Talk:Diabetes/Archive 11

Contradiction in Type 1 treatment discussion

Early on in the section titled "Type 1 diabetes mellitus" there is the following sentence: "Diet and exercise cannot reverse or prevent type 1 diabetes." A couple of paragraphs later, this is restated: "Currently, type 1 diabetes can be treated only with insulin, with careful monitoring of blood glucose levels using blood testing monitors." But then the next sentence contradicts: "Emphasis is also placed on lifestyle adjustments (diet and exercise)." This contradiction undermines the credibility of the article, or at least, the credibility of the treatment discussion. (Or accurately reflects confusion among physicians and researchers?) DrStan 14:59, 25 April 2007 (UTC)

Yes, the emphasis on lifestyle is obselete. It must have been based on the older insulin regimens (ie NPH) wherein you had to plan the mealtime and snack time and exercise time based upon the timing of the NPH peak. Now with the flexible techniques using insulin analogs, you can simply match your insulin to your actual need. Everyone of course benefits from exercise and a healthy diet, including all diabetics, but is really has nothing to do with treating type 1 diabetes anymore. So go ahead and fix it. mbbradford 18:58, 25 April 2007 (UTC)

No contradiction here, and so nothing to fix. Type 1 cannot be trated (as in cured) by diet or exercise. It can be managed and symptoms controlled by medication and diet and exercise. Food is of course required, and in Type 1 must be balanced, somehow, by insulin, ideally precisely timed to match glucose uptake. Whatever sort of insulin one is using. As for exercise, it increases glucose uptake w/o regard to insulin levels. Thus lifestyle is not clinically irrelevant today, nor was it in former times.

Since there's confusion this point, perhaps a rewording is in order? However, it would be in error to state that insulin alone is clinically sufficient for type 1, as it is not. ww 02:47, 26 April 2007 (UTC)

This goes again to the annoying confusion between type 1 and type 2. In management of type 2, diet and exercise are necessary and critical to controlling blood sugars. In type 1, they are no more beneficial in treatment of type 1 than they are for every person. The difficulty is to balance the insulin with the exercise and diet, regardless of what that might be. In days gone by, one had to plan the days physical activities, meal times, and carb counts with the insulin cocktail that was injected in the morning. Thankfully due to flexable insulin therapy, those days are gone. The article seems obselete to me. mbbradford 19:06, 1 May 2007 (UTC)

The root problem here is that Diabetes types 1 and 2 share a name by virtue of the fact that they share a common symptom - 'sweet' urine. The causes of each are very different, as is the treatment. If the conditions of heart attack and indigestion shared a name because they share a common symptom ('pain in chest') we would not be happy. There is a case for separating the naming, but I don't think the medical profession would like it. Pinkelk (talk) 21:04, 7 January 2008 (UTC)

Following on from the above paragraph, the original author of this item should re-read the whole, substituting "Diabetes Type 1" and "Diabetes Type 2" for each use of an unqualified "Diabetes" - and ask the question - is this correct? For example: "The way diabetes is managed changes with age. Insulin production decreases due to age-related impairment of pancreatic beta cells" - is this true for Type 1? I don't think so. Pinkelk (talk) 21:14, 7 January 2008 (UTC)

It is true that type 1 diabetes mangement does change with age but it is more of just changing insulin dosing and etc. But this is a result of growing since your metabolism begins to change as you age. Also I am a diabetic and i dont think that type one is normally treated with inhalable insulin... its not accurate enough. --Nogain (talk) 17:08, 19 January 2008 (UTC)

As far as I can see your problems seem to be in the definition of the word "treated". If by treated you mean managing, which as far as I can see can be the only option for Type 1, then yes exercise and diet can be used to treat Type 1 if the person is aware of their body and how to look after it. If they can recognise when they are Hyperglycaemic then they can excercise because adrenaline has a simmilar effect on cells to insulin and so they can lower their BGL. As for diet, eating low GI (Glycocidic index) foods means less radical changed in BGLs and so it is easier to treat with the insulin. You can't treat Type 1 using just diet and exercise, that much is obvious. I have also found another contradition in the type 1 article, I have not changed it incase I am just being stupid and have not thought of something. "The average glucose level for the type 1 patient should be as close to normal (80–120 mg/dl, 4–6 mmol/l) as is safely possible. Some physicians suggest up to 140–150 mg/dl (7-7.5 mmol/l) for those having trouble with lower values, such as frequent hypoglycemic events" This is saying take more insulin if you are more frequently hypoglycaemic? Sure it should be only if you are more frequently hypERglycaemic? More insulin would make hypoglycaemia worse surely? --BlackDice572 —Preceding comment was added at 07:44, 14 May 2008 (UTC)

