Total Care Podiatry

A new study led by York University researchers finds that young athletes with Type 1 diabetes may experience a marked decrease in performance as a result of their blood sugar levels.

The study, published in the International Journal of Pediatrics, reports that participants’ athletic prowess was sapped by low blood glucose, a condition known as hypoglycemia. Their cognitive abilities also declined as a result.

“Physical activity itself is unfortunately one of the factors that can cause this dip in blood sugar to occur,” says lead researcher Michael Riddell, associate professor in York’s School of Kinesiology & Health Science, Faculty of Health.

“Parents tend to get quite concerned about this, understandably so,” says Riddell, who was diagnosed with the disease at age 14 and regularly engages in competitive sports. “They wonder, ‘should I have my child enrolled in sports at all? Is vigorous activity safe?’ Our results show that those with diabetes can compete on equal ground, provided they learn to manage their condition.”

The study is the first to examine these interactions in a real-life setting. Researchers outfitted participants with 24-7 glucose monitors during a week-long diabetes sports camp at York University, testing their skills in tennis, basketball or soccer at various times during the day and recording blood sugar levels. Participants, who ranged in age from 6 to 17, were even monitored as they slept using this new technology. Data for the study was recorded during last summer’s camp; it will run again this year starting July 19.

Researchers found that sport skill performance was highest when blood glucose values were in a “normal” glycemic range. During hyperglycemia – or elevated blood sugar – results were only slightly reduced. This occurred nearly universally across all participants, however results suggest the degree to which one’s sport performance deteriorates depends on the individual.

“Some subjects showed only minor reductions in performance with hypoglycemia while others showed much greater impairment,” Riddell says. “This could be related to the level of blood glucose concentration, the rate at which glucose drops, and the individual’s capacity to maintain focus in the face of all these factors.”

Regular exercise is known to be beneficial for people with diabetes, but can make glycemic control challenging. This balance is even more difficult to achieve in adolescents, as insulin requirements are influenced by fluctuating nutritional intake, physical activity levels, and the rhythms of other anti-insulin hormones. Adding to the confusion is that the symptoms of low or high blood glucose are often masked by exercise, because they’re so similar: increased heart rate, sweating, shakiness, fatigue and dehydration.

“Any obvious issues with performance – poor passing, failed free throws and serves – that are really out of the ordinary should be a warning sign to check blood glucose levels and add carbohydrates,” Riddell says. The best way to boost blood sugar levels is to consume about 15-30 grams of a fast-acting carbohydrate, such as dextrose tablets, juice or a sports drink. “These are rapidly absorbed and immediately replenish the very small reserve of glucose normally found in the blood stream,” he says.

Incidents of moderate to severe hypoglycemia were common on the evenings following sports camp participation. However, researchers found no evidence that a bout of nocturnal hypoglycemia influences sport skill performance the following day. Cognitive testing also showed that participants’ reading ability was lower during episodes of hypoglycemia, as was the ability to distinguish and name colours.

Riddell notes the importance of conducting this type of field research, as opposed to lab-based studies. “Actually playing a sport involves different cognitive processing, reaction time and motor skill performance,” he says.

The paper:
“Blood glucose levels and performance in a sports camp for adolescents with type 1 diabetes mellitus: A field study” is co-authored by Dylan Kelly, a McMaster University undergraduate student under Riddell’s supervision, and Dr. Jill Hamilton, pediatric endocrinologist, The Hospital for Sick Children, University of Toronto.

The research was supported by the Natural Sciences and Engineering Research Council of Canada (NSERC), Medtronic Canada and Can-Am Care.

Source:
Melissa Hughes
York University

Article Date: 16 Jul 2010 – 0:00 PD

The alarming increase of morbidly obese diabetics is causing more new cases of a debilitating foot deformity called Charcot foot.

Charcot foot can make walking difficult or impossible, and in severe cases can require amputation.

But a surgical technique that secures foot bones with an external frame has enabled more than 90 percent of patients to walk normally again, according to Loyola University Health System foot and ankle surgeon Dr. Michael Pinzur. Pinzur, one of the nation’s leading surgeons who treat Charcot foot, describes the device in the journal Hospital Practice.

