Type 2 Diabetes and Healthy Living – Start Setting Realistic Goals

Whenever you aim to take on a challenge for a result, you are setting a goal. Goals may be ambitious or straightforward: veer off too much in one direction, and you risk wasting your time. Too simple, and you may not care enough about the result, and feel uninspired. Too ambitious, and you risk trying something too challenging, and finding more frustration than inspiration.

Aim for a balance. Set realistic goals that are not too easy but are well within your reach. If you are setting health goals, this is particularly important…

1. Setting realistic weight loss goals. Let us start with weight loss as it is a subject of much debate and interest. Weight loss requires a more realistic approach than perhaps anything else. It is one thing to say you will lose 30 pounds by the end of the year, and another to be able to follow through. It is much better to tell yourself you will take it one week or one month at a time, and then you will accumulate small, but significant amounts of progress.

One pound a week adds up quickly, and even if you are a bit short, it is progress in the right direction. Don’t be too optimistic about what you can achieve in the long-term. For now, worry about what you can accomplish in the next few weeks and months, and don’t run before you can walk.

2. Realistic nutrition goals. Nutrition is under the same scope because without eating well you are unlikely to make weight loss progress. However, it is best not to aim to drastically reduce your caloric intake, or make the same type of dramatic changes to your diet. Start with small steps. Small changes to your diet will go a long way.

3. Feasible exercise strategies. Exercise is essential. If you have been sedentary and recently had a wake-up call such as the diagnosis of Type 2 diabetes, you may have decided to change for good. This time it will be different, you tell yourself: that is a good start.

However, be careful about being overzealous. Don’t be too ambitious at first. If you are exercising to achieve…

weight loss,
lower blood sugar levels, or
improving your cardiovascular health,

moderation is key. Going from zero workouts to five or more a week is too much, and it is a difficult goal to sustain.

Instead, establish possible exercise strategies. Aim to exercise three times a week. Do this until it becomes a set routine in your life and you don’t need to think twice about it. If your nutrition is right, you will make progress. You will also be more likely to enjoy your workout at the gym, the walks you go on, and the fitness classes you attend.

Setting realistic goals is ultimately part of establishing a realistic plan for your health. Set health goals you will achieve, and accumulate these successes.

Although managing your disease can be very challenging, Type 2 diabetes is not a condition you must just live with. You can make simple changes to your daily routine and lower both your weight and your blood sugar levels. Hang in there, the longer you do it, the easier it gets.


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JDRF joins forces for Connect Immune Research project to tackle autoimmune conditions

A collection of charities representing people with autoimmune conditions have joined forces to launch a research project to understand the conditions, of which type 1 diabetes is one.
The UK has a high number of people diagnosed with autoimmune conditions, which include rheumatoid arthritis, celiac disease, multiple sclerosis and Addison’s disease in addition to type 1 diabetes and many others.
Autoimmune conditions are those whereby the immune system targets apparently healthy cells within the body. To date, there are only theories as to why the immune system can act in this way.
The research project, known as Connect Immune Research is a collaboration of three charities; type 1 diabetes research charity, JDRF, multiple sclerosis charity, the MS Society, and arthritis charity, Versus Arthritis in the project. The initiative is also supported by the British Society for Immunology and the Medical Research Council and Wellcome supported its development.
One of the first trials to be run as part of the project is a study into interferons, which are signalling proteins which play an important role within the immune system. Interferons are a particular area of interest in understanding type 1 diabetes as well as other autoimmune diseases.
The interferon study will be led by the University of Edinburgh’s Professor Yanick Crow and will aim to understand more about the role of interferons in autoimmunity.
It is believed about four million people in the UK have an autoimmune condition, including 400,000 people with type 1 diabetes. Almost a third of those with one of these conditions, also have another.
Karen Addington, JDRF’s chief executive in the UK, said: “Autoimmune conditions all involve the immune system acting inappropriately, so we know they are connected. But researchers investigating different autoimmune conditions are not. Until now they have largely worked separately, focused on the specific conditions rather than the interconnected factors of autoimmunity.
“By bringing them together, we can more find information about these conditions – meaning reduced costs, and more new treatments, faster. One insight into one condition could act as a skeleton key, unlocking a range of treatments and even cures.”
Director of research at Versus Arthritis Dr Stephen Simpson said: “The immune system continues to intrigue us and as we get closer to finding ways of moderating its response in inflammatory arthritis, new and unexpected challenges emerge. This is why it’s important for charities and scientists to come together in this way and look at autoimmune conditions collectively, as well as focusing on specific conditions.”
The MS Society’s director of research Dr Susan Kohlhaas added: “Autoimmunity needs to be recognised as a distinct area of research science, alongside the likes of cancer, infectious disease and dementia. We’re driving research into more and better treatments all the time, but autoimmunity must be supported to stand on its own and grow as a research area.”
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Rugby player with type 1 diabetes in FreeStyle Libre mission

