Debbi gives 3 major tips in helping autistic kids develop and maintain a positive self-image, and includes stories about her autistic granddaughter and her passion with cemeteries!
From MS Diagnosis to Ultra Running | How it happened and how it’s changed my life
In this video, I go over how I was diagnosed with Multiple Sclerosis and how I became an ultra runner. I start this story of when I got diagnosed with MS my fourth of freshman year of college to becoming an ultra runner.
Young adults show serious complications from Type 2 diabetes
South Texas youth whose Type 2 diabetes was followed for up to 15 years in the TODAY studies have made an immensely important contribution to understanding the early onset form of the disease, clinicians and researchers at UT Health San Antonio and University Health’s Texas Diabetes Institute said today.
The studies, published July 29 in the New England Journal of Medicine, showed that within 15 years of a Type 2 diabetes diagnosis, 60% of participants had at least one diabetes-related complication, and nearly a third of participants had two or more.
“Through this study, we really appreciated that Type 2 diabetes in youth is way more aggressive than the type of diabetes we see in their grandparents,” said Maria “Sukie” Rayas, MD, assistant professor of pediatric endocrinology at UT Health San Antonio.
“Now we have affirmation of how bad the complications are and how rapidly they can actually occur,” said Elia Escaname, MD, assistant professor of pediatric endocrinology and medical director of the children’s clinic at the Texas Diabetes Institute.
Study conducted on West Side
Dr. Rayas and Dr. Escaname served as co-investigators of the San Antonio TODAY study, for which Jane Lynch, MD, professor of pediatric endocrinology, was principal investigator. All patients attended appointments at University Health’s Texas Diabetes Institute on San Antonio’s West Side. TODAY stands for Treatment Options for Type 2 Diabetes in Adolescents and Youth.
“The findings are really astonishing, to think that someone in their mid-20s is already struggling with kidney disease or eye disease or another complication of diabetes,” Dr. Rayas said.
The study pointed out the lack of approved medications for children under 18 diagnosed with Type 2 diabetes.
“We need to expand treatment options and explore medications that we use widely for adults with Type 2 diabetes to see if they are safe and effective for children,” Dr. Rayas said.
Dr. Escaname added, “Hopefully this study will shed light on the need for more treatment options in children, because lifestyle modification is not enough for a lot of patients.”
Beyond insulin, only metformin, liraglutide and exenatide are approved by the U.S. Food and Drug Administration for the treatment of Type 2 diabetes in children and adolescents ages 10-17. Only insulin and metformin are approved for children under 10.
Health determinants
The TODAY findings also highlighted the study population’s lack of access both to healthy lifestyles and to medications and health care providers.
“Some families and children miss basic necessities such as healthy food options and parks and places where children can safely go out and play and exercise,” Dr. Escaname said. “We must assess this when counseling lifestyle modifications. Lack of necessities is one of the main reasons children have developed an issue in the first place.”
San Antonio, with its Hispanic majority population, was a crucial site for the study. One in seven people in Bexar County has diabetes and many more cases go undiagnosed. The COVID-19 pandemic only intensified the prevalence of Type 2 diabetes in the city and region.
“The rise in Type 2 diabetes is noticed all over South Texas during COVID, and our minority and racial ethnic groups including Hispanics were already more at risk of developing the disease,” Dr. Rayas said.
“We don’t have the new prevalence numbers yet, but in our practice we have observed high rates of new-onset diabetes during the last year,” Dr. Escaname said.
Findings
Study participants were ages 10-17 at the time of enrollment, had been diagnosed with Type 2 diabetes within the past two years, and were overweight or had obesity. The average age of participants after the TODAY studies follow-up was 26.
TODAY found:
- 67% of participants had high blood pressure.
- Nearly 52% had dyslipidemia, or high fat levels in the blood.
- Nearly 55% had kidney disease.
- 32% had evidence of nerve disease.
- 51% had eye disease.
The TODAY studies’ diverse cohort is representative of U.S. youth diagnosed with type 2 diabetes. Study participants had regular, intensive diabetes management through the study at no cost during the original TODAY trial, which researchers note may have actually lowered the rate of complications.
San Antonio participants received diabetes care at no cost to them at the Texas Diabetes Institute. Once they became young adults, participants were seen annually by TODAY staff and were transitioned to primary care providers who prescribed their medications.
“Most stayed on insulin and metformin due to costs at this final phase,” Dr. Lynch said, noting that the burden of high medical expenses precluded the young adults from being on more-expensive medications that might more aggressively treat the diabetes.
Diabetes: Study of satiety mechanism yields new knowledge
In purple, the tanycytes that form the brain’s cellular gateway to the hormone leptin; in yellow, the appetite-inducing neurons and, in blue, the appetite-suppressing neurons. Leptin targets both neuron types, inhibiting the former and using its appetite-suppressant signal to activate the latter. CREDIT Inserm/Vincent Prévot
Leptin, the satiety or appetite-suppressant hormone, is secreted by the adipose tissue at levels proportional to the body’s fat reserves and regulates appetite by controlling the feeling of fullness. It is transported to the brain by tanycytes – cells which it enters by attaching to the LepR receptors. Tanycytes are therefore leptin’s gateway to the brain, helping it to cross the blood-brain barrier and deliver satiety information to the neurons.
Previous research has revealed that such transport is impaired in subjects who are obese or overweight. This goes some way to explaining their dysfunctional appetite regulation given that it is more difficult for the information on satiety to reach the brain. In their new study, the researchers took a closer look at this transport mechanism, and more precisely the role played by the LepR receptors.
The key role of satiety hormone receptors in glucose management
In mouse models, the researchers removed the LepR receptor that is located on the surface of the tanycytes. After three months, the mice experienced a marked increase in their fat mass (which doubled over the period) as well as a loss of muscle mass (reduced by more than half). The total amount of weight gained was only fairly moderate. The scientists also regularly measured the animals’ blood sugar levels following the injection of glucose.
They found that in order to maintain blood sugar at normal levels (between 0.70 and 1.10 g/L), the mice secreted more insulin during the first four weeks of the experiment. Three months after removing the receptor, their ability to secrete insulin from the pancreas appeared to be exhausted.
Removing the LepR receptors and impairing leptin transport to the brain therefore led the mice to initially develop a pre-diabetic state. This occurs when the body releases more insulin than usual in order to control blood sugar. Then, in the longer term, the mice became unable to secrete insulin and as such unable to control their blood sugar levels. These data therefore suggest that impaired leptin transport to the brain via the LepR receptors plays a role in the development of type 2 diabetes.
In the last part of their research, the scientists reintroduced leptin to the brain and observed the immediate resumption of its pancreatic function-promoting action – particularly the ability of the pancreas to secrete insulin to regulate blood sugar. The mice quickly regained a healthy metabolism.
This study therefore elucidates the brain’s role in type 2 diabetes and also helps to further research into a disease that until then had not been considered to involve the central nervous system.
“We show that the brain’s perception of leptin is essential for the management of energy homeostasis[1] and blood sugar. We also show that blocking the transport of leptin to the brain impairs the functioning of the neurons that control pancreatic insulin secretion,” concludes Vincent Prévot, research director at Inserm and last author of the study.
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