The device, called a circular external fixator, is a rigid frame made of stainless steel and aircraft-grade aluminum. It contains three rings that surround the foot and lower calf. The rings have stainless-steel pins that extend to the foot and secure the bones after surgery.

The fixator “has been demonstrated to achieve a high potential for enhanced clinical outcomes with a minimal risk for treatment-associated morbidity,” Pinzer wrote. Pinzur treats about 75 Charcot patients per year with external fixators. Most of these patients are diabetics.

Charcot foot can occur in a diabetic who has neuropathy (nerve damage) in the foot that impairs the ability to feel pain. Charot foot typically occurs following a minor injury, such as a sprain or stress fracture. Because the patient doesn’t feel the injury, he or she continues to walk, making the injury worse. Bones fracture, joints collapse and the foot becomes deformed. The patient walks on the side of the foot and develops pressure sores. Bones can become infected.

The obesity epidemic is increasing the incidence of Charcot foot in two ways. The excess weight increases the risk of diabetic neuropathy, as well as the risk that patients with diabetic neuropathy will develop Charcot foot.

There has been an alarming increase in morbid obesity among diabetics. About 62 percent of U.S. adults with Type 2 diabetes now are obese, and 21 percent are morbidly obese, according to a 2009 study by Loyola kidney specialist Dr. Holly Kramer and colleagues published in the Journal of Diabetes and its Complications.

Morbid obesity is defined as having a body mass index (BMI) greater than 40. For example, a person who is 5-foot, 10-inches tall and has a BMI of 40 weighs 278 pounds.

Traditional surgical techniques, in which bones are held in place by internal plates and screws, don’t work with a subset of obese Charcot patients. Their bones, already weakened by complications of Charcot foot, could collapse under the patient’s heavy weight.

A common treatment in such cases is to put the patient in a cast. But bones can heal in deformed positions. And, it is difficult or impossible for obese patients to walk on one leg when the other leg is in a cast. Patients typically have to use wheelchairs and are confined to the first story of the house for as long as nine months. And after the cast comes off, they must wear a cumbersome leg brace.

By contrast, patients who are treated with an external fixator often are able to walk or at least bear some weight on the treated leg. The device is attached to the leg for only two or three months.

A 2007 study by Pinzer, published in Foot & Ankle International, demonstrated the benefits of the external fixator. Pinzur followed 26 obese, diabetic Charcot foot patients who had an average body mass index of 38.3. After surgery to correct the deformity, the foot bones were held in place by the external fixator. A year or more later, 24 of the 26 patients (92 percent) had no ulcers or bone infections and were able to walk without braces, wearing commercially available shoes designed for diabetics.

Pinzur is a professor in the Department of Orthopaedic Surgery and Rehabilitation at Loyola University Chicago Stritch School of Medicine.

Source:
Jim Ritter
Loyola University Health System

Article Date: 15 Jun 2010 – 0:00 PDT

Nearly half (42 per cent) of people still think eating too much sugar causes diabetes and a quarter (25 per cent) of people object to people with diabetes injecting insulin in public, according to a survey by Diabetes UK.

Diabetes UK is concerned that findings from our Diabetes Myths survey, which questioned 2,032 people, show that some beliefs are still worryingly widespread. We want to kick start Diabetes Week (13 – 19 June) by raising awareness of diabetes and dispelling the myths that still surround the condition.

Simon O’Neill, Director of Care, Information and Advocacy Services at Diabetes UK, explains: “These sorts of myths are not helpful and can lead to discrimination and bullying. Sadly, we often hear of children who are bullied at school because their peers believe they’ve brought their diabetes on themselves from eating too many sweets. People with diabetes have a hard enough time living with their condition without being made to feel ashamed or different from their peers.”

Fact over fiction

Diabetes is caused by a combination of genetic and environmental factors. Sugar does not cause diabetes. However, eating a diet high in sugar can cause people to become overweight which increases the risk of developing Type 2 diabetes.

