Diabetes

Diabetes comes in a variety of different forms. The most common form of the disease, type 2 diabetes, results from cells in the body not using insulin as well as they should. Type 1 diabetes (T1D), however, is much rarer, and results when the body simply can’t produce its own insulin at all. People who have this condition must take part in insulin therapy and other treatments in order to live a full and healthy life.

Scientists from Uppsala University have investigated the disease thoroughly, and believe that a certain protein found in the body could potentially provide a cure.

The protein in question is called interleukin-35 (IL-35), and it is made of immune cells. Dr. Kailash Singh, who is a PhD student at Uppsala University, began studying this immune cell when she was examining T1D in rat models. In her research, she found that immune regulatory T-cells in the models were producing pro-inflammatory destructive proteins instead of IL-35, which is an anti-inflammatory protein.

This reversal is the exact opposite of what should be happening in a normal body, and Singh believes that it may be something that is prompted by T1D.

“This suggests that the good guys (the anti-inflammatory proteins) have gone bad in early development of Type 1 diabetes and therefore our immune cells destroy the beta cell,” she said.

Crucial protein

As a result of this destructive process, Singh found that the levels of IL-35 that should have been present in the models were much lower than they should be. These low levels indicate that the protein may play a crucial role in stopping T1D.

The research team that Singh was a part of, which was led by Professor Stellan Sandler, set out to find if IL-35 could suppress or reverse T1D, even if the disease was already established. The team utilized mice who had been injected with a chemical that induced symptoms of T1D. After the symptoms had been established for two days, the researchers injected them with IL-35 to see if their blood glucose levels normalized.

Their findings show that the blood glucose levels in the mouse models stabilized after they were given the injections. In addition to this finding, the researchers were also able to test IL-35 injections against a specific model of T1D, called non-obese diabetic mouse (NOD). Even after the IL-35 treatments were stopped, diabetic symptoms did not return in any of the subjects.

Unique insights 

"To the best of our knowledge, we are the first to show that IL-35 can reverse established Type 1 diabetes in two different mouse models and that the concentration of the particular cytokine is lower in Type 1 diabetes patients than in healthy individuals. Also, we are providing an insight into a novel mechanism: how immune regulatory T cells change their fate under autoimmune conditions", said Singh.

The full study has been published in Scientific Reports. 

Many recent advances in treating diabetes have focused on making the disease more manageable by allowing those affected to measure their glucose levels more quickly and with less pain. Now researchers have developed a new way of doing just that for those suffering from Type 1 diabetes.

They have proposed implanting an “artificial pancreas” into people that can measure their blood sugar levels and automatically release insulin when it is needed.

Type 1 diabetes affects well over one million people living in the United States today, many of which are teenagers or children. The disease results from the immune system destroying pancreatic cells which are responsible for insulin production. In order to make up for this, patients take insulin injections every day to keep their glucose levels normal.

The current method of injecting insulin is less than optimal, since it relies on the user to constantly keep track of their blood sugar levels and the amount of insulin they are taking. This is particularly hard for people who are very young or very old, since they may not be able to keep track of all of the pertinent information.

Even after injecting the insulin, there is still a significant amount of time that needs to pass before it can affect a person’s system. This can be dangerous in cases where the desired effects are needed sooner rather than later. In order to fix this problem, Francis J. Doyle III and his team researched ways in which monitoring and delivering insulin injections would not be so laborious.

Faster reactions

Doyle and his team designed an algorithm that keeps track of blood sugar levels in the human body and calculates how much insulin is needed to counteract imbalances. The formula is designed to work with implanted devices, like the artificial pancreas.  

If proven viable, the artificial pancreas would be able to react to insulin needs much faster than someone with Type 1 diabetes ever could. Because it is constantly monitoring the body, it can deliver the correct dosage as soon as a person needed it. The algorithm is even designed to take food intake and sleep periods into account when making its determinations.

Early tests of the artificial pancreas have proven positive. It maintained blood sugar levels within a target range almost 80 percent of the time. The researchers will strive to improve upon that number as time goes on. They hope to begin testing the device in animals in the near future. 

Researchers from the University of North Carolina and NC State have developed a small insulin patch that may help the 387 million people who suffer from diabetes. If successful, the patch could replace painful insulin injections and better regulate blood sugar levels in the human body.

The developing patch is a thin square that is no bigger than a penny. It is covered with over one hundred “microneedles” that each hold a small store of insulin and a sensor that detects glucose. When you apply the patch to your skin, the sensors in the needles will detect if your blood sugar levels are too high. If they are, then the needles release their insulin stores to regulate your glucose levels.

“We have designed a patch for diabetes that works fast, is easy to use, and is made from nontoxic, biocompatible materials,” said Zhen Gu, who is co-senior author of the study. “The whole system can be personalized to account for a diabetic’s weight and sensitivity to insulin, so we could make the smart patch even smarter.”

Impractical and imprecise

The current standard for those with diabetes is to prick their fingers to test their glucose levels, and take an insulin shot if they need to. This can be a dangerous practice, though. John Buse, who is another co-senior author of the study, calls it impractical and imprecise.

“Injecting the wrong amount of medication can lead to significant complications like blindness and limb amputations, or even more disastrous consequences such as diabetic comas and death,” he said.

Researchers have already begun testing their patches on mice to see if they could control their blood sugar levels. One set of mice was given a standard insulin injection; their blood sugar levels dropped to normal levels, but rose back up to hyperglycemic range quickly. Another set of mice was given the new smart patch; their blood sugar levels were brought under control within 30 minutes and stayed that way for several hours.

These tests reflect positively on the smart patch’s ability to regulate blood sugar levels in people. Mice are less sensitive to insulin, so the stabilizing effects of the patch could last even longer when given to humans. Researchers hope that the patch could last up to a few days before needing to be changed. This would save a lot of time for diabetics who need to constantly be on top of their blood sugar regulation.

“The hard part of diabetes care is not the insulin shots, or the blood sugar checks, or the diet, but the fact that you have to do them all several times a day, every day, for the rest of your life,” said Buse. “If we can get these patches to work in people, it will be a game changer.

The full study has been published in Proceedings of the National Academy of Sciences.

Despite advances in modern medicine, there are still many diseases that stubbornly persist. Cancer, heart disease and diabetes are being worked on tirelessly by researchers and scientists every day.

So if there were a medicine that could help with these illnesses, wouldn’t you want to know about it? Unfortunately, it seems that many medical professionals are keeping us in the dark, or may be in the dark themselves.  

A study from UCLA shows that only a small fraction of practicing doctors are prescribing metformin, which has been proven to help prevent the onset of diabetes. It indicates that only 3.7% of U.S. adults with pre-diabetes were recommended to take the drug in a recent three-year period.

While many people struggle with fully formed diabetes, pre-diabetes is often understated. It is found in people who have higher-than-normal blood sugar levels, yet do not reach the threshold for diabetes. It is projected that one third of adults in the U.S. currently meet the requirements for pre-diabetes. Dr. Tannaz Moin, who is the study’s lead author and a professor of medicine at UCLA, says metformin can help those at risk.

“Diabetes is prevalent, but pre-diabetes is even more prevalent and we have evidence-based therapies like metformin that are very safe and that work," Moin said.

Different organizations have recognized the benefits of metformin in recent years. The American Diabetes Association added metformin to its guidelines for diabetes prevention in 2008. The organization specifically mentions that the drug should be used by those who have high blood sugar levels, even if they are not yet in the diabetes range.

Despite all of this support, only small fractions of patients are advised to take the drug. Of these, there were specific people that were more likely to get a prescription. In particular, women, the obese, and those suffering from multiple chronic diseases were preferred.

Various theories

Researchers are not completely certain why the drug is not being recommended, but they do have theories. One of these is that medical professionals are reluctant to “medicalize” pre-diabetes. Even patients may be hesitant to admit that they could be in danger. This lack of acceptance could very well be the reason that the FDA has not approved the drug for treatment of pre-diabetes.

While the study is telling, there are some shortcomings that need to be followed up on in the future. For example, the researchers focused only on adults who had commercial insurance. This excludes those who are uninsured or older. Being able to verify if patients could take the drug could also adjust the findings significantly.  

Additional research could very well lead to drastic improvements in health, says Dr. Sam Ho, a co-author of the study: "Identifying more effective ways to help people avoid diabetes is essential to individuals' lives and to society as a whole, which is why it was important to us to support this research," he says.

As Americans have become increasingly overweight and obese, there has been an explosion in the cases of type 2 diabetes. Unlike type 1 diabetes, type 2 is largely tied to lifestyle risk factors.

In 2014 the Centers for Disease Control and Prevention (CDC) estimated 29.1 million people – 9.3% of the U.S. population – had diabetes, a chronic condition that affects the way your body metabolizes sugar, or glucose.

Type 2 was once most common in adults – typically older adults – but the Mayo Clinic reports that it has increasingly begun to affect large numbers of children. The disease is managed through insulin drugs, as well as by eating well, exercising and maintaining a healthy weight.

In addition to the growing number of diabetes cases, the American Diabetes Association (ADA) estimates another 86 million American adults probably have prediabetes, meaning their blood sugar levels are higher than normal. More disturbing, the group says about 8 million Americans may have the disease and not know it.

Risk factors

How do you know if you or your child is at risk of developing type 2 diabetes? Being obese and living a sedentary lifestyle are 2 significant risk factors.

The ADA has developed a Diabetes Risk Test, an online app that allows users to measure their risks of developing the disease. The quiz asks users to answer short questions about weight, age, family history and other potential risk factors for diabetes.

The results are compiled into a numerical score that indicate either a low or high risk for developing type 2 diabetes. If the results suggest a high risk, the ADA urges you to speak with a health care provider to learn more about ways to either reduce the risk or delay the onset of the disease.

“Awareness is crucial in the effort to stop Diabetes,” said David Marrero, an executive at ADA. “We’re asking the public to take It. Share it. Step out. Take one minute to take the risk test today, share it with your loved ones and get started getting active by getting involved in your local Step Out event. The Diabetes Risk Test can be the first step in knowing your risk and helping us get closer to our vision of a life free of diabetes and all of its burdens.”

Primary risk factors

Doctors say you are most at risk of developing type 2 diabetes if you are overweight, sedentary, over the age of 45 and have a family history of diabetes. African Americans, Hispanics/Latinos, Native Americans, Asian Americans and Pacific Islanders are at an increased risk, as are women who have had gestational diabetes or had babies weighing more than nine pounds at birth.