MCOTW

I have nominated this article for the medical collaboration of the week. This reflects my conviction that despite the current reasonable quality of the article, there is still a lot to be done here. The main concerns are article structure, referencing and prioritising content for subarticles. I will continue to nibble away at this, but ultimately it would be nice to have this article at mega quality. JFW | T@lk 10:20, 9 September 2007 (UTC)

Also missing from the articles on Diabetes and related conditions is a general overview, in lay terms, of what the disease is. The serious fault of these articles is the inability of a newcomer to the subject to understand the article (or the disease) without having to click on numerous links just to understand the jargon used in the main discussion. I understand that all of the factors in this disease complex deal with balance and feedback within the system. Perhaps a graph depicting the basic healthy system could be shown, then show what parts of the system get out of whack and how--and then what can be done about preventing its getting out of whack, or restoring the "whack" if it is out. These articles need a less technical, graphically interpretive overview with links to the more technical information. With my very limited understanding of the subject, I know that such a graph would have a depiction of a pancreas, a liver, and other glands and organs with symbols showing their analogous functions. Use analogies to things in everyday experience and also to economic terms that everyone understands. Thermostats, float valves, storage tanks, factories, pipes, pumps, money, banks, all come to mind. The graphic at pathophysiology is still for physio-nerds and we ignoramuses still need something more bonehead. Thanks. pechaney (talk) 01:59, 11 August 2008 (UTC)

Developing type 2

Is it possible to get it from consuming to much sugar because I had 232% of my recomended sugar intake yesterday and 355% of my recomended sugar today and btw is it just me or does 'Type 2 diabetes can be cured by one type of gastric bypass surgery in 80-100% of severely obese patients' not make sense does it work for everybody or just 80% of people—Preceding unsigned comment added by 86.136.219.167 (talk) 18:12, 22 April 2008 (UTC)

One day's excessive sugar intake won't do it. As for the sugrical 'cure' (still being investigated), it works for 80% or so. Why it doesn't for the rest is part of what's being investigated. Makes perfect sense if you understand how scientific ignorance is dispelled. There's always a period during which understanding is murky -- we're in one o fhtem here. ww (talk) 18:21, 22 April 2008 (UTC)

I wish it was ones day sugary excess but I discoverd the breakfast Ive been having for 4 years is 92% by itself so theres a good change Ive had 1400ish days of excess —Preceding unsigned comment added by 86.136.219.167 (talk) 21:03, 23 April 2008 (UTC)

OK, I'll ask. 92% of what, by itself? ww (talk) 23:54, 23 April 2008 (UTC)

Please go to the reference desk if you have questions that are not directly related to updating and improving this article.

To touch on your question: type 2 diabetes has very little to do with sugar intake (unless you want to go into the high-fructose corn syrup controversy). Rather, it has to do with the tissues becoming so resistant to insulin that the islets cannot produce sufficient insulin to match the body's demands. Once the pancreas is exhausted and diabetes has developed, high-sugar foods can indeed cause fluctuations in the blood sugar levels. But having sugar itself doesn't really cause diabetes beyond contributing to weight gain and hence insulin resistance. JFW | T@lk 12:43, 20 May 2008 (UTC)

Adding an External Link to JDRF

Would it be alright to add a link to the Juvenile Diabetes Research Foundation (JDRF) -- www.jdrf.org -- at the bottom in the External links section? Thanks Rlewinson (talk) 18:02, 16 May 2008 (UTC)

We would be more helped if that link was on the page about "juvenile diabetes" (they really ought to update their name). This page is about diabetes in general. JFW | T@lk 12:33, 20 May 2008 (UTC)