O’Neill continues: “Diabetes UK is appalled that some people object to injecting in public. For people who treat their diabetes with insulin, this is not a choice – insulin keeps them alive and injections have to be administered at specific times. People should be able to inject in public without fear of being mocked or shunned by those around them.”

The survey also discovered that 50 per cent of people think that people with diabetes benefit from food and drink labelled “suitable for diabetics”.

The truth about diabetes

O’Neill explains: “Diabetic foods have no extra nutritional value and are more expensive. Diabetes UK advises that people with diabetes have the same healthy, balanced diet (that is low in fat, sugar and salt) as people without the condition. We are calling for an end to the use of the terms ‘diabetic foods’ and ‘suitable for diabetics’ on food labels altogether.

“Diabetes UK is hoping to destroy these myths by shedding light on them and replacing them with the truth – it is vital that people with and without diabetes have accurate information about the condition.”

Other diabetes myths include:

- Type 2 diabetes is mild diabetes
- If you have diabetes you can’t drive
- People with diabetes can’t play sport

Source
Diabetes UK

Diabetes (diabetes mellitus) is classed as a metabolism disorder. Metabolism refers to the way our bodies use digested food for energy and growth. Most of what we eat is broken down into glucose. Glucose is a form of sugar in the blood – it is the principal source of fuel for our bodies.

When our food is digested the glucose makes its way into our bloodstream. Our cells use the glucose for energy and growth. However, glucose cannot enter our cells without insulin being present – insulin makes it possible for our cells to take in the glucose.

Insulin is a hormone that is produced by the pancreas. After eating, the pancreas automatically releases an adequate quantity of insulin to move the glucose present in our blood into the cells, and lowers the blood sugar level.

A person with diabetes has a condition in which the quantity of glucose in the blood is too elevated (hyperglycemia). This is because the body either does not produce enough insulin, produces no insulin, or has cells that do not respond properly to the insulin the pancreas produces. This results in too much glucose building up in the blood. This excess blood glucose eventually passes out of the body in urine. So, even though the blood has plenty of glucose, the cells are not getting it for their essential energy and growth requirements.

Why is it called Diabetes Mellitus?

Diabetes comes from Greek, and it means a siphon. Aretus the Cappadocian, a Greek physician during the second century A.D., named the condition diabainein. He described patients who were passing too much water (polyuria) – like a siphon. The word became “diabetes” from the English adoption of the Medieval Latin diabetes.

In 1675 Thomas Willis added mellitus to the term, although it is commonly referred to simply as diabetes. Mel in Latin means honey; the urine and blood of people with diabetes has excess glucose, and glucose is sweet like honey. Diabetes mellitus could literally mean “siphoning off sweet water”.

In ancient China people observed that ants would be attracted to some people’s urine, because it was sweet. The term “Sweet Urine Disease” was coined.

There are three main types of diabetes:

Diabetes Type 1 – You produce no insulin at all.
Diabetes Type 2 – You don’t produce enough insulin, or your insulin is not working properly.
Gestational Diabetes – You develop diabetes just during your pregnancy.

(World Health Organization)

Diabetes Types 1 & 2 are chronic medical conditions – this means that they are persistent and perpetual. Gestational Diabetes usually resolves itself after the birth of the child.

Treatment is effective and important

All types of diabetes are treatable, but Type 1 and Type 2 diabetes last a lifetime; there is no known cure. The patient receives regular insulin, which became medically available in 1921. The treatment for a patient with Type 1 is mainly injected insulin, plus some dietary and exercise adherence.

Patients with Type 2 are usually treated with tablets, exercise and a special diet, but sometimes insulin injections are also required.

If diabetes is not adequately controlled the patient has a significantly higher risk of developing complications, such as hypoglycemia, ketoacidosis, and nonketotic hypersosmolar coma. Longer term complications could be cardiovascular disease, retinal damage, chronic kidney failure, nerve damage, poor healing of wounds, gangrene on the feet which may lead to amputation.

Taken from Medical News Today Website