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Type 1 Diabetes Vaccine Under Development

Lisa Feierstein Children's Health, Diabetes Leave a comment  
Researchers are testing a new vaccine for type 1 diabetes.

Researchers are testing a new vaccine for type 1 diabetes.

The CDC recommends children get vaccinated for 16 diseases including polio, the flu, chickenpox, and the measles. A vaccine for type 1 diabetes may be added to that list in the near future–researchers at the University of Florida are currently developing a vaccine for type 1 diabetes.

When tested on mice, the type 1 diabetes vaccine prevented 40% of the mice from developing the disease. Developing this vaccine was different than creating a vaccine for a disease like the flu. Vaccines for the flu signal the immune system to attack the virus, but with a type 1 diabetes vaccine, researchers had to find away to train the immune system to identify and accept insulin, rather than to fight it. The goal of this vaccine is different because it needs to stop an immune response, rather than to trigger one.

Researchers used two methods to deliver the vaccine and found both to be equally effective. Their goal is to identify which approach will be safest and require the least amount of injections. Scientists also hope to implement clinical trials as they better identify the best method to administer the vaccine.

Nearly 10% or about 30 million Americans had diabetes in 2012, and of those with the condition, 1.25 million have type 1 diabetes, according to the National Diabetes Statistics Report, 2014. Type 1 diabetes occurs when the body doesn’t make insulin, which is a hormone that extracts glucose from the bloodstream and delivers it to the body’s cells to use for energy. A viable vaccine would be a boon to the medical field since type 1 diabetes is treatable with medication, but there is no cure.


Diabetes Service Dogs Sniff Out Changes in Blood Sugar Levels

Lisa Feierstein Children's Health, Diabetes 3 Comments
Diabetes alert dogs are able to smell changes in blood sugar levels.

Diabetes alert dogs are able to smell changes in blood sugar levels.

I’m always impressed by the skills dogs can learn—skills that save lives in some cases. Service dogs help sight-impaired individuals better maneuver through their environment, are used in search and rescue missions, and protect soldiers over seas. Perhaps a less-widely known role for service dogs is assisting individuals with diabetes.

ABC News recently published a unique story about 15 year-old Elle Shaheen, a type 1 diabetes patient, and her service dog Coach, a yellow Labrador Retriever. Diabetes alert dogs are able to smell changes in blood sugar and can alert their owner right away by nudging or scratching their owner. Shaheen felt immediately reassured the first time Coach alerted her to a change in blood sugar. She was testing her blood sugar up to a dozen times a day, but now Coach can let her know right away if she needs to take a test. However, there is a waiting list for diabetes alert dogs and it took two years before Elle was matched with Coach.

The American Diabetes Association (ADA) encourages diabetics to do their homework when researching a diabetes alert dog to make sure the dog is properly trained. There isn’t a standardized training method, so it’s important to ask a lot of questions about how the dogs are trained. Diabetes alert dogs also aren’t a replacement for monitoring blood sugar levels with a blood glucose meter and continuous glucose monitor, but they can add an additional level of comfort and security to keeping up with blood sugar levels. Also, finding a diabetes alert dog can be a long and pricey process, but non-profit organizations often provide dogs at low to no cost to the owner. For a full list of qualifications to look for in a diabetes alert dog, as well as suggestions of organizations to go through, take a look at this buyers guide by the American Diabetes Association.

Resources:

Diabetes Alert Dogs: Buyers Beware, by Jennifer Cattet and Dana Hardin, American Diabetes Association

Diabetic Girl and Yellow Lab Bond While He Works to Keep Her Alive, by Sarah Kunin, ABC News


Chronic Inflammation Increases Diabetes Risk

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When we get hurt or have an infection, the body’s natural response is to trigger inflammation. Short-term inflammation helps the body heal as white blood cells fight off bacteria and viruses. Normal inflammation manifests as pain, swelling, redness, and a sensation of heat. Chronic inflammation, on the other hand, can occur in conjunction with some diseases, like arthritis, and it can also raise the risk of developing diabetes. In these cases, inflammation continues for years and damages body tissue. Individuals suffering from chronic sleep deprivation, gum disease, poor diet or obesity are among those at risk for long-term inflammation.

