News Snippet: Reversing Type II Diabetes?

I was intrigued by this recent article explaining a journalist’s experience at suppressing his newly-diagnosed Type II diabetes in an attempt to cause it to fully subside, thus ‘curing’ him of diabetes.

What is diabetes?

Diabetes mellitus (full name) is a condition which affects the body’s insulin levels enabling higher than normal glucose levels in the blood. This can cause a multitude of complications long-term such as problems with the kidney, eyes, feet, due to ineffective blood circulation.

Type II diabetes I is strongly associated with obesity and low rates of physical activity and is also known as ‘maturity onset’ diabetes as is most common in the over-40s. This is to distinguish it from type I which is characteristically diagnosed in young children, known also as ‘early-onset’ diabetes. The two types of diabetes differ in their physiological mechanisms which cause a rise in blood glucose level.

Insulin is a hormone produced and secreted from the beta-cells in the pancreas. Its mode of action stimulates increased uptake of glucose by the liver and conversion into its stored form, glycogen. Homeostasis regulates this process so that when glucose levels in the blood are higher than normal, more insulin is secreted so that more glucose is converted into glycogen, thus reduced the levels of glucose in the blood back to ‘normal.’ This is shown in top half of the diagram below (the bottom half shows the mechanism to increase blood glucose levels).

Essentially insulin is a key component in regulating glucose levels in the blood.

In type II diabetes, either:

- The body either does not produce enough insulin to regulate glucose

- The body becomes resistant to insulin and therefore it is less effective in regulating glucose

- Or it develops due to a combination of the above

Therefore treatment focusses on managing the glucose levels in the blood to the normal range.

How can it be treated?

A routine blood test called the HbA1c test records the glucose levels to monitory change, though the recommended average values will inevitably differ with many factors such as age, type of diabetes, general health and so on.

The following treatments are shown in typical chronological order:

- Lifestyle and dietary changes: Glucose is obtained through starchy and sugary foods, therefore eating low fat and sugar content foods as well as implementing regular physical activity may be enough to reduce glucose levels in some individuals as being overweight with abdominal fat distribution is the greatest risk factor for type II diabetes.

- Reduce other risk factors: smoking and high blood pressure are also modifiable risk factors

- Medication: there are many types which aim to boost insulin production in the pancreas or reduce glucose absorption, forms of insulin can also be given. This is dependent on the individual and a combination of treatments may be used, however in all cases they require very careful monitoring and committed adherence by the patient.

Reversing Type II Diabetes? 

The Guardian article mentions a research paper which was undertaken at Newcastle University published in 2011 which claims its results show reversal of pancreatic beta-cell failure and insulin resistance (ie. both causes of type II diabetes). The study only had 11 participants with relatively newly diagnosed diabetes (within the last 4 years) who were given a strict dietary regimen consisting of a highly nutritional liquid formula subsidised with three non-starchy vegetable meals per day. The participants were also encouraged to drink at least 2 litres of water per day (which can be a useful tool for suppressing hunger pangs) and maintain their normal physical activity rates.

Within a week of this dietary intervention, the blood glucose levels of the participants had decreased by almost half. The liver’s insulin resistance reacted quicker to this dietary intervention (reduced to normal within 7 days), with the pancreatic beta cell function changing gradually back down to normal over the whole study period of 8 weeks. The study concluded that the success of the results was due to the reduction in liver and pancreatic fat.

However further research needs to be undertaken to support these conclusions more strongly, as well as study into what time-frame this seeming reversibility would still occur (ie. only in newly diagnosed diabetics of less than 4-5 years, or possibly longer?). I would also be very interested in the follow-up of these patients and how their lifestyle and blood glucose levels fair within the next few months and years to see whether the reversibility is long-term and definitive for them.

The bottom line

As Richard Doughty, the author of the original article discovered, there have been many people who have successfully tried limiting their diet more extremely (in accordance with this study method) with good anecdotal results. If anything, this method is simply a more radical approach to the general advice a GP may give on eating healthily and increasing physical activity. An important point to bring up is that clearly not everyone with the risk factors develops diabetes and others who don’t have any (Doughty presents himself as a fit and healthy individual) may also be subject to this, therefore changes in diet and physical activity will be according to the patient’s normal routine. However the difficulty comes afterwards as Doughty writes, how permanent if at all will this ‘solution’ be? In my opinion, it is most definitely worth a shot if you have the determination to drastically change the way you eat for a duration of time and be committed to a lifelong ‘healthy diet’ instead of being committed to taking medication for a chronic disease that can progress with complications later in life.