Symptoms

How do you know if you have the disease? Symptoms can include blurred vision, excessive thirst and frequent urination. The problem is, these symptoms may not show up at the onset of the disease.

ADA is trying to close what it sees as a diagnosis gap, getting treatment to patients earlier in the disease and heading off dangerous complicaitons, like heart disease, blindness, kidney disease, stroke, amputation and even death.

The group cites studies showing type 2 diabetes can be prevented or delayed by losing just 7% of body weight, regular physical activity and healthy eating.

Patients diagnosed with diabetes are usually treated with insulin, a natural substance in the body that regulates how sugar is broken down and processed.

For decades insulin has been a life saver and allowed diabetics to live a healthier, more active life.

But for diabetics who lack prescription drug benefits, insulin prescriptions are costly, running anywhere from $120 to $400 a month. While many expensive drugs have less-expensive generic alternatives, insulin does not – at least not in the U.S.

Normally, pharmaceutical companies obtain a patent for a drug, allowing them exclusive right to sell it under a name brand. Eventually the patent expires, and other drug companies may then produce it and sell it for less in its generic form.

But that hasn't happened with insulin, even though it was introduced more than 90 years ago.

Evergreening

Writing in the New England Journal of Medicine, Johns Hopkins researchers Jeremy Greene and Kevin Riggs say insulin is an example of what's called “evergreening.” The drug company holding the patent keeps making small improvements to the drug and each time it does it renews the patent.

These regular tweaks result in more effective medication for people with diabetes but has had the effect of blocking entry of a generic insulin drug to the market.

True, generic drug makers could produce the older versions of the drugs, but the authors say they don't because they have less incentive. As a result, they say many patients who should be taking insulin don't because they can't afford it.

While there are generic drugs for just about everything else, Greene and Riggs say a generic insulin would be highly beneficial.

Limits of competition

“We see generic drugs as a rare success story, providing better quality at a cheaper price,” said Greene, who is an associate professor of the history of medicine at the Johns Hopkins University School of Medicine and a practicing internist. “And we see the progression from patented drug to generic drug as almost automatic. But the history of insulin highlights the limits of generic competition as a framework for protecting the public health.”

There have been many notable improvements to insulin over the years. In the 1930s and 1940s, insulin treatments became longer-acting, so that most patients only had to take a single dose each day.

In the 1970s and 1980s, manufacturers improved the purity of cow and pig extracted insulin. Since then, several companies have developed synthetic forms.

The authors say the patents on the first synthetic insulin expired last year, but these newer forms are harder to copy so these unpatented versions will go through a lengthy Food and Drug Administration (FDA) approval process and will cost more to make.

Riggs and Greene say there may ultimately be some generic versions of these insulin drugs but they probably won't be a lot cheaper than the name brands.

It's often said that maintaining your health will result in spending less money on doctor's visits, tests and prescription medicine.

It would make sense that is true, but can anyone really back it up? Researchers at Wake Forest Baptist Medical Center say they can.

In a study, they found that overweight people who have diabetes can save, on average, $500 per year by shedding pounds through proper diet and exercise.

"Lifestyle interventions promoting weight loss and physical activity are recommended for overweight and obese people with type 2 diabetes to improve their health," said Mark A. Espeland, lead author of the study. "This is the first study to show that weight loss can also save money for these individuals by reducing their health care needs and costs."

In the study, subjects with type 2 diabetes, a condition largely the result of obesity and other lifestyle factors, were put on an intensive lifestyle intervention program, supplemented with diabetes support and education. Others in the study maintained their normal lifestyle and managed their diabetes solely through medication.

Results

The researchers say at the end of the study, those who lost weight and adopted a healthier lifestyle had 11% fewer hospitalizations. Those who were admitted to hospitals were discharged 15% earlier. They also had to purchase fewer medications.

The researchers were able to put a dollar amount on those differences. The group that lost weight saved an average $5,280 over 10 years – or $528 per year.

Espeland said the people who lost weight and increased physical activity improved their overall health because they had better control of their diabetes, blood pressure, sleep quality, physical function and symptoms of depression. The cost savings appeared to be consistent regardless of age, initial weight, gender or ethnicity.

"Type 2 diabetes is a chronic disease that is affecting more and more adults, increasing their health care needs and costs," Espeland said. "This study shows that by losing weight and being physically active, individuals can reduce these costs."

Boost for corporate wellness programs

The findings may provide additional support for corporate wellness programs, that provide incentives for employees to get regular exercise and adopt a healthy lifestyle. According to Kiplinger, more than 40% of large employers surveyed by the National Business Group currently offer their employees some kind of incentive for participating in a wellness programs.

The average incentive is just under $400. The corporations hope to recoup the cost of those incentives through lower health insurance premiums, as well as increased worker productivity and fewer sick days.

According to Kiplinger, some employers may add $75 to an employee's health savings account if they participate in an exercise program.

The U.S. military is grappling with the effects poor lifestyle choices have on health, not just in dealing with rising health care costs but in filling out its ranks.

According to Army Magazine, about 1 in 4 possible recruits is eligible to enlist. Some of the other 75% might be ineligible, have weight or medical issues that keep them out of uniform.

It quotes Army officials as say the declining pool of recruits is a problem, so the urgency for better health and lifestyle choices is no longer simply a national health issue, nor just an economic one -- it's a matter of national security.  

Princeton University researchers have developed a way to use a laser to measure people's blood sugar, and, with more work to shrink the laser system to a portable size, the technique could allow diabetics to check their condition without pricking themselves to draw blood.

"We are working hard to turn engineering solutions into useful tools for people to use in their daily lives," said Claire Gmachl, the project's senior researcher. "With this work we hope to improve the lives of many diabetes sufferers who depend on frequent blood glucose monitoring."

In an article published June 23 in the journal Biomedical Optics Express, the researchers describe how they measured blood sugar by directing their specialized laser at a person's palm. The laser passes through the skin cells, without causing damage, and is partially absorbed by the sugar molecules in the patient's body. The researchers use the amount of absorption to measure the level of blood sugar.

Sabbir Liakat, the paper's lead author, said the team was pleasantly surprised at the accuracy of the method. Glucose monitors are required to produce a blood-sugar reading within 20% of the patient's actual level; even an early version of the system met that standard. The current version is 84% accurate, Liakat said.

"It works now but we are still trying to improve it," said Liakat, a graduate student in electrical engineering.

Jardiance (empagliflozin) tablets have been given the green light to be used to improve glycemic control in adults with type 2 diabetes.

Approximately 26 million people are affected by type 2 diabetes, which accounts for more than 90% of diabetes cases diagnosed in the U.S. Over time, high blood sugar levels can increase the risk for serious complications, including heart disease, blindness, and nerve and kidney damage.

"Jardiance provides an additional treatment option for the care of patients with type 2 diabetes," said Curtis J. Rosebraugh, M.D., M.P.H., director of the Office of Drug Evaluation II in the Food and Drug Administration’s Center for Drug Evaluation and Research. “It can be used alone or added to existing treatment regimens (diet and exercise ) to control blood sugar levels in the overall management of diabetes.”

Safe and effective

Jardiance is a sodium glucose co-transporter 2 (SGLT2) inhibitor. It works by blocking the reabsorption of glucose (blood sugar) by the kidney, increasing glucose excretion, and lowering blood glucose levels in diabetics who have elevated blood glucose levels.

The drug’s safety and effectiveness were evaluated in seven clinical trials with 4,480 patients with type 2 diabetes receiving Jardiance. The pivotal trials showed that Jardiance improved hemoglobin A1c levels (a measure of blood sugar control) compared to placebo.

Jardiance has been studied as a stand-alone therapy and in combination with other type 2 diabetes therapies including metformin, sulfonylureas, pioglitazone, and insulin. It should not be used: to treat people with type 1 diabetes; in those who have increased ketones in their blood or urine (diabetic ketoacidosis); and in those with severe renal impairment, end stage renal disease, or in patients on dialysis.

Further study required

The FDA is requiring four postmarketing studies for Jardiance:

• Completion of a continuing cardiovascular outcomes trial.
• A pediatric pharmacokinetic/pharmacodynamic study.
• A pediatric safety and efficacy study. As part of the safety and efficacy study, the effect on bone health and development will be evaluated.
• A nonclinical (animal) juvenile toxicity study with a particular focus on renal development, bone development, and growth.

Warnings

Jardiance can cause dehydration, leading to a drop in blood pressure (hypotension) that can result in dizziness and/or fainting and a decline in renal function. The elderly, patients with impaired renal function, and patients on diuretics to treat other conditions appeared to be more susceptible to this risk.

The most common side effects of Jardiance are urinary tract infections and female genital infections.

Jardiance is distributed by Boehringer Ingelheim Pharmaceuticals of Ridgefield, Conn.

Can you stop type 2 diabetes with a single shot? Salk scientists, writing up their latest findings in the journal Nature, say that you can and that they have.

The result could be a whole new generation of drugs that could safely and effectively stem the rising type 2 diabetes epidemic.

The magic bullet in this case is the protein FGF1. The Salk experiments discovered that a single injection could restore blood sugar levels to the safe range for several days.

More than just managing the disease

More significant, perhaps, the experiments showed that sustained treatment doesn't just act as a controlling mechanism but actually reduces insulin insensitivity, the underlying cause of the disease.

Type 2 diabetes is different from type 1, in that type 1's cause is mostly genetic while type 2 is largely caused by obesity and an unhealthy lifestyle. Not surprisingly, type 2 is now the more common form of the disease.

When you have diabetes your body causes blood glucose, or sugar levels to rise higher than normal. It's a condition known as hyperglycemia.

When you have type 2 diabetes your body does not use insulin properly, a condition known as insulin resistance. The pancreas tries to compensate for it but over time it isn't able to keep up and can't make enough insulin to keep your blood glucose at normal levels.

No cure – yet

According to the Mayo Clinic there is currently no known cure for type 2 diabetes but the disease can be managed through diet and exercise and maintaining a healthy weight. Medication and insulin therapy helps where lifestyle changes fall short.

No one is using the word “cure” just yet but the Salk scientists say the results of the FGF1 experiments may be a big step in that direction. So far they have found no side effects that might reduce the effectiveness of the treatment or prevent some patients from receiving it.

