Diabetes – What’s New and Can Actually Work?

  • What's New in the World of Diabetes

Read on to find out what you may have recently missed in the ever-changing world of diabetes. It could potentially make your life easier and help better control your diabetes. Never stop reading or learning!

1. The Proclaim XR SCS System (recently FDA approved)

Diabetic neuropathy remains one of the most painful and debilitating complications associated with diabetes and it can affect your quality of life. Somewhere between 50-70% of people with diabetes in the US suffer with diabetic neuropathy. There are over 100 types of peripheral neuropathy, but diabetes remains the leading cause.

Out of control, high blood sugars over a long period of time, and poor circulation can be the main causes of diabetic neuropathy. The risk of neuropathy increases with tobacco use, hypertension, obesity, peripheral artery disease and high cholesterol. Almost 40 % of those affected never seek treatment. Nerve damage lowers your ability to sense pain and changes in temperature may increases your risk of injury.

What symptoms are included?

Symptoms of diabetic neuropathy include: tingling, burning, throbbing, pain, changes in balance, changes in skin texture and hair on the lower legs and feet, changes in your toenails, inability to sweat properly, numbness and even possible paralysis. The longer you have diabetes, the more common diabetic neuropathy is. It could affect any nerve in the body but most often affects the nerves in the feet and lower legs. Neuropathy can impact the foot and its mechanics as well as foot and knee alignment which may affect your mobility.

Is there a cure for neuropathy?

Currently there are no real medical treatments just symptom relief and pain management. Although you can’t reverse the damage, proper treatment can slow the progression. It may not be possible to completely resolve the symptoms of peripheral neuropathy. Cool and cold temperatures make the sensitivity from neuropathy even more painful.

What else may be recommended?

Patients can try acupuncture, yoga, Tai Chi, gentle walking, or a specific exercise regimen for symptom pain relief. Supplements such as alpha lipoic acid, primrose oil and acetyl-l-carnitine are also used with positive results. Even nutmeg extract has been suggested to help with pain.

A secondary problem of nerve damage or neuropathy from lack of sensation is development of an injury or open area. Foot ulcers, if not properly treated, can lead to a severe infection, possible gangrene and even amputation.

Enter the Proclaim XR SCS system spinal cord stimulator, which was originally approved for general chronic pain treatment in 2019. Now it can be used specifically for diabetic neuropathy or DPN. It can provide an alternative to taking oral medications and offer pain relief without severe side-effects. Spinal cord stimulation has been around since the 1960s.

The XR SCS system has “burst DR stimulation which works by mimicking natural patterns found in the brain by modifying pain signals and changing the way your body perceives pain.” The company offers a trial period which helps elevate its effectiveness before it is actually implanted. According to patients who have used this technology, “they have had real pain relief, a greater ability to perform daily activities and have had improved sleep.”

If you and your health care provider decide that this is right for you, you will be referred to a pain management specialist or a spinal surgeon. The procedure requires general anesthesia and takes between 1-2 hours to implant. Once implanted, you can regulate the therapy through an APP on a smartphone. You can also communicate with your physician through a virtual clinic from Abbott. The physician can change settings remotely or make sure present settings are correct. At this point, the device and implantation is “covered by most insurance plans” including Medicare. Check with your insurance company and doctor’s office.

What does a spinal cord stimulator do?

A spinal cord stimulator sends electricity in low levels into the spinal cord to relieve/block pain. There are 2 separate procedures:

  • Test or trial period
  • Implantation

It is used when other non-surgical treatments have failed. It may improve your quality of life and your sleep quality. It can be used with other pain management treatments. Although pain can sometimes be protective and a response to an injury, chronic pain can be debilitating. Chronic pain can alter your brain and nervous system and the stimulator “alters how the rain senses that pain.”

By using a spinal cord stimulator, you can interrupt signals from reaching your brain, quieting the pain signals and minimizing how you perceive it. There are about 30,000 people in the US who undergo implantation of a spinal cord stimulator, annually.