Further Reading:

Patient UK summary about Type II diabetes

NHS diabetes page with detailed information about symptoms, diagnosis etc. and checking if you are risk

Research trial paper in full led by Professor Roy Taylor at Newcastle University

Powerpoint presentation of the above research paper

My End of First-Year Thoughts on ‘Living Away from Home’

Since I am nearing the end of my first year studying Medicine, I thought I’d do a mini series of posts on ‘My End of Year Thoughts on…’ since I feel in some ways, I have changed quite a lot as a whole university year (especially the first) gives you the chance to consider different perspectives on a whole range of topics. I thought I’d start with ‘living away from home’ as it’s one I feel I given a lot of thought to as I have felt definite changes in my attitude about this during the year.

September 2012

Moving away from home for university in September was a strange experience for me. For the most part, I was very excited, I had been making endless lists like a crazy person since summer when my university offer was finalised about what to bring and important details to remember, after all I was going to be starting my dream course. Once I was packed, I had the satisfaction of ticking off things I’d done, that literally gave me so much joy.

Anyway, the journey to my halls was pretty good, my family drove me here and it was a lovely sunny day. But as I got closer to actually formalising my living accommodation and collecting the key, I was beginning to feel a bit more hesitant by the minute, no more so than when I turned the key in the lock and opened the door to my dungeon  room. It looked all grey and miserable (not helped by my annoying North-facing window) and smelt funny; when I tried to open the window, I discovered it only opened about the length of a mini 15cm ruler at most – that’s what you get for being allocated to the ground floor. It was not what I had been expecting. Anyway, I didn’t say much about it and as a family, we went out for a lovely family meal at an Italian restaurant. By this point, the realisation that I was actually going to be all alone in my grey room dawned on me. My siblings took to arguing and I just sort of sat there, a bit quiet. The food was yummy, but it didn’t make me feel any better. At the same time, I didn’t want to leave my family thinking I was all sad so I tried to make some sort of excuse, but it’s quite difficult to hide things from the people you know well.

So that evening, I unpacked my things which made the room seem more ‘me’ and tried to get to sleep. My family stayed the night at a hotel before driving back the next day, we met up for breakfast (after about an hour of getting lost and not being able to find each other) and it’s strange, I don’t even remember saying goodbye, or the actual moment when they left. I do have a tendency to sort of erase bad memories (that’s the optimist in me) so it’s not unusual for me to only remember the ‘happy parts’. That being said, I also have an appalling memory, that might have something to do with it too.

(First Term) October-December 2012

This was basically just me settling in to a new routine and life. I had lots of fun buying my own groceries and collected my Tesco club card points (sad I know), washing dishes for only one, and just chilling by myself. I stopped having to take a map with me everywhere which was good and found some lovely spots for running. In retrospect, I think that I was pretty happy this term because the novelty of living my oneself was still evident in me. I chatted to my family on the phone/skype quite regularly and had plenty to tell but wasn’t really ‘missing’ them as perhaps I’d expected to, maybe just missing having people to chat to.

Christmas Holidays 2012-2013

I went home for Christmas and got to see everyone.

(Second Term) January-March 2013

This was the bad term, let’s just say that upfront. I failed a major exam, which definitely knocked my confidence hugely. I think the reason I had been so content living by myself was because I had the comfort of knowing it was good for my studies and I was coping well. Failing an exam however made me question my ability (a lot) to do the course I’d worked so hard to get into – studying was the one thing that I knew if I worked hard enough, I could do (at least to an average standard). With that gone, I definitely missed having the support of others. In the months leading up the Easter holidays, I definitely was missing home a lot more. Couple that with having another exam just before Easter and I was not in the best shape, emotionally or physically for that matter. As I am quite an optimistic and generally happy person, it was very odd to feel so down-hearted (not to a large extent, but just in comparison to be ‘usual self’) – I feel that I lost some of my momentum and motivation too. Talking to family just made me even more upset sometimes, and I literally cannot remembering crying so much ever (probably about five times that term) just from talking on the phone, I was an emotional wreck. I did not like this ‘new me’ at all – I am a bit of a control-freak but I definitely did not feel in control then.

