DR MICHAEL MOSLEY: Why won't the NHS tell you how to treat diabetes?

DR MICHAEL MOSLEY: Why won’t the NHS tell you the secret to treating diabetes? (Clue: It costs nothing)

Eight years ago I managed to beat type 2 diabetes by going on my 5:2 diet (cutting my calories two days a week) and losing weight — 9kg to be precise. 

Since then I’ve become something of a broken record on the importance of shedding body fat to improve your blood sugar levels.

So I was delighted last week by the news from the Norfolk Diabetes Prevention Study — the largest of its kind in the world — which showed that even modest weight loss can have a big impact.

A recent review by Danish researchers found more than 70 per cent of people with type 2 diabetes who had lost significant amounts of weight were still medication-free more than five years later [File photo]

The Norfolk study recruited more than 1,000 people with pre-diabetes (meaning they had raised blood sugar levels). They were asked to lose weight, then were monitored for more than eight years. Those who managed to lose 2kg to 3kg, and keep it off, almost halved their risk of developing full-blown type 2.

This adds to extensive research carried out by British scientists showing that, as well as pre-diabetes, type 2 diabetes can be put into remission by going on a rapid weight-loss diet. And, as we’ve known for 20 years, weight-loss surgery can also reverse type 2.

In fact, a recent review by Danish researchers found more than 70 per cent of people with type 2 diabetes who had lost significant amounts of weight were still medication-free more than five years later.

Despite all this, the NHS Choices website still tells you type 2 diabetes is a ‘progressive’ disease that ‘usually gets worse over time’, with most people needing ever increasing levels of medication. What a depressing — and I would argue inaccurate — message.

So why aren’t they being a bit more encouraging? The situation with type 2 diabetes reminds me of a tussle I had with the medical establishment more than 25 years ago. 

In 1993 I was looking around for a subject to make a science documentary, when I came across the work of two Australians, Dr Barry Marshall and Dr Robin Warren, who had a striking new theory about stomach ulcers.

I was delighted last week by the news from the Norfolk Diabetes Prevention Study — the largest of its kind in the world — which showed that even modest weight loss can have a big impact [File photo]

At the time, stomach or duodenal ulcers (affecting the first part of the small intestine) were incredibly common but, like type 2, were seen as something of a mystery.

Gut ulcers can be excruciatingly painful and lead to internal bleeding. Doctors knew they were caused by excess acid and they could be managed by drugs such as ranitidine, which stopped the stomach from producing acid. These drugs, known as proton pump inhibitors, were expensive but there was a lot of incentive to use them because if you didn’t, or if the drugs stopped working, there was a high chance you’d need some of your stomach and intestines removed.

Robin and Barry, however, were convinced they had a cheap and effective cure. Their research showed that most patients with ulcers were infected with a bacterium, which the two doctors called Helicobacter pylori.

The patients’ stomachs were producing more acid to get rid of the bacterium, but this failed because Helicobacter is resistant to acid attack. But it is vulnerable to the right antibiotics.

To prove the point, Barry deliberately infected himself with Helicobacter (he swallowed a flask of it) and soon developed gastritis — massive inflammation — which he cured with a short course of antibiotics. This was in 1984.

Nine years later, when I began filming with Robin and Barry, there was still widespread resistance to their claims, despite extensive proof they were right.

When I asked Barry how long he thought it would take to persuade his colleagues to take their claims seriously, he laconically replied, ‘Well it’s been ten years and ten per cent of doctors are treating ulcers this way. Perhaps in 100 years they will all be doing it.’

In fact, within ten years almost all doctors were doing it. Not least because Barry and Robin won the Nobel Prize for Medicine in 2004 for their work.

But back in 1994, when my documentary, Ulcer Wars, detailing their work, came out, the medical reaction was either indifference or hostility. A review in The British Medical Journal by a leading gastroenterologist described the film as ‘one sided and tendentious’.

However, patients with duodenal ulcers who’d watched the programme soon began demanding antibiotic treatment.

Many later wrote to me and as one man put it: ‘I saw your programme a week before I was due to have surgery, and it was only because my doctor was prepared to listen that I was cured by antibiotics rather than having a chunk of my guts removed.’

