Diabetes and Alternative Medicine: Cause for Concern

‘Alternative’ medicines are becoming increasingly popular, and in this paper we describe our experience with alternative approaches to orthodox diabetes management. Four patients with insulin-dependent diabetes reduced or stopped their insulin in favour of therapeutic approaches including prayer, faith healing, unusual diets, and supplements of vitamins and trace elements. This resulted in ketoacidosis in three, in one case life-threatening; and weight loss and hyperglycaemia in the other. One patient developed serious retinopathy. Additionally, eight other types of alternative diabetic treatment are described, not as far as we know associated with such serious complications. These include homeopathy, reflexology, meditation, herbal treatment, ‘cellular nutrition’, ‘subconscious healing’, ‘pearl therapy’ (drinking milk in which pearls have been boiled) and ‘astrotherapy’ (tying pieces of coral around the arm). Diabetes is a chronic incurable disease, for which modern treatments remain somewhat unsatisfactory. It is therefore perhaps not surprising that some patients seek alternative treatments with more attractive claims. Diabetes health professionals need to be aware of the potential dangers associated with some of these treatments.     

Severe Ketoacidosis Complicated by ‘Ecstasy’ Ingestion and Prolonged Exercise

Ecstasy (3,4-methylenedioxymethamphetamine or MDMA) is used with increasing frequency as a recreational drug. Accumulated evidence over recent years indicates a growing demand for the drug with a corresponding increase in number of reports of adverse effects from its use. There are reported metabolic disturbances due to MDMA use. These, in addition to the prolonged exercise involved in dancing at ‘raves’ where MDMA may be used, may exacerbate ketoacidosis. We report two cases of ketoacidosis complicated by MDMA ingestion.     

Recurrent Hypoglycaemia Associated with First and Second Trimester Insulin Sensitivity in a Patient with Insulin-dependent Diabetes

A 35-year-old insulin-dependent diabetic woman presented at 8 weeks gestation with multiple severe hypoglycaemic episodes occurring during the day and night without warning. Her pre-pregnancy insulin dosage of 45 units daily was progressively reduced by 73 % to 12 units daily by week 17 because of multiple hypoglycaemic episodes. Investigation showed no pathological cause for the hypoglycaemia. Insulin dosage increased to 16 units daily by week 19 and then increased sharply to 60 units daily at 23 weeks and finally to 72 units at week 37. Following delivery her insulin dosage returned to pre-pregnancy values. Insulin-dependent diabetic women may rarely develop exaggerated insulin sensitivity in the first trimester of pregnancy resulting in severe hypoglycaemia, but spontaneous improvement occurs with increasing insulin resistance in the second and third trimesters.     

Intensive education improves knowledge, compliance, and foot problems in type 2 diabetes.

Despite the established role of foot care education in diabetes management, reports evaluating such interventions are rare. The effectiveness of an intensive foot care intervention programme and a conventional one were therefore compared in Type 2 diabetes. The intensive group showed significantly greater improvements than the conventional group in foot care knowledge (p less than 0.001), compliance with the recommended foot care routine (p = 0.012), and compliance with the initial advice to consult a podiatrist (other than the project podiatrist) for further treatment (p = 0.008). At the first follow-up visit the intensive group also showed a significantly greater reduction in the number of foot problems requiring treatment than the conventional group.     

Vasopressin secretion during insulin-induced hypoglycaemia: exaggerated responses in people with type 1 diabetes

Insulin hypoglycaemia causes a rise in plasma vasopressin concentrations in man and the rat, and vasopressin stimulates glucagon secretion and increases hepatic glucose output in man. Vasopressin has also been suggested to have an important synergistic role with corticotrophin releasing factor in the release of adrenocorticotrophin hormone, and a counter-regulatory role for the hormone has been proposed. As diminished anterior pituitary hormone responses to hypoglycaemia have been reported in diabetes mellitus, we studied the plasma vasopressin responses to insulin-induced hypoglycaemia in 10 patients with established Type 1 diabetes and 10 matched control subjects. Blood glucose fell from 4.5 +/- 0.3 to 1.6 +/- 0.1 mmol l-1 (p less than 0.001) in the diabetic group and from 4.6 +/- 0.2 to 1.5 +/- 0.2 mmol l-1 (p less than 0.001) in control subjects, with delayed blood glucose recovery in the diabetic patients. Plasma vasopressin rose in the diabetic patients from 0.9 +/- 0.2 to 6.9 +/- 2.8 pmol l-1 (p less than 0.001), a significantly greater rise (p less than 0.05) than in the control subjects, 0.8 +/- 0.1 to 2.4 +/- 1.0 pmol l-1 (p less than 0.001). Plasma osmolalities remained unchanged and haemodynamic changes were similar in both groups. There is an exaggerated rise in plasma vasopressin concentrations in diabetic patients in response to insulin-induced hypoglycaemia. The putative mechanisms and potential significance of the exaggerated rise are discussed.     

