Talk:Diabetes/Archive 10

16 year old get diabeties

can a 16 year old who is 50 pounds over wieght get type 1 or type 2 diabeties?

Anyone can get diabetes at any age. --Idleguy 02:30, 16 June 2007 (UTC)

Diabetes type 1 is still quite common in that age group, but there is an additional risk of type 2 in those who are overweight, especially if the weight is around the waist.

Even without diabetes, losing weight is sensible to prevent extremely painful complications such as osteoarthritis. JFW | T@lk 21:08, 10 July 2007 (UTC)

oops im sorry... ithought you said you were fifty. well anyways fifty punds would increase your risk of type 2 not type one but either of them is possible at that age Nogain (talk) 01:36, 24 January 2008 (UTC)

Cure?

What is the definition for cure? Is the article saying that surgery can simply get rid of T2 Diabetes? --MasterA113 17:06, 12 October 2007 (UTC)

Yes. The article is citing a New England Journal of Medicine article which says that hundreds of patients were cured of diabetes by gastric bypass surgery. Deaths from diabetes were reduced 92%. I can't find the word "cure" in the NEJM article; I think it was used in one of the other articles that somebody deleted. Nbauman 17:50, 13 October 2007 (UTC)

I think this is too stark an answer. Varoious surgeons in various places have patients who seem to have been cured. And further seem to have been so as a result of a particulat sort of bariatric surgery. However, not all such surgeries are done the same way (even the cited type), and not all hospital courses are identical, and since we don't really understand just what gives with the insulin resistance of assorted Type 2 (if it is the same from one to the next, in any case and if the effect is lasting), it is too much to claim in a WP article that there is a cure. This word means much to the Average Reader and something rather different to the readers of such as NEJM.

So what our article should say is that many patients of several surgeons have apparently been cured and the the technique has much potential for becoming a standard clinical treatment once it is better caharacterized and understood. It is not yet a cure as that term is commonly understood. I attempted some such correction of the claim a little while ago and was promptly reverted. I think we've got to revert the reversion, more or less. Comments from others? Some of the medical types? JDFW or alterprise? ww 16:44, 15 October 2007 (UTC)

The word "cure" is used in Rubino & Gagner 2002 (currently footnote 30) in the article title. The article discusses "whether surgery for morbid obesity can represent a cure for type 2 diabetes in nonobese patients as well [as obese patients]". Footnote 31 (Rubino, et al 2006), states "The majority of obese patients who undergo selected types of bariatric surgery experience resolution of type 2 diabetes and enjoy normal blood glucose and glycosylated hemoglobin levels, with discontinuation of all diabetes-related medications." Sounds like the definition of a cure to me. Colin°^Talk 18:33, 15 October 2007 (UTC)

Absolutely not. If you quote correctly then the authors are questioning it, and have only a majority of patients benefiting. Or cured. This is not a cure, this is something of a lottery. Whatever is happening needs to be better understood, certainly clinically, before we can use words like cure in an article such as this. Lots of potential, and we should say so, and we should also say that it's unclear just what is happening, and is not ready for routine clincal use as s 'cure'. Again, comments from others? Maybe some of the doctor folk? ww 04:09, 17 October 2007 (UTC)

I'm more than happy to hear from (and be corrected by) our WikiDocs. The article only uses the word "cure" wrt obese patients and makes it clear that it isn't always 100% of those. The above quote had the doctor questioning only whether non-obese patients might be similarly cured—the implication of that article's sentence was clearly that obese patients already have a potential cure. I think your definition of "cure" implies that most/all patients using the therapy will undergo complete remission. That's not my definition, which accepts that not all will be cured. The comparison with epilepsy applies: current drugs will never affect a cure; surgery can, but not always, and few are selected for it. Colin°^Talk 06:08, 19 October 2007 (UTC)

"Cure" is a treatment intended to complete abrogate a disease process. "Treatment" could mean cure or long-term remission, but also chronic suppression of a disease process. If the studies show that patients who have had surgery can come off the their medication and lead a normal life, then that sounds like a cure to me, even if a small proportion go on to develop diabetes again.

The use of the word "cure" in medical articles is troublesome. I don't think it should be used outside the strict limits of completely removing a disease, e.g. resection for small cancers, which leads to curation in many patients. Most bacterial infections can be "cured" because we have rather good antibiotics. Some chronic viral infections can be cured (e.g. hepatitis B).