Why did it take so long for doctors to adopt this approach, despite overwhelming evidence that eradicating Helicobacter could change patients’ lives? This was a question that researchers from Harvard asked in 2019 — concluding that it was mainly because doctors get much of their information from pharmaceutical companies, and these companies had no incentive to promote a cheap alternative to their acid-reducing drugs (which, of course, you took for life).

The parallels with type 2 diabetes are clear. As the millions of those affected in the UK will know, type 2 is usually treated with medication. 

While this will reduce the long-term damage caused by high blood sugar levels, it doesn’t deal with the underlying disease — and like all medication, the drugs can have significant side-effects, particularly when you move on to injecting insulin.

So how long before there’s widespread acceptance that most cases of type 2 diabetes can be put into remission by a rapid weight-loss diet? 

It is beginning to happen, but I wouldn’t guarantee that NHS Choices will be telling you the good news any time soon.

Like us, worms need to sleep. And the way their bodies prepare for sleep is also surprisingly similar to humans — one of the key triggers for a bit of shut eye is the release of melatonin, also known as the ‘hormone of darkness’.

Melatonin is produced in your brain and levels rise when it gets dark (synthetic melatonin is a popular sleep aid and is used to treat jet lag — I find it very effective).Now researchers at the University of Connecticut have discovered how melatonin actually works — in worms at least.

It slows the release of neurotransmitters, substances that allow messages to travel between nerve cells. So melatonin effectively tells your brain cells to stop chatting to each other — the chemical equivalent of a giant ‘shhh’!

Covid-19 vaccines are like buses; you wait for one, then two come along, almost together, with other contenders coming close behind.

This week we learnt that the vaccine made by Moderna may be even more effective than Pfizer’s. That both are more than 90 per cent effective is fantastic news and a real poke in the eye for the sceptics who claimed we might never get a vaccine against Covid-19, let alone several.

These findings also suggest that our immune system is doing what evolution designed it to do: mount a strong response to the virus.

There was a fear that Covid-19 might mutate into a more resistant form — or that our immune response might weaken. 

Yet recent research suggests that while antibody levels tend to fall over time, your immune system retains a ‘memory’ of the virus. So if you encounter it again, your body is ready to begin churning out antibodies and T-killer cells.

Which makes me wonder why Boris, who’s had Covid, is self-isolating. He’s unlikely to be ‘bursting with antibodies’ as he claims, but he’s also very unlikely to get it again, or to be infectious, so I can’t see how he’s a threat to others. 

Our immune system has been severely tested by Covid, but as the new vaccines show, it just needs a bit of help to get back on top.

Covid-19 vaccines are like buses; you wait for one, then two come along, almost together, with other contenders coming close behind [File photo]

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Diabetes is a ticking time bomb in sub-Saharan Africa

Diabetes is a serious, chronic condition that affects the lives and well-being of individuals, families, and societies globally. It is characterized by excess levels of sugar in the blood.

There are three main types of diabetes: type 1 diabetes, type 2 diabetes, and gestational diabetes.

Type 1 diabetes often begins from childhood. It occurs when the body attacks the pancreas with antibodies. The pancreas is damaged and is unable to produce the hormone, insulin, responsible for regulating the blood sugar level. As a consequence, people with type 1 diabetes rely on daily injections of insulin to survive. Type 1 diabetes constitutes about 5%–10% of all cases of diabetes

Type 2 diabetes occurs mostly in adults from the ages of 20 to 79. It accounts for about 90% of all diabetes cases. In type 2, the pancreas produces insulin, but it is either not enough or the body cells fail to use it—what’s known as insulin resistance. People who are obese have a high risk of developing type 2 diabetes.

Gestational diabetes refers to high blood sugar that appears only in pregnancy, and usually goes away after delivery. But women with gestational diabetes have high chances of developing type 2 diabetes later in their life.

In 2019 about 1 in 11 adults in the world—436 million people—had diabetes. Of these, 19 million lived in sub-Saharan Africa. Around 60% of them were not aware of their condition.