Worcester Warriors player Chris Pennell, who has type 1 diabetes, is calling on NHS bosses in his county to end the FreeStyle Libre postcode lottery.
The fullback self-funds the flash glucose monitoring system and says it has transformed his life.
Abbott’s FreeStyle Libre, which eliminates the need for regular finger prick testing for blood glucose levels, became available to the NHS from November last year, subject to decisions at a local level.
Two out of three NHS Clinical Commissioning Groups (CGGs) in the country now offer the technology. This however leaves people living in the other one in three CCGs, including Worcestershire, unable to access the system unless they pay for it themselves.
The rugby star says decision makers at the CCGs in Worcestershire should act swiftly by allowing the health service to prescribe the device because it “saves lives”.
The 31-year-old, who lives in the city, told Worcester News: “This could save lives. The impact it made on my life was enormous in terms of getting to grips with my diabetes management. It allows you to see early if your glucose is going to rise. Over two thirds of the country have access to Libre, we are lagging behind.”
A former captain of his club, the sportsman was diagnosed with type 1 diabetes in 2007.
Speaking about how the technology revealed he was dropping into hypoglycemia in the night, he said: “If I had not [realised], the risk of me having some kind of bad complication was pretty high.”
He believes the FreeStyle Libre will help the NHS to save money because it allows people with diabetes to look after themselves better, reducing the risks of diabetes complications.
Healthwatch Worcestershire is backing the rugby player and is calling on people living in the county with diabetes to come forward and add their names to the campaign.
Speaking to Worcester News, its chief operating officer Simon Adams said: “The benefits are obvious to the layperson but Worcestershire CCGs [Clinical Commissioning Groups] are one of the few CCGs that have refused to fund it.
“To the layperson it appears to be a common-sense solution to managing a complex condition which is absolutely in line with the CCGs policy on self-care and management of conditions and the health minister’s commitment to a digital NHS.”
But a Worcestershire CCGs spokesman said: “Currently the three Worcestershire CCGs do not commission the use of flash glucose monitoring devices. In Worcestershire, the process used to decide which medicines (including appliances such as blood glucose testing equipment) are approved for NHS funding is managed by the Worcestershire Area Prescribing Committee (APC).
“This committee, to date, concludes that there is insufficient evidence to support use of any flash glucose monitoring device at the current time. The situation will continue to be monitored as more data is published.”
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NHS audit reveals importance of preventing diabetes-related complications

The importance of reducing the risk of diabetes-related complications has been emphasised after new data was revealed by the NHS.
The NHS National Diabetes Audit is one of the largest annual clinical audits worldwide, integrating patient information from primary and secondary care practices to assess how care could be improved.
This year’s audit has been released, and it contains an important finding: each week, 500 deaths from avoidable complications such as kidney disease and sight loss could be prevented among people with diabetes.
Over the last three years, deaths from preventable diabetes-related complications have increased by roughly 10%.
This is undeniably concerning information, but it hopefully highlights how complications are indeed preventable.
People with diabetes can reduce their complications risk through focusing on positive changes to health, such as restricting sugar intake. These days many of us do not realise how much sugar is being sneaked into foods by manufacturers.
Getting regular exercise is too beneficial for all-round health and your health team can help you choose a level of activity that is appropriate for you.
Charity Diabetes UK has called on NHS England to continue to improve the quality of local diabetes services, which it has been doing through the Diabetes Transformation Fund.
Since 2017, the NHS Diabetes Transformation Fund has invested more than £80 million across England to improve diabetes care.
The charity stressed that while good work is being done, the statistics revealed in the National Diabetes Audit highlight how the NHS needs to help curb the growing numbers of preventable deaths as a matter of urgency.
Editor’s note: Eating a low carb diet has been shown to have heart health benefits and our award-winning Low Carb Program has helped people with diabetes lose weight, reduce their HbA1c levels and even put type 2 diabetes into remission.
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In This Issue of Diabetes