“Controlling glucose is a dominant problem in our society,” said Ronald Evans, director of Salk's Gene Expression Laboratory and corresponding author of the paper. “And FGF1 offers a new method to control glucose in a powerful and unexpected way.”

The diabetes drugs currently approved for use attempt to boost insulin levels and reverse insulin resistance by altering the expression levels of genes to lower glucose levels in the blood. But the researchers say drugs that increase the body’s insulin production can also cause glucose levels to fall too low and lead to life-threatening hypoglycemia, as well as other side effects.

Pleasant surprise

As many breakthroughs are, this one was something of a surprise. The experiment used obese mice as stand-ins for obese, diabetic humans.

Evans’ team injected doses of FGF1 into the obese mice with diabetes to see how it affected metabolism. Researchers said they were stunned by what happened: they found that with a single dose, blood sugar levels quickly dropped to normal levels in all the diabetic mice.

“Many previous studies that injected FGF1 showed no effect on healthy mice,” said Michael Downes, a senior staff scientist and co-corresponding author of the new work. “However, when we injected it into a diabetic mouse, we saw a dramatic improvement in glucose.”

More research is ahead before an FGF1 drug is submitted for FDA approval, but the scientists hope to move next to human trials. Evans says there are still many questions from the study that need to be answered. But, he says, “the avenues for investigating FGF1 in diabetes and metabolism are now wide open.”

Statins -- the drugs that lower cholesterol -- have no doubt saved many lives by preventing heart attacks. But they can also have a devastating side effect, raising the risk of diabetes in some users.

Now, Canadian researchers at McMaster University say they have found one of the pathways that link statins to diabetes, a key tool in developing the next generation of statins.

"Statins are among the most prescribed drugs in the world, and have been fantastic at reducing cardiovascular events," said McMasters researcher Jonathan Schertzer. "But the side effects of statins can be far worse than not being able to eat grapefruit. Recently, an increased risk of diabetes has been added to the warning label for statin use. This was perplexing to us because if you are improving your metabolic profile with statins you should actually be decreasing the incidence of diabetes with these drugs, yet, the opposite happened."

Immune response

Schertzer's group investigated further.

"We found that statins activated a very specific immune response, which stopped insulin from doing its job properly. So we connected the dots and found that combining statins with another drug on top of it, Glyburide, suppressed this side effect."

He says the finding has the potential to develop new targets for this immune pathway that do not interfere with the benefits of statins.

Schertzer emphasized that statins are important and widely prescribed drugs and understanding how they promote adverse effects may lead to necessary improvements in this drug class, which has the potential to affect a large segment of the population.

"With the new federal warning label on the risk of diabetes with statin usage, people are heavily debating its pros and cons. We think this is the wrong conversation to have. Statins are a great drug for many people. What we really should be talking about is how to make them better and we are beginning to understand the basic biology of statins so we can do just that."

The research is published in the medical journal Diabetes and was supported by funding from the Canadian Institutes of Health Research and the Canadian Diabetes Association.

A growing number of people in the U.S. have diabetes -- and a lot of them don't know it.

According to a report released by the Centers for Disease Control and Prevention (CDC), more than 29 million people in this country diabetes 3 million more than the CDC estimated in 2010. The scary thing is that 25% of those who have it don't know.

Another 86 million adults in the U.S. -- that's more than one -- have predicates, where their blood sugar levels are higher than normal but not high enough to be classified as type 2 diabetes. Without weight loss and moderate physical activity, 15-to-30% of them will develop type 2 diabetes within 5 years.

Alarming development

“These new numbers are alarming and underscore the need for an increased focus on reducing the burden of diabetes in our country,” said Ann Al bright, Ph.D., R.D., director of CDC’s Division of Diabetes Translation. “Diabetes is costly in both human and economic terms. It’s urgent that we take swift action to effectively treat and prevent this serious disease.”

According to the National Diabetes Statistics Report, 2014 (based on health data from 2012):

• 29 million people in the United States (9.3%) have diabetes.
• 1.7 million people aged 20 years or older were newly diagnosed with diabetes in 2012.
• Non-Hispanic black, Hispanic, and American Indian/Alaska Native adults are about twice as likely to have diagnosed diabetes as non-Hispanic white adults.
• 208,000 people younger than 20 years have been diagnosed with diabetes (type 1 or type 2).
• 86 million adults aged 20 years and older have predicates.
• The percentage of U.S. adults with predicates is similar for non-Hispanic whites (35%), non-Hispanic blacks (39%) and Hispanics (38%).

Danger lurks

Diabetes is a serious disease that can be managed through physical activity, diet, and appropriate use of insulin and oral medications to lower blood sugar levels. Another important part of diabetes management is reducing other cardiovascular disease risk factors, such as high blood pressure, high cholesterol and tobacco use.

People with diabetes are at increased risk of serious health complications including vision loss, heart disease, stroke, kidney failure, amputation of toes, feet or legs, and premature death.

In 2012, diabetes and its related complications accounted for $245 billion in total medical costs and lost work and wages. This figure was $174 billion in 2007.

With diabetes cases growing rapidly in the last decade, more people are sensitive to possible symptoms.

But if you're approaching 50 it's very easy to confuse real symptoms of diabetes with normal signs of aging. For example, your vision and hearing may be degrading. Cuts and bruises take longer to heal.

It could be a sign of diabetes. Then again, it could just be a sign you're getting older. It's important to be able to tell the difference.

Risk increases with age

As you get older you have an greater risk of developing type 2 diabetes. If you are overweight – even just as little as 10 pounds overweight – your diabetes risk rises.

Genes play a role too, not just in developing diabetes but also high blood pressure, high triglyceride levels and low HDL cholesterol. If you are African American, Latino, American Indian or Asian you also may be at higher risk.

Complicating things further is the fact that type 2 diabetes symptoms tend to be more subtle. Often you have the disease and don't know it. In fact, an estimated 7 million people with the disease are unaware of it.

Type 2 diabetes affects the way your body metabolizes sugar – or glucose -- your body's main source of fuel. A healthy body turns glucose into energy but if you have type 2 diabetes the glucose continues to build, leading to high blood sugar, causing a variety of symptoms.

When to ask a doctor

Here are some signs that you may have diabetes and should consult a doctor:

• Communication problems: you have a hard time understanding people when they talk. Your eyesight seems to be failing, causing you to squint. Hearing loss may just be a matter of age but is twice as common in people with diabetes as in those who don’t have the disease, according to research.
• Feeling tired and grouchy: this could be because you're getting older and having a more difficult time doing the things you once did. But if you have type 2 diabetes your body isn’t effectively converting glucose in your blood to energy. As a result you usually feel exhausted and, when you’re tired, you tend to be irritable.
• Odd symptoms: have you recently developed dry, itchy skin? Or maybe you've noticed darkening and velvety patches of skin around your neck or other parts of the body. Does it take cuts and bruises a long time to heal? Have you felt tingling and numbness in your hands and feet? Many of these symptoms occur because the blood vessels and nerves are damaged by the excessive amounts of glucose.

Gotta go

Other diabetes symptoms include feeling hungry all the time or needing frequent bathroom breaks.

If you have diabetes you have an excess of glucose and your body tries to get rid of the glucose that’s building in your blood by causing you to urinate frequently. When you do you lose a lot of fluid, making you dehydrated and thirsty.

According to the National Institutes of Health (NIH) type 2 diabetes usually occurs slowly over time. In most cases people with the disease are overweight when they are diagnosed. Increased fat makes it harder for your body to use insulin the correct way.

If you are unsure your symptoms are diabetes or age related, by all means ask your doctor. Fortunately, type 2 diabetes is treatable, often without medication – just lifestyle changes.

Type 1 diabetes is generally regarded as genetic, but new experiments on mice show that mouse mothers can protect their pups from developing type 1 diabetes by eating a gluten-free diet and reseachers at the University of Copenhagen say the findings may apply to humans.

"Preliminary tests show that a gluten-free diet in humans has a positive effect on children with newly diagnosed type 1 diabetes. We therefore hope that a gluten-free diet during pregnancy and lactation may be enough to protect high-risk children from developing diabetes later in life," said assistant professor Camilla Hartmann Friis Hansen from the Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences.

The findings have recently been published in the journal Diabetes.

Findings from experiments on mice are not necessarily applicable to humans, but the study's co-author, Prof. Axel Kornerup, says that may not be the case with diabetes.

"Early intervention makes a lot of sense because type 1 diabetes develops early in life. We also know from existing experiments that a gluten-free diet has a beneficial effect on type 1 diabetes," he said.

Experiments of this type have been going on since 1999, originally initiated by Prof. Karsten Buschard from the Bartholin Institute at Rigshospitalet in Copenhagen, another co-writer on the study.

"This new study beautifully substantiates our research into a gluten-free diet as an effective weapon against type 1 diabetes," Karsten Buschard explains.

Gluten-free diet affects bacteria

The experiment showed that the diet changed the intestinal bacteria in both the mother and the pups. The intestinal flora plays an important role for the development of the immune system as well as the development of type 1 diabetes, and the study suggests that the protective effect of a gluten-free diet can be ascribed to certain intestinal bacteria.

The advantage of the gluten-free diet is that the only side effect seems to be the inconvenience of having to avoid gluten, although more research is needed to be certain.

"We have not been able to start a large-scale clinical test to either prove or disprove our hypothesis about the gluten-free diet," Buschard said.

A study of more than three million American children and adolescents finds a "significant" increase in both type 1 and type 2 diabetes occurred between 2001 and 2009.

Despite widespread concern about a diabetes "epidemic," there has been limited data to support the concern. 

"The increases in prevalence reported herein are important because such youth with diabetes will enter adulthood with several years of disease duration, difficulty in treatment, an increased risk of early complications, and increased frequency of diabetes during reproductive years, which may further increase diabetes in the next generation," the researchers write. "Further studies are required to determine the causes of these increases."

The study appears in the May 7 issue of JAMA, a theme issue on child health. This issue is being released early to coincide with the Pediatric Academic Societies Annual Meeting.

The analysis included cases of physician-diagnosed type 1 diabetes in youth ages 0 through 19 years and type 2 diabetes in youth 10 through 19 years of age in 2001 and 2009. The study population came from five centers located in California, Colorado, Ohio, South Carolina, and Washington state, as well as data from selected American Indian reservations in Arizona and New Mexico.

