Readers:
As 2008 comes to a close I would like to thank you for
reading.
Today, I has an interesting story about Jay Cutler, quarter-
back for the Denver Broncos, taking control of his type 1
diabetes.
Also, learn about the use of Metformin therapy in
Postpartum Diabetes Prevention.
And, we finish up with a terrific recipe for Instant Cocoa
Mix. Good Stuff.
So, enjoy today’s edition of the Diabetic Digest and have
a Happy and Healthy New Year!
Regards,
Steve
Concerned about your health?
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QB keeps type 1 diabetes in check, stays on his game
Jay Cutler has a cannon for an arm. A few weeks ago, when
the 6-foot-3, 240-pound quarterback for the Denver Broncos
and his team were backed up on their 1-yard line, he took
the ball, faked a handoff and spun left to find himself
face to face with a 300-pound lineman. Cutler passed,
juking the opponent out of his socks.
You’d never guess the quarterback spends a good portion
of every game on the sidelines keeping tabs on his type 1
diabetes, a condition that, if left unmonitored, can cause
severe health problems.
Cutler, who was diagnosed last spring just before his 25th
birthday, uses a fingerprick kit to check his blood sugar
levels, sometimes half a dozen times during a game. If the
reading is too low, he gulps down enough Gatorade to push
it up. His medication is always on hand in case his blood
sugar jets abnormally high.
Being an athlete with type 1 has its complexities, but
research shows exercise improves the health of patients
with diabetes, says Michael Jensen, professor of medicine
and director of endocrine research at the Mayo Clinic.
Snacking, hydrating and protecting vulnerable body parts
become lifelines for athletes with diabetes. But Cutler
and experts say the condition doesn’t have to stop a
person from becoming a star athlete — or even just
enjoying a game of flag football now and again.
Type 1 diabetes accounts for about 5% to 10% of all
diabetes cases, and about 1.4 million people in the USA
have the disease, according to the American Diabetes
Association. About 90% to 95% of diabetes patients have
type 2, which is brought on by obesity and other lifestyle
factors. Type 1, however, is an autoimmune disease that
happens when the insulin-producing cells in the pancreas
are destroyed by the body. Insulin is a hormone that
helps the body use glucose for energy.
Effects of low blood sugar
It’s common for someone with type 1 to experience low blood
sugar, called hypoglycemia, during exercise, says Serge
Jabbour, an endocrinologist at Jefferson Medical College
in Philadelphia. The effects of untreated hypoglycemia
include fatigue, a symptom Cutler experienced in the months
before his doctors discovered his condition. Untreated,
hypoglycemia can lead to coma and death.
On the other hand, high blood sugar, or hyperglycemia, can
hit when a person with type 1 eats too much and doesn’t
take enough insulin. Chronic hyperglycemia can lead to
kidney damage, vision problems and nerve complications,
says Mayo’s Jensen.
“When you and I exercise for any period of time, whether
it’s light or hard, our body needs less insulin, and the
pancreas automatically does that for us,” Jensen says.
With type 1 diabetes, that doesn’t happen naturally.
Blood sugar can drop super-low during sports, and the
only way to correct it is with food. If it jumps too high,
Jensen says, insulin is needed.
Type 1 athletes should know their bodies and what’s right
for their sports routine, Jensen says. “It varies immensely
depending on the sport you’re in.”
Improvement with insulin
Cutler remembers feeling lousy for about six months before
he was diagnosed, during which he dropped 30 pounds. “I
wasn’t eating. I didn’t have any energy,” he says. The
sluggishness followed him onto the field. “It absolutely
impacted my game. I was tired before the game even started,
and I was dead tired after.”
Once he started taking insulin, Cutler’s game and even
his psychological outlook improved, says Steve Antonopulos,
head trainer for the Broncos.
Offseason, Cutler uses an insulin pump attached to his
body. When the football season started, he switched to
manual injections.
Taking ownership of diabetes is the key for athletes,
Antonopulos says. “Jay has tremendous knowledge about it,
and he knows exactly how he should and shouldn’t feel. He
does everything he’s supposed to do.”
