced by 20%
  
• Glycated albumin was reduced 17%
  
• Adiponectin* increased 57%
  
• C-reactive protein** was reduced by 34%

*Adiponectin is a hormone produced by fat cells, found in lesser amounts in overweight individuals. Lower levels are associated with an increased risk for type 2 diabetes.

** C-reactive protein is a marker for inflammation

They concluded:

"These data support the hypothesis that subacute-chronic inflammation contributes to the pathogenesis of obesity-related dysglycemia and that targeting inflammation may provide a therapeutic route for diabetes prevention."

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Later in 2008, Joslin researchers reported similar findings; the anti-inflammatory drug salsalate again showed benefits for blood glucose control:

Use Of Salsalate To Target Inflammation In The Treatment Of Insulin Resistance And Type 2 Diabetes Clinical and Translational Science, Clinical and Translational Science, May 2008

Results of the three, small, proof-of-concept trials in this study included:

• Reduced fasting* and post-meal glucose
  
• Reduced circulating free fatty acids
  
• Increased levels of adiponectin
  
• Reduction in inflammation markers

* "Fasting glucose levels fell by approximately 1.1 mmol/L (20 mg/dl) in both 4.5 and 3.0 g/d cohorts [of salsalate]."

The above is noteworthy, since the 4.5 g/d salsalate group had prestudy fasting glucose near normal levels (6.2 mmol/L = 112 mg/dl), and as the authors state, "it is more difficult to improve glycemia within the near-normal range than when glucoses are less well controlled."

Indeed, these participants started with a fasting glucose of 112 mg/dl, and after 2 weeks, without weight loss, had a fasting glucose of 91 mg/dl ... merely by taking several grams/day of a generic, inexpensive NSAID.
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Note: Salsalate is a nonsteroidal antiinflammatory drug similar to aspirin and available without a prescription. One way it differs from aspirin, or acetylsalicylic acid, is that it is not acetylated. As such, it does not inhibit cyclooxygenase enzymes, Cox 1 and Cox 2, it does not inhibit platelets, and is not associated with internal bleeding. It can however result in hearing difficulties and tinnitus ("ringing in the ears") when taken in amounts of several grams/day, such as those used in this study.

Clues That Inflammation Is At The Heart Of Type 2 Diabetes, Part 1

Dr. Steve Shoelson, professor of medicine at Harvard Medical School and a researcher at Joslin Diabetes Center has been investigating the role of inflammation in the development of insulin resistance and type 2 diabetes.

He notes:

1. "Epidemiologists have found that patients with type 2 diabetes and cardiovascular disease have slightly elevated levels of inflammatory markers in their bloodstream, raising the possibility that inflammation might be associated with the development of these diseases."

2. "Proinflammatory cytokines such as TNF-α and IL-6 promote insulin resistance in experimental models."

3. "A third series of investigations really provided a breakthrough for our understanding. Drawing upon earlier studies suggesting that anti-inflammatory salicylates reverse hyperglycemia in diabetic patients, we identified the NF-κB pathway as a target of this effect and found it to be activated by obesity. We found that activation of the inflammatory NF-κB pathway in fat and liver by weight gain leads to the production of inflammatory mediators that cause both local and systemic insulin resistance."

Here's the study which supports that last point:
Local And Systemic Insulin Resistance Resulting From Hepatic Activation Of IKK-Beta And NF-Kappab, Nature Medicine, February 2005

It investigated the effect of activation of this inflammatory pathway on both transgenic mice (bred to exhibit type 2 diabetes), and mice fed a high-fat diet. It concluded:

"These findings indicate that lipid accumulation in the liver leads to subacute hepatic 'inflammation' through NF-kappaB activation and downstream cytokine production. This causes insulin resistance both locally in liver and systemically."

Of note:

"Oral salicylate* therapy reversed insulin resistance in LIKK mice."

