As Temps Rise, Risk of Pregnancy Complication May Too

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(*this news item will not be available after 08/13/2017) Monday, May 15, 2017

MONDAY, May 15, 2017 (HealthDay News) -- Outdoor air temperature may influence a pregnant woman"s risk of developing gestational diabetes, a new study suggests.

Mothers-to-be in very cold climes are less likely to develop diabetes during pregnancy than women exposed to hotter temperatures, researchers say.

If borne out in other studies, these findings could have important implications for the prevention and management of gestational diabetes, said study lead author Dr. Gillian Booth.

Changes in temperature may only lead to a small increase in the risk of gestational diabetes, but the number of women affected may be substantial, said Booth. She is a scientist at the Li Ka Shing Knowledge Institute at St. Michael"s Hospital in Toronto.

Also, areas that are getting hotter because of climate change could see more cases of gestational diabetes, the study authors theorized.

Others are less certain of this link, however.

"Temperature and risk of diabetes is a hot topic," said Dr. Joel Zonszein, director of the clinical diabetes center at Montefiore Medical Center in New York City.

However, the study doesn"t show a direct cause-and-effect relationship, and Zonszein cautioned that it"s too soon to consider the findings definitive.

"Pregnant women or those wanting to become pregnant should not pay attention to this finding at this time, as more studies are needed to show a true causal effect," said Zonszein, who wasn"t involved in the study.

Moreover, "the findings of this study do not support that climate change, a rise in global temperatures, increases the incidence of diabetes in Canada or worldwide," he said.

Booth explained that gestational diabetes in women develops in the second trimester of pregnancy and is usually temporary. Women are screened for it at 24 to 28 weeks of pregnancy.

If there is a connection between temperature and gestational diabetes risk, cells called brown fat might help explain it.

According to Zonszein, "Brown fat cells are cells that -- instead of storing energy -- burn energy."

Booth speculated that extreme cold triggers activity of brown fat, thus controlling weight gain. It might even lead to weight loss, improving blood-sugar levels, she noted.

However, Zonszein said that many environmental factors -- such as excessive food intake, sugary drinks, inactivity, stress and lack of sleep -- can cause gestational diabetes in women genetically susceptible to the disease.

"Genetic factors are very important," he said, "and they are affected by many environmental factors, probably temperature is one more."

For this study, the researchers analyzed about 500,000 births in the Toronto area over 12 years. The researchers also looked at the average temperature for 30 days before diabetes testing, then compared temperature readings with results of the diabetes testing.

In women exposed to extreme cold -- 14 degrees Fahrenheit or lower -- in the month before the test, gestational diabetes was less than 5 percent. But it was about 8 percent for women when temperatures averaged 75 degrees Fahrenheit or higher, the findings showed.

Moreover, the odds of developing gestational diabetes rose slightly with every 18-degree rise in temperature, Booth said.

The association held up whether women were born in hot climates or colder regions, she added.

"Furthermore, the same association was seen when we looked at consecutive pregnancies in the same woman," Booth said.

Besides a healthy diet and physical activity to avoid excess weight, controlling temperature might be something women can do for a healthier pregnancy, Booth suggested.

"For example, turning down the thermostat and getting outside in the winter, or using air conditioning in summer, and avoiding excess layers in hot weather may help to lower the risk of gestational diabetes," she said.

An association between temperature and gestational diabetes was also reported last September in a Swedish study. In that paper, researchers found that gestational diabetes was more common in the summer than in other seasons.

Booth said the findings of the new study might also pertain to developing type 2 diabetes.

"The risk factors for gestational diabetes and type 2 diabetes are virtually the same," she said.

The report was published online May 15 in the CMAJ (Canadian Medical Association Journal).

SOURCES: Gillian Booth, M.D., scientist, Li Ka Shing Knowledge Institute, St. Michael"s Hospital, Toronto, Canada; Joel Zonszein, M.D., director, Clinical Diabetes Center, Montefiore Medical Center, New York City; May 15, 2017, CMAJ (Canadian Medical Association Journal), online

HealthDay Copyright (c) 2017 HealthDay. All rights reserved. News stories are written and provided by HealthDay and do not reflect federal policy, the views of MedlinePlus, the National Library of Medicine, the National Institutes of Health, or the U.S. Department of Health and Human Services.

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When Paying for Insurance Makes Paying for Diabetes Supplies Impossible

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The Cost of a Chronic Illness – Tuesday 5/16
Insulin and other diabetes medications and supplies can be costly. Here in the US, insurance status and age (as in Medicare eligibility) can impact both the cost and coverage. So today, let’s discuss how cost impacts our diabetes care. Do you have advice to share? For those outside the US, is cost a concern? Are there other factors such as accessibility or education that cause barriers to your diabetes care? (This topic was inspired by suggestions from Rick and Jen.)

Diabetes is one of the most costly conditions in the US. For many of us who depend on life-saving insulin, the cost can be astronomical every month. With insulin ranging from $200-300 per vial (depending on what type and where you get it) to over $500 per pack of insulin pens, it’s hard to understand how any family can make it when they have to not only pay for the insulin but other supplies like test strips.