Diabetes and gastric cancer: The potential links

This article reviews the epidemiological evidence linking diabetes and gastric cancer and discusses some of the potential mechanisms,confounders and biases in the evaluation of such an association.Findings from four meta-analyses published from 2011 to 2013 suggest a positive link,which may be more remarkable in females and in the Asian populations.Putative mechanisms may involve shared risk factors,hyperglycemia,Helicobacter pylori(H.pylori)infection,high salt intake,medications and comorbidities.Diabetes may increase the risk of gastric cancer through shared risk factors including obesity,insulin resistance,hyperinsulinemia and smoking.Hyperglycemia,even before the clinical diagnosis of diabetes,may predict gastric cancer in some epidemiological studies,which is supported by in vitro,and in vivo studies.Patients with diabetes may also have a higher risk of gastric cancer through the higher infection rate,lower eradication rate and higher reinfection rate of H.pylori.High salt intake can act synergistically with H.pylori infection in the induction of gastric cancer.Whether a higher risk of gastric cancer in patients with diabetes may be ascribed to a higher intake of salt due to the loss of taste sensation awaits further investigation.The use of medications such as insulin,metformin,sulfonylureas,aspirin,statins and antibiotics may also influence the risk of gastric cancer,but most of them have not been extensively studied.Comorbidities may affect the development of gastric cancer through the use of medications and changes in lifestyle,dietary intake,and the metabolism of drugs.Finally,a potential detection bias related to gastrointestinal symptoms more commonly seen in patients with diabetes and with multiple comorbidities should be pointed out.Taking into account the inconsistent findings and the potential confounders and detection bias in previous epidemiological studies,it is expected that there are still more to be explored for the clarification of the association between diabetes and gastric cancer.     

Diabetes in British South Asians: Nature,Nurture, and Culture

Diabetes mellitus and its complications account for a high proportion of avoidable morbidity and premature mortality in people of South Asian origin living in the UK. This review examines available evidence as to why this might be and what can be done to address the problems. The sources for data were a Medline search by MeSH terms, free text and key authors by name, and relevant references, searched by hand, from all review articles in the AIM journals, up to April 1996. Most trials identified were epidemiological surveys. The high instance of diabetes and some of its complications do not have a single explanation. The early incidence of diabetes and its link with coronary heart disease may be partially explained by the central adiposity–insulin resistance syndrome. Predisposition to this is probably largely genetic but exacerbated by other factors such as diet, immune-inflammatory changes, and physical activity levels. There is less evidence to support conventional dietary risk factors and some for potentially deleterious effects of traditional Western dietary advice in this population. The impact of the genetic and environmental influences is exacerbated by suboptimal use of health services. The contribution of economic deprivation to the poor outcome of diabetes in these patients may be substantial. There is a considerable impact of psychosocial stress on morbidity, supporting the view that a narrow biomedical model will neither fully explain the problem nor provide solutions. To be successful, strategies for the secondary prevention of diabetes complications in British South Asians need to incorporate a number of paradigms: genetic, physiological, psychological, anthropological, and sociological. Recommendations for a multidimensional approach to this important clinical issue are proposed. © 1997 by John Wiley & Sons, Ltd.     

A scoping review of best practice guidelines for the dietary management of diabetes in older adults in residential aged care

Over the last two decades guidelines have been published on the subject of the care and liberalised nutrition management of older adults with diabetes in residential aged care, recognising that they may have different needs to those older adults in their own home. This study aimed to scope and appraise these guidelines using the AGREE II tool. Overall physician developed guidelines were more robust, but there was discordance in their recommendations compared to guidelines developed by dietitians; particularly regarding the use of therapeutic diets. A lack of standardised approach has implications for optimal dietary management of diabetes in aged care.     

Human insulin use and hypoglycaemia: insights from the Pittsburgh Epidemiology of Diabetes Complications Study.