In 2001, the prevalence of type 1 diabetes among a population of 3.3 million was 1.48 per 1,000, which increased to 1.93 per 1,000 among 3.4 million youth in 2009, which, after adjustment, indicated an increase of 21 percent over the 8-year period.

The greatest prevalence increase was observed in youth 15 through 19 years of age. Increases were observed in both sexes and in white, black, Hispanic, and Asian Pacific Islander youth.

"Historically, type l diabetes has been considered a disease that affects primarily white youth; however, our findings highlight the increasing burden of type l diabetes experienced by youth of minority racial/ethnic groups as well," the authors write.

Dana Dabelea, M.D., Ph.D., of the Colorado School of Public Health, Aurora, Colo., and Elizabeth J. Mayer-Davis, Ph.D., of the University of North Carolina, Chapel Hill, and colleagues with the SEARCH for Diabetes in Youth Study, conducted the study.

There's been a turnaround of sorts in some of the complications suffered by people with diabetes.

According to a study by the Centers for Disease Control and Prevention (CDC), rates of five major diabetes-related complications among U.S. adult diabetics have declined substantially in the last 20 years.

The study, published in the current issue of the New England Journal of Medicine, found that rates of lower-limb amputation, end-stage kidney failure, heart attack, stroke, and deaths due to high blood sugar (hyperglycemia) all declined.

Cardiovascular complications and deaths from high blood sugar decreased by more than 60% each, while the rates of both strokes and lower extremity amputations -- including upper and lower legs, ankles, feet, and toes -- declined by about half. Rates for end stage kidney failure fell by about 30%.

A long way to go

“These findings show that we have come a long way in preventing complications and improving quality of life for people with diabetes,” said Edward Gregg, Ph.D., a senior epidemiologist in CDC’s Division of Diabetes Translation and lead author of the study. “While the declines in complications are good news, they are still high and will stay with us unless we can make substantial progress in preventing type 2 diabetes.”

Because the number of adults reporting diabetes during this time frame more than tripled -- from 6.5 million to 20.7 million -- these major diabetes complications continue to put a heavy burden on the U.S. health care system.

Nearly 26 million Americans have diabetes and an additional 79 million have prediabetes and are at risk of developing the disease. Diabetes and its complications account for $176 billion in total medical costs each year.

CDC researchers used data from the National Health Interview Survey, National Hospital Discharge Survey, U.S. Renal Data System, and Vital Statistics, to examine trends in the occurrence of diabetes-related complications in the United States between 1990 and 2010.

Although all complications declined, the greatest declines in diabetes-related complications occurred for heart attack and stroke -- particularly among people aged 75 years and older.

The study authors attribute the declines in diabetes-related complications to increased availability of health care services, risk factor control, and increases in awareness of the potential complications of diabetes.

Cases of diabetes and pre-diabetes in the United States have nearly doubled since 1988, with obesity apparently to blame, according to new research from the Johns Hopkins Bloomberg School of Public Health.

The burden of the disease has not hit all groups equally, with alarming increases in diabetes in blacks, Hispanics and the elderly.

According to new research reported in the April 15, 2014 issue of the Annals of Internal Medicine, diabetes increased from 6% to 10% in the past two decades and pre-diabetes also doubled in prevalence over the same period. Depending on the definition used, current estimates of the prevalence of pre-diabetes range from 12% to 30% in the population.

“There is a growing need to recognize this serious issue, especially since most cases of diabetes can be prevented through weight loss and other lifestyle changes,” said lead author, Elizabeth Selvin, PhD, MPH, an Associate Professor at the Johns Hopkins Bloomberg School of Public Health.

More cases being diagnosed

“The implications of the increase in pre-diabetes and diabetes are enormous but the good news is we are doing better with screening and diagnosis,” says Selvin.

While diabetes has increased dramatically in the population, the investigators found that the proportion of undiagnosed cases has decreased. Currently, only 11% of diabetes cases in the U.S. population are undiagnosed, suggesting major improvements in screening and diagnosis of diabetes during the last two decades.

However, major challenges still exist despite improvements in screening and treatment for diabetes. The investigators found a greater prevalence of pre-diabetes and diabetes, particularly undiagnosed diabetes, in ethnic minorities compared with whites. This disparity has increased over the past 20 years.

“The substantially greater prevalence of pre-diabetes and diabetes, and poor rates of glycemic control (even among persons with medication-treated diabetes) in ethnic minority populations is particularly concerning,” Selvin said. “Especially since blacks and Mexican Americans are also at a greater risk for complications of diabetes.”

Total diabetes in blacks was nearly double the prevalence in whites (15% vs. 9%). Mexican Americans also had a greater prevalence of diabetes than whites (12% vs. 9%).

43,000 cases studied

In 2010, approximately 21 million American adults aged 20 or older had confirmed diabetes (either diagnosed or undiagnosed). The investigators analyzed data from more than 43,000 participants collected over two decades in the National Health and Nutrition Examination Surveys (NHANES), hoping to update national trends in pre-diabetes, diabetes and its treatment based on data from the NHANES.

One novel aspect of this study was to “confirm” cases of undiagnosed diabetes in the population. The investigators used a lab test that measures glucose over the past three months to confirm all cases of undiagnosed diabetes in their study to give the most realistic estimate of the burden of the condition in the population.

The study was funded by the National Institutes of Health.

With the huge increase in obesity in the U.S., there has been a spike in cases of type 2 diabetes.

According to the American Diabetes Association, diabetes causes blood glucose, or sugar, levels to rise to abnormally high levels. The clinical term for it is hyperglycemia. Type 2 has now become the most common form of diabetes and its rise has been linked to the rise in obesity.

People with type 2 diabetes have something called insulin resistance. The pancreas works overtime to make extra insulin but eventually can't keep up. At that point, patients have to take insulin.

Type 1 diabetes, which normally occurs in youth, is not reversible. Under certain conditions, however, doctors say type 2 can be reversed – by reducing weight, increasing exercise and eating better.

Cleveland Clinic study

Now, doctors at the Cleveland Clinic say undergoing bariatric surgery has helped some obese patients reverse type 2 diabetes. In fact, a recent trial helped most of the participating patients to be free of insulin and many to be free of all diabetic medications three years after surgery.

"We see patients whose lives are ravaged by diabetes,” said Sangeeta Kashyap, M.D., one of the lead investigators and an endocrinologist at Cleveland Clinic's Endocrinology & Metabolism Institute.

Doctors say that, when examined at the three-year point, the procedure showed itself to be highly effective in reversing the effects of the disease.

90% no longer needed insulin

"More than 90% of the patients who underwent bariatric surgery were able to lose 25% of their body weight and control their diabetes without the use of insulin and multiple diabetes drugs," Kashyap said.

Besides being able to drop insulin treatments, patients in the study experienced improvements in their quality of life following the surgery, which reduces the size of the stomach. They no longer needed insulin and in many cases, their blood pressure and cholesterol readings improved without relying on medications.

At the end of the study, doctors say only 5% to 10% of patients still had to use insulin.

"The three-year data confirm that bariatric surgery maintains its superiority over medical therapy for the treatment of type 2 diabetes in severely obese patients," said lead investigator Philip Schauer, M.D. "Moreover, data show that bariatric surgery is as effective in treating type 2 diabetes in patients with mild obesity. That's why Cleveland Clinic health insurance plan now covers bariatric surgery for its members with mild obesity and uncontrolled diabetes."

Early risks

Bariatric surgery hasn't always enjoyed such a reputation. According to the American Society of Metabolic and Bariatric Surgery, the procedure was first used in the 1960s and complications were common.

Over the intervening years the procedure has evolved and been improved, though the procedure still has risk. The National Institutes of Health now recommends bariatric surgery for obese patients with a Body Mass Index (BMI) of at least 40.

A British study finds that eating high levels of flavonoids found in berries, tea and chocolate could offer protection from type 2 diabetes. Findings published today in the Journal of Nutrition reveal that high intakes of these dietary compounds are associated with lower insulin resistance and better blood glucose regulation.

A study of almost 2,000 people by researchers at the University of East Anglia (UEA) and King's College London also found that these food groups lower inflammation which, when chronic, is associated with diabetes, obesity, cardiovascular disease, and cancer.

"Our research looked at the benefits of eating certain sub-groups of flavanoids," said Prof. Aedin Cassidy from UEA's Norwich Medical School led the research. "We focused on flavones, which are found in herbs and vegetables such as parsley, thyme, and celery, and anthocyanins, found in berries, red grapes, wine and other red or blue-coloured fruits and vegetables."

"This is one of the first large-scale human studies to look at how these powerful bioactive compounds might reduce the risk of diabetes," Cassidy said. "Laboratory studies have shown these types of foods might modulate blood glucose regulation – affecting the risk of type 2 diabetes. But until now little has been know about how habitual intakes might affect insulin resistance, blood glucose regulation and inflammation in humans."

2,000 women studied

Researchers studied almost 2,000 healthy women volunteers who had completed a food questionnaire designed to estimate total dietary flavonoid intake as well as intakes from six flavonoid subclasses. Blood samples were analyzed for evidence of both glucose regulation and inflammation. Insulin resistance, a hallmark of type 2 diabetes, was assessed using an equation that considered both fasting insulin and glucose levels.

"We found that those who consumed plenty of anthocyanins and flavones had lower insulin resistance. High insulin resistance is associated with Type 2 diabetes, so what we are seeing is that people who eat foods rich in these two compounds – such as berries, herbs, red grapes, wine– are less likely to develop the disease.

"We also found that those who ate the most anthocyanins were least likely to suffer chronic inflammation – which is associated with many of today's most pressing health concerns including diabetes, obesity, cardiovascular disease, and cancer.

"And those who consumed the most flavone compounds had improved levels of a protein (adiponectin) which helps regulate a number of metabolic processes including glucose levels.

"What we don't yet know is exactly how much of these compounds are necessary to potentially reduce the risk of type 2 diabetes," she added.

Saying that having diabetes is "like having a part-time job," Google researchers are working on a "smart" contact lens that could sample the glucose level in tears as often as once every second.

That would relieve diabetics of the nagging task of measuring their blood glucose level, a process that involves pricking their finger several times per day.

The company's secretive Google[X] lab is using a wireless chip and miniature glucose sensor embedded between two layers of soft contact lens material to measure the glucose levels in tears.

Noting that diabetes affects one in every 19 people on the planet, Google researchers Brian Otis and Babak Parviz said they're hoping to make it easier for people with diabetes to keep their blood sugar levels under control.