I have good insurance now through my husband’s employer, however, it wasn’t always that way for me. I worked a job where there were only 5 employees, and my boss was not required to offer benefits. The plan that was offered was group health insurance through the parent company we worked for, but I paid 100% of the cost. The only thing I could afford on my just-above-minimum-wage paycheck was a premium that was $450 (and this was 10 years ago too), but it also carried a deductible of $2500 – and one that absolutely nothing was covered, not even prescriptions – until this deductible was met. So, if I had even paid for the deductible to even get to the 70% co-insurance by December, I I would have paid $7,900 total. So I did the only thing I could do.

I bought my insulin bottle by bottle, and rationed my insulin – running my sugars in the 200-400 range. I can even remember the pharmacy technician asking me if I had insurance to cover any part of the cost. (And what is mindblowing is that the very same insulin I bought then has tripled in price since then.)

I also had an insulin pump, and I would wear the sites for a week or longer if I could – most of which would become infected.

I rarely checked my blood sugar because I couldn’t afford the $80 per box for test strips that I needed.

I didn’t even go to a doctor, let alone an endocrinologist, for an entire year.

So, how does cost affect diabetes care? It affects it directly. If a person is too strapped to afford to even pay for medical coverage, how can they also be expected to pay the exorbitant costs of the supplies that they also need?

It’s not enough for people to have coverage – they need coverage that is both affordable and helps pay for the medications and supplies they need. Otherwise, more and more people will be in the same boat as I was — and so many are now — due to catastrophic plans being the only thing that is remotely affordable: skipping appointments and rationing medications and supplies just to pay for the healthcare they may never be able to use. And with insulin being the highest of all yet most necessary, it’s certainly not something anyone should ever have to ration.

People with diabetes and other costly conditions need better access to the medications and supplies they need, without it costing a literal arm, leg, or eye to get it.

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How to Safely Use Glucose Meters and Test Strips for Diabetes

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NHS provides outpatients updates following cyber attack

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The NHS has provided an update about planned treatment and outpatient appointments following the ransomware attack on its IT systems.
It has posted advice for patients after a small number of hospitals had to cancel patient appointments due to a cyber attack which affected 150 countries worldwide.
The update says: "If you have a planned operation, procedure or outpatient appointment at a hospital affected by this incident, please visit the hospital website for further advice and information about routine services at this time. If you are still unsure what to do, contact the hospital directly.
"Patients already in hospital at this time will continue to receive normal care. Inpatients will be told if any changes to their planned treatment are needed because of this incident."
The NHS announced on Monday that it was "open for business" but acknowledged that some hospitals and GP surgeries are still suffering disruption.
Home Secretary Amber Rudd said that a million people were treated on Monday, with GP surgeries working hard to ensure as few patients as possible are affected.
People with diabetes who have blood tests or other appointments with their GP are urged to attend unless they are contacted by their surgery and told otherwise.
"All GPs surgeries did open, though some of them had to use pen and paper," said Ms Rudd. "The vast majority of patients have noticed no difference. It has been a very strong response."
Dr Anne Rainsberry, national incident director at NHS England, added: "There are encouraging signs that the situation is improving, with fewer hospitals having to divert patients from their A&E units.
"The message to patients is clear: the NHS is open for business. Staff are working hard to ensure that the small number of organisations still affected return to normal shortly."
The NHS has warned the appointments at hospitals and GP may be slower than normal while the disruption caused by the ransomware attack subsides.
The update continued: "You can help the NHS cope by choosing the right service for your needs, and attending A&E only if it is essential.
"Apart from your hospital, there"s a range of other primary care services that can offer help, such as your GP, pharmacist, dentist or optician."Type 2 Diabetes Treatment
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Smartphone app set to help people with type 2 diabetes and high blood pressure

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An augmented reality app to help people with type 2 diabetes and high blood pressure manage their medication in Australia is to be developed.
Augmented reality (AR) comprises technology that generates real world data and then provides digital information to overlay new data on top of it.
Dr Alireza Ahmadvand, who is a research scholar from the Queensland University of Technology (QUT), and colleagues are investigating how best to use augmented reality to help people who require a variety of medication, including people with diabetes.
Ahmadvand said: "A person with diabetes sometimes has to take, on average, eight medications at the same time including blood sugar-lowering medications, cholesterol-lowering medications, aspirin, anti-depressants/anxiolytics or medications for weight management.
"Keeping track of all the advice, understanding it, and being able to ask the right questions are major challenges. AR brings the possibility of using smartphones to give information on specific medications in a form appropriate to each person"s level of understanding in a convenient and timely way."
Ahmadvand added that compliance is often low and medications may not be taken on time among people who are required to take multiple drugs, but the use of smartphones enables new ways to deliver healthcare and help people manage health conditions.
The smartphone app will also give people the opportunity to call or message diabetes helplines, should they have a question about their medication.
"[Patients] receive a lot of high-level professional advice but at the point of having to take the medication they are alone, it is then that our solution will step in.
"The app can give the possibility of calling, messaging or direct contact to credible diabetes helplines, if they are in doubt as to what to do if they have forgotten something about their medication or its side effects.
"We hope this will decrease the complexity and increase compliance with medications for people managing both type 2 diabetes and hypertension by improving understanding of their conditions."Type 2 Diabetes Treatment
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Mother says teenage daughter barred from school trip due to her type 1 diabetes