I think that someone who has diabetes and is able to make radical lifestyle changes, leading to withdrawal of all treatment, then that also sounds like a "cure" to me. JFW | T@lk 09:08, 22 October 2007 (UTC)

Absolutely not. One still has diabetes, and that much effort and attention has relieved a major aspect of it (ie, aberrant glucose levels) does NOT constitute a cure. Ask anyone on insulin, especially, as all those injections are hard to lose track of. Those on pills (the Type 2s) or on exercise and diet (or both) may find it easier to have their awareness of diabetes recede into the background some, but in neither case is there a cure. One doesn't cure chronic conditions by managing symptoms, though those with the disease/condition will certainly prefer symptomatic treatment if a cure is not actually available.

What these studies report, if confirmed over more than a few patients (and ideally with blinded trials, though that's hard when we're talking about surgery I suppose) might be a cure, as in JDFW's point about cancer surgery in some cases. At present they are a very hopeful development, perhaps even to become confirmed as a cure in future, but not now a cure. ww 04:08, 23 October 2007 (UTC)

I don't think JFW was implying that someone who successfully treated their diabetes with pills and injections would regard themselves as cured. Instead, I think he was describing a case where "radical lifestyle changes" (diet/exercise) meant that pills and injections where avoided/stopped. It certainly sounds more natural than relying on the pharmacy but I wouldn't go as far as to describe that as a cure. Much like the person with coeliac disease is not cured by their dietary restriction, though this may alleviate all symptoms.

Ultimately, it doesn't really matter if we three disagree to some extent on our definition of cure. The article, wrt type 2, uses the word once for a restricted group of patients, and the word in that context is totally supported by a reliable source. To remove it, we'd have to uncover (and source) a body of medical opinion that did not regard such surgery as curative (in some people). Colin°^Talk 06:55, 23 October 2007 (UTC)

My point is just that, so far, the group of patients for whom this seems to have worked (is it permanent in a serious sense?) is limited. Much better than some mysterious cure reported for 4 people in rural Outer Fredonia, to be sure, but clinical worth will depend on more than has been reported to date. And the use of the word 'cure' is a VERY BIG flag for the Averae Reader. We should not raise it prematurely, and so far this is structurally premature. Perhaps it will turn out to be the long sought solution to Type 2, but we don't know yet. This should not be left in the article. ww 05:37, 28 October 2007 (UTC)

I find it rather unusual that the 'cure' section is longer than treatment and management section. Plan of management for millions of sufferers is directed towards achieving better glycemic control and preventing complications. This should be emphasized. Management of complications is largely overlooked perhaps because complication section is kept below treatment (it should be moved up). The 'cure' section has been improved a great deal from its initial state. But I still feel that most of its content should be moved to diabetes management since most of it is still in research stage and yet to be accepted in management guidelines. The article is already too large and by emphasizing more on cure and less on current accepted treatments it is in danger of giving wrong impression to the general reader.--Countincr ^{( t@lk )} 14:03, 28 October 2007 (UTC)

I'm surprised there has been no mention of the recent (Dec 2007) research by Hans Michael Dosch's team in Toronto in which they were able to cure mice of diabetes via an injection (at least for several weeks). Paul Dulaney —Preceding unsigned comment added by 199.46.200.232 (talk) 23:28, 21 April 2008 (UTC)

Losing Weight Myth

Losing weight does not help keep diabetes in check. It's well-established that weight loss is but a (temporary and often rare) side effect of the real things that help control diabetes: exercise and healthy eating. People can do both without losing weight and still enjoy the benefits.

Thank you for your opinion. Do you have some sources to support your views, because active weight loss is an established way to prevent diabetes (PMID 11832527), and improves glycaemic control in people with confirmed diabetes. JFW | T@lk 08:49, 13 January 2008 (UTC)

Liposuction

I have again removed the addition by Unidoctor (talk · contribs) about liposuction in diabetes. The last major trial on this subject Klein et al, 2004 was negative. Unless there have been major trials since then, I don't think we should mention this further.