Researchers have found that chronic inflammation raises the risk of developing diabetes because it interferes with insulin’s ability to regulate glucose, which can cause high blood sugar. Inflammation damages beta cells that produce insulin in the pancreas, and inflammation is also a result of the main diabetes risk factors – obesity, smoking, and diets high in fat and sugar. High-carb, low protein diets are inflammatory for many people, but low-carb diets and diets higher in fruits and vegetables have been known to reduce inflammation. In observational studies, participants on the Mediterranean diet – high in fish, whole grains, beans, nuts and vegetables – have reported low inflammatory markers.

Gum disease, air pollution and cigarette smoke, and lack of exercise are all threats that can lead to chronic inflammation. These risk factors can be reduced through good dental hygiene, the use of indoor HEPA filters and by avoiding cigarette smoke, and with regular exercise. There are also some foods, spices and teas that can help to reduce inflammation. One of my favorite anti-inflammatory foods is dark chocolate! One square of dark chocolate (at least 70% cocoa) a day can help reduce inflammation. You can also reduce inflammation by drinking a few cups of rose hip tea a day, and by adding the spice turmeric to food. If you would prefer to take a rose hip or turmeric supplement, talk to your doctor to make sure these supplements don’t conflict with any medication you’re taking. Your doctor can also test for inflammation and work with you to develop a treatment plan.


Diabetes Drug Maker Owes Billions in Settlement

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Type 2 diabetes patients should check with their doctor if they’re taking Actos – the medication has been linked to bladder cancer in several medical studies. Takeda Pharmaceuticals, the maker of Actos, didn’t admit liability but settled around 9,000 lawsuits related to the drug and owes $2.37 billion as part of the settlement. Patients taking Actos filed lawsuits for a number of reasons including Takeda’s failure to warn the public and health care providers that taking Actos could increase bladder cancer risk if taken for longer than a year, failing to properly test the drug, distributing the drug despite knowledge of dangerous side effects, and withholding research data on Actos from the public.

Actos has been banned in France, Germany and India, but is still on the market in the U.S. with a Food and Drug Administration warning about bladder cancer. Symptoms of bladder cancer include abdominal pain, frequent or painful urination, and blood in urine. Bladder cancer usually occurs in individuals over the age of 55, and the average age of diagnosis is 73. In 2015, 74,000 new cases of bladder cancer were diagnosed in the U.S. and men have 3 to 4 times the risk of developing bladder cancer to women. If you take Actos, talk to your doctor about any concerns you may have after reading this blog.

 


Introducing the Smart and Painless Insulin Patch

Lisa Feierstein Diabetes Leave a comment  

Imagine having to self-administer medication with a needle multiple times a day. This is a reality for diabetics that have to regularly inject insulin. Diabetes currently affects over 387 million people worldwide, and that number is projected to reach 592 million by 2035. Researchers recently made some headway that could create a break in the insulin injection cycle. Scientists at the University of North Carolina and North Carolina State University developed a “smart” insulin patch that could make painful injections a thing of the past. The tiny penny-sized patch contains over 100 needles, but the needles are each the size of an eyelash and can painlessly deliver insulin. The needles also contain glucose-sensing enzymes that are released when blood sugar levels spike.

The patch worked well in a study of mice with type 1 diabetes, and researchers hope to mirror those positive results in human trials. The patch lowered blood glucose levels in mice for up to nine hours, but since humans are more sensitive to insulin than mice, the patch could last longer for humans.

The patch is “smart” because it can be personalized to the patient based on their weight and sensitivity to insulin. Injecting the wrong amount of medication can cause serious problems anywhere from limb amputation to comas to death. The “smart” patch could reduce the risk of human error and improve the accuracy of medication delivery. Researchers can also customize the patch to only alter blood glucose levels within a certain range. When administered too frequently, insulin injections can cause blood sugar levels to lower at a dangerous rate, so the customized patches would alleviate this problem.

Additional Resources:

Smart insulin patch could replace painful injections for diabetes, by Mark Derewicz, UNC Health Care and UNC School of Medicine


Pregnant Mothers of Boys Have Greater Risk of Gestational Diabetes

Lisa Feierstein Children's Health, Diabetes, Women's Health Leave a comment  

Gestational diabetes can be a real source of stress and concern for mothers. On top of stocking up on supplies for the baby and pouring over parenting books, mothers with gestational diabetes also have to regularly check their blood sugar and be extra careful about their diet.