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A teenager with type 1 diabetes has been left "devastated" after she was barred from a school trip because of her condition, says her mother.
Aaliyah Thomson, from Scotland, was due to travel to Highlands Holiday Park with students from Elgin High School, but her mum says the school stopped her going at the last minute.
Speaking to the Press and Journal newspaper, Jaye Thomson said: "She was really looking forward to it, but then spent all of Friday evening [upset] when she found out she couldn"t go, she was really devastated.
"Diabetes is classed as a disability and it’s the only reason she"s not been allowed to go."
According to Ms Thomson, the plans for the trip were made in January and she even met with teachers about her daughter"s condition.
Ms Thomson says she had informed the school about Aaliyah"s diabetes in advance of the trip, but received a recent email asking about medical problems affecting any of the children going on the trip.
She said: "I went to a meeting at the school earlier this month just to go over things and to make sure Aaliyah would be safe. At that point, I got the impression that the teachers didn’t want her to go because it would be a hassle for them."
A Moray Council spokesman said: "The school did everything possible to get the necessary information from Ms Thomson about Aaliyah"s condition and medication but, despite repeated efforts over a number of weeks, this was not forthcoming.
"In the absence of that information and following consultation with professionals from other sectors, the school decided that it could not take the risk of allowing Aaliyah to join the class trip to what is a relatively remote area. We can understand her disappointment but we"re satisfied that no fault lies with the school."
But Ms Thomson has insisted she had provided school with the necessary information in relation to her daughter"s type 1 diabetes.
She said: "I had adjusted Aaliyah"s insulin so that she would be fine for all the activities, but she was on a similar trip last year with New Elgin Primary School and had no problems.
"It"s the way the school went about this that hurts the most, they made it so hard for her and I do consider it discrimination."Type 2 Diabetes Treatment
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New research links lack of sleep with heightened risk for type 2 diabetes in youth

http://type2diabetestreatment.net/diabetes-news/new-research-links-lack-of-sleep-with-heightened-risk-for-type-2-diabetes-in-youth/

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A new review of scientific literature on the importance of sleep in youth suggests that a lack of sleep can lead to decreased appetite control and body weight regulation, all of which can raise risks for the development of type 2 diabetes.
The largest decline in sleep duration and poor sleep quality over the past decades has been seen in children and adolescents, a trend that earlier studies say may contribute to weight gain, increased risks for cardiovascular disease and poor mental health.
This new review of evidence, published in the journal Nutrition and Diabetes, has looked at 23 studies on the topic of risk factors for type 2 diabetes and sleep variables to try and elucidate the mechanisms that may explain the association between the two.
Researchers from Children’s Hospital of Eastern Ontario Research Institute, in Canada, reviewed studies that not only assessed risks from inadequate sleep, described as sleeping less than six hours per night - a two-hour or so sleep deficit compared to standard advice for children - but also sleep architecture.
A healthy sleep architecture refers to having the right number of restorative sleep cycles and rapid eye movement phases to feel sufficiently well-rested. An out of whack sleep architecture has been associated in past studies with insulin resistance.
In terms of sleep duration, researchers have found that the lowest risk for type 2 diabetes is observed, similar to the figure given for adults, at a minimum sleep duration of seven to eight hours per day.
Drawing from the findings of the different studies evaluated, they have identified a number of mechanisms by which the lack of sleep can elevate risks for type 2 diabetes among children.
One of them, perhaps the most prominent one, is the increased exposure to the stress hormone cortisol due to short sleep duration. This may contribute to the accumulation of visceral fat and subsequent increased insulin resistance.
The reason for this is that the authors also noted that the association between sleep quality and insulin resistance was not independent of the level of adiposity - the increase in the number of fat cells.
There may also be another phenomenon implicated that has to do with the nervous system which, in response to the stress of not sleeping, negatively influences the hormone leptin.
While we sleep, leptin usually rise to control appetite. However, when sleep is restricted, leptin gets inhibited. The inhibition of leptin leads to an increase in hunger and a decrease in satiety. These effects can translate into progressive weight gain.
Sleep is a modifiable lifestyle habit associated with the prevention of type 2 diabetes. One randomised trial that was part of the review conducted among children aged 8 to 11 years showed that increasing sleep duration by just 1.5 hour per night over a week resulted in lower food intake and lower body weight.
Although more studies are needed to shed light on the mechanisms linking insufficient sleep with type 2 diabetes risk, there"s no possible risk in children and teens improving their sleep and getting enough of it on a regular schedule each night.Type 2 Diabetes Treatment
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