These numbers are expected to grow exponentially over the next 25 years. The number of people with diabetes in sub-Saharan Africa is expected to more than double to 45 million by 2045. This is because many people are at high future risk of diabetes, otherwise known as people with prediabetes. In 2019, about 45 million Africans aged 20 to 79 years had impaired glucose tolerance, which is a form of prediabetes.

The Global Burden of Disease Study estimates that diabetes is the fifth leading cause of deaths due to noncommunicable diseases in the region. Others ahead of it are stroke, ischaemic heart disease, congenital birth defects, and chronic liver diseases.

The expected rapid rise in diabetes must not be overlooked as it could have devastating health and economic consequences for the region. Most national health systems are unprepared to deal with the growing burden as they struggle to cope with infectious diseases. The COVID-19 pandemic has added to these pressures.

Given that this is a lifestyle disease, governments need to act urgently to encourage changes in behavior in a bid to manage it.

Implications of high rates of diabetes

Diabetes and other noncommunicable diseases result in people living many years in poor health in sub-Saharan Africa. The average life expectancy in the region is currently estimated to be 64.5 years, with 11% of those years spent in poor health.

One-third of all health loss (measured using disability-adjusted life-years) in 2019 in sub-Saharan Africa was due to noncommunicable diseases such as diabetes. This figure rose from 18% in 1990. Disability-adjusted life-years is a measure of disease burden that captures both early death and ill health.

According to the Global Burden of Disease Study, the proportion of all years of life lost to early death due to diabetes and other noncommunicable diseases increased by more than 68% in sub-Saharan Africa between 1990 and 2019.

Diabetes can lead to death and life-threatening complications, such as severe damage to the heart, blood vessels, eyes, kidneys, and nerves. These complications can lead to heart attacks, strokes, blindness, kidney failure, and lower limb amputation. For example, adults with diabetes are three times more likely to suffer from heart attacks and strokes than adults without diabetes.

Diabetes can also increase the risk of infectious diseases such as pneumonia and tuberculosis. It has also been shown that people living with diabetes who are infected with SARS-CoV-2 are more likely to develop severe COVID-19, to require extended stay in the hospital, to have a greater need for ventilation, and to have higher chances of dying from COVID-19.

Future risks

Sub-Saharan Africa faces unique challenges in combating diabetes. These include the lack of funding for noncommunicable diseases, lack of studies and guidelines specific to the population, lack of medications, differences in urban and rural patients, and inequity between public and private sector health care.

Because of these challenges, diabetes has a more significant impact on health loss in sub-Saharan Africa than any other region in the world.

The International Diabetes Federation estimated the cost of diabetes in sub-Saharan Africa in 2019 to be US$ 9.5 billion, and this will increase to US$ 17.4 billion by 2045.

The rising prevalence of diabetes is linked to the increase in obesity and other lifestyle changes such as poor eating habits and lack of physical activity.

The risk factors for developing diabetes are modifiable, meaning they can be changed. People should be encouraged to eat healthily, be physically active, and avoid extreme weight gain. Such simple lifestyle changes are effective in preventing type 2 diabetes.

Studies over the past two decades have unequivocally shown that lifestyle modification can prevent or delay the onset of type 2 diabetes in people who are at high future risk of the disease. Such studies have been conducted in numerous countries, including the United States of America, Finland, China, India, Japan, and Pakistan.

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Smartphones can screen for diabetes, metabolic disease susceptibility

Smartphones can be used to estimate body composition and indicate health and mortality risks, according to a new study by a University of Hawaiʻi Cancer Center researcher and his team. This accessible and cost-effective option will enable early screening and monitoring of physiological indicators of metabolic diseases in regions where medical imagery or clinical assessment is not available.

“This is beneficial as smartphones are already owned by middle and low-income individuals who are most susceptible to metabolic diseases, including diabetes and non-alcoholic fatty liver disease,” said John Shepherd, lead study investigator.

Patients’ health and mortality risks can be indicated by total and regional body composition measurements using 3-D imaging, which require expensive and specialized equipment and are restricted to clinical settings. The study found that body composition can be estimated from a single frontal consumer level photograph of a patient’s body that can be taken on conventional consumer cameras, such as those on smartphones.

