0 Overeating impairs brain insulin function can lead to diabetes and obesity

New research from Mount Sinai School of Medicine sheds light on how overeating can cause a malfunction in brain insulin signaling, and lead to obesity and diabetes. Christoph Buettner, MD, PhD, Associate Professor of Medicine (Endocrinology, Diabetes and Bone Disease) and his research team found that overeating impairs the ability of brain insulin to suppress the breakdown of fat in adipose tissue.

In previous research Dr. Buettners team established that brain insulin is what suppresses lipolysis, a process during which triglycerides in fat tissue are broken down and fatty acids are released. When lipolysis is unrestrained, fatty acid levels are elevated, which can initiate and worsen obesity and type 2 diabetes. The current study is published online in The Journal of Biological Chemistry. The first study was published in the February 2, 2011 issue of Cell Metabolism.

"We are interested in understanding why people who eat too much eventually develop diabetes. Our recent studies suggest that once you overeat, your brain develops insulin resistance. Since brain insulin controls lipolysis in adipose tissue by reducing sympathetic nervous system outflow to adipose tissue, brain insulin resistance causes increased spillage of fatty acids from adipose tissue into the blood stream," said Dr. Buettner.

Increased fatty acids induce inflammation and that, in turn, can further worsen insulin resistance, which is the core defect in type 2 diabetes. Fatty acids also increase glucose production in the liver which raises blood glucose levels, Dr. Buettner explained. "Its a vicious cycle and while we knew that this can begin with overeating, this study shows that it is really the brain that is harmed first which then starts the downward spiral."

In this study, researchers fed rats a high-fat diet comprised of 10 percent lard for three consecutive days. This increased their daily caloric intake by up to 50 percent compared to the control rats that were fed a regular low fat diet. The researchers then infused a tiny amount of insulin into the brains of both groups of rats that they had shown in earlier studies to suppress release of glucose from the liver and fatty acids from fat tissue. They found that overeating impaired the ability of brain insulin to suppress glucose release from the liver and lipolysis in fat tissue. Similarly, short-term overeating in humans is known to produce comparable insulin resistance which could be explained by brain insulin resistance.

"When you overeat, your brain becomes unresponsive to these important clues such as insulin, which puts you on the road to diabetes. We believe that what happens in rats also happens in humans" said Dr. Buettner.

Dr. Buettners team plans to investigate methods of improving brain insulin function that could restrain lipolysis and improve insulin resistance.

0 The Prospects for Inhaled Insulin

... Are getting better and better.

Researchers reporting in the July issue of Diabetes Care found that for their Type 1 patients, inhaled insulin was comparable to injected insulin for meal-time doses. Subjects still injected a basal dose twice a day, but used an inhaler when bolus insulin was needed.

The inhaled insulin used in the study was Exubera^TM, a short-acting, dry powder, human insulin developed in a joint venture by Sanofi-Aventis and Pfizer. The inhalation device (shown) was developed by Nektar Therapeutics.

Exubera is not currently available. It was submitted to the FDA for approval in March of this year and could be approved before the end of the year. Its planned to be marketed for patients with either type 1 or type 2 diabetes.

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For a summary of the study:
Study: Inhaled insulin works for type 1

For the study itself (abstract only, subscription required for full article):
Use of Inhaled Insulin in a Basal/Bolus Insulin Regimen in Type 1 Diabetic Subjects

Pfizers news releases:
Data Presented at American Diabetes Association Scientific Sessions Support Exubera® Efficacy and Safety Profile in Type 1 and Type 2 Diabetes

also:
Pfizer and the Sanofi-Aventis Group Seek Approval to Market Exubera® in the United States

0 Aggressive Insulin Treatment vs Pills for Diabetes with Athersclerotic Disease No Difference in Outcomes

When doctors and their patients review the treatment options for diabetes mellitus, a common question is "Why mess around?" If the blood glucose, thanks to a relative lack of the hormone "insulin," is "high," shouldnt the more "natural," tighter and physiologic answer be... insulin? While there are pills that can lower blood glucose levels and patients detest shots, its unclear if the long term clinical, economic and quality-of-life outcomes favor one approach (oral medications) over another (insulin).

The Disease Management Care Blog thinks that these are the issues that were explored by the important, international and huge multi-center "ORIGIN" Study.  The results have just been published by the New England Journal.

Over 12,000 persons over age 50 years with

1) impaired glucose control or "pre" diabetes (more on this topic here), or

2) just-diagnosed diabetes or,

3) well-controlled diabetes (A1c less than 8 to 9%) on no or just one oral medication

and

4) established heart or atherosclerotic vascular disease

were randomly assigned to insulin glargine (with dosing that aimed for a normal blood glucose of 95 mg.%) or usual care (that relied on physician judgement and local guidelines). 

After one year, 50% of the insulin group hit their targeted blood glucose level and their median A1c (a measure of average blood glucose control over time) was 5.9%.  The usual care group achieved a median glucose level of 123 mg.% and after one year the A1c was 6.2%.  The difference in A1cs persisted over the remainder of the study (Table here)

The mean age of the participants was 63 years with an impressive median follow-up of 6 years that yielded outcome results on 99% of the participants.

Results?  No difference in heart attacks or kidney disease.

When cardiovascular death, nonfatal heart attack, non-fatal stroke were combined, the incidence was the same in both groups - about 3% per year.  There was no difference in kidney outcomes including deterioration in function or need for dialysis.  Hospitalization rates for any cause were the same in both groups.  There was an isolated difference involving angina that, in the DMCBs mind, may have been a statistical fluke.  You can look at the outcomes for yourself here.

