A form of diabetes, having features that overlap with both Type 1 and Type 2 diabetes, has been given the name, Type 1.5 Diabetes. Researchers suggest that Latent Autoimmune Diabetes in Adults (LADA), may comprise 10% of the diabetic population, and require insulin treatment be instituted earlier than in those previously diagnosed with Type 2 diabetes, because they may have an autoimmune etiology (seen in Type 1 diabetics)…… hence a Diabetes Type 1.5.

Type I vs. Type II vs. Type 1.5 Diabetes

Type I Diabetes, previously called insulin dependent or Juvenile diabetes, occurs when the pancreas doesn’t produce insulin, possibly from the immune system destroying the cells that produce the hormone. When this occurs there is rapid weight loss and death could occur if the cells don’t get the sugar they need.  Insulin has to be administered regularly.

Type II Diabetes, previously called non-insulin dependent or adult-onset diabetes,  occurs in those who began with a fully functioning pancreas but as they age the pancreas produces less insulin, called insulin deficiency, or the insulin produced meets resistance. This is the fastest growing type of diabetes in both children and adults.

So Type 1.5 Diabetes may develop after childhood, as a working pancreas may, during adulthood, become damaged by the body’s immune system or, suggested by some, a virus.  Those with Type 1.5 diabetes therefore may not be obese, may have had difficulty managing their blood sugar by diet and exercise alone, and may need assistance with insulin supplementation.  If medical providers don’t recognize this early, and appropriate treatment is delayed, a patient may suffer multiple health issues and risks the longer their blood glucose levels are uncontrolled.

What is Diabetes?

Diabetes is a disease in which the body doesn’t utilize and metabolize sugar properly. When we consume food, its broken down into proteins, nutrients, fats, water, and sugar. These components are necessary for cell growth and function.  They get absorbed in the small intestine and make it to the bloodstream.   In order for a cell to utilize sugar, it needs the hormone insulin to help guide it in.  It’s similar to a key that fits in the keyhole of the “door” of the cell, opening it up so sugar can enter. Insulin is produced in the pancreas, an organ that receives signals when one eats to release insulin in preparation of the sugar load coming down the pike.

Diabetes Explained

So I imagine our mouth like a waiting room, the blood stream like a hallway, and the cells of the body the rooms along the hallway.  Insulin is the key to open the cells’ “doors” allowing sugar to enter.  If the sugar does not get in, it stays in the bloodstream “hallway” and doesn’t feed the cell. Weight loss occurs, and individuals may become more thirsty as the sugar in the blood makes it fairly osmotic, something the body wants to neutralize, reduce.  The kidneys are going to want to dump the excess sugar, so to do so, one would urinate more, again causing thirst.  So when a diabetic loses weight, urinates more frequently and becomes thirsty, you now understand why.

Complications of Diabetes

Cardiovascular disease – Sugar is sticky, so it can easily add to atherosclerotic plaques.

Blindness – high sugar content draws in water to neutralize and small blood vessels in the eye can only take so much fluid before they burst.  Moreover, high blood sugar weakens blood vessels.

Kidney disease – the kidneys work overtime to eliminate the excess sugar. Moreover, sugar laden blood isn’t the healthiest when they themselves need nourishment.

Infections – pathogens love sugar. Its food for them.  Moreover blood laden with sugar doesn’t allow immune cells to work in the most opportune environment.

Neuropathy – nerves don’t receive adequate blood supply due to the diabetes-damaged blood flow and vessels, hence they become dull or hypersensitive causing diabetics to have numbness or pain.

Dementia – as with the heart and other organs, the brain needs healthy blood and flow.  Diabetes has been found to increase risk of Alzheimer’s as well.

What is insulin resistance?

Insulin resistance, if using our hallway and door analogy, is as if someone is pushing against the door the insulin is trying to unlock. As we know, those with obesity are at higher risk for diabetes, hence fat can increase insulin resistance.  It’s also been associated with an increase in heart disease.