Photographs taken of patients are processed to predict internal health measures such as body fat percentage and lean muscle mass, which provides useful and detailed information about various health and wellness risks.

This new technology helps to achieve the UH Cancer Center’s mission of reducing the burden of cancer through research, education, patient care and community outreach because of its solution to high-cost medical treatment that is not feasible for many of Hawaiʻi’s patients in lower socioeconomic brackets.

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Type 2 diabetes – drinking pomegranate juice may lower high blood sugar levels

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Type 2 diabetes is the eventual outcome of processes in the body that are not functioning properly. Namely, your pancreas is not producing enough insulin or the insulin it does produce is not being absorbed efficiently by the cells. Insulin is a hormone that polices blood sugar levels in the body.

Blood sugar – also known as glucose – is obtained through the foods we eat and is the main type of sugar found in blood.

The sugar supplies the body with energy and nourishes the body’s organs, muscles and nervous system.

However, regularly having high blood sugar levels for long periods of time can result in permanent damage to parts of the body such as the eyes, nerves, kidneys and blood vessels.

Insulin therefore plays a protective role by regulating the supply of blood sugar in the body.

Poor insulin production therefore puts people with diabetes at a higher risk of severe complications.

Luckily, you can control blood sugar through another means – healthy dietary choices.

According to research published in the journal Nutrition Research, pomegranate juice may perform this function.

The researchers were interested in assessing whether the benefits of drinking pomegranate juice, which include lowering blood pressure due to its antioxidant properties, extend to lowering blood sugar.

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To investigate this, they recruited 85 people with type 2 diabetes and assigned them to receive 1.5 millilitres of pomegranate juice per kilogram of body weight.

Blood sugar and insulin levels, and beta cell function were assessed three hours after ingestion.

Beta cells are unique cells in the pancreas that produce, store and release the hormone insulin.

Results showed that pomegranate juice was associated with significant lower fasting glucose levels compared with control participants.

While the exact mechanisms involved remain unclear, the researchers suggest it may lie in juice’s antioxidant ability, which helps to thwart oxidative stress.

Oxidative stress is an imbalance of unstable atoms called free radicals and antioxidants in the body, which can lead to cell and tissue damage.

Oxidative stress plays a pivotal role in the development of diabetes complications.

General tips to lower blood sugar

There’s nothing you cannot eat if you have type 2 diabetes, but you’ll have to limit certain foods.

That’s because certain foods can send blood sugar levels soaring; the worst being carbohydrates.

Carbohydrate is broken down into glucose relatively quickly and therefore has a more pronounced effect on blood sugar levels than either fat or protein.

Physical exercise helps lower your blood sugar level – you should aim for 2.5 hours of activity a week, advises the NHS.

“You can be active anywhere as long as what you’re doing gets you out of breath,” it adds.

Type 2 diabetes – how to spot it 

Many people have type 2 diabetes without realising – this is because symptoms do not necessarily make you feel unwell.

Symptoms of type 2 diabetes include:

  • Peeing more than usual, particularly at night
  • Feeling thirsty all the time
  • Feeling very tired
  • Losing weight without trying to
  • Itching around your penis or vagina, or repeatedly getting thrush
  • Cuts or wounds taking longer to heal
  • Blurred vision.

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Study reveals type 2 diabetes remission can restore pancreas size and shape

In 2019, research revealed that achieving remission of type 2 diabetes by intensive weight loss can restore the insulin-producing capacity of the pancreas to levels similar to those in people who have never been diagnosed with the condition. Now, new research being presented at the Annual Meeting of the European Association for the Study of Diabetes (EASD), held online this year, demonstrates for the first time that reversing type 2 diabetes can also restore the pancreas to a normal size and shape.

“Our previous research demonstrated the return to long term normal glucose control, but some experts continue to claim that this is merely ‘well controlled diabetes’ despite our demonstration of a return to normal insulin production by the pancreas. However, our new findings of major change in the size and shape of the pancreas are convincing evidence of return to the normal state”, says Professor Roy Taylor from Newcastle University, UK, who led the research.