What else can you do to lower neuropathy risk

  • Keep your blood sugars well controlled.
  • Take proper care of your feet.
  • Check your feet daily and keep them warm, dry and covered.
  • Adopt a walking program and use supportive and well-fitting footwear.
  • Think about a regular podiatrist visit.
  • Report symptoms as soon as you feel them.
  • Do not smoke.
  • Drink alcohol in moderation or not at all.
  • Correct vitamin deficiencies.
  • Maintain your weight.
  • Have your blood pressure and cholesterol controlled.
  • Establish relaxation techniques.
  • Consider foot braces or orthotics to help keep your walking stable.

2. To snack or not snack with diabetes. This is a very common question.

This is an extremely popular question for those with diabetes. There is no right or wrong answer, and it truly depends on your own personal situation. Always consult your health care provider or try to consult with a dietician. Think about your level of hunger between meals, your actual intake at a meal, if you are physically active and how your blood sugars read overall.

Remember that snacks are not needed to regulate blood sugars in most cases with type 2 diabetes, especially if you are not taking insulin. Too many snacks can elevate blood sugars, add calories and lead to extra weight gain. Think about if you get shaky, sweaty or weak between meals due to hypoglycemia or low blood sugar.

Do you wake up with low blood sugars? Do you wake up in the middle of the night with high blood sugars? Do you eat within an hour of waking up or do you wait to eat? Which diabetes medications do you take? Regardless of what you answered, here are some tips you can apply to your eating habits concerning snacks. Your snacks should depend on your blood sugars, diabetes medications, physical activity program, meal timing and current weight. Remember that food generally makes your blood sugars go up, especially carbohydrates. Good fats and protein raise them less and take longer to get into your blood stream.

Things you can do for healthful snacking:

  • Look for snacks that are “nutrient dense” and promote fullness that do not cause your blood sugars to elevate too much. Nutrient dense foods are foods that are high in vitamin and mineral content relation to its weight and make you feel full for longer. Included would be nuts, seeds, beans, lean meats, healthy fats and whole grains.
  • Snacks should be about 150-200 calories and should be balanced with fiber, protein and a healthy fat.
  • Snacks should generally be 1-2 servings of a carbohydrate or 15-30 grams.
  • They should also be easy to prepare, convenient to carry and to “eat on the go.”
  • You should not have to compromise on flavor and taste.
  • Do not eat directly out of containers. You will certainly eat a bigger serving than what is recommended.
  • Think about serving size. Either purchase “individualized servings” snacks (more expensive) or create your own snacks in bag or containers prior to eating them.
  • Read and understand food labels.
  • Buy nuts that are roasted but unsalted.
  • The key is not to graze all day long. Do not lose the structure of your meals but do treat yourself now and again. Listen to your body.

What would be considered a reasonable snack with diabetes?