Alzheimer's

Many practicing doctors will have heard about the somewhat elusive entity of diabetic encephalopathy. 203.10.59.12 (talk · contribs) now wants to add an entire paragraph that basically turns Alzheimer's disease into a form of insulin resistance of the brain, and quotes researchers that maverickishly refer to AD as "type III diabetes". All very good and well, but this is not standard terminology, and frankly I find the use of diabetes terminology for AD pretty offensive. Thoughts invited on WP:WEIGHT here. JFW | T@lk 12:43, 20 May 2008 (UTC)

Fasting BM predicts DM

Even in people with a normal range fasting blood sugar, there is a direct relationship with the risk of diabetes. doi:10.1016/j.amjmed.2008.02.026 JFW | T@lk 11:16, 21 May 2008 (UTC)

Very interesting. Does this then mean (or hint) that glucose itself causes tissue changes which lead to the Type 2. For instance, changes in the upper small intestine which then proceed to emit a signal which causes the insulin resistance in the periphery and thus the cascade of events which is too often Type 2? The variety of problems with assorted tissues in diabetic complications certainly suggest something like this. Again, very interesting. ww (talk) 19:11, 22 May 2008 (UTC)

Protected

I have sprotected the page for a month. Every single contribution from anonymous IPs constitutes vandalism. JFW | T@lk 15:07, 22 May 2008 (UTC)

You may want to rephrase that. There may have been vandalism from anonymous contributors, or even a lot of it, but anonymous contributions certainly are not per se vandalism.

Since you have semi-locked the page from editing, I'll leave it to do to fix the following stylistic problems in the section under "Cures for type 2 diabetes":

1. "precise clausal mechanisms" should be changed to "precise causal mechanisms"
2. In the sentence after the above, which starts with "this approach may ...", "this" should be capitalized.
3. In the same sentence, "some Type 2s in the relatively near future" should be changed to "some type 2 diabetes in the relatively near future". --71.162.249.251 (talk) 19:09, 7 June 2008 (UTC)

Fine, you are an unusual one, Mr 71.162. I'll try to fix these errors soon. "Relatively" is not qualified - is this opinion? JFW | T@lk 09:56, 11 June 2008 (UTC)

Chaos

ACCORD (doi:10.1056/NEJMoa0802743) and ADVANCE (doi:10.1056/NEJMoa0802987) have appeared online and will appear in print tomorrow. These will need to be mentioned. Why did ACCORD cause SUEs and ADVANCE not? Is it all due to the 90% on rosiglitazone? JFW | T@lk 09:56, 11 June 2008 (UTC)

OK. I've now waited quite a while and have seen no further elucidation of the difference found. Is either true (large studies, so one expects no distortions due to too small n, but...) or are both wrong and lowering Hb1c for years causes more abduction by aliens instead, and both these studies missed it? What gives??? ww (talk) 00:20, 25 June 2009 (UTC)

Treatment topic bias

I find the wording in the treatment section regarding American health care rings of a bias. No one needs to be told that the U.S. is a developed country. "Clarifying" that it's a developed country is unnecessary unless one was trying to point out something other than the U.S. as an example of a country who has privatized healthcare. To prevent that section sounding political and to protect the integrity of the article, it needs to be changed. —Preceding unsigned comment added by 207.68.243.109 (talk) 01:52, 21 June 2008 (UTC)

Suggest you get a username, and then {{sofixit}}. JFW | T@lk 07:39, 5 August 2008 (UTC)

I expect that the US data mentioned here was available to the writer, not that there is or was a conspiracy to denigrate other countries or population. The cure, of course, is to add comparable data for other countries or populations. Be Bold. Add it if you've got it. ww (talk) 15:41, 6 August 2008 (UTC)

Management of Diabetes Mellitus

It would be helpful to emphasize the importance of blood pressure control in the management as improved glycaemic control does not reduce cardiovascular mortality though it improves the lipid profile. The benefits of strict blood pressure control are far greater thatn strict blood sugar control.Plasmons (talk) 20:08, 9 July 2008 (UTC)Plasmon

I was under the impression that we had some endpoint data on macrovascular disease. But I agree that hypertension is the biggest killer in diabetes. JFW | T@lk 07:39, 5 August 2008 (UTC)