He goes on to explain, “Large amounts of insulin cause tissues to grow, or at least maintain their size. Normally, inside the pancreas the amounts of insulin present after a meal are very high. But in type 2 diabetes this does not happen. This new study suggests that achieving remission of type 2 diabetes restores this healthy, direct effect of insulin on the pancreas.”

Affecting 1 in 11 of the world’s adult population (415 million people), and on the rise, type 2 diabetes is caused by too much glucose (a type of sugar) in the blood due to the pancreas not producing enough insulin (a hormone which breaks down glucose into energy in the cells) together with insulin resistance.

Previous imaging studies have shown reduced size and abnormal shape of the pancreas in people with type 2 diabetes. But whether these abnormalities resulted from, rather than led to, the disease state was unknown until now.

In the study, 64 participants from the landmark Diabetes Remission Clinical Trial (DiRECT) and 64 age-, sex-, and weight- matched controls without type 2 diabetes were measured over 2 years for pancreas volume and fat levels, and irregularity of pancreas borders using a special MRI scan. Beta cell function—key to the body’s ability to make and release insulin—was also recorded. Responders (people in remission) were classified as achieving a glycated haemoglobin A1c (HbA1c) level of less than 6.5% and fasting blood glucose of less than 7.0 mmol/l, off all medications.

At the start of the study, average pancreas volume was 20% smaller (64 cm3 vs 80 cm3), and pancreas borders more irregular, in people with diabetes compared with controls without diabetes.

After 5 months of weight loss, pancreas volume was unchanged irrespective of remission (63 cm3 to 64 cm3 for responders and 59 cm3 to 60 cm3 in non-responders). However, after 2 years, the pancreas had grown on average by around one fifth in size (from 63 cm3 to 76 cm3) in responders compared with around a twelfth (from 59 cm3 to 64 cm3) in those who did not.

In addition, responders lost a significant amount of fat from their pancreas (1.6%) compared with non-responders (around 0.5%) over the study period, and achieved normal pancreas borders.

Similarly, only responders showed early and sustained improvement in beta-cell function. After 5 months of weight loss, the amount of insulin being made by responders increased and was maintained at 2 years, but there was no change in non-responders.

“Our findings provide proof of the link between the main tissue of the pancreas which makes digestive juices and the much smaller tissue which makes insulin, and open up possibilities of being able to predict future onset of type 2 diabetes by scanning the pancreas”, says Professor Taylor.

“All our research has been focused on type 2 diabetes which has developed within the last 6 years. Although some people with much longer duration diabetes can achieve remission, it is clear that the insulin producing cells become less and less able to recover as time passes. We need to understand exactly why this is and find ways to restore function in long duration type 2 diabetes.”

He concludes, “Type 2 diabetes is a simple disease occurring when an individual has more fat inside their body than they can cope with. The solution to the huge and growing problem of type 2 diabetes in the population lies in the hands of politicians. Legislation on supply of high calorie foods is essential to change our environment.”

Despite these important findings, the study has some limitations including that follow up was only for 2 years, and the observations were not pre-planned but made in retrospect.

Dr. Elizabeth Robertson, Director of Research at Diabetes UK, who funded the study, said: “Our landmark DiRECT trial has revolutionised thinking about type 2 diabetes—we no longer consider it to be a life-long condition for everyone, and know that remission is possible for some people. And we’re continuing to learn more about remission of type 2 diabetes every day. These new findings help to build a clearer picture of the biology behind remission, and how the health of the pancreas can be restored by weight loss.

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Study shows that rheumatoid arthritis is associated with a 23% increased risk of developing diabetes

A new study presented at this year’s annual meeting of the European Association for the Study of Diabetes (EASD), held online this year, shows that rheumatoid arthritis (RA) is associated with a 23% increased risk of type 2 diabetes (T2D), and may indicate that both diseases are linked to the body’s inflammatory response. The research was conducted by Zixing Tian and Dr. Adrian Heald, University of Manchester, UK, and colleagues.

Inflammation has emerged as a key factor in the onset and progression of T2D, and RA is an autoimmune and inflammatory disease. The team suggest that the systemic inflammation associated with RA might therefore contribute to the risk of an individual developing diabetes in the future.