  1. Greek plain yogurt or Icelandic plain yogurt with a handful on nuts and berries. Greek yogurt has protein, fat and is low carbohydrates plus contains probiotics. “Probiotics may improve your body’s ability to metabolize foods that contain sugar.”
  2. A small fruit with a tablespoon of natural peanut butter or other type of nut butter. Avoid honey coated nuts or honey added to nut butters. Nut butters and nuts have protein, healthy fat and fiber and in small quantities are excellent for people with diabetes.
  3. 15 grapes and a low-fat string cheese. Fruit is high fiber, polyphenols and vitamins. Polyphenols “may protect pancreatic cells.”
  4. A ½ cup of low-fat cottage cheese with a small peach.
  5. ¼ of an avocado with a touch of olive oil and Balsamic vinegar smashed on 2 whole grain crackers. Avocado has fiber and good fat and is heart healthy.
  6. A hardboiled egg on a rye crisp cracker.
  7. A cup of low-sodium vegetable juice.
  8. Slice of turkey or low-sodium ham rolled up with mustard on a whole grain cracker.
  9. ½ sweet potato with the skin and a slice of low-fat cheese.
  10. 2-3 cups of plain popcorn with 1-2 tablespoons of grated Parmesan cheese.
  11. Small baked apple cooked in diet ginger ale and cinnamon. Add an individual round cheese.
  12. A handful of roasted chickpeas with a handful of no salt almonds.
  13. 1-2 tablespoons of garlic hummus on celery sticks or whole grain crackers.
  14. A rice cake with a spoon of almond or cashew butter.
  15. Grass-fed beef sticks with a few cheese crisps. Grass fed beef sticks are high in protein and Omega 3s, plus low in calories. Watch out for sodium content.
  16. Small kiwi with the skin left on and a handful of dry walnuts.
  17. Make your own trail mix. Add a handful of unsalted peanuts, almonds, dried cherries, pumpkin seeds and plain cheerios. Avoid too much dried fruit which is too high in sugar.
  18. ¼ cup of Ricotta cheese on whole grain toast.
  19. Make your own peanut butter or low-fat cheese sandwich crackers.
  20. Homemade chia seed pudding which can be high in nutrients such as protein, fiber and Omega 3 fatty acids.
  21. No bake energy bites. Combine 1 cup old fashioned oats, ¼ cup ground up unsalted nuts, ½ cup ground chia seeds, ½ ground flax seeds, ½ cup hemp seeds, 1 tablespoon of wheat germ, 2/3 cup natural creamy nut butter, 12 dark chocolate chips, and 1 tablespoon of high-quality honey. Combine all ingredients in a bowl and stir together. Roll into bite size balls and refrigerate for at least one hour. These are sweet, just make sure to eat only 1-2 per snack.
  22. Chop 2 black and 2 green olives and add some spices. Add ½ sliced red or yellow bell pepper and eat with a cube of low -fat cheese.
  23. Make homemade black bean salad. Drain a can of black beans and add diced red onions, 2 scallions, diced green and red bell peppers, garlic and lemon and vinaigrette dressing. Refrigerate.

Snacking can be delicious and satisfying when you make the right choices and don’t overdo it.

3. How can I lower my insulin levels if I have hyperinsulinemia?

Although we need insulin, an important hormone made by the beta cells, in the pancreas too much can lead to hyperinsulinemia. Hyperinsulinemia can lead to weight gain, heart disease and even cancer. High levels of insulin can also cause you to become “resistant to it” creating a precursor to type 2 diabetes known as insulin resistance.

What are the main causes of insulin resistance?

The main causes of insulin resistance are: family history of type 2 diabetes, pre-diabetes, metabolic syndrome, PCOs-polycystic ovarian syndrome, obesity, belly fat or visceral fat, inactivity, and a diet high in simple carbohydrates. High levels of insulin also occur in Cushing’s Syndrome or when taking steroid medications for respiratory disease, arthritis or other chronic diseases. Insulin resistance is a complication of obesity and closely linked with type 2 diabetes.

How can you be checked for hyperinsulinemia?

You can have a blood test ordered by your physician which can check your insulin levels. Out of pocket costs are about 60 dollars. You may also need a GTT or glucose tolerance test to check for insulin resistance. Insulin and glucose levels should be in balance. With insulin resistance, glucose can’t reach the cells, causing it to stay in the blood stream and blood glucose levels rise.

What are symptoms of insulin resistance?

  1. Weight gain
  2. Sugar cravings
  3. Frequent and intense hunger
  4. Low concentration, brain fog
  5. Anxiety and panic attacks
  6. Fatigue

What helps lower your insulin levels?