Blood sugar numbers

If your fasting blood sugar (glucose) is greater than 126 mg/dl, or your non fasting blood sugar is greater than 200 mg/dl, you may be considered diabetic.  Pre-diabetes occurs when the fasting blood sugar is between 100 and 125 mg/dl.  If ignored, and the sugar rises, pre-diabetics may go on to develop diabetes.

SOURCE DIABETESMEALPLANS.COM

Preventing/Controlling Diabetes

1/3 of American adults are currently pre-diabetic.  Experts predict 1/3 of US Adults will be diabetic by the year 2050.  Although genetics plays a big role, decreasing ones sugar intake and maintaining an active lifestyle can help ward of diabetes.

Foods high in sugar and carbohydrates increase one’s risk, so a diet rich in vegetables and lean meats is preferred.

For more information, visit http://www.diabetes.org/.

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Daliah Wachs is a guest contributor to GCN news, her views and opinions, medical or otherwise, are her own. Doctor Wachs is an MD,  FAAFP and a Board Certified Family Physician.  The Dr. Daliah Show , is nationally syndicated M-F from 11:00 am - 2:00 pm and Saturday from Noon-1:00 pm (all central times) at GCN.

The FDA has disclosed a new E. coli romaine lettuce outbreak, that has supposedly ended.

23 people from 12 states have become ill due to this recent outbreak of E. coli. 

No deaths have been reported.

The Shiga toxin-producing E. coli O157:H7 sickened 23 people and hospitalized 11 between the dates July 12 and September 8th, with cases occurring in Arizona, Florida, Georgia, Illinois, Maryland, North Carolina, Nevada, New York, Oregon, Pennsylvania, and South Carolina, with the majority of cases in California.

The FDA emphasizes that they believe the outbreak is over.  However many wonder why they this wasn’t disclosed earlier.

The CDC did appear to begin its investigation earlier this Fall, and forward their concerns to the FDA, but jointly the disclosure didn’t come until now.

 

On their website, the FDA reports the following:

Symptoms of E. coli poisoning can occur anywhere from 1-10 days after ingestion.

They include:

• Nausea
  Vomiting
  Diarrhea, may be bloody
  Fever
  Chills
  Body Aches
  Abdominal Cramps

And if progresses, can cause

• Shortness of Breath
  Nose bleeds
  Anemia
  Dehydration
  Seizures
  Renal Failure
  Death

Exposure to E. coli may occur from exposure to contaminated foods (from human or animal waste) or undercooked meats.

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Daliah Wachs is a guest contributor to GCN news, her views and opinions, medical or otherwise, are her own. Doctor Wachs is an MD,  FAAFP and a Board Certified Family Physician.  The Dr. Daliah Show , is nationally syndicated M-F from 11:00 am - 2:00 pm and Saturday from Noon-1:00 pm (all central times) at GCN.

The high cost of medical care is on the lips of every politician and draining the pocketbooks of most Americans. After creating the Medicare/Medicaid monster, the government’s expanded intervention into the medical care marketplace with the inaptly named Affordable Care Act doubled the premiums and deductibles for both employer-sponsored and individual insurance. Piling on more laws, regulations, and agencies is not the answer.

Anonymity, complexity, and opacity invite shady behavior. Individuals, companies, and patients who defraud the massive federal “health system” would never dream of lifting money from their patients’ wallets or stealing from their doctors’ cash drawer.

The government’s track record does not bode well for imposing more bureaucracy to remedy a problem created by the layers of third-party payer bureaucracy. Waste, fraud, and abuse are so rampant that the government has a Medicare Strike Force to root out and recover lost federal funds. Medicare fraud—about $60 billion in 2016 alone—is about 10 percent of Medicare’s total payments. By contrast the typical private business loses 5 percent of its revenues to fraud. Unfortunately, since its inception in March 2007, the Medicare Strike Force has recouped less than $2 billion per year in misappropriated funds.