LED lights

They're investigating the potential for the device to serve as an early warning for the wearer, by integrating tiny LED lights that could light up to indicate that glucose levels have crossed above or below certain thresholds.

"Many people ... say managing their diabetes is like having a part-time job. Glucose levels change frequently with normal activity like exercising or eating or even sweating," the two said in a blog posting. "Sudden spikes or precipitous drops are dangerous and not uncommon, requiring round-the-clock monitoring. Although some people wear glucose monitors with a glucose sensor embedded under their skin, all people with diabetes must still prick their finger and test drops of blood throughout the day. It’s disruptive, and it’s painful. And, as a result, many people with diabetes check their blood glucose less often than they should."

Uncontrolled blood sugar can lead to dangerous complications, including damages to the eyes, kidneys and heart. 

"We hope this could someday lead to a new way for people with diabetes to manage their disease," Otis and Parviz said, adding that they were in early discussions with the U.S. Food and Drug Administration (FDA).

"We’ve always said that we’d seek out projects that seem a bit speculative or strange, and at a time when the International Diabetes Federation (PDF) is declaring that the world is 'losing the battle' against diabetes, we thought this project was worth a shot," they said.

November is not only American Diabetes Month, it's also Pet Diabetes Month, intended to remind pet owners that their dogs and cats can develop diabetes just as humans can.

"Pet owners should be aware of the possible warning signs of pet diabetes and see their veterinarians for a definitive diagnosis," said Dr. Madeleine Stahl, a veterinarian speaking on behalf of Merck, which makes Vetsulin, an insuline product for dogs and cats. "Considering the fact that pet diabetes can be effectively managed, lack of owner awareness may be the biggest risk factor associated with this condition." 

Lethargy, excessive thirst and frequent urination are some of the most common signs of diabetes mellitus in dogs and cats. Pets may also exhibit increased hunger while losing weight, cloudy eyes (due to cataracts) in dogs and weakness of the back legs in cats.

Though any dog or cat can have diabetes, it is most commonly found in miniature schnauzers, German shepherds, golden retrievers and poodles. It strikes females more than males and it usually appears in a dog's middle years – age six to nine.

The causes of diabetes in dogs are similar to those in people. The islet cells in the pancreas slow down, failing to produce enough insulin. Without the proper amount of insulin, glucose can't pass into cells and produce energy for metabolism.

The result is high blood sugar as well as too much sugar in the urine.

Awareness campaign

To call attention to the problem, Merck Animal Health is launching a global awareness campaign during November. It has created three videos to help pet owners learn more about the condition and its signs. Those videos can be found at www.petdiabetesmonth.com along with a variety of pet owner educational materials.

As America packs on the pounds and becomes more sedentary, the number of cases of diabetes grows. The disease, a malfunction of the body's ability to process blood sugar, is particularly prevalent among overweight seniors, according to health statistics.

Data from the 2011 National Diabetes Fact Sheet found a total of 25.8 million children and adults in the U.S. – 8.3% of the population – have diabetes. About seven million of those cases remain undiagnosed, making them even more dangerous. 

To understand diabetes and whether you have it, or are at risk, we need to start with the classifications of the disease – Type 1 and Type 2 diabetes.

In Type 1 diabetes, your body does not produce enough insulin. It needs insulin to break down carbohydrates and fat and regulate your metabolism. People with Type 1 are usually diagnosed as children or young adults and the disease is not preventable. It's also fairly rare, making up only 10% of the diabetes cases in the U.S.

Type 2, on the other hand, is preventable in most cases. In Type 2 diabetes, blood sugar levels are abnormally high, a condition known as hyperglycemia. If you are overweight or obese you have a higher risk of developing Type 2 diabetes, compared to those with a healthy body weight. Not surprisingly, doctors have seen a corresponding rise in Type 2 diabetes with the recent rise in obesity.

Symptoms

How do you know if you have diabetes? The symptoms for the two types vary slightly. According to the Mayo Clinic, those with pre-diabetes or Type 2 may not have any symptoms right away. On the other hand, if you have developed Type 1 diabetes, you'll experience symptoms almost immediately. Symptoms for both types include: 

• Increased thirst
• Frequent urination
• Extreme hunger
• Unexplained weight loss
• Presence of ketones, a byproduct of the breakdown of muscle and fat that happens when there's not enough insulin, in the urine
• Fatigue
• Blurred vision
• Slow-healing sores
• High blood pressure
• Frequent infections, such as gums or skin infections and vaginal or bladder infections

Seniors at risk

If you are a senior and have put on weight late in life, you may be especially vulnerable to Type 2 diabetes. Though the reasons are unclear, doctors suspect that the combination of adding body weight while decreasing physical activity in old age is a major catalyst. Men whose testosterone levels fall as they age may also be at higher risk, since some research suggests low testosterone levels are linked to insulin resistance.

People with diabetes, either Type 1 or Type 2, typically manage their disease with insulin, a nutritious diet and regular physical activity. Type 2 patients may be able to avoid insulin – at least in the beginning – by following a healthy lifestyle. However, Type 2 is a progressive disease that, over time, usually gets worse.

Toby Smithson, a nutritionist and author of the book “Diabetes Meal Planning and Nutrition for Dummies, says proper meal planning is a simple way patients can gain influence over the potentially harmful influence of food.

"People with diabetes want to stay healthy, but we are constantly surrounded by images of food, messages about food, and food itself,” Smithson said. “Your amazing brain can make the best food choices for your health if you give it the facts and some quiet time to come to a conclusion. But, wander aimlessly through the grocery or start down a buffet line with an empty plate and impulse wins every time. Planning ahead is the secret to healthy eating and diabetes health."

The first definitive, large-scale clinical trial to investigate if a vitamin D supplement helps prevent or delay type 2 diabetes in adults who have prediabetes is underway.

The study, funded by the National Institutes of Health, is taking place at about 20 study sites across the United States, involving adults who are at high risk for developing type 2 diabetes.

The multiyear Vitamin D and Type 2 Diabetes (D2d) study will include about 2,500 people. The goal is to learn if vitamin D -- specifically D3 (cholecalciferol) -- will prevent or delay type 2 diabetes in adults aged 30 or older with prediabetes. People with prediabetes have blood glucose levels that are higher than normal but not high enough to be called diabetes.

“This study aims to definitively answer the question: Can vitamin D reduce the risk of developing type 2 diabetes?” said Myrlene Staten, M.D., D2d project officer at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of NIH. “Vitamin D use has risen sharply in the U.S. in the last 15 years, since it has been suggested as a remedy for a variety of conditions, including prevention of type 2 diabetes. But we need rigorous testing to determine if vitamin D will help prevent diabetes. That’s what D2d will do.”

“Past observational studies have suggested that higher levels of vitamin D may be beneficial in preventing type 2 diabetes,” said Anastassios G. Pittas, M.D., the study’s principal investigator at Tufts Medical Center, Boston, “but until this large, randomized and controlled clinical trial is complete, we won’t know if taking vitamin D supplements lowers the risk of diabetes.”

First of its kind

D2d is the first study to directly examine if a daily dose of 4,000 International Units (IUs) of vitamin D -- greater than a typical adult intake of 600-800 IUs a day, but within limits deemed appropriate for clinical research by the Institute of Medicine -- helps keep people with prediabetes from getting type 2 diabetes. Based on observations from earlier studies, researchers speculate that vitamin D could reduce the diabetes risk by 25%. The study will also examine if sex, age or race affect the potential of vitamin D to reduce diabetes risk.

“An estimated 79 million Americans have prediabetes, and nearly 26 million more have diabetes,” said NIDDK Director Griffin P. Rodgers, M.D. “With D2d, we seek evidence for an affordable and accessible way to help prevent or delay type 2 diabetes.”

Researchers are recruiting volunteers to take part in D2d. Half of the participants will receive vitamin D. The other half will receive a placebo -- a pill that has no drug effect. Participants will have check-ups for the study twice a year, and will receive regular health care through their own health care providers.

In the dark

The study will be double-blinded, so neither participants nor the study’s clinical staff will know who is receiving vitamin D and who is receiving placebo. The study will continue until enough people have developed type 2 diabetes to be able to make a scientifically valid comparison between diabetes development in the two groups, likely about four years.

There have been other NIH-funded studies of methods to delay or prevent type 2 diabetes, including the Diabetes Prevention Program, which showed that -- separately -- lifestyle changes to lose a modest amount of weight and the drug metformin are both effective in slowing development of type 2 diabetes in people with prediabetes. However, additional safe and effective preventative strategies are needed to stem the increasing numbers of people developing type 2 diabetes.

As the number of people diagnosed with diabetes continues to grow, so does the number of illegally sold products promising to prevent, treat, and even cure diabetes.

That's prompted the Food and Drug Administration (FDA) to warn consumers against using such products. The agency cites a number of problems with these products: they may contain harmful ingredients or may be otherwise unsafe, or may improperly be marketed as over-the-counter (OTC) products when they should be marketed as prescription products; they carry an additional risk if they cause consumers to delay or discontinue effective treatments for diabetes. Without proper disease management, people with diabetes are at a greater risk for developing serious health complications.

"People with chronic or incurable diseases may feel desperate and become easy prey,” said Gary Coody, R.Ph., national health fraud coordinator for FDA. “Bogus products for diabetes are particularly troubling because there are effective options available to help manage this serious disease rather than exposing patients to unproven and risky products. Failure to follow well-established treatment plans can lead to, among other things, amputations, kidney disease, blindness and death."

Warning letters issued

In July 2013, FDA issued letters warning 15 companies about selling products for diabetes in violation of federal law. These products are sold as dietary supplements; alternative medicines, such as ayurvedics; prescription drugs and over-the-counter drugs, including homeopathic products: Examples of claims made by these illegally marketed products include:

• "Lower your blood sugar naturally."
• "Lowers A1C levels significantly."
• "You'll lower your chances of having eye disease, kidney disease, nerve damage and heart disease!"
• "It can replace medicine in the treatment of diabetes."
• "For Relief of Diabetic Foot Pain."

Some of the companies also promote unapproved products for other serious diseases, including cancer, sexually transmitted diseases and macular degeneration.

FDA tested products marketed as "all natural" treatments for diabetes and discovered some of them contained one or more active ingredients found in prescription drugs to treat type 2 diabetes.