The team conducted a comprehensive search of a range of medical and scientific databases up to 10 March 2020, for cohort studies comparing the incidence of T2D among people with RA to the diabetes risk within the general population. Statistical analyses were performed to calculate the relative risks, as well as to test for possible publication bias (in which the outcome of research influences the decision whether to publish it or not). The eligible studies identified comprised a total of 1,629,854 participants. Most of the studies were population-based and one was hospital-based, while no evidence was found for publication bias in any of them.

The authors found that having RA was associated with a 23% higher chance of developing T2D, compared to the diabetes risk within the general population. They conclude that: “This finding supports the notion that inflammatory pathways are involved in the pathogenesis of diabetes.”

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New test better predicts which babies will develop type 1 diabetes

A new approach to predicting which babies will develop type 1 diabetes moves a step closer to routine testing for newborns which could avoid life-threatening complications.

Scientists at seven international sites have followed 7,798 children at high risk of developing type 1 diabetes from birth, over nine years, in The Environmental Determinants of Diabetes in the Young (TEDDY) Study. The TEDDY Study is a large international study funded primarily by the US National Institutes of Health and U.S. Centers for Disease Control, as well as by the charity JDRF.

In research published in Nature Medicine, scientists at the University of Exeter and the Pacific Northwest Research Institute in Seattle used the TEDDY data to develop a method of combining multiple factors that could influence whether a child is likely to develop type 1 diabetes. The combined risk score approach incorporates genetics, clinical factors such as family history of diabetes, and their count of islet autoantibodies—biomarkers known to be implicated in type 1 diabetes.

The research team found that the new combined approach dramatically improved prediction of which children would develop type 1 diabetes, potentially allowing better diabetes risk counseling of families. Most importantly, the new approach doubled the efficiency of programs to screen newborns to prevent the potentially deadly condition of ketoacidosis, a consequence of type 1 diabetes in which insulin deficiency causes the blood to become too acidic. Identifying which children are at highest risk will also benefit clinical trials on drugs that are showing promise in preventing the condition.

Dr. Lauric Ferrat at the University of Exeter Medical School, said: “At the moment, 40 per cent of children who are diagnosed with type 1 diabetes have the severe complication of ketoacidosis. For the very young this is life-threatening, resulting in long intensive hospitalizations and in some cases even paralysis or death. Using our new combined approach to identify which babies will develop diabetes can prevent these tragedies, and ensure children are on the right treatment pathway earlier in life, meaning better health.”

Professor William Hagopian of the Pacific Northwest Research Institute, said: “We’re really excited by these findings. They suggest that the routine heel prick testing of babies done at birth, could go a long way towards preventing early sickness as well as predicting which children will get type 1 diabetes years later. We’re now putting this to the test in a trial in Washington State. We hope it will ultimately be used internationally to identify the condition as early as possible, and to power efforts to prevent the disease.”

Researchers believe the combined approach can also be rolled out to predict the onset of other diseases with a strong genetic component that are identifiable in childhood, such as celiac disease.

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Pseudoislet system expected to advance pancreas and diabetes research

The multicellular, 3-D structure of human pancreatic islets—the areas of the pancreas containing hormone-producing or endocrine cells—has presented challenges to researchers as they study and manipulate these cells’ function, but Vanderbilt University Medical Center researchers have now developed a pseudoislet system that allows for much easier study of islet function.

A pancreatic islet is composed primarily of beta cells, alpha cells and delta cells, but also includes many supporting cells, such as endothelial cells, nerve fibers and immune cells, which act in concert as a mini organ to control blood glucose through hormone secretion. Insulin, secreted from beta islet cells, lowers blood glucose by stimulating glucose uptake in peripheral tissues, while glucagon, secreted from alpha islet cells, raises blood glucose through its actions in the liver.

Dysfunction of these islet cells is a primary component of all forms of diabetes, and a better understanding of this dysfunction can lead to improved treatment and management of the disease. Vanderbilt scientists and others around the world have identified potential targets for diabetes using both mouse models and human tissue, however the lack of a system to manipulate these pathways in human islet cells has limited the field.