Medicare’s $16.7 billion per year hospice program is fertile ground for the unscrupulous. Hospices are paid a fixed daily sum for each patient enrolled “regardless of the services provided.” One amoral scheme recruits patients who unknowingly forgo curative treatment options by joining hospice. A recent Office of Inspector General (OIG) report revealed that in 2012 hospices billed Medicare more than $250 million for services to patients in long-term care or assisted-living residences who did not require hospice care, costing four times more than the appropriate level of care. Even worse, the OIG found that the quality of care suffered in 31 percent of programs. The bureaucratic morass allows the perpetrators to pocket the fixed fee and skimp on the services.

Further, the government cannot keep track of its program dollars. According to another OIG audit, in 2009, Medicare Prescription Drug program paid $33.6 million and hospice patients paid $3.8 million for medications that should have been included in the hospice daily fee. Even after discovering the snafu, the problem got exponentially worse. In 2016 the government paid $160.8 million for drugs that hospice organizations should have paid for from its fixed daily fee. Our tax dollars paid for the drugs twice.

Physicians know what patients want and are acting on it. Free from the restraints of government “healthcare” programs, the physician-led, price-transparent, direct-pay Surgery Center of Oklahoma performs some surgeries for less than the copays of some insurance policies. Direct Primary Care physicians provide 24/7 access and basic labs for as little as $50 per month with at-cost medications and low-priced x-rays.

The corporate private sector has learned a thing or two from innovative physicians. Care Accelerator is Sam’s Club’s version of “affordable [medical care] options with transparent pricing.” To offer relief from high out-of-pocket costs, $50 (individual) to $240 per year (families) buys access to lab screening for diabetes and heart disease, free generic drugs, telehealth, and up to a 30 percent discount on vision, dental, and other ancillary services. Additionally, Walmart is training its own employees for jobs in the health sector and ideally to staff Walmart’s own medical services. For their employees, Apple has “health care built around you” with its AC Wellness that offers office and home visits; Amazon launched its Amazon Care telemedicine services.

Given the outrageous price of drugs—largely due to the pharmacy benefit manager middlemen—Good Rx discount coupons are just what the doctor ordered. Good Rx is free to the consumer and makes money from advertisements on the website and referral fees. One typical victory is a Medicare patient whose neurologist prescribed a drug for his Parkinson’s disease symptoms. The government demanded testing that could not be done because of the patients debilitated condition. Despite a sympathetic ear and supporting research, the government arbiter could only parrot the party line: because the drug was not on the “list,” it was not covered by Medicare. In a fortunate twist of fate, with a Good Rx coupon the patient paid $34 per month cash instead of the drug’s $1,100 per month price with 20 percent patient co-pay that would have been charged through the Medicare Prescription Drug program.            

Congress claims it plans a full-frontal attack on the high cost of medical care (with the same results as the war on poverty and drugs?). Frankly, we are better off with Congress engrossed in its impeachment clown show and keeping its nose out of our medical business.

Dr. Singleton is a guest columnist. Her opinions are her own. Dr. Singleton is a board-certified anesthesiologist. She is Immediate Past President of the Association of American Physicians and Surgeons (AAPS). She graduated from Stanford and earned her MD at UCSF Medical School. This is an edited version of her column that originally appeared on pennypress.com. Reprinted with permission.  

The CDC reported this week that teen suicide rose 58% over the years 2007-2017 in the age group 10-24.  Although many experts blame social media and teen drug use, one theory may need to be considered:  nicotine withdrawal from vaping.

Millions of middle school and high school students admit to vaping…and many more are assumed who don’t admit to it when surveyed.  So we have an underestimation of how many adolescents take regular hits of their electronic cigarette, exposing them to the powerful, addictive nicotine. One pod, placed in an electronic cigarette to be vaped, contains as much nicotine as a pack of cigarettes.  Hence if a pod is smoked at school, and when the child is home goes hours without, they may “come down” off the nicotine high that they had hours earlier.

In 2002 Picciotto et al discussed how nicotine can affect mood swings, anxiety and depression, where in some cases it can act as an antidepressant but when one withdrawals from it can have increased and anxiety and depression.

The teenage mind and psyche is still developing during this time and a chemical dependency could muddy the mental health waters.