Undeclared ingredients can cause serious harm. If consumers and their health care professionals are unaware of the actual ingredients in the products they are taking, these products may interact in dangerous ways with other medications. One possible complication: Patients may end up taking a larger combined dose of the diabetic drugs than they intended, and that may cause a significant unsafe drop in blood sugar levels, a condition known as hypoglycemia.

Online pharmacies

FDA also looked at sales of prescription drugs from fraudulent online pharmacies. Signs that indicate an online pharmacy is legitimate include: requiring that patients have a valid prescription; providing a physical address in the U.S.; being licensed by a state pharmacy board; and having a state-licensed pharmacist to answer questions.

Some fraudulent online pharmacies illegally sell drugs that are not approved in the United States, or sell prescription drug products without meeting necessary requirements.

One website that is subject to a warning letter shipped a prescription diabetes drug without requiring a prescription, and even included an unsolicited free sample of a prescription drug for erectile dysfunction. Moreover, the prescription diabetes drug was dispensed without the medication guide and other precautions required by FDA to ensure the drug is used safely and appropriately.

Although some of these websites may offer for sale what appear to be FDA-approved prescription drugs, FDA cannot confirm that the manufacture or the handling of these drugs follows U.S. regulations or that the drugs are safe and effective for their intended uses. Also, there is a risk the drugs may be counterfeit, contaminated, expired or otherwise unsafe.

A major problem

There are 26 million people in the U.S. with diabetes, including about 7 million who are undiagnosed, according to the Centers for Disease Control and Prevention. www.cdc.gov Millions more have pre-diabetes, meaning they have higher than normal blood sugar levels and can reduce their risks of developing diabetes through healthy lifestyle changes, including diet and exercise.

"Products that promise an easy fix might be alluring, but consumers are gambling with their health. In general, diabetes is a chronic disease, but it is manageable and people can lower their risk for developing complications by following treatments prescribed by health care professionals, carefully monitoring blood sugar levels, and sticking to an appropriate diet and exercise program," said Coody.

Eating more red meat over time is associated with an increased risk of type-2 diabetes in a follow-up of three studies of about 149,000 U.S. men and women, according to a report published Online First byJAMA Internal Medicine, a JAMA Network publication.

“Our results confirm the robustness of the association between red meat and type-2 diabetes and add further evidence that limiting red meat consumption over time confers benefits for diabetes prevention,” the researchers concluded.

But a commentary accompanying the study noted that the emphasis might be better placed on limiting saturated fat.

“A recommendation to consume less red meat may help to reduce the epidemic of type-2 diabetes. However, the overwhelming preponderance of molecular, cellular, clinical and epidemiological evidence suggests that public health messages should be directed toward the consumption of high-quality protein that is low in total and saturated fat," said William J. Evans, Ph.D., of GlaxoSmithKline and Duke University, Durham, N.C.

"These public health recommendations should include cuts of red meat that are also low in fat, along with fish, poultry and low-fat dairy products. It is not the type of protein (or meat) that is the problem: it is the type of fat,” Evans concludes.

Previous studies

Red meat consumption has been consistently related to an increased risk of type-2 diabetes, but previous studies measured red meat consumption at a baseline with limited follow-up information. However, a person’s eating behavior changes over time and measurement of consumption at a single point in time does not capture the variability of intake during follow-up, the authors note in the study background.

An Pan, Ph.D., of the National University of Singapore, and colleagues analyzed data from three Harvard group studies and followed up 26,357 men in the Health Professionals Follow-up Study; 48,709 women in the Nurses’ Health Study; and 74,077 women in the Nurses’ Health Study II. Diets were assessed using food frequency questionnaires.

During more than 1.9 million person-years of follow-up, researchers documented 7,540 incident cases of type-2 diabetes. 

The results indicate that compared with a group with no change in red meat intake, increasing red meat intake of more than 0.50 servings per day was associated with a 48 percent elevated risk in the subsequent four-year period.

Reducing red meat consumption by more than 0.50 servings per day from baseline to the first four years of follow-up was associated with a 14 percent lower risk during the subsequent entire follow-up.

Diabetes is a disease that increasingly strikes Americans. As it turns out, our dogs also suffer from it in increasing numbers.

It's called diabetes mellitus, or sugar diabetes. Though any dog can have it, it is most commonly found in miniature schnauzers, German shepherds, golden retrievers and poodles. It strikes females more than males and it usually appears in a dog's middle years – age six to nine.

The causes of diabetes in dogs are similar to those in people. The islet cells in the pancreas slow down, failing to produce enough insulin. Without the proper amount of insulin, glucose can't pass into cells and produce energy for metabolism.

The result is high blood sugar as well as too much sugar in the urine.

Symptoms

How do you know your dog is suffering from diabetes? The symptoms are similar to a human's. The glucose in the urine causes them to urinate frequently. Because they are passing so much fluid, they get dehydrated and drink lots of water. Later, they may become lethargic, stop eating and be prone to vomiting.

Often these symptoms are cited by pet owners who blame a particular brand of dog food for their pet's condition. In some cases, these symptoms might have nothing to do with the dog food but the onset of diabetes. Only your vet can tell for sure.

The good news is diabetes in dogs is treatable, just as it is in humans. Many veterinarians prescribe daily insulin injections, along with a strict diet. Your vet will decide how much insulin your dog needs. It's hard to predict and will vary, depending on the level of damage to the pancreas.

Typically, you are your pet will start the treatment at home. After a week or so of proper diet and daily insulin injection, the vet will want to see the dog again to run some blood tests. The goal is to see when glucose levels rise and fall.

How to give an injection

Below is a brief video that demonstrates the way to give your dog an insulin shot.

Left untreated, diabetes will affect all the dog's organs. It will result in enlarged livers and hearts and the dog can become easily infected. Sometimes a dog with advanced diabetes will have major problems with its central nervous system.

Avoid obesity

Just as with humans, avoiding obesity makes it easier to treat diabetes. If the dog is obese, it can reduce its responsiveness to insulin. So when your dog is diagnosed with diabetes, it's important to make sure he or she is at a proper weight.

If your dog is overweight, institute a high-carbohydrate, high-fiber diet. Try to avoid foods that are high in sugar – they include most soft-moist food and doggie treats.

According to the Whole Dog Journal, dogs with diabetes have survival rates similar to those without the disease, as long as they get proper treatment and good care. The greatest risk is early in the treatment and a diabetic dog is more likely to die of complications, like kidney disease, than diabetes itself.

What to do

Take note and act quickly if your dog exhibits symptoms of diabetes. Some may be subtle at first, but uncharacteristic indoor “accidents” may be a sign that your pet is suffering.

Tell your vet exactly what symptoms you have observed. If diabetes is the diagnosis, learn the proper technique for administering insulin shots and commit yourself to it.

Ask your vet to recommend a healthy dog food and make sure your pet gets plenty of exercise.

Adults with type 2 diabetes have a new treatment option.

The Food and Drug Administration has approved canagliflozin tablets, which are marketed as Invokana, to improve glycemic control. The pills are to be used in conjunction with diet and exercise.

Approval of the drug came after it was evaluated in nine clinical trials involving over 10,285 type 2 diabetes patients.

There are some side effects associated with the medication, including vaginal yeast infection, urinary tract infection and a sudden fall in blood pressure when standing up.

Learn more about Inkovana and its uses here.

There's been real progress over the past couple of decades in the way people with diabetes are handling the disease.

According to a study conducted and funded by the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC), more people are meeting recommended goals in the three key markers of diabetes control.

The report, published in Diabetes Care, shows that -- from 1988 to 2010 -- the number of people with diabetes able to meet or exceed all three of the measures that demonstrate good diabetes management rose from about 2 percent to about 19 percent. Each measure also showed substantial improvement, with over half of people meeting each individual goal in 2010.

The markers

The measures are A1C -- which assesses blood sugar (glucose) over the previous three months -- blood pressure and cholesterol. They are often called the ABCs of diabetes. When these measures fall outside healthy ranges, people are more likely to be burdened by complications of diabetes, including heart disease, stroke, kidney disease, blindness and amputation.

Despite improvement, the results show continued need for better diabetes control. In particular, young people and some minority groups were below average in meeting the goals.

To gauge diabetes management, researchers analyzed data from the National Health and Nutrition Examination Surveys from 1988-1994 and 1999-2010. “The most impressive finding was the significant improvement in diabetes management over time across all groups,” said Catherine Cowie, Ph.D., the study’s senior author and director of the Diabetes Epidemiology Program at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), which conducted and funded the study. “However, we see a lot of room for improvement, for everyone, but particularly for younger people and some minority groups.”

Steady progress

According to 2007-2010 data on Americans with diabetes:

• 53 percent met A1C goals, compared with 43 percent in 1988-1994 data
• 51 percent met blood pressure goals, compared with 33 percent in 1988-1994 data
• 56 percent met cholesterol goals, compared with 10 percent in 1988-1994 data

Improved cholesterol control was likely due to the increase in the use of statins, a type of cholesterol-lowering drug, from about four percent of people with diabetes during 1988-1994 to 51 percent during 2007-2010.

Falling short

Glucose control was worse in Mexican-Americans and in younger adults. Only 44 percent met A1C goals, versus 53 percent of whites and blacks in 2007-2010 data. People between 20-49 years old were less likely to meet A1C goals than older people.

“It is particularly disturbing that good control was seen less frequently in young people,” said Judith Fradkin, M.D., director of the NIDDK Division of Diabetes, Endocrinology, and Metabolic Diseases. “Research has shown that good diabetes control early in the course of disease has long-lasting benefits reducing the risk of complications. For people with long life expectancy after diagnosis of diabetes, it’s especially important to focus on meeting diabetes management goals as early as possible, because with that longer life comes a greater chance of developing complications if they do not control their diabetes.”

“Not only do Mexican-Americans and non-Hispanic blacks have higher rates of diabetes, members of these groups who develop diabetes also have poorer health outcomes,” said the paper’s first author, Sarah Stark Casagrande, Ph.D., an epidemiologist from Social & Scientific Systems Inc., Silver Spring, Md., whose work is supported by NIDDK. “While diabetes control has improved in these populations, some disparities remain, demonstrating the need for improved management of the disease to prevent its devastating complications.”

Setting goals

Goals for A1C, blood pressure and cholesterol must be individualized for people with diabetes, as effects of diabetes can differ depending on a person’s age, type of diabetes, diabetes medications, complications from diabetes and other factors.

