Type 1 Diabetes New Staging System Promotes Early Detection

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diabeteswordThis article was submitted by the Baylor College of Medicine, please share your comments below…..

For most people with type 1 diabetes, the disease seems to occur suddenly, often resulting in a trip to the emergency room with life-threatening complications. But a new recommendation calls for a diabetes staging classification that could mean earlier diagnosis and better outcomes for patients in the long run.

The recommendation was made by the JDRF, the American Diabetes Association and the Endocrine Society in the January issue of the journal Diabetes Care and is based on research from TrialNet, an NIH-funded international network of research centers, including Baylor College of Medicine and Texas Children’s Hospital.

The research indicates that type 1 diabetes can now be most accurately understood as a disease that progresses in three distinct stages.

Stage 1 is the start of type 1 diabetes. Individuals test positive for two or more diabetes-related autoantibodies. The immune system has already begun attacking the insulin-producing beta cells, although there are no symptoms and blood sugar remains normal.

Stage 2, like stage 1, includes individuals who have two or more diabetes-related autoantibodies, but now, blood sugar levels have become abnormal due to increasing loss of beta cells. There are still no symptoms.

For both stages 1 and 2, lifetime risk of developing type 1 diabetes approaches 100 percent.

Stage 3 is when clinical diagnosis has typically taken place. By this time, there is significant beta cell loss and individuals generally show common symptoms of type 1 diabetes, which include frequent urination, excessive thirst, weight loss and fatigue.

“Clinical research supports the usefulness of diagnosing type 1 diabetes early – before beta cell loss advances to stage 3. The earlier diagnosis is made in the disease process, the sooner intervention can take place, and the more beta cells are likely to remain. More beta cells may lead to better outcomes regarding blood sugar control and reduction of long-term complications,” said. Dr. Maria Redondo, director of the Texas Children’s/Baylor TrialNet Clinical Center and associate professor of pediatrics at Baylor and in the diabetes and endocrinology section at Texas Children’s Hospital.

The Texas Children’s/Baylor TrialNet Program serves as one of the 14 TrialNet Clinical Centers throughout the United States, Europe, Canada and Australia. TrialNet was founded in 2001 and since then has screened approximately 150,000 participants for type 1 diabetes markers.

Screening is recommended for people who have relatives with type 1 diabetes. Family members have a 15 times greater risk of being diagnosed than a person with no family history. TrialNet screening is available at no charge to:

* Anyone between the ages of 1 and 45 with a sibling, child or parent with type 1 diabetes.

* Anyone between the ages of 1 and 20 with a sibling, child, parent, cousin, uncle, aunt, niece, nephew, grandparent or half-sibling with type 1 diabetes.

“TrialNet’s goal is to identify the disease at its earliest stage, delay progression and ultimately prevent it. We offer screening and clinical trials for every stage of type 1 diabetes and close monitoring for disease progression,” Redondo said.

For people who participate in type 1 diabetes prevention research like TrialNet, the risk of diabetic ketoacidosis (DKA) at diagnosis decreases to less than 4 percent from 30 percent. DKA is a serious complication of diabetes than can lead to coma or even death.

For more information or to participate, call 832-824-1207 or email TrialNet@texaschildrens.org.

Maintaining Your Irrigation System And Yard Fencing

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By David E. MacLellan

sunIt has been a tough winter! This year’s polar plunge has had crippling effects all over the country. But there is hope; Spring has arrived.

Ah, spring the time to take stock of the ravages of winter. Whether you’re getting ready to plant your new seasonal garden or you’re still keeping the snow shovel handy, it won’t be long before green shoots assert their presence in your lawn and garden.

Two of the most important spring maintenance tasks involve your yard fencing and irrigation system.

Wooden fencing will warp, twist, split, rot and may need early replacement. By taking a few simple steps each spring, you can extend the life of your fencing to 20 years or more. On an annual or as-needed basis, do the following:

* look for warped or split boards and replace them

* look for top and bottom rails that have pulled away from the posts

* re-nail the rails with a one size larger galvanized nail, or if the gap is too big, tie the post and rail together with a galvanized framing strap

* replace rotted posts with a post replacement kit found at any home improvement store

* dig out posts leaning more than 10 degrees, and re-level or replace.

The other important maintenance item is your irrigation system. Each Spring, check the sprinkler heads and the system for leaks and breakage.

Whether or not you live in an area that is subject to freezing, an important precaution to take before winter begins is to turn off your irrigation water at the main supply valve. Leaving the water on and only turning off the controller could lead to a very surprising and expensive water bill.

Here’s why: electric irrigation valves are notorious for sticking open, sticking closed, and/or leaking at the main body gasket. Valves are usually housed in an underground box where small leaks can go undetected for weeks or months. Turning off the controller just turns off the power to the valves, and if the irrigation water supply is still on, the valves remain under pressure. If a valve is stuck slightly open, it will allow water to flow to the sprinkler heads. If the main body gasket is loose, water will drip out between the two valve parts. Fixing a valve that sticks open or closed usually involves replacement of the solenoid, a simple task that runs about $25 in parts. Fixing a valve that leaks at the main body gasket involves tightening the screws that hold the two parts together. If that doesn’t work, then the entire valve will need to be replaced at a cost of about $45 in parts.

