The traditional medical approach to diabetes is simply to
manage it after it has been diagnosed. Because there isn't a cure, the emphasis
is on keeping blood sugars as close to normal as possible -- usually with
exercise and weight loss coupled with medication -- and dealing with
complications as they arise. But while this sort of treatment can allow people
with diabetes to have full and relatively normal lives, it doesn't get at the
root causes of the illness.
Thomas Buchanan, MD, professor of medicine at the University of
Southern California, believes this is precisely why the thrust of diabetes
treatment needs to be changed.
In every issue of WebMD the Magazine, we ask our experts to answer readers' questions about a wide range of topics. In our July/August 2012 issue, we asked WebMD's diabetes expert, Michael Dansinger, MD, about the link between diabetes and poor sleep.
Q: I have diabetes, and I'm not sleeping well. Are the two related, and what can I do?
A: Yes, people with diabetes often have reduced sleep quality and quantity. Sleep apnea, medications, lack of exercise, and abnormal glucose and hormone...
"Typically, in diabetes treatment, the whole focus is on
blood sugar," says Buchanan, who is also director of the clinical research
center at the Keck School of Medicine. "But people aren't thinking enough
about the actual disease that's causing the problem."
To address this issue, Buchanan led the Troglitazone in
Prevention of Diabetes (TRIPOD) study, which treated women at risk of
developing type 2 diabetes with a class of drugs called glitazones or
thiazolidinediones, or more commonly, TZDs. The results were dramatic: The
drugs were apparently effective in preventing the onset of the disease.
Given that an epidemic of type 2 diabetes may be on the horizon
-- due primarily to the increasing levels of obesity in the U.S. and around the
world -- preventing diabetes is an urgent public health priority. TZDs could be
part of the solution.
TZDs and the TRIPOD Study
Unlike some drugs used to treat diabetes, the main strength of
TZDs as treatment doesn't lie in their ability to directly boost insulin
production or lower glucose levels. Instead, TZDs work on a different level by
affecting the beta cells in the pancreas.
For the body to use blood glucose as energy, beta cells secrete
the hormone insulin. As insulin circulates throughout the body, it attaches
itself to individual cells; once the insulin is attached, the cell becomes
receptive to glucose and absorbs it, providing itself with energy. In many
people developing type 2 diabetes, the body becomes less sensitive to insulin
-- a condition called insulin resistance -- making the absorption of glucose
from the bloodstream more difficult.
The pancreatic cells respond by producing more insulin to make
up for this resistance. While the beta cells may be able to produce enough
insulin to keep blood glucose at normal levels for a time, the increased
production of insulin eventually may take a toll. The beta cells may become
compromised and their ability to produce insulin will diminish, causing insulin
deficiency. The body will become less capable of processing blood sugar, blood
sugar levels will rise, and type 2 diabetes can follow. About 70 to 80 million
Americans are estimated to have insulin-resistance syndrome and 17 million have
type 2 diabetes.
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Your level is currently
If the level is below 70 or you are experiencing symptoms such as shaking, sweating or difficulty thinking, you will need to raise the number immediately. A quick solution is to eat a few pieces of hard candy or 1 tablespoon of sugar or honey. Recheck your numbers again in 15 minutes to see if the number has gone up. If not, repeat the steps above or call your doctor.
People who experience hypoglycemia several times in a week should call their health care provider. It's important to monitor your levels each day so you can make sure your numbers are within the range. If you are pregnant always consult with your health care provider.
Congratulations on taking steps to manage your health.
However, it's important to continue to track your numbers so that you can make lifestyle changes if needed. If you are pregnant always consult with your physician.
Your level is high if this reading was taken before eating. Aim for 70-130 before meals and less than 180 two hours after meals.
Even if your number is high, it's not too late for you to take control of your health and lower your blood sugar.
One of the first steps is to monitor your levels each day. If you are pregnant always consult with your physician.
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