  

Easter Holidays 2013

This was my favourite holiday and I enjoyed it more than Christmas (I know!). Though it was short, I felt like I got a lot done but also had the chance to relax a bit. I’m sure to my family I seemed like a huge chatterbox though – their theory was that since I had no one to talk to at university, I suddenly sort of ‘burst’ out with everything to them, sorry!

(Third Term) April-June/July 2013

My best term. I feel great, probably boosted by having a good exam result in April. I do have scary upcoming exams but I feel much more self-assured and think I’ve got a good balance now.

This was my own personal experience and so it is by no means reflective of everyone else, in fact, I’m probably in the minority. So of course, living away from home can be a very strange experience, but overall, I think I’ve accomplished it ( I know it’s not really a ‘task’ as such, but you know what I mean) in my own way.

Please feel free to leave comments below (it doesn’t take long), I would love to hear from you:

> What was your experience of first living away from home like?

> What, if anything, would you have done differently?

> What advice would you give others entering this position? 

I don’t think I would have done anything different, everyone always says ‘be really friendly’ and ‘meet new people’, but I’m not really a ‘people person’ in that way and am not the type to deliberately make the effort to initiate that, but that’s fine – I’m content the way I am. But my advice to others would be to form some kind of support network, or at least a key person who you can turn to when things don’t pan out the way you want.  My other piece of advice would be to ‘make nice’ with your flatmates, there will undoubtedly be times when you need to borrow something, call someone, or get them to let you in because you’ve forgotten your key – in these situations, it’s nice to have a friendly face to call to help.

Technology Woes…

So there I was, working to plan and the day after my previous blog-post my computer decided to play up. I mean BIG-TIME. Like not being able to access anything –  not exactly great for my essay deadline that was looming closer. My word of warning to you boys and girls is always ALWAYS back-up your most important files and documents. I knew this already and wasn’t exactly a computer-newbie. But I just didn’t think much could happen on my computer so never even thought twice to save my essay elsewhere, now I know better. Luckily it all got fixed and my essay has been submitted, though I remain multiple pounds lighter in the pocket. Nonetheless I am glad it made me realise not to get complacent with technology as ultimately everything has a life-span and even computers have their ‘off days’…

Heart to heart

The study unit that I am undertaking at the moment is in the broad topic of cardiology which encompasses the study and care of the heart as well as treating disorders involving it.

The focus of the diagnoses were on ischaemic heart conditions (narrowing of the heart vessels) generally caused by progressive atherosclerosis and coronary heart disease. The symptoms of this include severe chest pain, shortness of breath and worsening pain on exertion, which could then manifest into angina and an MI (myocardial infarction) when coronary arteries become stenosed or occluded.

How coronary artery disease progresses…

Treatment for these occurrences involve drug therapy which may include thrombolytics, anticoagulants, and various drugs to slow and control the heart rate. There is also the option for surgery such as a CABG (coronary artery bypass graft) which is the ‘gold standard’ for severe coronary artery disease as well as angioplasty which involves using a stent to balloon up a stenosed/narrowed vessel to increase the blood and oxygen flow to the heart again. Coronary arteries are incredibly important as they supply the heart with blood and oxygen, enabling it to carry out its important function of pumping the systemic blood around the body.

A image demonstrating the three types of grafts that can be harvested for a coronary artery heart bypass and how they can bypass the damaged coronary arteries by anatomising at various points.

Angioplasty involves inserting stents, ballooning them up to expand and filling the vessel circumference so they remain firmly fixed in place.

One of our scheduled sessions was on cardiac medical imaging which involved looking at a lot of CT and MRI scans in a number of different planes trying to identify the diagnoses as well as some angiograms. We were also able to  see narrowed vessels on these images and try to identify which coronary artery was in trouble whilst revising our knowledge of anatomy. This day was actually very helpful for focussing my learning on the heart (which we’d covered before Easter) and clinical presentation and diagnoses of conditions which can arise from heart problems. We also had a chance to have a go on an echo-cardiogram which was used on a simulated ‘patient’ to view the heart with a different imaging technique which was also really interesting to try.