When the irrigation system is determined to be free of leaks, it should be tested. Although most controllers have a test mode, it is often too short a time span to adequately observe the sprinkler heads at each station. Set each station to “manual” and allow enough time to walk around and observe the water flow. Look for excessive leakage at the sprinkler head, misdirected spray patterns, and leaking or broken risers. Remember, the time to make the repairs is during the cooler spring days, and not the scorching days of summer.

Following these tips for routine, seasonal inspection of your fencing and irrigation system will save you money and extend the life of their components.

Note: There is a FREE Home Maintenance Checklist available at www.HouseFixIt.com that will help homeowners determine which tasks to perform throughout the year. Adapted with permission from The Home Book: A Complete Guide to Homeowner and Homebuilder Responsibilities by David E. MacLellan, George E. Wolfson, AIA, and Douglas Hansen © 2014, www.HouseFixIt.com

– David E. MacLellan is a nationally recognized expert in homebuilding related litigation and an author of three books on homebuilding standards and home maintenance. He has 25 years of experience as a builder in home construction. In 2011, MacLellan was inducted into the California Homebuilding Foundation Hall of Fame.

Managing Anxiety By Accepting Your Brain’s Alarm System

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By Bob Livingstone

brainThere have been dramatic studies about the science of the brain, how it works and how we can deal with our emotional pain in new ways. There have been many articles and books written in the last few years about the different parts of the brain, how they function, and how they can heal emotional anguish.

This article will focus on the workings of the part of the brain called the amygdala. I am concentrating on this part of the brain because it has a huge impact on our emotional lives.

The amygdala is a necessary part of our brain that has kept us safe throughout history. It becomes activated when you are in real danger. It triggers the fight or flight response. If you see a wild dog running towards you, your amygdala will mobilize and you will take whatever action is necessary to protect yourself.

Without the amygdala, we would not be able to prepare for peril, so it is a necessary part of our being. However, sometimes the amygdala can become over active due to situations that create post-traumatic stress syndrome. (PTSD)

The amygdala plays a part in the creation and storage of memories associated with emotional events. The amygdala also plays a role in the formation of many fear responses including freezing, rapid heartbeat, increased respiration and stress hormone response.

If you are a victim of child abuse, if your parents had a hostile divorce, if someone close died when you were young, if you were a soldier in a war zone, or if you had physical health problems; you may be suffering from PTSD.

In the original trauma, the normal and natural fight flight response kicks in, the amygdala immediately decides it is a dangerous situation that must be reacted to in that way; and that is a normal body response to danger.

In the original trauma, the normal and natural fight flight response kicks in, the amygdala immediately decides it is a dangerous situation that must be reacted to in that way; and that is a normal body response to danger. The higher functions of the brain located in the frontal lobe allows us to sort our experience, compare and contrast, make meaning out of what is going on and finding a safe resolution. These higher functions vanish during the original trauma; making it impossible to create any kind of logical strategy for dealing with this emotional disturbance. They go offline because protecting a real threat to the body overrules any other brain task.

Sometimes the amygdala can misinterpret body sensations. Jane can be thinking about the possibility about being rejected by her boyfriend and her abandonment issues get triggered. The amygdala is sensing that her life is being threatened when in essence she is not in danger, but panicking because she has strong, negative feelings and memories of being abandoned by someone she truly loved. This panic is wrongly identified as the possibility of grave physical harm by the amygdala, so its forces rev up.

Around four years ago, I had a number of health issues happen one right after the other: I had the H. Pylori stomach virus that felt like rats were fighting for control over my stomach which led to acid reflux. I remember lying on the floor feeling without energy as the country celebrated the inauguration of the first African-American president. A couple of months later, the electrical system in my heart wore out which resulted in the installation of a heart pacemaker. Then I had surgery to remove a seven millimeter kidney stone that became infected. This followed with intermittent back and other muscle pain.

brainthinkingMy amygdala kicks in when I experience any body sensation that reminds me of the electrical system of my heart giving out or kidney stones floating in painful areas. I could be feeling winded when I exercise or heartburn or any other sensation that seems out of the ordinary. I feel the sensation and then thoughts about my possible demise enter and panic sets in like an unwanted visitor.

I also can be triggered by any incoming body sensation that I feel may lead to my death-even though there are no conscious thoughts that I am going to die, but the amygdala is getting the message that I am in danger and it sounds the alarm that is experienced as intense fear in my body. I feel so overwhelmed when this occurs and don’t know what to do. The panic can last a few minutes or can be intermittent over the course of a day.

This feeling of impending death is experienced at the same time as the memory of suddenly and without any warning, passing out while I was on my five mile run.