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Hepatic Insulin Clearance in Regulation of Systemic Insulin Concentrations–Role of Carbohydrate and Energy Availability

Hyperinsulinemia is the hallmark of insulin resistance in obesity, and the relative importance of insulin clearance, insulin resistance, and insulin hypersecretion has been widely debated. On the basis of recent experimental evidence, we summarize existing evidence to suggest hepatic insulin clearance as a major and immediate regulator of systemic insulin concentrations responding within days to altered dietary energy and, in particular, carbohydrate intake. Hepatic insulin clearance seems to be closely associated with opposite alterations in hepatic lipid content and glucose production, providing a potential mechanistic link to hepatic insulin sensitivity. The molecular regulation of insulin clearance in the liver is likely to involve changes in insulin binding and receptor internalization in response to the dietary alterations, the molecular mechanisms of which await further research.

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Developmental Programming of Obesity and Diabetes in Mouse, Monkey, and Man in 2018: Where Are We Headed?

Childhood obesity and its comorbidities continue to accelerate across the globe. Two-thirds of pregnant women are obese/overweight, as are 20% of preschoolers. Gestational diabetes mellitus (GDM) is escalating, affecting up to 1 in 5 pregnant women. The field of developmental origins of health and disease has begun to move beyond associations to potential causal mechanisms for developmental programming. Evidence across species compellingly demonstrates that maternal obesity, diabetes, and Western-style diets create a long-lasting signature on multiple systems, including infant stem cells, the early immune system, and gut microbiota. Such exposures accelerate adipogenesis, disrupt mitochondrial metabolism, and impair energy sensing, affecting neurodevelopment, liver, pancreas, and skeletal muscle. Attempts to prevent developmental programming have met with very limited success. A challenging level of complexity is involved in how the host genome, metabolome, and microbiome throughout pregnancy and lactation increase the offspring’s risk of metabolic diseases across the life span. Considerable gaps in knowledge include the timing of exposure(s) and permanence or plasticity of the response, encompassing effects from both maternal and paternal dysmetabolism. Basic, translational, and human intervention studies targeting pathways that connect diet, microbiota, and metabolism in mothers with obesity/GDM and their infants are a critical unmet need and present new challenges for disease prevention in the next generation.

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Mitochondrial ADP Sensitivity and Transport: New Insights Into Diet-Induced Mitochondrial Impairments

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Exosomes or Microvesicles, a Secreted Subcellular Organelle Contributing to Inflammation and Diabetes

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Sydney GP loses appeal over insulin murder

A Sydney doctor has lost an appeal against his conviction for the murder of his second wife with a lethal dose of fast-acting insulin.
Brian Kenneth Crickitt, 65, was jailed for a minimum of 20 years in May 2017 after being found guilty of killing his wife, Christine Crickitt. The murder took place shortly before or after New Year in 2010, at the couple’s home in Woodbine, South-West Sydney.
It was originally found by the trial judge that Crickitt spent the night with his new lover, Linda Livermore, after allegedly administering the injection. The judge also found that Crickitt’s increasing dislike of his wife and new attraction to Ms Livermore provided a motive for the murder.
Crickitt was supported by his third wife, Julie Crickitt, throughout his trial.
Crickitt was found to have performed two internet searches on insulin overdose in the days prior to the murder. The trial judge also found that he had improperly used a prescription he had written for a patient with diabetes to obtain fast-acting insulin from a pharmacy.
The autopsy could not conclude the cause of death, however the judge ruled out suicide and accidental death, ultimately finding the overdose of insulin to be responsible.
Crickitt’s appeal argued that medical experts could not determine his wife’s cause of death and that the verdict was unreasonable and unsupported by evidence.
The appeal court was required to decide if the Crown had proven in the trial, beyond reasonable doubt, that Crickitt was responsible for the death of his wife and so, if the trial judge had made the correct ruling.
The court ultimately rejected all grounds of the appeal, concluding that “in this case, it was well open to the trial judge to infer from the facts that he found that the applicant deliberately and intentionally caused the death of the deceased by administering insulin to her.”
A number of healthcare professionals have been convicted of causing death deliberately with insulin. Thankfully, this form of murder is limited to very rare cases.
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