The yellow arrow points to calcification of a coronary artery (basically the whiter section) – it can be difficult to tell from one image but looking through the complete set of images from the chest CT scan would enable diagnoses as to which coronary artery is damaged.

This week we had the opportunity to go to the cardiothoracic theatres at the local hospital. I managed to see some transcatheter aortic valve replacement (TAVI) procedures which involved feeding the small valve folded up through the femoral artery in a catheter and into the aorta to be expanded. They don’t even remove the old damaged valve, they just squish it with the new valve as it balloons open. Huh. They can also take the valve trans-apically through the septum of the heart which is a bit more of a short-cut.

I also got the chance to see an open heart bypass which was very exciting especially since I had a front-row seat! You could see them harvesting (this always makes me feel a bit weird because I associate it with collecting food not blood vessels but that’s how it’s described) the grafts. The patient we saw had two vein grafts from each leg and the left internal mammary artery taken out as he had three stenoses/occlusions to repair which we saw beforehand on the angiograms. Aside from the sternotomy part (sawing open and bolting back together with thick metal wire), the operation was pretty delicate and the consultant actually only came in once the ‘prep-work’ grafts had been harvested so he could attached them to the damaged coronary arteries. He was extremely friendly and explained what he was doing – it’s kind of cool being the consultant, you get to turn up only when you need to and choose the background music.

Seeing this bypass kind of re-inspired my interest in surgery – I had been really interested in it before applying to medical school but everyone tends to think it’s one of the ‘cool’ jobs even though I had been in theatre once before, but then in medical school you are always being told surgery is extremely competitive and difficulty to get into. Obviously as a pre-clinical medical student, I don’t really need to be thinking that far ahead but it’s nice to have a few areas of interest so that I could potentially try and do projects/essays in those areas.

Other than that I am nearly done on my essay and trying to fit in some revision in between.

Home Sweet Home

So my blog has been feeling a little neglected as of late – so here I am, back to get into my usual routine of posting weekly (I hope!). Just a quick word on the holidays for today.

Mine are not very long but it was definitely really great to get back home and spend time with my family. At the end of last term I was feeling a little down, perhaps just out of missing home – my family, not the house. I hadn’t really felt like that before as my first term was pretty jam-packed but I think that having slow weeks really gives you time to think and wonder a lot… Anyway, the holiday weeks went by unbelievably fast but I had such a good time that I think it will banish any ‘home woes’ for sure. I feel great to be back and studying again (my mother can attest to my slothy ways over the Easter break) -

The thing about being back at university is that my main priority here is to study (although the motivations of some fellow students could perhaps be misinterpreted…); at home, there are just far too many distractions especially since everyone seems to congregate in the living room all the time. So in a way I do really relish being back in my lonesome little room as it is far more productive for me and also I sensed the rest of the family were getting a bit tired of my ‘In your face!’-ness 24/7.

It is also interesting to see the changes in your ‘family balance’ I guess you could call it – since I am only really living at home during my sparing holidays and of course the long summer to come, I have begun to feel more of a spectator in terms of usual ‘family life’, ie. I don’t participate in the everyday goings-on of the home, just mainly the ‘eventful’ stuff. Also as I have younger siblings, they change quite a bit sometimes as does my relationship with them (generally for the better I can safely say). It also makes me think about what happens when I move out for good (that’s quite some time away though) and you get less and less involvement with the everyday things – that’s not to say that I wouldn’t also be hugely excited at the prospect of having a place where everything is just the way I like it, because that would be pretty cool.

Anyway I think that’s enough rambling for now about my pretty uneventful holidays – in terms of university, I just can’t believe I have nearly finished my first whole year at medical school! I am currently on another self-study unit and at last, I can get to grips with something science-y compared to last time – this one is all about cardiology and is super interesting (but that’s for another blog post). So yay, here’s to another chilled month or so whilst I’m off my usual timetable and trying to construct a decent essay, revise for upcoming summer exams and prepare for a clinical exam too!

P.S. For those of you who read this blog post on my failed exam last term (and thank you to all the lovely people who took the time to comment), I am extremely happy to let you know that I upped my failed mark by doubling it and safely passed the most recent exam. I had definitely been doing a lot more exam focussed revision as well as setting out my goals on a study timetable so was very pleased with the result – huzzah!