  • Eating a low carbohydrate diet. Do not completely eliminate high quality carbohydrates which are an important dietary component even with diabetes. “Low carbohydrate diets can improve the metabolic syndrome, increase insulin sensitivity and lower insulin levels.”
  • Lower sugar intake. Even without diabetes you should eliminate empty calories and added sugar which promotes inflammation and chronic disease. Fructose (a natural sugar), honey, agave and corn syrup are “especially harmful for insulin resistance.” Avoid foods with added sugars such as regular soda, flavored yogurts, lemonade, regular fruit juices, sweet tea, sugary sweets and desserts, canned fruits in sugary syrup, processed foods, bagged foods. Lower or avoid alcohol intake and saturated fats found in red meat, butter, whole milk, full-fat cheese and coconut oil. Learn to count carbohydrates and read food labels.
  • Reduce your portion size. Eating large portions of food at one sitting causes your body to make extra insulin leading to hyperinsulinemia. Larger meals with a “high glycemic index” spikes blood sugars causing a big release of insulin. Eating fewer calories at a sitting could increase insulin sensitivity.
  • Keep your activity level up. Regular physical activity is powerful and can lower insulin levels. Aerobic activities like walking, swimming, biking, and dancing are great forms of exercise to increase insulin sensitivity. Weightlifting and resistance bands are good especially for older adults. Combine these activities for best results.
  • Weight reduction. Weight reduction will lower insulin levels. Losing 5-10% of your body weight will lower insulin resistance. A large belly is “visceral fat that is linked with multiple health issues and chronic diseases.” Visceral fat causes inflammation and insulin resistance. When you lose weight, you will lose it all over including belly fat. You can’t spot reduce. “Insulin sensitivity after weight loss may in part be due to a reduction in pro-inflammatory/stress response in skeletal muscle.”
  • Add cinnamon. Studies have shown that “cinnamon can decrease insulin levels and increase insulin sensitivity. The spice tastes good and can’t harm you unless you are allergic. Cinnamon is loaded with antioxidants and can add an interesting taste to your food. Sprinkle it on your oatmeal, winter squash, in your coffee, on fruit or on whole grain toast. Cinnamon comes from the bark of the Cinnamomum trees and has been used for medicinal purposes for thousands of years. “Cinnamon may help lower blood sugars by imitating the effects of insulin and by increasing the movement of sugar from the blood stream to your cells. It may also slow the rate of food leaving the stomach which helps prevent after meal blood sugar spikes.”
  • The carbohydrates you eat should be complex. Avoid refined and processed foods and cereals with added sugars. These foods enter your bloodstream quickly and raise blood sugars fast, leading to hyperinsulinemia. Stick to whole fruits, starchy vegetables and 100% whole grains. Eat beans, wild rice, barley or whole grain pasta.
  • Add soluble fiber. “Soluble fiber can aid in weight loss and decrease blood sugar levels.” Soluble fiber absorbs water and forms a gel which slows down the movement of food through your digestive tract. It also feeds the friendly bacteria in your colon which may help reduce insulin resistance. Carrots, sunflower seeds, oats, apples, barley, black, kidney and lima beans, figs, sweet potatoes, nectarines, Brussel sprouts, turnips, broccoli, peas and figs are all sources of soluble fiber. Soluble fiber from whole foods seems to be more effective when compared to soluble fiber found in fiber supplements.
  • Eat more fatty fish. Omega 3s may lower insulin resistance. By eating salmon, herring, tuna, sardines and anchovies, you will be able to lower insulin levels and insulin resistance. If you are allergic or do not eat fish, talk to your health care provider about taking supplements.
  • Eat high quality proteins and enough of them. Eating protein at every meal can reduce hunger and prevent over-eating at the next meal. Eating plant proteins such as: tofu, lentils, nut butters, chick- peas, greens, nuts and seeds are especially helpful.

By lowering your insulin levels naturally, you can help avoid metabolic syndrome, insulin resistance and possibly type 2 diabetes. Use these tips. Always check with your health care team before making any changes to your diet or trying new things to help lower your insulin levels.

