diabetic-diet-secrets.com

An increasing number of diabetic patients are facing a new disease complication called "double diabetes," the term used to describe having symptoms of both type 1 and type 2 diabetes.

Researchers say they have strong evidence that double diabetes could be a growing phenomenon. Recent studies have found that as many as one in three newly diagnosed childhood diabetics now have both type 1 and type 2 diabetes.

Double Diabetes, Double Trouble
Type 1 diabetes is an autoimmune disease that occurs early in life, often in children. For unclear reasons, the body’s immune system begins attacking and destroying the beta cells in the pancreas needed produce the hormone insulin. Insulin is what ushers blood sugar (glucose) from the bloodstream into the cells to create energy. Without insulin, glucose levels in the bloodstream rise.

Type 2 diabetes usually has a later onset. Because of a combination of poor diet, lack of exercise, and too much body fat, the cells of the body become resistant to the insulin the pancreas has been making. Glucose levels remain elevated: The pancreas tries to keep up with the added demand by producing more insulin, but over time burns itself out.

Double diabetes occurs when a person with type 1 diabetes develops resistance to the insulin they are taking, insulin resistance being the hallmark of type 2 diabetes. It can also occur in a patient who appears at first glance to have the more common type 2 version of diabetes because they are overweight. However, blood tests to look for the specific proteins that attack pancreatic beta cells will reveal that they also have type 1 disease.

Obesity is the main risk factor for double diabetes. Patients with double diabetes are most often overweight. Doctors suspect double diabetes might be partly caused by type 1 diabetics who take insulin, but haven't made the other healthy lifestyle changes needed to help manage the disease. Because insulin use causes weight gain, if the type 1 diabetic patient doesn't take steps to eat healthy food and exercise regularly, weight gain could begin making his or her cells insulin-resistant.

Treating Double Diabetes
Treating a person with double diabetes is complicated because the preferred methods of treating type 1 and type 2 diabetes are different:

Type 1 diabetic patients take insulin to treat their disease because they cannot produce the hormone on their own.
Type 2 diabetic patients take oral medicine to manage the amount of glucose in their bloodstream, by either stimulating insulin production or helping cells use insulin more efficiently. It's not until the later stages of the disease that they must begin taking insulin to survive.

Medication. Doctors are weighing different combinations of medications that could help double diabetes patients. Some double diabetes patients might be best served by a treatment plan that includes both insulin and oral medication.

Diet and weight loss. One approach that seems to work is a low-calorie diet for weight loss that features foods high in fiber and bulk. Fiber helps stabilize blood glucose and reduce the need for insulin, while the increased amount of food prevents hunger.

Exercise. Physical exercise is also considered a prime means of treating double diabetes. Workouts help to improve the body's response to insulin, decreasing insulin resistance.

Preventing Double Diabetes
The best treatment for double diabetes is prevention.

Doctors recommend that children who are obese or overweight develop a healthier diet based on smaller portion sizes and get a good amount of exercise, especially if they have type 1 diabetes, to keep from developing type 2 as well.

Drug's adverse effects negated when combined with older diabetes drug

Enrique Rivero

| 4/30/2009 11:35:49 AM

A drug widely used to treat Type 2 diabetes may have unintended effects on the pancreas that could lead to a form of low-grade pancreatitis in some patients and a greater risk of pancreatic cancer in long-term users, UCLA researchers have found.

In a study published in the online edition of the journal Diabetes, researchers from the Larry L. Hillblom Islet Research Center at UCLA found that sitagliptin, sold in pill form as Januvia, caused abnormalities in the pancreas that are recognized as risk factors for pancreatitis and, with time, pancreatic cancer in humans. Januvia is marketed by Merck & Co. Inc. Sitagliptin is a member of a new class of drugs that enhance the actions of the gut hormone known as glucagon-like peptide 1 (GLP-1), which has been shown to be effective in lowering blood sugar in people with Type 2 diabetes. The study is available at http://diabetes.diabetesjournals.org/cgi/content/abstract/db09-0058v1.

"Type 2 diabetes is a lifelong disease — people often take the same drugs for many years, so any adverse effect that could over time increase the risk for pancreatic cancer would be a concern," said Dr. Peter Butler, director of the Hillblom Center and the study's lead investigator. "A concern here is that the unwanted effects of this drug on the pancreas would likely not be detected in humans unless the pancreas was removed and examined."

An observed connection between Byetta, a drug used to treat Type 2 diabetes that is related to Januvia in its intended actions, and pancreatitis has already been reported, prompting a Food and Drug Administration warning. Amylin Corp., which markets Byetta, has suggested that since there is no known mechanism linking the cases of pancreatitis with Byetta, the association might be chance. The UCLA study suggests that there may indeed be a link between drugs that enhance the actions of GLP-1 and pancreatitis — by increasing the rate of formation of cells that line the pancreatic ducts.

In the study, researchers used human IAPP transgenic (HIP) rats to test both sitagliptin and metformin; metformin, a member of an older, different class of diabetes drugs in use since the 1950s, has recently been found to have anti-tumor properties. The researchers sought to determine how the drugs, both singly and in combination, affected islet disease progression in the pancreas — particularly how they affected beta cells in the pancreas's Islets of Langerhans. Beta cells are responsible for releasing insulin in people with normal metabolism, but they don't produce insulin in sufficient amounts in diabetes patients. HIP rats approximate both the islets and metabolism of people with Type 2 diabetes. The drugs were tested in 40 rats for 12 weeks.

The researchers found that the two drugs in combination had a synergistic effect that helped preserve beta cells, improved their function and enhanced insulin sensitivity in the test rats. With the sitagliptin alone, however, the rats had abnormally high rates of cell production in their pancreatic ducts; a few developed an abnormality known as ductal metaplasia, and one developed pancreatitis.

But the metformin, trade name Glucophage, seems to counteract sitagliptin's adverse effect.

"The apparent protection against the unwanted actions of sitagliptin in the exocrine pancreas are intriguing and may offer a potential way of using the GLP-1 class of drugs safely," Butler said. "The protective effect may have been either by the actions of metformin to decrease blood glucose values or its recently appreciated properties as a tumor suppressive agent."

Butler noted that the present study was undertaken in rats and that it is possible the adverse effects observed would not occur in humans.

"Given these findings, it is probably sensible to use the GLP-1 class of drugs only with metformin until other data is forthcoming," he said.

The National Institutes of Health, the Larry Hillblom Foundation and the Merck Research Foundation funded this study.

In addition to Butler, researchers included Aleksey V. Matveyenko, Heather I. Cox, Artemis Moshtaghian, Tatyana Gurlo, Ryan Galasso and Alexandra E. Butler, all of the Hillblom Center, and Sarah Dry of the department of pathology and laboratory medicine at the David Geffen School of Medicine at UCLA.

The Larry L. Hillblom Islet Research Center at UCLA, established in 2004, is the first center dedicated to the study of the Islets of Langerhans, which include the insulin-producing cells in the pancreas. An understanding of the causes of islet cell destruction is key to finding a cure for diabetes. The center's faculty members, recruited from around the world, provide leadership in the worldwide fight against the disease. The center is funded by a grant from the Larry Hillblom Foundation, which supports medical research in the state of California.