A Rehabilitation Centre

So I have been away for a little while (apologies) – mainly preoccupied by exam revision but I’m back again with another blog post. My most recent placement was at a rehabilitation centre for adults with drug and alcohol addictions. The centre was situated quite a deprived part of the city that I had not really seen much of and on the bitterly cold walk there I noticed a lot of the neighbourhood shops and buildings were boarded up. Most service users (as the staff preferred to call them) had been referred onto the centre from their GPs and various other social health networks to try and find a way to deal with and manage their problems. The main aim of the rehabilitation centre was to work towards abstinence by providing group therapy as well as a range of activities to engage them in other outlets. Service users could use the centre and it’s resources for free including a gym (surprisingly this was not as popular as I thought it would be as one of the staff told me that the guys who were ‘high’ didn’t want to sweat it out and lose the effects of the drug in their system), arts and crafts room etc., as well as receive a cooked lunch and snacks throughout the day.

Observing a women’s group therapy session was really interesting as it enabled me to find out a bit more about some of the individual’s backgrounds. It was a very quiet morning and so there were only four women amongst the three staff. The staff were all extremely friendly and had obviously formed good bonds with the women over time so they felt comfortable sharing things. The women were asked to recount their last few days (highs and lows) and the staff prompted other questions to gain a better understanding of their emotions on particular things. I found that all four women were fairly open with everyone which was an integral part of making it a successful session – by communicating with others, the ethos of the centre is that group therapy enables service users to relate to others and offer advice based on their own circumstances so that the journey to abstinence is a shared experience.

However this clearly comes with its downfalls and one problem was the fact that several of the service users had complicated relationships with others at the centre which could sometimes provoke heated debate, especially when coupled with difficult social arrangements at home and substance misuse. The majority of the women had children, however due to their addictions, contact was limited and talking about the recent Mother’s Day really allowed them to open up about their feelings. The staff had mentioned to me that the vast majority of the children of the service users will inevitably have social services strongly involved in their lives and can become exposed to drugs and alcohol misuse at a very early age. Reflecting on this makes you realise the vast array of situations that people live in – drug and alcohol misuse is highly prevalent in deprived social areas and children brought up in environments such as these are far more predisposed to substance misuse; combine that with higher teen pregnancy rates, low rates of unemployment and higher crime rates etc., and it seems like quite a frightening situation to be in. Though these are just generalised statistics, the reality is that people living in these deprived areas are very much existent anywhere in a city or country, and probably account for more patients that you may care to think.

I think that the most important thing is just trying to be understanding and non-judgemental towards them; routine history questions about consumption of alcohol or recreational drugs may be far more sensitive and these should be approached carefully with the view of doing the best for your patient. Personally I was humbled to have the opportunity to visit this rehabilitation centre as it made me a little more aware of the problems that some people face with drugs and alcohol addiction on a daily basis. One woman described looking forward to a family holiday to Butlins with her two sons as she had recently acquired more custodial time with them. Previously she used to really struggle and frequently took amphetamines when looking after them – in group therapy, she proudly told everyone how she had been sober and drug-free the whole 4 days with them, and felt a lot more positive. She recognised that her weakness was the days that she didn’t have her sons with her as now she would never dream of ‘using’ with them around. However planning ahead to the holiday, she realised her she would be sharing a caravan with her ex-boyfriend and new partner who still used drugs in front of his two children. The staff facilitator showed encouragement that she was thinking ahead and together they planned how to broach a conversation where she could share her views on not wanting him to ‘use’ in front of her children and practical arrangements they could sort out.

One final thing that I was surprised to find out was that the service users could ask for rationed vouchers for the food bank – they could use them to receive free bags of canned and preserved food. One of the women said she would be embarrassed being seen inside but the others gave her confidence and said it was a great resource and that lots of people went there. They even gave her practical tips such as to bring a large rucksack to carry the food back in – I didn’t even know what food banks were or that they existed until I saw a recent documentary on poverty in America (I know this may seem like ignorance to some). Sometimes it is difficult to comprehend that in such a developed society you only have to travel a little out of a major city to find people who need a great deal of help just to get by.