4. What is special about Mark Cuban’s recent drug plan called “Cost Plus Drugs?”

Mark Cuban, a well-known billionaire investor and Dr. Alexander Oshmyansky cofounded an online medication pharmacy in January 2022 called Cost Plus Drugs. It is a consumer-friendly system that is transparent about medication pricing when compared to regular pharmacies. Cost Plus Drugs carries over 800 generic drugs at “15% above manufacturers cost, then charges $3.00 for dispensing and $5.00 for shipping.”

The regular mark-up on generic drugs are often at least 100% and, in some cases, up to 1000% higher. Costco, Sam’s Club, Kroger’s, CVS, Rite Aid, Amazon, Select RX, Express Scripts, Bioplus, RX Outreach and Walgreens have had some similar programs prior to this but not as cost effective or transparent. They are currently building a “state of the art pharmaceutical facility” in Texas. It does not address brand name medications yet and remains best for those uninsured or under-insured.

Eventually Cost Plus Drugs want to work with big company employers and health plans to widen their reach. The way they are able to lower prices is by “eliminating the pharmacy benefit managers (PBM), who are the middlemen.” The PBMs go between the drug companies and the insurers to “negotiate discounts with drug makers and pass the cost savings on to the insurers, not you.

Mr. Cuban believes “Everyone should have safe and affordable medications in this country with transparent pricing.” It works easily since they purchase the medications directly from the manufacturers. You can check with your insurance prescription plan to see if your medications are covered.

  • You find your medication.
  • You get your provider to send the Cost Plus Drugs pharmacy your prescription.
  • You receive your medications.
  • They do not process any claims.

Cost Plus Drugs offers many medications including certain cardiac and diabetes pills. Check the site to see what is available. Their drugs may be cheaper than going through your current drug plan.

5. What is the new medication that could revolutionize type 2 diabetes treatment?

Patas is a new class of antidiabetic drug called Adipeutics. Adipeutics will specifically target adipocytes or cells that store fat. Since type 2 diabetes effects millions of people globally, research for these medications is a priority. Patas, a peptide, is being developed and human trials will begin at the end of 2023. Researchers from the US, Australia, England and France are currently working on it.

Patas is “supposed to reboot how your fat cells use insulin. It corrects an abnormality in the fat cells by separating two proteins that are associated with insulin resistance.” It also will examine insulin resistance and regulate glucose metabolism. Insulin resistance in fat tissue cells has been a stumbling block in treating and preventing type 2 diabetes.

Patas is still in development and may be delivered in a patch or injection form. It is being developed by AdipoPharma. This is truly an exciting discovery and may help many patients with chronic disorders. Most of the previous type 2 medications focus on lowering blood sugars not targeting insulin resistance. This study was published in the journal Diabetes.

New products, new theories, new technology and new drugs are constantly being approved for the treatment of diabetes. With over 415 million cases of diabetes worldwide in 2019 and over ½ billion expected in 2040, new medications are constantly being discovered for treatment.


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About the Author: Roberta Kleinman

Roberta Kleinman, RN, M. Ed., CDE, is a registered nurse and certified diabetes educator. She grew up in Long Island, NY. Her nursing training was done at the University of Vermont where she received a B.S. R.N. Robbie obtained her Master of Education degree, with a specialty in exercise physiology, from Georgia State University in Atlanta, Georgia. She is a member of the American Diabetes Association as well as the South Florida Association of Diabetes Educators. She worked with the education department of NBMC to help educate the hospital's in-patient nurses about diabetes. She practices a healthy lifestyle and has worked as a personal fitness trainer in the past. She was one of the initiators of the North Broward Diabetes Center (NBMC) which started in 1990 and was one of the first American Diabetes Association (ADA) certified programs in Broward County, Florida for nearly two decades. Robbie has educated patients to care for themselves and has counseled them on healthy eating, heart disease, high lipids, use of glucometers, insulin and many other aspects of diabetes care. The NBMC Diabetes Center received the Valor Award from the American Diabetes Center for excellent care to their patients. Robbie has volunteered over the years as leader of many diabetes support groups. More about Nurse Robbie

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