A new study found that a mother’s risk of developing gestational diabetes is actually affected by the baby’s gender. Dr. Baiju Shah, one of the authors of the study, said that a “male fetus leads to greater pregnancy-associated metabolic changes than a female fetus does.” In the study, researchers collected data from insurance records on about 643,000 women who had their first child between April 2000 and March 2010. Although the risk of developing gestational diabetes is greater with a boy, the study also showed that mothers with gestational diabetes carrying a girl had an increased risk of type 2 diabetes post-pregnancy. Gestational diabetes occurs as a result of combined underlying metabolic abnormalities that the mother has plus the metabolic changes that happen during pregnancy.

Gestational diabetes generally develops during the 24th week of pregnancy, according to the Amercian Diabetes Association. As many as 9.2% of mothers develop gestational diabetes, and the condition develops when a mother’s body is unable to create and use all the insulin needed for pregnancy. Left untreated, gestational diabetes can be dangerous to the baby, increasing their risk of conditions like obesity, type 2 diabetes, and breathing problems. By working with a doctor to develop a treatment plan, mothers with gestational diabetes can greatly improve their health and the health of the baby.

Additional Resources:


Scientists Identify Gene that could Prevent Type 2 Diabetes

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The media often focuses on the rising risk of type 2 diabetes on a regular basis, and the importance of diet and exercise as ways to prevent against the disease. A new study took a different route in investigating the causes of type 2 diabetes by looking at genetic factors.

Researchers compared the genes of 81,000 individuals without type 2 diabetes and compared their genetic information to individuals with type 2 diabetes. The study found that individuals with a mutation in the gene for the glucagon-like peptide-2 receptor (GLP1R) are 14% less likely to develop type 2 diabetes.

The gene mutation is also linked to lower fasting glucose levels, which could also be a contributing factor in reducing the risk of diabetes for individuals with the gene mutation. For the rest of us, it’s still important to focus on the three pillars of health – sleep, diet and exercise – as the best way to prevent against type 2 diabetes.


Childhood Trauma Linked to Increased Risk of Diabetes

Lisa Feierstein Children's Health, Diabetes Leave a comment  

Doctors don’t know the exact cause of type 1 diabetes, but a new study shows that childhood trauma is linked to an increased risk of developing type 1 diabetes. Researchers polled over 10,000 Swedish families and discovered that children who had experienced a trauma were nearly three times more likely to develop type 1 diabetes. Scientists questioned families about the occurrence of childhood stressors like divorce, illness or a death in the family. Researchers questioned families in southeast Sweden with children born between October 1997 and September 1999.

Dr. Johnny Ludvigsson, coauthor of the study, said that he’s not surprised by the results because of the “connections between the brain and immune system.” Doctors believe type 1 diabetes could be caused by genetics or environmental factors, like exposure to a virus. Type 1 diabetes develops when the body’s immune system starts destroying insulin-producing (islet) cells in the pancreas. After many islet cells are destroys, the body produces little to no insulin.

Although this study shows a link between a stressful childhood event and an increased risk of type 1 diabetes, it doesn’t prove that those events cause type 1 diabetes. Dr. David Marrero, president of health care and education at the American Diabetes Association, says that although you can’t say a childhood trauma was the direct result of your child developing diabetes, it’s worth making an effort to avoid exposing children to high stress events. Encouraging children to eat right and exercise frequently is also an important step in preventing type 2 diabetes.

Additional Resources:


More Cases of Diabetes Diagnosed Since Expansion of Medicaid Program

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Medicaid access expanded in 26 states in January 2014 and diagnosed cases of diabetes have also increased significantly in those states. Diagnosed diabetes cases among Medicaid recipients grew 23% in the states that increased their Medicaid programs under the Affordable Care Act. In the 24 states that didn’t expand Medicaid programs, the increase was only 0.4%.

Early detection of diabetes decreases the risk of complications related to the condition; undiagnosed diabetes can result in major medical problems like kidney failure, stroke, heart disease, blindness, and leg and feet amputations. The financial cost of diabetes is also high; total medical costs and the price of lost work and wages amounted to $245 billion in 2014, according to the Center for Disease Control (CDC). Quest Diagnostics funded the research on the increase of diabetes cases related to Medicaid expansion, and found a greater uptick in diagnoses among men and older individuals aged 50 to 64.