Recently, concern has arisen that human (as opposed to beef or pork) insulin may cause more frequent and/or severe hypoglycaemia in association with reduced warning symptoms. This question was examined from questionnaire data of 628 Type 1 diabetic patients (mean age 28 years and duration of diabetes 19 years) participating in the baseline examination of a follow-up study of diabetes complications. Those using human insulin (n = 73) reported an insignificantly higher frequency of hypoglycaemic reactions in the last year than those using animal insulin (66 vs 55% with reactions at least monthly) and only a weak trend was seen overall for the prevalence of human insulin use to increase with increasing frequency of hypoglycaemia (p = 0.06). Hypoglycaemic reactions resulting in unconsciousness were too rare to permit analysis by type of insulin used. The prevalence of reduced awareness of hypoglycaemia was similar among human insulin users to that seen in animal insulin users (25 vs 19%, NS). However, prevalence of reduced awareness showed a strong relationship to current blood glucose in the animal (r = -0.18, p less than 0.001) but not human (r = -0.06, NS) insulin users. Excluding patients with autonomic symptoms or neuropathy did not alter the results, nor did excluding the 34 individuals taking more than three insulin injections per day. It is concluded that human insulin use is not associated with either any substantial increased frequency of hypoglycaemia or reduction in awareness of hypoglycaemia. However, human insulin use does appear to be associated with reduced awareness of hypoglycaemia in those whose blood glucose control is relatively poor.     

Outcome of focused pre-Ramadan education on metabolic and glycaemic parameters in patients with type 2 diabetes mellitus

Background

Ramadan fasting is associated with the risk of acute complications including hypoglycaemia. Therefore, patients' education before Ramadan and follow up during Ramadan is essential for safe fasting.

Perceived needs of general practitioners and practice nurses for the care of diabetic patients.

This study compared the aims and needs of General Practitioners (GPs) and practice nurses who wished to improve the service they provided for non-insulin-treated diabetic patients. Contact was made with 242 GPs in 110 practices in Central and North Nottingham, and a questionnaire was sent to the 149 (62%) who requested one. Completed questionnaires were returned by 110 (74%) of these, and by 48 (80% of 60) of their practice nurses. Only 19 GPs ran a specific diabetic clinic, but nearly all (95%) wanted to improve the service they provided for diabetes care. In doing so, many wished for involvement of opticians, chiropodists, and dietitians, and all wished to involve the practice nurse. The need for involvement of hospital-based diabetes specialist nurses was perceived by only 37% GPs. More than two-thirds (69%) of practice nurses wanted more input into the care of diabetes. Both GPs and practice nurses felt that the role of the practice nurse should include screening for complications, although there was some disagreement about the extent of this involvement. GPs envisaged that patient education would be a major problem in establishing a diabetes service, but only 58% identified education as a task that could be accomplished by the practice nurse.     

Diabetes mellitus in Bahrain: an overview.

Bahrain has faced a rapid transition in its socio-economic status, which resulted in great changes both in life-style and in patterns of health and disease. There has been a marked decline in infectious diseases and an increase in chronic diseases. Diabetes mellitus has become one of the most common public health problems in the country. In 1988 it was estimated that 3.4% of total deaths in Bahrain were due to diabetes. A community-based study among mothers aged 18 to 48 years showed that 8.5% of them had diabetes. The percentage was found to be higher among elderly Bahrainis (12.9%). Obesity, lack of physical activity, alteration in food habits, and change in social conditions have all played a vital role in the changing prevalence of diabetes in this country. The current programmes to manage and control diabetes are limited and ineffective. Thus measures to treat diabetes should be given a high priority in the national health policy. Training of physicians in the management of diabetes, public education, epidemiological surveys, and nutritional evaluation of local foods are among the most important measures needed to control diabetes in Bahrain.     

Validation of I.V. small-dose insulin infusion therapy in diabetic ketoacidosis of depancreatized dogs

Summary A validation of small-dose insulin infusion therapy was studied by the constant i.v. infusion of various doses of insulin into ketoacidotic depancreatized dogs. Constant insulin infusion of 5 × B, 10 × B, 30 × B and 50 × B (B=225 μU/kg/min) was performed for 3 h by mechanical pump. The following results were obtained: (1) plasma concentrations of immunoreactive insulin (IRI) increased proportionally to the dose of infused insulin, but the higher IRI did not result in a greater fall in plasma glucose concentration, correspondingly; the mean rate of fall in plasma glucose concentration of 5 × B was not significantly lower than that of 50 × B; β-hydroxybutyrate and arterial pH improvements were observed in each group during the 3-h insulin infusion. These data suggested that for the improvement of diabetic ketoacidosis, the insulin infusion rate of more than 30 × B, which raised the plasma IRI levels above the physiological range, was not essential; (2) the necessity of potassium supplementation during the small-dose insulin infusion was suggested if the pre-treatment level of serum potassium was low. These results confirmed that in the absence of infection or severe acidosis small-dose insulin infusion therapy is as effective as the conventional large-dose insulin therapy.     