My point about WP:MEDRS was the use of Med Hypoth as a source. This journal does not contain research or reviews - it contains speculation, and usually fairly controversial speculation. Unless you can prove that the hypothesis has found wide support, I don't think any paper from Med Hypoth is ever useful on Wikipedia. JFW | T@lk 08:49, 13 January 2008 (UTC)

More surgical studies

Obese type 2 diabetics who received an adjustable gastric band within 2 years of diagnosis has a 73% chance of remission (i.e. normal glucose without medication) vs 13% in the normal treatment group. Follow-up was 2 years, so whether this might be labeled a "cure" is still preliminary - http://jama.ama-assn.org/cgi/content/abstract/299/3/316?etoc JFW | T@lk 17:31, 23 January 2008 (UTC)

It's anecdotal, I know, but in support of the idea that certain surgical interventions can "cure" diabetes I offer the case of my wife, (who was previously a T2 taking oral insulin). She underwent a laparoscopic Roux-en-Y in June 2001 and one month after surgery her GP reported that her clinical results indicated that she was no longer T2. That situation has persisted to date, which means she's coming up on seven years of being "cured". Again, anecdotally, her surgeon reports that all of his patients who have undergone any form of bypass and who were T2 beforehand are now no longer T2. His numbers are respectable - he and his team have performed some 3,000 surgeries in that period. AncientBrit (talk) 02:25, 29 February 2008 (UTC)

Alternative Treatment for Type 2

The hypothetical role of dietary carbohydrates has not been addressed. Readers should be made aware that books about using very low carbohydrate diets to control A1c and fasting BG are available. Authors include: Bernstein and Atkins. Reference on the role of refined carbohydrates on insulin and diabetes can be found in: "Good Calories, Bad Calories" by Gary Taubes.69.110.0.222 (talk) 01:02, 17 February 2008 (UTC)

If you could kindly provide full citations and the relevant evidence base... JFW | T@lk 20:53, 8 April 2008 (UTC)

Lack of glucose supplying carbs in the diet (lots of them don't) means that the living body must obtain energy from internally generated glucose, or use fat. There are no other choices save death in the pretty short run.

There are only a few non food sources of glucose. In no particular order then,

• 1 -- the carbohydrate backbone of the triglycerides (gycerol), but it is a poor source as there isn't much of it in dietary fat.
• 2 -- assorted stores inside cells (eg, in liver cells and muscle cells (glycogen)), but these are limited and will not last very long even in the inactive.
• 3 -- protein degradation to gain access to those few amino acids which can be converted to glucose. The remaining amino acids are, more or less, thrown out. This is the major cause of the gaunt, skeletal appearance of those with untreated diabetes or long term starvation.
• 4 -- using fat as a fuel. This is satisfactory if periodic, and is the primary mechanism which uses calories stored in fat tissue, but not in the long run as there is risk of ketoacidosis if some of the intermediate breakdown products build up (the so-called ketone bodies). Furthermore, some cell types are unable to use anything but glucose very well, and so there are further derangements in their operation under conditions of prolonged ketosis.

It is a common misconception among some popular writers (and others) that glucose can be produced internally from fats if not present (or deficient) in the diet. This is in error as animals lack the necessary enzymatic machinery; plants have it and can produce glucose for internal use from stored lipids (as for instance in seeds).

The complementary conversion, glucose into lipids, is broadly possible for humans as energy (from glucose) + any of several lipids = the rest of the needed lipids. The exceptions are the necessary lipids and these are required in the diet, rather like vitamins. The same is true for the amino acid building blocks of protein; we require some of them (the essential amino acids) in the diet, but can if necessary build the rest from those starting blocks.

Does this clarify some of the urban legends and pseudo science purveyed by the diet writers? ww (talk) 22:50, 16 April 2008 (UTC)

I would like to include a new resourse for Diabetes page: Supercourse Open Library of Lectures www.pitt.edu/~super1

If you would like to teach about diabetes you can use these powerpoint lectures: http://www.pitt.edu/~super1/assist/topicsearch.htm#dis3 Supercourse is is a global repository of lectures on public health and prevention targeting educators across the world. Supercourse has a network of over 43435 scientists in 175 countries who are sharing for free a library of 3385 lectures in 26 languages.Eshubn (talk) 21:06, 26 February 2008 (UTC)

This kind of link is not normally regarded as suitable. JFW | T@lk 15:25, 4 March 2008 (UTC)

