| A BATTLE FOR CONTROL: Special issue on diabetes
October 26, 2009 at 3:00 am
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|  Without a doubt, many patients require insulin. But some who have Type 2 disease resolve to change their lives instead.
Simply put, diabetes is a contest between people and their blood. For people whose bodies don't produce enough insulin to manage their blood sugar, the goal is a normal blood score, achieved through a balancing act of lifestyle and medication. ¶ "Eventually most patients will follow a course of lifestyle, medications, then insulin," said Dr. Enrico Cagliero, referring to people diagnosed with the most common form of diabetes, known as Type 2. He's an endocrinologist at Massachusetts General Hospital and associate professor of medicine at Harvard Medical School. "Overall about 30% of all diabetics are on insulin, but, given the progressive nature of the disease, close to 60% can expect to be on it eventually." ¶ To buck that trend, some of these diabetics, with the help of physicians who share their mission, are adopting rigorous diet and exercise regimens to get off insulin, or never have to go on it. Unlike Type 1 diabetics, who have no choice but to take insulin, Type 2 diabetics still produce some of the hormone -- and more than a few are determined to make the most of it. ¶ Dr. Wei-An "Andy" Lee, an endocrinologist and assistant professor at USC's Keck School of Medicine, is a firm supporter of this approach. He's among a handful of physicians using radical lifestyle changes to get insulin-dependent patients off insulin. ¶ "I wish more doctors and patients would not assume insulin injections are their only option," he said. "I don't see why more don't give lifestyle a try. It's better for the patient, costs less than medications or surgery, and is better for the country." ¶ Newer non-insulin medications, specifically ones that boost incretins (hormones found in the digestive tract), along with strict diets can help patients actually reverse their disease and ditch the insulin, he says. Lee presented two such case studies to the Endocrine Society in Washington, D.C., last summer, and points to dozens of individual success stories. ¶ He prescribes incretin medications and a very low-calorie diet (600 to 800 calories a day). Once off insulin and stabilized, patients can maintain normal blood levels through lifestyle alone, he says: a low-calorie diet (1,000 to 1,200 calories a day), weight loss, moderate daily exercise and regular eating and sleeping schedules. 
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| Gastric bypass: Is it a diabetes fix?
October 26, 2009 at 3:00 am
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|  Within days of various weight-loss surgeries, blood sugar levels become easier to manage -- or are normal.
The discovery came about by accident more than a decade ago: Weight-loss surgery often led to dramatic improvements in the control of Type 2 diabetes, often before patients had even left the hospital. 
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| Diabetes: the basics
October 26, 2009 at 3:00 am
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|  In the United States, an estimated 23.6 million people -- or 7.8% of the population -- have diabetes, federal statistics show. Of those, 5.7 million are undiagnosed. 
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| Children adapt to Type 1 diabetes
October 26, 2009 at 3:00 am
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|  Despite the managing, testing and planning, diabetic kids like Reilly Reynolds have relatively normal lives.
Restless from math calculations using play money, the second-graders look relieved when their teacher instructs them to gather their lunches and line up. They're heading down a stairwell to the schoolyard when Reilly Reynolds, a sturdy 8-year-old with blond hair and a cherubic face, remembers a pre-lunch appointment. 
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| Eat, drink and -- just maybe -- prevent diabetes
October 26, 2009 at 3:00 am
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|  If you've been able to reverse your diabetes, there's a place to let everyone know.
What you eat may help reduce the risk of diabetes, says a recently released report from Harvard Medical School. Among its findings: 
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| Patients kick the insulin habit through diet, exercise
October 26, 2009 at 3:00 am
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| Counting calories -- and miles walked -- helped these people control their diabetes.
By harnessing the power of lifestyle, the following people are managing their Type 2 diabetes without insulin, and in some cases without any medication at all. Some made the commitment when they were first diagnosed, but others reversed a condition that had been spiraling downward for years. Here's how they did it: 
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| Link between diabetes and heart disease scrutinized
October 26, 2009 at 3:00 am
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| Figuring out precisely why diabetics are more prone to heart attacks and strokes has the potential to revolutionize treatment.
The link between diabetes and heart disease is well-known -- diabetics are two to four times more likely to have cardiovascular disease than nondiabetics, and two-thirds will die of an early heart attack or stroke. But the link itself is poorly understood. 
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| Incretin therapy shows promise
October 26, 2009 at 3:00 am
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| In experiments on rats, the gut hormones increased the number of insulin-producing cells in the pancreas.
Physicians who treat diabetes consider incretin therapy one of the most exciting new tools that they've seen in a long time for combating the disease. 
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| Diabetes drugs may leave heart at greater risk
October 26, 2009 at 3:00 am
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| Working harder to lower blood glucose in Type 2 diabetics doesn't help the heart, studies say.
Medications for Type 2 (adult-onset) diabetes are very effective at controlling blood sugar levels. You'd think, then, that the drugs would also be very effective at controlling complications of the disease related to those spikes in blood sugar: cardiovascular disease, kidney failure, blindness, nerve damage and amputation of limbs. Surprisingly, though, that has not turned out to be the case for cardiovascular events such as heart attacks and strokes. One study, in fact, hints that too-tight control may even cause patients harm. 
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Q: My husband has high cholesterol. His doctor put him on Lipitor. After the dosage was increased, I noticed he wasn't as enthusiastic about our previously very active sex life. He said he wasn't feeling aroused and his usual morning erections weren't occurring. He asked his doctor if the Lipitor might be responsible, and the doc said to stop it for a month and see what happened. 
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