At least one in three people will develop diabetes, according to the CDC. Both type 1 and type 2 diabetes can develop at any age, but unlike type 1, most cases of type 2 can be prevented. Combining medication with proper diet and exercise can make a big difference in the success of diabetes management plans. For more information on how to manage your diabetes, check out this infographic, “A Snapshot: Diabetes in the United States” by the CDC.


Temporary Tattoo Painlessly Tests Blood Sugar

Lisa Feierstein Diabetes 3 Comments

Tattoos aren’t just a fashion statement anymore—nanoengineers have developed a temporary tattoo that can test blood sugar levels. This technology is promising for diabetics since their current option for testing blood sugar levels is by taking fingertip pricks several times a day. Using a temporary tattoo instead would be a much more comfortable and convenient way to test blood sugar levels.

Amay Bandodkar, graduate student and colleagues in Professor Joseph Wang’s laboratory at the NanoEngineering Department and Center for Wearable Sensors at the Jacobs School of Engineering at the University of California, San Diego, developed the sensors in the temporary tattoo. The sensors emit a mild electrical current that measures glucose levels. The electrodes are printed on tattoo paper that gives the user a painless way to test their blood sugar. The tattoos last a day and only cost a few cents.

A closer look at the temporary tattoo that measures glucose levels.

A closer look at the temporary tattoo that measures glucose levels.

The tattoo was tested on seven healthy male patients that do not have diabetes. Although the tattoo recorded a change in their glucose levels, scientists had to remove the tattoo in order to collect data because it doesn’t currently provide the patient with a way to read or monitor their own glucose level. In the future, the tattoos will connect with Bluetooth so data collected by the tattoo can be transmitted to the patient’s doctor or stored in the cloud. The technology used in the tattoo could eventually be used for other medical purposes, like delivering medicine or identifying important metabolites.

 

 

 

Additional Resources:

 

Photo credit: Jacobs School of Engineering/UC San Diego


Nascar Driver Teams Up With American Diabetes Association

Lisa Feierstein Diabetes Leave a comment  

Elite athletes have strict fitness routines and carefully calculated diets, and although Nascar drivers are more stationary, they still have to be in top physical condition. Drivers face strong G-forces and have to quickly manually shift so it’s important that they regularly do intensive cardiovascular, upper body, core and leg exercises. A Nascar driver’s overall health makes a big difference on their success on the track, but driver Ryan Reed recently faced a health challenge that threatened to end his Nascar career.

Ryan Reed started racing at a young age and won the Kid’s Kart Track Championship at only four-years old. In 2010, he was named Rookie of the Year in the Super Late Model Division at Toyota Speedway at Irwindale, but in 2011 he received news that his career may already be over. Reed was diagnosed with type 1 diabetes and told he could no longer race. By working with doctors, his personal trainer, and support systems like his pit crew, Reed has been able to continue driving and also successfully manage his diabetes. He later founded Ryan’s Mission, a non-profit focused on encouraging diabetics and raising awareness about diabetes.

Reed’s story exemplifies how important it is for diabetics to have a strong treatment management plan for their condition. He saw his condition as an opportunity instead of an obstacle; Reed is now the driver of the No. 16 American Diabetes Association Drive to Stop Diabetes presented by Lilly Diabetes Ford Mustang. How does your story compare to Reed’s? Did you overcome an obstacle by implementing a better diabetes management plan? Share your story in our comment section!

 


NBA Hall of Famer Launches Diabetes Dream Team

Lisa Feierstein Diabetes Leave a comment  

March Madness will be heating up soon, sparking an annual heated rivalry among fans and players alike. One former basketball player has created his own “team” in the hopes of unifying a diverse group with a common goal. NBA Hall of Famer Dominique Wilkins launched a Diabetes Dream Team in 2014, and the Team’s goal is to help adults with type 2 diabetes improve their ability to manage the condition. Dominique’s Diabetes Dream Team stresses three important tools to a successful diabetes management plan: diet, exercise and proper medication. Dominique’s own team is comprised of his physicians, a diabetes educator, a nutritionist and a fitness expert, who together offer him guidance on daily diabetes management.

Wlikins said he realized that small changes can make a big impact in treating his diabetes, and he wants to encourage others to “think differently about managing their diabetes.” Diabetics can download Dominique’s “Diabetes Coaches’ Clipboard” for tips on diabetes management from Dominique and his team of experts.