Exercise increases feelings of well-being and shows people
that they are not limited by their disease, says David
Nathan, director of the Diabetes Center at Massachusetts
General Hospital. And “physically, it improves the
sensitivity of muscle to insulin effects.”
Since last spring, Cutler has gained back the lost weight,
and he has been selected to play in the NFL Pro Bowl. “I
feel very good where I’m at,” he says.
Diabetes shouldn’t hold athletes back, Cutler says. “If
you’ve got a dream or something you want to accomplish,
you can definitely still do it.”
Copyright 2007 USA TODAY, a division of Gannett Co. Inc.
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Metformin Can Prevent Postpartum Diabetes
NEW YORK (Reuters Health) – Following gestational diabetes,
a type of diabetes that developments during pregnancy and
usually goes away after pregnancy, treatment with metformin
or intensive lifestyle interventions can prevent or delay
diabetes from becoming permanent in the postpartum period,
new research shows.
Lead author Dr. Robert E. Ratner at Medstar Research
Institute in Hyattsville, Maryland, and co-researchers
evaluated responses to each intervention among pregnant
women with impaired glucose tolerance, a major risk factor
fore diabetes, enrolled in the prospective Diabetes
Prevention Program.
The current subgroup analysis, reported in the Journal of
Clinical Endocrinology and Metabolism, included 350 women
with a history of gestational diabetes and 1416 with no
such history. Subjects were randomly assigned in a 1:1:1
ratio to metformin therapy, intensive lifestyle inter-
vention – exercise and diet), or placebo.
Although all women entered the trial with similar glucose
levels, those with a history of gestational diabetes in
the placebo group had a 71-percent increased incidence of
diabetes compared with control subjects during 3 years of
follow-up.
However, metformin was associated with a 50-percent
reduction and the intensive lifestyle modification with
a 53-percent reduction in the risk of developing diabetes
following gestational diabetes, Ratner and associates
report.
Among women without a history of gestational diabetes,
lifestyle modification reduced the risk by 49 percent,
while metformin reduced the risk by only 14 percent,
which was not statistically significant.
The authors estimate that five to six women with
gestational diabetes and impaired glucose tolerance
would need to be treated over 3 years with either
metformin or lifestyle modification to prevent one
case of diabetes.
The corresponding numbers needed to treat the control
subjects with impaired glucose tolerance were 9 for
intensive lifestyle intervention and 24 for metformin.
“Continued follow-up and testing for diabetes should be
part of the lifetime assessment of women with a history
of gestational diabetes mellitus,” Ratner’s team adds.
“We need to commit ourselves to caring for women with
gestational diabetes mellitus when they are not pregnant,”
Dr. Jeffrey L. Ecker, at Harvard Medical School in Boston,
writes in an accompanying editorial.
Ecker recommends that these women be told of the importance
of regular follow-up, and that healthcare providers be
aware of the risks of these patients.
SOURCE: Journal of Clinical Endocrinology and Metabolism,
December 2008.
Copyright 2006 Reuters Limited. All rights reserved.
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Diabetic Recipe
Instant Cocoa Mix
(makes 2 2/3 cups, enough for eight 3/4-cup 180 ml servings)
2 cups (672 g) nonfat dry milk powder
1/2 cup (48 g) lower-fat powdered nondairy creamer
1/2 cup (119 g) unsweetened cocoa powder
10 packets Equal® or 1 tablespoon (15 ml) Equal®Measure
1 teaspoon (5 g) ground cinnamon (optional)
1. Mix together all ingredients. Transfer to a self-sealing
plastic bag.
2. When ready to use, place 1/3 cup (105 g) of the mix in
a heat-proof mug. Add 3/4 cup (180 ml) boiling water
and stir.
Per serving: 104 calories, 8 g protein, 7 g carbohydrate,
2 g fat
Diabetic exchanges: 1 carbohydrate (nonfat milk)
Copyright 1997-2001 Diabetic-Lifestyle.
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