* Salicylate is an anti-inflammatory drug similar to the active component in aspirin (acetylsalicylic acid)
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Inaccuracies In Blood Glucose Monitors

A story in the New York Times this month reported that the FDA, under Commissioner Hamburg, is pressuring the international group that sets standards (International Organization for Standardization: IOS) to tighten allowable errors for in-home blood glucose monitors.

If the IOS fails to act, the FDA may change the standards for meters in the US.

Self-monitoring of blood glucose devices (SMBG devices) are currently allowed to be inaccurate by up to 20%. However:

"A study by government researchers found that when comparing tests from five different popular monitors, results varied by as much as 32 percent.

For a class science project recently, Morgan DiSanto-Ranney, 16, of Bishop O’Connell High School in Arlington, Va., bought seven different glucose monitors and had her father, a diabetic, use all of them.

“What I found was that almost all of the meters were off from one another by 60 to 75 points,” Morgan said in an interview. Two of the meters — Ascensia Breeze and Ascensia Breeze II, both made by Bayer — differed by an average of 62 points, she said."

An inaccuracy of 75 mg/dl is not trivial.
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Link Between Lantus Insulin And Cancer

The European Association for the Study of Diabetes (EASD)'s journal, Diabetologia, has four papers and an Editorial in press, addressing a possible link between insulin glargine (Lantus insulin) and cancer.

You can access their studies and press release here.

From their press release:

"The concerns about a possible link between use of Lantus insulin and increased cancer risk were raised by a German study of around 127,000 insulin-treated patients in an insurance database. The research identified a statistically significant link between patients who had used Lantus insulin and those who had been diagnosed with cancer. Compared with people using similar doses of human insulin, out of every 100 people who used Lantus insulin over an average of about one-and-a-half years, one additional person was diagnosed with cancer. Of particular note in this study was the finding that the increased risk of cancer was dose-dependent. Thus for patients given a dose of 10U, Lantus insulin alone increased the risk of cancer by 9% compared with human insulin; but for a dose of 50U, the increased risk was 31%."

Additional studies were carried in Sweden, Scotland, and the UK:

• The Swedish study found that compared with patients on insulins other than Lantus insulin, patients on lantus insulin alone had double the risk of breast cancer.
  
• The Scottish study found a non-significant increased risk for breast cancer specifically.
  
• The UK study found no link between insulin glargine and cancer.

The studies are observation and not conclusive. More research is needed. The EASD is advising patients not to stop taking Lantus insulin without contacting their healthcare provider. Alternatives may be available.
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Low-fat Vegan Diet Surpasses ADA Diet

Recent research from the American Journal of Clinical Nutrition supplies more evidence that a low-fat vegan diet is better than a conventional diabetes diet for managing blood glucose and cholesterol.¹

People with type 2 diabetes were assigned to either a low-fat, vegan diet (49 participants) or a diet adhering to the 2003 American Diabetes Association (ADA) guidelines (50 participants).

After about a year and a half (74 weeks), members in both groups lost weight, but the difference between them wasn't significant: 4.4 kg (9.7 lbs) wt. loss in the vegan group, 3.0 kg (6.6 lbs) weight loss in the ADA group.

However, there was a significant difference between the groups in the following measures:

• Hb A1c:
  -0.40 for the vegan diet
  -0.01 for the ADA diet
  
  
• Total cholesterol (mg/dL):
  -20.4 for the vegan diet
  -6.8 for the ADA diet
  
  
• LDL cholesterol (mg/dL):
  -13.5 for the vegan diet
  -3.4 for the ADA diet

The authors concluded:

"Both diets were associated with sustained reductions in weight and plasma lipid concentrations. In an analysis controlling for medication changes, a low-fat vegan diet appeared to improve glycemia and plasma lipids more than did conventional diabetes diet recommendations."

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¹ A Low-Fat Vegan Diet And A Conventional Diabetes Diet In The Treatment Of Type 2 Diabetes: A Randomized, Controlled, 74-Wk Clinical Trial, AJCN, May 2009

Photo of vegan pyramid: Nutrispeak.com, the home page of Vesanto Melina, MS RD.