Are you looking for additional support and ideas in how to better manage your diabetes? Download our free diabetes management resources and join our free diabetes newsletter!

 

 


North Carolinians Hit Hard by Harsh Flu Season

Lisa Feierstein Asthma, Breathe EZ, Diabetes Leave a comment  

The NC Department of Health and Human Services released new figures about the total flu-related deaths in NC – the count has increased to 114, with 15 new deaths during the week of Jan. 11. Adults 65 and older have taken the hardest hit this flu season; doctors recommend everyone get the flu shot, especially children, elder adults, and those with asthma.

This year’s strain, H3N2, is particularly dangerous, and a mutation of the strain has limited the effectiveness of the flu shot. However, doctors still recommend the flu shot because it can make a difference in many cases. Common complications caused by the flu are sinusitis, bronchitis and pneumonia. The flu can cause inflammation around the heart, dehydration, and can worsen medical conditions like asthma and diabetes.

If you have a chronic medical condition like asthma or diabetes, talk to your doctor about preventative care, like the flu shot, and also about a management plan if you contract the flu. The CDC recommends influenza antiviral drugs for high-risk patients; antiviral drugs can lessen symptoms, reduce the amount of time you have the flu by up to two days, and can prevent complications like pneumonia. Antiviral drugs are most effective when administered within two days of getting sick, but using them later can still be beneficial. In addition to getting a flu shot, take other precautions like washing your hands frequently, and sanitizing common areas and office workstations with disinfectants.  If you do contract the flu, it’s best to stay home to avoid spreading the illness to others.


The Dilemma of Diabetes for Low-Income Patients

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Patients with diabetes know that managing their condition is a daily challenge of monitoring and medicating their condition. Some diabetics face an added hurdle because they face daily food insecurity; low-income diabetics wrestle with being able to afford medication and healthy food. A recent study looked at a group of Boston-based Type 2 diabetics of varying financial status. The group with food insecurity that also tried to cut back on their medication was half as likely as the more financially secure group to manage their diabetes.

Patients with food insecurity were 97 percent more likely to have high blood sugar and high levels of “bad” cholesterol, which indicates that their diabetes was not under control. Researchers determined that addressing access to both medication and food could play a role in improving patients’ ability to manage diabetes. Patients and doctors need to look at the whole picture and identify if a patient’s basic needs are being met in addition to having access to medication.


Implantable Pump Could Reduce Diabetes Treatments

Lisa Feierstein Diabetes Leave a comment  

Consistently taking medication and monitoring blood-sugar levels can be a big challenge for diabetics. A new implantable pump could make a big difference in the treatment plan for many individuals with diabetes. Intarcia Therapeutics Inc. is a Boston-based startup that has developed a pump, about the size of a matchstick, that can be implanted into the patient’s abdomen. The pump continually delivers a small amount of exenatide, which controls blood-sugar levels, for up to a year. The results of a study of 520 patients using the pump and oral medicines showed promising results by significantly lower blood sugar.

The pump is called the ITCA 650, and only requires a five-minute procedure to insert the device. Intarcia Therapeutics Inc. is receiving some funding support from Servier, a French pharmaceutical company. Regulators will review the device in early 2016 before it can go to market.


Holiday Meal Planning for Diabetics

Lisa Feierstein Diabetes Leave a comment  

I bet you have a favorite Holiday dish, maybe something that you look forward to all year. Friends and family bring their A-game when baking and cooking for the Holidays, but it can be challenging for diabetics to enjoy the festive food while staying on track with managing their diabetes. A little planning will help you enjoy your favorite Holiday foods in a healthy way.

Meal Time Madness

One aspect of Holiday meals that could throw off your diabetes management plan is that Holiday meals often include more food than usual, and might happen midafternoon. Your family might skip lunch, eat midafternoon, and skip dinner as they recover from food comas. To keep your glucose levels on track, consider eating a snack at your normal meal time.

Select Healthy Substitutions

You don’t have to pass on pie to stay on track with a healthy diet during the holidays. There are small changes you can make to still enjoy Holiday meals, but cut back on calories. Try fat-free or lite alternatives to sour cream and mayonnaise, cut back a little on the amount of sugar you put in desserts, and consider steaming veggies or sautéing with low calorie alternatives to oil like soy sauce.