There was one important difference.  Among the 1456 persons without formal diabetes (the "impaired" group - see above), persons given the insulin were less likely to progress to a formal diagnosis of diabetes (25% vs. 31%).  Unfortunately, they paid a price, because they had a higher rate of insulin-induced low blood sugar reactions (an incidence of 17 vs. 5 per 100 person-years).

Based on these results, the DMCB thinks:

1. Turning to insulin treatment early in the course of pre or diabetes treatment for persons with heart disease doesnt appear to offer any important difference in macrovascular (heart attack and stroke) disease or kidney disease outcomes. However, thats only true among patients who have achieved an A1c below 7%.  (The DMCB cant figure out what happened to the patients with a baseline A1c in the 8% to 9% range who didnt get to an A1c below 7 - did insulin help them?)

2. Whats more, its possible that driving an A1c lower - once its below 7% - doesnt offer any additional outcomes advantage.

3.  While early insulin supplementation may prevent the "burn out" of the insulin-producing cells of the pancreas, the price for that is a higher incidence of low blood sugar reactions.  Even though this "cure" of diabetes may seem like a big deal, why bother if theres no difference in survivorship?

4. As the population health management service providers discuss care planning with their patients with diabetes and heart disease, the topic of early aggressive insulin may come up.  Heres an answer to that question.

5. If accountable or risk-assuming organizations believe that early aggressive insulin treatment will lower the direct costs attributable to heart disease among their patients and enrollees with diabetes, the answer is no.

That out-of-ate but compelling image is from a 2003 HHS website on why Prevention Makes Common Cents

0 Product Recall Insulin Pump Adapter

On July 29, Disetronic Medical Systems recalled its D-Tron adapter - for use with the D-Tron and D-TronPlus insulin pumps, and the Accu-Chek D-TronPlus insulin pump.
(A DTronPlus insulin pump is shown. The clear plastic adapter can be seen attached to the right of the pump.)

According to Disetronic:

"Use of the recalled adapter may result in the over delivery of insulin of up to 1.8 units of insulin." This "may pose a potentially life-threatening situation to children using the pump."

Overdelivery of insulin can result in hypoglycemia or low blood glucose. Anyone who requires a small amount of daily insulin or who is insulin sensitive and uses this adapter may be at risk for this condition.

Disetronic has manufactured new adapters. In the meantime, they recommend you inspect your adapter package before use. The affected adapter is marked as Part # REF 3000803. Their website has posted the old, recalled package label (left) and their new package label (right):


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For information regarding replacement of affected D-TRON adapters:
Contact the Disetronic Pump User Support Group at 1-800-688-4578.

For Disetronics recall notice:
URGENT PRODUCT RECALL: Potential Life-Threatening Situation to Children Using the Pump

For the FDAs press release on the recall:
Disetronic Medical Systems, Inc. Announces a Voluntary Recall of the D-TRON Adapters, Used With the D-TRONplus Insulin Pump

0 Type 2 Diabetes Having Psoriasis Can Lead To Insulin Resistance

Psoriasis is a hereditary, non-contagious, inflammatory skin disease. People diagnosed with psoriasis have high levels of the inflammatory molecules IL-6 and TNF-alpha. Having high levels of these inflammatory molecules on a permanent basis is thought to cause:

• clogged blood vessels,
• insulin resistance,
• high blood pressure, and
• Type 2 diabetes.

Researchers at the Goztepe Training and Research Hospital in Instanbul, Turkey, looked at the number of people diagnosed with the metabolic syndrome in a population of people with psoriasis, compared to individuals without the skin condition.
This study, published in April 2011 in the Scientific World Journal, included:

• 115 people diagnosed with psoriasis, and
• 140 participants with healthy skin.

The group of people with psoriasis had more cases of the metabolic syndrome, and it was more common after the age of 40.

From this information, it was concluded since psoriasis patients are at high risk for Type 2 diabetes, high blood pressure, and the metabolic syndrome, they should be treated as soon as diagnosed and watched closely for Type 2 diabetes and the metabolic syndrome.

Psoriasis is an autoimmune disease, meaning the immune system mistakes skin cells for invaders and attacks them. The skin becomes inflamed and skin cells multiply far too fast. It was named for the Greek word for itchy, because of the dryness and irritation seen in the condition. It is manifested by red patches often covered with white scales.

Topical medications combine moisturizers with cortisone to reduce inflammation. Oatmeal baths are also used to sooth the skin and reduce itching, and sun exposure in moderation can reduce the speed of skin cell reproduction. People with psoriasis often find their skin gets better during the summer months and in warm, sunny climates.

Oral medications: Methotrexate and cyclosporine are two medications taken orally. Methotrexate, also used for some types of cancer, slows down the rapid cell reproduction. Cyclosporine, used also to prevent graft rejection, acts by slowing down the immune system.

Biological medications: These are the most effective treatment. They work by blocking some of the immune systems action, and must be taken only when no infection is present. They are injected just under the skin, and the frequency of injections depends upon the kind of medication injected, and the dose.
One advantage the biologicals have over topicals is they are also effective against psoriatic arthritis.

• Enbrel is injected under the skin twice weekly for three months and then once a week. Patients quickly become adept at injecting it at home.
• Humira is also injected under the skin, every other week.
• Stelara is injected twice, four weeks apart, and then once every twelve weeks.
• Remicade is given by IV injection in a doctors office.

Individuals who have psoriasis or suspect they do should see a dermatologist. Even if the rash is considered only a minor nuisance, it should be treated to prevent any complications.

How do you start to create a healthy lifestyle today so you can avoid developing insulin resistance and Type 2 Diabetes?

For nearly 25 years Beverleigh Piepers has searched for and found a number of secrets to help you build a healthy body.

The answer isnt in the endless volumes of available information but in yourself.

Article by : Beverleigh H Piepers, Source: http://EzineArticles.com/?expert=Beverleigh_H_Piepers