The VUMC team led by Marcela Brissova, Ph.D., research professor of Medicine and director of the Islet Procurement and Analysis Core of the Diabetes Research and Training Center, began attempting a protocol for the pseudoislet system in 2016, performing countless trials. In late 2017, Rachana Haliyur, then a Vanderbilt MD/Ph.D. student, combined media containing factors that support vascular cells and endocrine cells into what the group named the Vanderbilt Pseudoislet Media. The team watched as the cells began reaggregating, or organizing themselves in a way that resembled native islets.

“A lot of things in science happen serendipitously, and this was one of those,” said Brissova. “We tried and failed many times, and basically it came down to the media we used for our cells. In our recent publication, we have provided all experimental details and our protocol so others can make the media and create pseudoislets in their own laboratories.”

Because of the complex structure of the human islet, it is difficult to introduce and manipulate cells past the first cell-layer of the islet sphere. The pseudoislet system allows investigators to separate the pancreatic islet into single cells, introduce a virus into the cells which allows genetic manipulation and then combine the cells back together again into a pseudoislet. This allows researchers to target certain cell types or replicate changes happening in disease and study them in the 3-D environment of the islet.

John “Jack” Walker, an MD/Ph.D. student in the Powers & Brissova Research Group, continued to refine the pseudoislet system protocol and was co-first author on a recent study based on the system published in JCI Insight, an open access journal published by the American Society for Clinical Investigation (ASCI).

The pseudoislet system allowed the VUMC investigators to more clearly examine intracellular signaling pathways, allowing genetic manipulation of those pathways to change their function and better understand how insulin and glucagon secretion are altered with that manipulation. They determined that activation of Gi protein signaling reduced insulin and glucagon secretion while activation of Gq protein signaling stimulated glucagon secretion but had both stimulatory and inhibitory effects on insulin secretion.

In addition, this approach allowed the scientists to introduce biosensors into the islet cells to measure intercellular signaling events within the cells and better understand how those are linked to hormone secretion.

Another advance was the combination of the pseudoislet system with a unique microfluidic device, developed by co-authors Matthew Ishahak and Ashutosh Agarwal, Ph.D., from the University of Miami, that allowed the investigators to simultaneously document the changes in both calcium ions and hormone secretion.

“The exciting thing about this approach is that we both deconstruct the islet for our manipulation and reconstruct it to understand functional consequences at a larger level,” Walker said. “Since we put the islet cells back together, we can look at both insulin and glucagon secretion, but in a coordinated manner. Both of the secretion profiles measured are reflective of intra-islet interactions that are happening as well.”

This work greatly benefited from the research environment and infrastructure at Vanderbilt, particularly the National Institutes of Health (NIH)-funded Diabetes Research and Training Center (DRTC) and the Vanderbilt Cell Imaging Shared Resource.

“Another research direction will be creating pseudoislets that replicate a specific disease state, such as pseudo-islets that look like native islets from an individual with type 1 diabetes,” Haliyur said.

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Diabetes type 2 warning – the two sexual symptoms of high blood sugar you shouldn’t ignore

Diabetes is a common condition that affects more than four million people in the UK, and 90 percent of all cases are caused by type 2 diabetes. You could be at risk of high blood sugar if you develop either of these two symptoms, it’s been claimed.

Type 2 diabetes could be caused by the body not producing enough of the hormone insulin, or the body not reacting to insulin.

Without enough of the hormone, the body struggles to convert sugar in the blood into usable energy.

It’s crucial that if you think you may have diabetes, you speak to a doctor as soon as possible.

You could be at risk of diabetes if you develop erection problems, it’s been revealed.

Struggling to achieve or maintain an erection could be one of the earliest warning signs of high blood sugar, warned Benenden Health’s Society Matron, Cheryl Lythgoe.

It can be caused by damage to the nerves and blood vessels around the penis.

Poor long-term blood sugar control increases the risk of erectile dysfunction.

You should consider speaking to a doctor if you’ve developed problems with an erection.

Type 2 diabetes symptoms: Signs when you sleep that can signal it [RESEARCH]
Diabetes type 2 – surprising ‘superfood’ that could lower your risk [STUDY]
Type 2 diabetes: The cooking oil proven to lower blood sugar levels [ANALYSIS]

“When it comes to diabetes, there are many symptoms that should be getting our attention,” warned Lythgoe.