Vegan diet

Could any of these links be added? are they not suited, if so, why? Is it ok to add these right away? You know of any other? I know there is but I dunno how to search for them or if they are even accessible from the net. [1] and [2] Scrdcow (talk) 03:56, 10 April 2008 (UTC)

Both of these articles are secondary sources. While I have no objection to including them, I think it would be much better to find the primary sources that they are talking about and link to these instead. Google scholar is a good place to look. Try starting with a simple query like this one: [3] Good luck! Cazort (talk) 17:33, 12 April 2008 (UTC)

Explanation for confusing tag

I added the "confusing" tag to the "prevention" section. I have a lot of issues with the accessibility of this whole page but let me start by making some specific comments about this suggestion:

• The section is a collection of random facts, and although the facts are referenced, there is no coherent narrative nor any attempt to weave the facts into a big picture.
• Many terms are undefined. For a specific example:
• The term "ATZ poisoned mice" is not defined. In my opinion, either this comment and reference should be deleted, or ATZ should be fully defined and explained. If there is not enough room for this, I suggest wikifying ATZ and making a page that explains what it is and gives enough background that the average reader could understand this comment. If we don't want to explain this I think the comment should be shortened to "It is possible that adequate copper could help prevent insulin dependent diabetes". What is the purpose of inculding a "because" clause if the explanation is highly technical and not accessible to a typical wikipedia reader, and wikipedia does not give any way to gather information in order to understand the explanation?

Yes, so that's my beef. Let's start with this section, but I think the whole page needs a lot of work. Cazort (talk) 16:46, 12 April 2008 (UTC)

I Love Matthew Port!!!!!!! —Preceding unsigned comment added by 67.8.212.89 (talk) 22:58, 14 April 2008 (UTC)

Type 2

In the introduction to Type 2 a distinction is drawn between "insulin resistance" and "reduced increased sensitivity". I currently work at the charity Diabetes UK and am unable to find anyone who can clarify this to me. Is there a difference. If not I would recommend the latter be removed as it confuses. —Preceding unsigned comment added by Eustonian (talk • contribs) 12:32, 16 April 2008 (UTC)

By and large, "insulin resistance", "insulin insensitivity", and "impaired glucose tolerance" are the same thing in different words. If your cells no longer respond to insulin and absorb glucose from the blood, the are either resistant or insensitive to insulin. And you don't tolerate glucose very well either, letting it just build up in the blood, because of the insulin insensitivity.

Measurements are easier to make from the glucose end, as insulin is never present except in vanishingly small amounts (it's a hormone, remember). So the usual clues are derived from glucose levels, eg those measured with the meters and strips. Or in exotic hospital lab machinery. ww (talk) 22:55, 16 April 2008 (UTC)

Diabetes symptoms

"The classical triad of diabetes symptoms is polyuria, polydipsia and polyphagia, which are, respectively, frequent urination; increased thirst and consequent increased fluid intake; and increased appetite. Symptoms may develop quite rapidly (weeks or months) in type 1 diabetes, particularly in children. However, in type 2 diabetes the symptoms develop much more slowly and may be subtle or completely absent. Type 1 diabetes may also cause a rapid yet significant weight loss (despite normal or even increased eating) and irreducible fatigue. All of these symptoms except weight loss can also manifest in type 2 diabetes in patients whose diabetes is poorly controlled. " the italicized part is what i must disagree with. I was diagnosed with Juvenile Type 2 diabetes three years ago. And one of the symptoms that lead to my diagnosis was increased weight loss. So weight loss does occasionally manifest in Type 2. could someone fix that please? Ono (talk) 16:34, 16 April 2008 (UTC)

The tag 'classical' was used to denote the typical case. Indeed, most Type 2s are not initially gaunt, but rather quite often obese. The abdominal fat stores are associated with the development of insulin resistance (probably due to hormones emitted as a result of inflammation in that fat tissue).

But, diabetes in an individual, and the course of it in that individual, vary quite a lot. Especially for type 2s as there are considerable variations in the amount of insulin resistance and reactions to it. Type 1 is simpler.

I think the phrase to which you object is perhaps poorly written, but it's not in plain error.

Be bold. Reword it. ww (talk) 18:37, 18 April 2008 (UTC)