Sample, Don’t Stuff!

When it’s time to eat, stick to your favorites, don’t feel obligated to try everything. If someone insists you try their famous mashed potatoes, just take enough for two bites. If you’re inclined to try it all, make sure veggies take up the most real estate on your plate. Every little bit helps!


Artificial Sweeteners Could Increase Risk of Diabetes

Lisa Feierstein Breathe EZ, Diabetes Leave a comment  

For years, diet sodas have been touted as a healthy alternative to regular sodas, but scientists recently found that artificial sweeteners may be a risk factor for diabetes. Scientists studied a control and experimental group–mice drinking plain water, and mice drinking water that contained artificial sweeteners. They found that the mice consuming artificial sweeteners showed marked glucose intolerance because the artificial sweeteners alter the balance of gut microbes.

Researchers also conducted a trial with 400 people and discovered that those who consumed artificial sweeteners had “markers” for diabetes like higher blood sugar levels and glucose intolerance. Scientists leading the study said that artificial sweeteners may exacerbate glucose intolerance and diabetes; instead of being a healthy substitute, artificial sweeteners could make diabetes worse. The sweeteners used in the study were saccharin, sucralose and aspartame. Next time you reach for a diet soda, consider a potentially healthier alternative like sparkling water.


Getting a Grip on Diabetes and Depression

Lisa Feierstein Breathe EZ, Diabetes 1

Diabetes and its relationship to depression is a bit of a chicken and egg situation. Doctors and researchers don’t fully understand the relationship between diabetes and depression, but they do have some insight on how diabetes and depression can cause and exacerbate symptoms of each other.

Let’s start with diabetes. Managing diabetes can at times be overwhelming, it can lead to other health problems, and ultimately these stressors can cause symptoms of depression. On the flip side, depression can lead to diabetes if as a result of depression, an individual starts making poor eating choices, exercises less frequently, and/or smokes. These actions plus weight gain are all risk factors for diabetes. As depression worsens, it can affect a patient’s ability to focus and communicate clearly which in turn can make managing diabetes harder.

Since diabetes and depression often go hand in hand, it’s key to address your physical and mental wellbeing. Taking the right medications, seeking therapy, and healthy eating combined with frequent exercise are just a few methods to manage both depression and diabetes. If you need assistance managing your diabetes, call one of our caring professionals to handle your insulin pump, Continuous Glucose Monitor and testing supply needs.


Americans with Diabetes on the Rise

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The number of Americans with diabetes and the cost of are on the rise according to the National Diabetes Statistics Report, 2014, from the National Center for Chronic Disease Prevention and Health Promotion. In 2010, 26 million Americans had diabetes—that number rose to 29.1 million in 2014, or 9.3 percent of the U.S. population. Of those 29.1 million with diabetes, 8.1 million people have undiagnosed diabetes.

These statistics are troubling since the CDC estimates the total cost of diabetes has increased from $174 billion in 2010 to $245 billion in 2012, or a 41 percent increase in costs. These costs include medical expenses, disability, work loss and premature death.


Yoga and Strength Training Reduces Risk of Diabetes in Women

activeadmin Breathe EZ, Diabetes, Women's Health Leave a comment  

It’s common knowledge that regular aerobic exercise reduces the risk of diabetes, but a recent study revealed strength training, or anaerobic exercise, also reduces the risk of Type 2 diabetes in women. The Nurses Health Study from the Harvard School of Public Health found that women who do strength training exercises just an hour a week reduce their risk of developing diabetes by 14 percent. Over 150 minutes of weekly conditioning exercises reduces the risk by 40 percent.

This study also showed that you don’t need to run off to the gym and grab the biggest dumbbell available. Exercises like yoga and stretching are also great diabetes prevention activities. Researchers aren’t sure why yoga and stretching are also beneficial to reducing the risk of diabetes, but they think it may be linked to the effect these exercises have on lowering the loss of lean muscle mass or on how the body processes glucose. An added benefit to building lean muscle mass is that you burn more calories when your body is at rest.

Health.gov recommends moderate exercise for 150 minutes (2 hours 30 minutes) a week (a little over 20 minutes a day), and doing strength training at least twice a week. If just the thought of going to the gym makes you sweat, start small. Fit 10-minute increments of exercise into your schedule and slowly build up to longer periods of activity.


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