饮食控制与糖尿病筛查在妊娠期糖尿病防治中的作用研究

目的 探究在妊娠期糖尿病防治中应用饮食控制与糖尿病筛查的效果.方法 随机抽取2017年6月—2019年2月该院行糖尿病筛查的172名孕妇为观察对象,筛查显示50例为葡萄糖阳性,经确诊为妊娠期糖尿病,将其作为实验组,其他孕妇作为对照组.并对实验组25例患者实施胰岛素治疗,实验组其他25例患者实施饮食控制+胰岛素治疗.对比...     

Diabetes in the United Kingdom: a personal series.

A personal series of 6780 patients with diabetes mellitus is reported. Of these 1410 were thought to have insulin-dependent (Type 1) diabetes and 4926 non-insulin-dependent (Type 2) diabetes. Among the former, 128 patients were only diagnosed when in severe ketoacidosis or coma. In 116 patients the diabetes was diagnosed in pregnancy. Chronic alcoholism was an aetiological factor in 75 patients; in 52 it led to the diagnosis being made, and it complicated treatment in 129 additional patients. In the patients with Type 2 diabetes whose treatment was stabilized 23.5% were having insulin injections, 44.5% tablets, and 32.0% diet only. Sight-threatening retinopathy developed in 21.3% of patients with Type 1 and 7.9% of those with Type 2 diabetes. The rate of developing sight-threatening retinopathy was 1.1% of patients per year. Blindness occurred in 0.28% of patients with Type 1 diabetes per year and 0.097% per year in Type 2 diabetes. If the mean survival of patients with retinopathy going blind is 7.5 years, this would mean 7500 people in the UK blind from diabetic retinopathy. There was a striking drop in the annual incidence of blindness after 1970 coinciding with the introduction of specific treatment for diabetic retinopathy. Juvenile cataract developed in 1.7% of patients who developed Type 1 diabetes before 30 years of age. Clinically important diabetic neuropathy developed in 17.4% of patients with Type 1 and 11.6% of those with Type 2 diabetes. The main features were paraesthesiae and numbness (49%), neuropathic ulceration (37%), pain (5%), autonomic symptoms (5%), and amyotrophy (4%). Oculomotor palsies and mononeuropathies were noted. Foot ulceration occurred in 81 patients with Type 1 and 279 of those with Type 2 diabetes. Charcot changes in the feet were noted in 21 patients. Major amputations were needed in 18 patients with Type 1 and 60 with Type 2 diabetes. Proteinuria believed to be due to diabetic nephropathy developed in 12.8% of patients with Type 1 and 4.7% of those with Type 2 diabetes. The prevalence of early renal failure was 4.6% and 1.4%, respectively. Coronary artery disease was noted in 9% of patients with Type 1 diabetes, and was more common in those who developed diabetes after 20 years of age. Myocardial infarction was as common in women as in men. In Type 2 diabetes coronary artery disease gave rise to symptoms in 19.1%, and myocardial infarction was more common in men.(ABSTRACT TRUNCATED AT 400 WORDS)     

Continuity of care in patients with type 2 diabetes in Croatian primary care setting during COVID-19 pandemic: A retrospective observational study

AimTo examine the differences in the continuity of health care for type 2 diabetic patients before and during COVID pandemic in family medicine depending on whether the physician who provided care finished vocational training in family medicine or not.MethodsThis retrospective longitudinal research lasted from 2018 to 2020 in eight family medicine practices on 648 patients with type 2 diabetes diagnosed before 2018, and without Sars-Cov2 infection in previous medical history in Zagreb, Croatia. Follow-up parameters (HbA1c, LDL, eGFR, blood pressure, BMI, eye fundus and neurological findings, number of check-ups and vaccination against the flu) were noted before (2018, 2019), and in the COVID period (2020) in the care of family medicine specialists (FMPs) and without it (FMPws).ResultsNo differences were found between the gender and age of patients. A decrease was seen in existing laboratory findings (64–47%, P < 0.001), eye fundus check-ups (39–37%, P = NS), neurologist check-ups (28–25%, P = NS) and FMP check-ups (382–321, P < 0.001) during the COVID period with significant differences between FMPs and FMPws. Significant changes were seen in LDL cholesterol (2.7–2.4 mmol/L, P < 0.001) and eGFR (83–80 ml/min/1.73 m2, P = 0.002), but BMI, blood pressure and HbA1c (>7% had 42% of patients) values did not differ during the COVID period.ConclusionAccording to the observed parameters, the continuity of care for diabetic patients in Zagreb has worsened during the COVID pandemic but remained significantly better in care of FMPs than in FMPws, without differences in achieving target values of follow-up parameters.