She told Express Health: “For example, if you struggle with one infection after another – a wound infection that won’t settle or a fungal infection such as thrush or athletes foot for example – this could be a symptom of diabetes.

“As could be episodes of blurred vision, a change to your colour vision or dark ‘floaters’ in the eyes.

“For gents, erectile problems including both achieving and maintaining an erection could also be a symptom.”

But, just because you have an episode of impotence, it doesn’t necessarily mean that you have diabetes.

There are a number of causes for erectile dysfunction that could be remedied with a few lifestyle changes.

Stress, anxiety, or even drinking too much alcohol could all lead to impotence.

You could lower your risk of the symptom by simply losing weight if you’re overweight, eating a healthy diet, and by doing regular exercise.

Many people may have diabetes without even knowing it, because the signs and symptoms don’t necessarily make you feel unwell.

Common diabetes symptoms include having cuts or wounds that take longer to heal, having an unquenchable thirst, and passing more urine than normal.

You should speak to a doctor if you’re worried about the warning signs or symptoms of diabetes, or if you think you may be at risk.

Diagnosing the condition early is very important, because patients are more at risk of some deadly complications, including heart disease and strokes.

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Diabetes type 2 – surprising ‘superfood’ that could lower your risk of high blood sugar

Diabetes is a common condition that affects more than four million people in the UK, and 90 percent of all cases are caused by type 2 diabetes. You could lower your risk of high blood sugar by regularly eating full-fat Greek yoghurt, it’s been claimed.

Type 2 diabetes could be caused by the body not producing enough of the hormone insulin, or the body not reacting to insulin.

Without enough of the hormone, the body struggles to convert sugar in the blood into usable energy.

It’s crucial that if you think you may have diabetes, you speak to a doctor as soon as possible.

Making some changes to your daily diet is one of the easiest ways to manage your blood sugar levels.

Greek yoghurt is a complex superfood that’s low in sugar and carbohydrates, while being rich in protein.

Full-fat yoghurt is the better option for diabetes patients, compared to low-fat varieties, according to medical website Diabetes.co.uk.

People that eat the most Greek yoghurt have the lowest risk of insulin resistance, as well as lower blood sugar levels, scientists have added.

You can combine your Greek yoghurt with nuts and berries for the largest diabetes benefits.

Type 2 diabetes symptoms: Signs when you sleep that can signal it [ANALYSIS]
Type 2 diabetes: The cooking oil proven to lower blood sugar levels [STUDY]
Diabetes type 2 warning – the ‘very foul’ smell that could be a sign [ANALYSIS]

“There are certain foods that provide huge health benefits for people with diabetes,” said Diabetes.co.uk. “They are often known as ‘diabetes superfoods’.

“Greek yoghurt is one of the more complex ‘superfoods’. Certainly, it has its benefits – it’s low-carb, high-protein, and low in sugar – but the debates regarding fat content can be confusing.

“Full-fat Greek yoghurt is better for people with diabetes, which may sound strange but fat’s bad reputation isn’t justified.

“This is because there are different kinds of saturated fat. Essentially, some saturated fat particles increase the risk of heart disease, and some don’t.”


  • Type 2 diabetes symptoms: The toilet habit to watch out for

But, if you decide to have Greek yoghurt for breakfast, you should avoid having fruit juices as an accompanying drink, warned the medical website.

Diabetes patients should limit the amount of fruit juices in their diet, it urged.

Although it’s previously been considered a healthy option, fruit juice may contain large amounts of sugar.

The sugar could directly increase blood sugar levels in diabetes patients, which may lead to hyperglycaemia.


  • Type 2 diabetes: Sign in your breath

Many people may have diabetes without even knowing it, because the signs and symptoms don’t necessarily make you feel unwell.

Common diabetes symptoms include having cuts or wounds that take longer to heal, having an unquenchable thirst, and passing more urine than normal.

You should speak to a doctor if you’re worried about the warning signs or symptoms of diabetes, or if you think you may be at risk.

Diagnosing the condition early is very important, because patients are more at risk of some deadly complications, including heart disease and strokes.

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