For A1C, a goal for many people is below seven percent. It is particularly important for people with long life expectancies to control A1C to protect against eye, nerve and kidney disease in the future. Goals can be less stringent for people with limited life expectancy, since complications develop over time. For blood pressure, the goal for most people is 130/80. Moderate- or high-dose statin therapy is recommended for people over 40 with diabetes, with a goal of keeping the low-density lipoprotein (LDL) -- sometimes called bad cholesterol -- less than 100 milligrams per deciliter. Control of blood pressure and cholesterol are particularly important for lowering cardiovascular risk.

People at risk

About 26 million Americans have diabetes, and another 79 million have prediabetes, a condition that places them at increased risk for developing type 2 diabetes and heart disease. Between 1988 and 2012, the prevalence of diagnosed diabetes has more than doubled, from nearly four percent of the U.S. population to nearly nine percent, according to data from the CDC.

To help people improve their health, the National Diabetes Education Program (NDEP), an initiative of the NIH and the CDC, is working to assist people in making positive, lasting changes to improve their health. NDEP’s Make A Plan tool can help make these changes become part of a daily routine to support people in reaching their health goals. The NIDDK's National Diabetes Information Clearinghouse creates and promotes research-based health information and campaigns for the public. Among many publications, the A1C Test and Diabetes explains how this important test can help with diagnosis and management of diabetes.

Diabetes is becoming a more common disease in the U.S. but one that remains little understood by those most at risk.

An estimated 26 million U.S. children and adults have either diabetes 1 or 2 and another 79 million have what is known as “prediabetes,” meaning they are at risk of developing type 2 diabetes.

Type 1 diabetes is a condition in which the body does not produce insulin. It usually develops in children or young adults and is nowhere near as common as type 2, comprising only 10% of all U.S. diabetes cases. Type 1 is primarily genetic, meaning it's not related to lifestyle.

Type 2 diabetes usually develops from lifestyle factors, such as poor diet and excessive weight. It's similar to type 1 in that insulin levels are out of control. The result is excessive levels of blood sugar.

Managing type 2 diabetes

Some people may be able to control type 2 diabetes symptoms by losing weight, eating a healthy diet, exercising, and monitoring their blood glucose levels. But it's usually a progressive disease and the patient will probably have to take insulin to treat it.

Because of America's obesity epidemic, type 2 diabetes is growing at an alarming rate. A late 2012 study by the U.S. Centers for Disease Control and Prevention found 18 U.S. states saw diabetes cases increase more than 100% from 1995 to 2010.

The report, appearing in CDC's Morbidity and Mortality Weekly Report, found that states with the largest increases are Oklahoma (226 percent), Kentucky (158 percent), Georgia (145 percent), Alabama (140 percent), and Washington (135 percent).

"Regionally, we saw the largest increase in diagnosed diabetes prevalence in the South, followed by the West, Midwest, and Northeast," said Linda Geiss, a statistician with CDC's Division of Diabetes Translation and lead author of the report. "These data also reinforce findings from previous studies, which indicate that the prevalence of diagnosed diabetes is highest in the southern and Appalachian states."

Extremely serious

Undiagnosed, diabetes is extremely serious. Those with the disease can lose limbs and their eyesight and they can die from its complications.

How do you know if you have it? Being obese or overweight is a major risk factor. Having a lot of visceral fat, also known as central obesity or belly fat, is a risk multiplier, causing the body to release chemicals that can play havoc with the body's cardiovascular and metabolic systems.

The risk also increases as a person ages, though experts aren't sure why.

According to the National Institutes of Health (NIH), symptoms of diabetes include blurry vision, excessive thirst, fatigue, hunger, frequent urination and unexplained weight loss.

Because type 2 diabetes develops slowly, some people with high blood sugar have no symptoms.

Symptoms of type 1 diabetes develop over a shorter period of time. People may be very sick by the time they are diagnosed.

Diagnostic tests

A urine test may reveal elevated blood sugar levels but by itself does not diagnose diabetes. Measuring blood sugar levels after fasting is a much more reliable method.

According to NIH, diabetes is diagnosed if the fasting blood glucose level is higher than 126 mg/dL twice. Levels between 100 and 126 mg/dL are called impaired fasting glucose or pre-diabetes. These levels are risk factors for type 2 diabetes.

Once diagnosed, a patient will need to measure their blood sugar daily using a glucose meter.

“Many patients will need to test 6-8 times per day, but some will need to test more, depending upon their activity level, how often they eat and what other types of activities their day may include,” said Carol Wysham, MD, section head for the Rockwood Center for Diabetes and Endocrinology. “It is not reasonable or practical to set a specific number for all people with diabetes who are on intensive insulin regimens, as no two people’s lives are the same. Even for the same individual, no two days are exactly alike. A person may need to test six times one day and 10 the next.”

Possible new treatment

While diabetes is normally treated with insulin, University of Michigan (U-M) researchers have found that amlexanox, an off-patent drug currently prescribed for the treatment of asthma and other uses, also reverses obesity, diabetes and fatty liver in mice.

“One of the reasons that diets are so ineffective in producing weight loss for some people is that their bodies adjust to the reduced calories by also reducing their metabolism, so that they are ‘defending’ their body weight,” said researcher Alan Saltiel. “Amlexanox seems to tweak the metabolic response to excessive calorie storage in mice.”

Saltiel is teaming up with clinical-trial specialists at U-M to test whether amlexanox will be useful for treating obesity and diabetes in humans.

A study of two "lifestyle intervention" diabetes prevention programs finds the programs resulted in weight loss, as well as improvements in waist circumference and fasting plasma glucose level for overweight or obese adults compared with usual care over a 15-month period.

“Proven effective in a primary care setting, the 2 DPP-based lifestyle interventions are readily scalable and exportable with potential for substantial clinical and public health impact,” said the authors of the report of a randomized trial published Online First by Archives of Internal Medicine, a JAMA Network publication.

With an estimated 69 percent of U.S. adults overweight or obese, diabetes prevention is a top public health and previous studies have found that lifestyle modifications that focus on modest weight loss (5 percent to 10 percent) and moderate-intensity physical activity are associated with a reduced incidence of type 2 diabetes.

But, the study authors said, there has been a failure to incorporate weight management into clinical practice, according to the study background.

Jun Ma, M.D., Ph.D., of the Palo Alto Medical Foundation Research Institute, Palo Alto, Calif., and colleagues evaluated two adapted diabetes prevention program (DPP) lifestyle interventions among overweight or obese adults who were recruited from one primary care clinic and had pre-diabetes, metabolic syndrome, or both.

The Evaluation of Lifestyle Interventions to Treat Elevated Cardiometabolic Risk in Primary Care (E-LITE) was a primary-care based randomized trial designed to evaluate the effectiveness of the adapted DPP lifestyle interventions.

Three groups

Participants were assigned to one of three groups: a coach-led group intervention, a self-directed DVD intervention or usual care. The behavioral weight loss program was delivered during a 3-month intervention phase by a lifestyle coach or home-based DVD and then was followed by a 12-month maintenance phase, according to the study.

The participants (47 percent of whom were women) had an average age of nearly 53 years at baseline and an average body mass index (BMI) of 32. At month 15, the average change in BMI from baseline was -2.2 in the coach-led group,-1.6 in the self-directed group and -0.9 in the usual care group.

The percentage of participants who reached the 7 percent DPP-based weight-loss goal were 37 percent and 35.9 percent in the coach-led and self-directed groups, respectively, compared with 14.4 percent in the usual care group. Compared with the usual care group, improvements reached “statistical significance” for waist circumference and fasting plasma glucose levels in both interventions, according to the study results.

“The E-LITE trial makes a unique contribution to this growing literature in that its interventions integrate standardized, packaged DPP translational programs (delivered in groups or by DVD) with existing health IT [information technology],” the authors conclude. “Although these intervention components and delivery channels are not new, their integration into structured interventions for use in primary care is novel.”

Type 2 diabetes, along with heart disease and cancer, seems to be a curse of civilization, increasing rapidly in many industrialized nations, with diagnosed cases increasing by 100 percent or more in 18 states between 1995 and 2010, according to a recent study by the Centers for Disease Control and Prevention (CDC). 

Both types of diabetes have a genetic component. What triggers the development of type 1 is not fully understood while type 2 diabetes is often associated at least partly with obesity and a sedentary lifestyle.

It's type 2 diabetes -- too much glucose in the bloodstream -- that has been increasing at such an alarming rate in recent years, marching along in tandem with the incidence of overweight and obesity and the increasingly sedentary lifestyle found in developed countries.

So, if that's the cause of diabetes, it should be easy to find a cure, right? Unfortunately, no. Someone once compared type 2 diabetes to a car wreck -- once it happens, the resulting injuries can treated but the only complete  cure is to avoid the accident in the first place.

Reducing weight through exercise and a healthy diet can often reduce the severity of type 2 diabetes and even enable some people to return to more normal glucose levels. In more severe cases, it is sometimes possible to nudge type 2 diabetes into remission through weight-loss surgery, a drastic step but one that is sometimes the most effective option for the morbidly obese.

However, it's important to note that a remission is not a cure. If the patient regains the weight, as many do, the diabetes is likely to return.

Potential type 1 cures

Researchers are developing and testing many potential cures for both types of diabetes, including stem cell therapy, which could theoretically be used to build new pancreatic cells that would generate and control insulin for those with type 1 diabetes.

But while stem cells may hold the key to treating many types of illness, there is still no proven method for implanting them in humans, so any cure involving stem cells is far from imminent.

Islet cell transplantation can improve the quality of life for patients with type 1 diabetes, by enabling the pancreas to produce and regulate insulin more effectively but while it may improve quality of life, it is not yet regarded as a cure.

Type 2

But while stem cells and islet cell transplants are seen as potential cures for type 1 diabetes, there is still no cure on the horizon for type 2 diabetes, which is why prevention is so important and why public health officials are so alarmed at the virulent spread of type 2 diabetes.

The Internet is full of ads and bogus news stories about "natural" and "secret" cures for diabetes -- the types of claims we hear about every chronic disease, often using phrases like "the diabetes cure they don't want you to know about."

Such claims can cause consumers to pursue phony treatments that may leave them worse off than when they started -- while also draining their bank accounts.

"I keep receiving bill for a book. I already paid for a book called 30 Day Diabetes Cure with a check that was cashed by Bottom Line Books," said Marjorie of Greenville, N.C., in a recent posting to ConsumerAffairs.