I realize that this hyperactive amygdala had its origins when my father died suddenly when I was fifteen years old. My innocence was instantly shattered and I was abruptly pushed into a world of having no father and no means to deal with such a loss.

I have felt shame about this fear/amygdala sensation being activated for most of my life. I always believed the fear was my fault and experienced humiliation since I’ve had no success in warding it off.

Now I know that the amygdala becomes active whenever it senses danger. I have had no control over that process when it does give out its warnings. A huge part of my emotional healing is about learning to accept that the amygdala will do its thing no matter what. Sometimes I will not be able to respond to the trigger immediately and the sirens from that part of my brain will ring with danger and a call to be ever vigilant.

When I was younger, I perceived the amygdala to be the critical parent inside me and now I am aware that I have mislabeled this part. We all have different parts of us inside that may include the child, teenager, calming mother or raging father. The amygdala is not in this category at all. It is part of your brain that is designed to keep you safe by alerting you to danger.

brainExample of how this all works: First you notice a physical sensation like heartburn and as soon as you feel it, you tell yourself that this feeling is not dangerous, that it is only heartburn and not a heart attack or heart failure. You will have to practice this; it won’t be natural to you at first, but after repeating this process several times, it will begin to become second nature. You then tell yourself to take some deep breaths and feel yourself relax. If you are focusing on your breathing, it is difficult to concentrate on anything else like fear.

It is important to realize that hardly any time elapses between the moment you are triggered and the amygdala can be deactivated. The amygdala, at the moment you are triggered is like a pot of water that is only simmering now, but will be boiling over soon if you don’t interrupt its process. Therefore, you don’t have much time to intervene and the trick is to identify what is happening quickly and calm yourself so the amygdala doesn’t sense danger and therefore doesn’t sound its full alarm.

Let’s revisit the case of Jane from earlier. When she was a small child, her father, who she loved very much, one day decided to leave his family without any notice or conveyed reason. Now, whenever she thinks about being abandoned, which she does often, she has the memory of her father leaving and then gets triggered. Shortly after she is triggered, the amygdala kicks in because it senses danger and possible catastrophe. Her past memory falsely interpreted that she is in danger now/in the present.

Jane can then feel out of sorts and very anxious the rest of the day until the amygdala senses that the danger has passed.

She can learn to identify when she feels triggered. She learns that it commences with an anxious feeling followed by her childhood memory of dad leaving. This self-awareness is a cue that the trigger-amygdala activation is about to begin. At this moment she tells herself that she can take care of herself no matter what, that she can tolerate being alone and that she doesn’t need to give this trigger any more energy. She chooses to focus on something else such as work or guitar lessons.

The amygdala will not sense any danger and therefore will not get charged up.

If the amygdala has been activated and you are feeling overwhelmed, anxious, hopeless, distressed, and/or confused; healthy distraction is a great technique to use.

If the amygdala has been activated and you are feeling overwhelmed, anxious, hopeless, distressed, and/or confused; healthy distraction is a great technique to use. In the midst of these intense negative feelings, you can give yourself permission to distract yourself from the fear by concentrating on something else. You may choose to focus on a work related activity, exercise or a walk on the beach. This diversion from the fear will cause the amygdala to shut down its warning system because it will no longer feel that you are at risk for demise.

One form of healthy distraction for me is to get angry at this sense of overwhelm and by telling myself how sick I am of having to deal with bone aching anxiety. The amygdala may have felt that my anger signified that I was in control and therefore no danger was on the horizon.

It is very important to understand that mastering the process above is far from an easy endeavor. It takes lots of practice and patience. It takes many instances of trial and error. You may find that one or more of these techniques presented here is effective or you may discover something that works for you that no one else has discovered. Sometimes no matter how good you are at these techniques, the amygdala is going to get fired up and you will be overwhelmed. It is possible to reduce the frequency of these incidents though and you need to be a warrior to reach your goals. Go for it!

Psychotherapy Techniques that may help you: Eye Movement Desensitization and Reprocessing (EMDR), Emotional Freedom Technique (EFT), Cognitive Therapy and Mindfulness.

Other techniques that may help: Meditation, Breathing Exercises, Relaxation Skill Training, and other Stress Reduction Programs

Medication prescribed by a psychiatrist may be helpful as well as certain herbs and supplements recommended by alternative healers.

I do recommend that you do your own research for all these helpful possibilities.

– Special Thanks to Kathy Carlson MFT and Sharon Kman MFT for assisting with this article.

Bob Livingstone is the author the critically acclaimed Unchain the Pain: How to be Your Own Therapist, Norlights Press 2011, The Body Mind Soul Solution: Healing Emotional Pain through Exercise, Pegasus Books, 2007 and Redemption of the Shattered: A Teenager’s Healing Journey through Sandtray Therapy, Booklocker 2002. He is a psychotherapist, licensed clinical social worker in private practice in The San Francisco Bay Area and has nearly twenty five years experience working with adults, adolescents and children.