There’s no doubt social media and the misconception teens have that their lives are not as glorious as those who they view online is contributing to lack of confidence, poor self-esteem and depression.  But the decision to commit suicide may also be chemically induced, or a withdrawal of one and should be investigated.

Vaping Linked to Heart Disease and Cancer

A study from New York University found the nicotine in electronic cigarettes to cause DNA damage similar to cigarette smoking.

Dr. Moon-shong Tang and his colleagues exposed mice to e-cig smoke during a three-month period, 5 days a week for three hours a day.  They found these mice, compared to those breathing filtered air, to have DNA damage to cells in their bladders, lungs and hearts. The amount of nicotine inhaled was approximately 10mg/ml.  That dose would be commonly consumed by many humans who vape.

They then looked at human bladder and lung cells and found tumor cells were able to grow more easily once exposed to nicotine and vaping chemicals.

Last May, researchers from Vanderbilt-Ingram Cancer Center in Nashville found e-cig smoke to increase one’s risk of bladder cancer.

In 2015, the University of Minnesota identified chemicals commonly found in e-cig vapor to include:

• Formaldehyde (human carcinogen)
• Acetaldehyde (carcinogen related to alcohol drinking)
• Acrolein (highly irritating and toxic)
• Toluene (toxic) NNN, NNK (tobacco carcinogens related to nicotine)
• Metals (possible carcinogens and toxins)

Although electronic cigarette “juice” may appear safe, it could produce harmful chemicals once heated to become a vapor.

A lethal dose of nicotine for an adult ranges from 30-60 mg and varied for children (0.5-1.0 mg/kg can be a lethal dosage for adults, and 0.1 mg/kg for children).  E-cigs, depending on their strengths (0 – 5.4%) could contain up to 54 mg of nicotine per cartridge (a 1.8% e -cig would contain 18mg/ml).

The topic of nicotine increasing one’s vulnerability to cancer is nothing new as decades ago researchers found nicotine to affect the cilia (brush border) along the respiratory tree, preventing mucus production and a sweeping out of carcinogens trying to make their way down to the lungs.

More research needs to be performed but this recent report reminds us that exposing our delicate lung tissue and immune system to vaping chemicals may not be as safe as we think.

For more on the study read here.

Toxic metals found in vaping liquid

Last week, experts warned that many chemicals in vaping liquid may change to toxic substances (once heated) that can irritate the lungs.

Last year one study reported that toxic levels of lead and other metals may leak from the heating coil element into the vapor inhaled during e-cig use.

Researchers at Johns Hopkins Bloomberg School of Public Health found these metals to include:

• lead
• nickel
• manganese
• chromium
• arsenic

We’ve known for some time that vaping fluid could contain chemicals that turn toxic once heated, but this study shed light on e-cig metal components causing metal leakage to the vapor making contact with delicate respiratory epithelium (lining).

Reported by Forbes, Rich Able, a medical device marketing consultant, stated the following, “the FDA does not currently test any of the most popular vaping and e-cigarette instruments being manufactured at unregulated factories in Asia that source  low-grade parts, batteries, and materials for the production of these devices,” suggesting that “the metal and parts composition of these devices must be stringently tested for toxic analytes and corrosive compounds.”

These chemicals may act as neurotoxins, affecting our nervous system, cause tissue necrosis (cell death) and even multi-organ failure. Moreover, they can affect how our immune system reacts to other chemicals as well as foreign pathogens, affecting our ability to fight other diseases.

Although studies have suggested e-cig vapor to be safer than tobacco smoke, not enough research has been done, in the relatively few years vaping has been around, looking at how heat-transformed chemicals and leaked metals affect our breathing, lungs and other organs once absorbed into the body.

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Daliah Wachs is a guest contributor to GCN news, her views and opinions, medical or otherwise, are her own. Doctor Wachs is an MD,  FAAFP and a Board Certified Family Physician.  The Dr. Daliah Show , is nationally syndicated M-F from 11:00 am - 2:00 pm and Saturday from Noon-1:00 pm (all central times) at GCN.