Even cookware manufacturers have been known to claim that using their pots and pans will somehow prevent or cure diabetes. Rena Ware International, Inc., agreed to pay more than $600,000 a few years ago to settle claims by the California attorney general that it "made fraudulent and unethical claims" that its high-priced cookware could cure diseases such as diabetes and heart disease.

A good rule of thumb is to immediately dismiss any claims -- about anything -- that supposedly reveal a "secret" known only to a handful of insiders. While the CIA may still have a few secrets up its sleeve, the truth is that very few things are secret in today's wide-open world of information, misinformation and disinformation.

Rest assured, if anyone develops a cure for diabetes, scientists, public health officials, the government, the press and the health insurance companies that now pay billions to treat diabetes will be quick to publicize it.

"Natural" cures

Consumers should also be cautious of claims made by nutrition supplement peddlers and those who say there are "natural" cures for diabetes and other diseases.

There is a natural prevention for type 2 diabetes -- maintaining a good diet, keeping weight to a healthy level and exercising regularly. While this may not be 100 percent effective, most experts agree it would prevent millions of new cases of type 2 diabetes.

Will adding a few magnesium and chromium supplements to your diet prevent or cure diabetes? Not likely.

While vitamin and mineral supplements may contribute to overall health, it's important to talk with your doctor before taking any supplement. Many can conflict with prescription medications or aggravate existing health conditions.

Misinformation

The Internet has arguably done a few good things for humanity but enabling  the spread of false and misleading health information is not one of them. There are many sources of sound information, including the American Diabetes Association website and sites operated by major medical centers, like the Mayo Clinic and the Johns Hopkins Diabetes Center.

However, it's important to remember that all health information pubished in books, on websites and elsewhere is general in nature. Only your doctor can apply general information to your particular situation.

It's worth noting that taking the steps recommended to prevent or treat diabetes -- a heathy diet, regular exercise, limited or no use of alcohol -- can also contribute to a reduced risk of heart disease, stroke, cancer and many other health problems.

Sitting in a chair reading fraudulent claims on the Internet isn't nearly as good as taking a brisk walk around the neighborhood.

Diabetes is, unfortunately, a relatively common disease in dogs, just as it is in humans. In both species, obesity and a sedentary lifestyle can be contributing factors, although dogs are more likely to develop Type 1 diabetes -- the kind that is caused by inadequate production of insulin by the pancreas rather than by lifestyle factors.

Thus, heredity gets most of the blame in dogs, as the disease occurs more widely in some breeds than in others and in some families within breeds. It can also result from repeated bouts of pancreatitis, inflammation of the pancreas. 

Pet owners sometimes blame their pet's food for diabetes, pancreatitis and other conditions.

"I have been feeding my 4 Chihuahuas Science Diet for 8 years. They are 10 and 11 years old and all 3 have diabetes and one has kidney problems from the dog food," said Cathy of Van Bureau, Ark., in a ConsumerAffairs posting. Medical authorities aren't likely to agree with Cathy, however.

"It is usually unclear why one pet develops diabetes and another does not. It is likely that many factors are involved and that most of them were beyond your immediate control," says Ron Hines, DVM, PhD, a widely-quoted Texas veterinarian.

Proper diet

Whatever the cause of your pet's diabetes, just as in humans, keeping it under control involves eating a proper diet -- one prescribed by the veterinarian who is caring for your pet -- as well as seeing to other lifestyle factors that can have a big influence on how well your dog manages its diabetes.

It's important to remember that Type 1 diabetes cannot be cured but it can be managed with daily injections of glucose and careful monitoring of blood sugar levels. Just like humans, dogs with Type 1 diabetes don't manufacture enough of the insulin that's needed to transfer glucose from the bloodstream into the cells, where it's needed to maintain life.

Thus, a dog whose diabetes is not properly managed can quickly develop too much sugar, or glucose, in the bloodstream while, at the same time, its muscle and nerve cells are starving because of inadequate glucose. This can lead to serious complications, including death, so it's not to be taken lightly, which brings us back to careful monitoring of blood sugar levels.

"There is absolutely no question in my mind that the best way to monitor pets with diabetes to aid in regulating insulin levels is for the veterinary client to learn to monitor blood sugar at home using a blood glucose meter," said Dr Mike Richards, DVM, in a posting on VetInfo.com. "If your vet is one of those who discourages clients from attempting home glucose monitoring I personally think that you ought to change vets, at least for the pet with diabetes, unless there is a really compelling reason to stay."

Simple answer

What kind of food is best for a diabetic dog? The simple answer is, the kind your veterinarian prescribes. In general, these will be high-fiber foods that are low in simple sugars. This helps prevent fluctuations in blood sugar levels throughout the day.

There are many prescription dog foods and chances are, your vet will prescribe one or more. Whether your dog will eat it is, of course, another matter.

If your dog refuses to eat the food your vet prescribes, you may have better luck with over-the-counter foods that are intended for overweight dogs. Again, check with your vet.

Dogs that refuse to eat prescribed foods may need additional insulin injections.

Lifestyle changes

Most dogs are creatures of habit. Left to their own devices, they tend to do the same thing at the same time day in and day out. Fortunately, this is exactly what your veterinarian is likely to prescribe for your dog -- a consistent schedule that combines feeding, insulin injection, exercise and the lounging about that is the specialty of most dogs.

If your dog is a female, it's important to have her spayed, as the pregnancy and reproduction routine causes wild fluctuations in hormones, just as it does in humans. This is bad news for diabetes management.

Also, since diabetes is regarded as primarily hereditary in dogs, spaying diabetic dogs helps to hold down the number of affected animals. 

As in humans, diabetes is a serious disease that cannot be taken lightly. If your dog is not treated properly, it will not have long to live. So take action promptly and follow your veterinarian's instructions. 

Here's a statistic that may be surprising to some pet owners:

There has been a 32 percent rise in dogs being diagnosed with diabetes between the years of 2006 and 2010, according to a study released by Banfield Pet Hospital called the “State of Pet Health 2011 Report.”

The study shows that canine obesity was one of the leading factors in dogs developing Diabetes Mellitus, and it remained within the top five causes for the disease among young adult, mature adult and geriatric dogs.

The authors of the report advise owners to bring dogs to the vet twice a year as opposed to once, which will increase the chance of the illness being discovered in its beginning stages.

Also, pet owners should be engaging their dogs in the right amount of physical activity, while constantly managing their food intake, meal portions and other nutritional needs.

All of these methods combined will significantly lower the possibility of your dog developing diabetes or other dangerous illnesses, say experts.

Placing one hand on your dog's side is one quick way of checking to see if your dog is obese or not. If you're not able to feel your dog's ribs quickly and upon first touch, it's a good indication he or she may be overweight.

Other symptoms

There are also other symptoms that owners will notice when their dog is suffering from the disease.

“Polyuria, which means urination. Polydipsia, which is drinking more, is the first sign you see in dogs and weight loss,” said Dr. Sailendra Roy, a veterinarian at Ambassador Animal Hospital, located in Silver Spring, Md. in an interview with ConsumerAffairs.

“That's the characteristic or sign which prompts the owner to say 'hey something is going wrong here.' And then they bring the animals in, we do the blood work exactly the same way like humans. So that's the typical symptom. Once you get the blood work it tells you more if there are any other organs involved and things like that. But these are the primary symptoms," he said.

Experts also say if your dog is diagnosed with diabetes, but still able to hold down food and water without vomiting, they may be able to be treated as an outpatient and won't require an expensive and sometimes stressful hospital stay.

Of course this will be ultimately determined by the veterinarian during the initial diagnosis or within your pet's follow-up visits.

Insufficient insulin

Canine Diabetes is usually due to an insufficient amount of insulin being created in the dog's body, which is the Type 1 version of the disease, formerly known in humans as Juvenile Diabetes. In rare cases a dog may have enough natural insulin but the pancreas will process it in the wrong way, say experts. This can cause Type 2 diabetes, formerly known in humans as Adult Onset Diabetes.

Currently, there is no cure for the disease in animals, and although treatments vary, Dr. Roy says insulin has a far better success rate than other types of medicines, and really should be your first line of attack against dog diabetes.

“Once a dog is diagnosed, most dogs will be depending on insulin or medication,” he said. “In cats and dogs oral medication has questionable benefits.”

“So you start with insulin and there's a lot of foods out there which are designed as a prescription diet for diabetic patients,” he noted. “There are quite a few out there like Waltham. They have different kinds of diabetic diets that are normally recommended because home meds are kind of impossible [to properly treat the dog].”

The Banfield Hospital report also shows that geography may play a part in dogs being diagnosed with diabetes. In 2010, Rhode Island, Iowa, Idaho, Nevada, and Delaware had the highest rate of Diabetes Mellitus in dogs.

Although the reason why these states had a higher prevalence for Canine Diabetes wasn't revealed in the report, it could be due to the same reason diabetes numbers fluctuate between states among humans.

Awareness, lifestyle and overall culture have always impacted health and potential treatments in humans and their pets.

Chronic condition

Once a dog starts treatment, it's unlikely that the condition will reverse itself, and medication will be needed for the remaining years of the animal's life, Dr. Roy said.

“Once the insulin starts, spontaneous remission is non-existent,” he said. "Most dogs will be getting it for the rest of their lives. There are some reports that [show] sometimes dogs and cats get into remission, but it's so rare. I haven't seen that happen."

According to Michigan veterinarian Dr. Race Foster, who co-authored four books on pet health, certain dog breeds are more prone to getting diabetes than others.

Labrador and golden retrievers, German shepherds, Yorkshire terriers, the Keeshond, the beagle and poodles of various sizes all have a slightly greater chance of developing the disease, he says.

Although Dr. Roy agrees there are some key findings on the link between genetics and Canine Diabetes, there isn't enough large-scale research for veterinarians to make a full and absolute conclusion.

“In the same way that research has been done in humans you can see a familiar test result,” [in dogs] he says. “We ask the patient if their parents had diabetes. I don't think as far as my knowledge is concerned that there is any extensive research to find out whether there's an inherited gene that's possible for diabetes in animals.”

Experts also say that using a portable blood glucose meter for your dog as well as keeping an informational chart of the results is imperative once your dog is diagnosed, and it's also important not to change your pet's diet until you discuss it first with your veterinarian.