UCLA researchers report Nevada County, California residents have the lowest rate of diabetes in the state -- 2.6 percent. That's about one-third the state-wide average (6.8 percent), and slightly less than one-quarter the prevalence of diabetes in Imperial County (11.2 percent).

Take a few guesses why Nevada County's rate of diabetes is so much lower than Imperial County, and well under the national average of 7 percent. Do families eat less processed food around the dinner table? More jogging trails? Better health insurance coverage? Researcher Theresa Hastert states, "There is no one thing, but higher income is associated with better foods and exercise."

Hastert explained Nevada County is mostly white, affluent, educated and insured. Imperial County has a large population of Latinos and migrant farm workers. Nevada County's numbers support general findings that minorities without affordable, continuous health care are more prone to the disease. Who's got time for the dinner table -- Hastert openly speculates eating more junk food may be a consequence of dodging between three jobs just to get by. Also, Nevada County is a beautiful area -- she wonders if environmental factors play a role.

Is diabetes a socio-economic disease? If so, we're in trouble. The gap is widening between our nation's haves and have nots, and large concentrations of poor minorities may explain the disproportionate rates of diabetes from county to county. Read more in The Union.

Diabetic foot complications are responsible for many lower extremity amputations. But this last drastic step can be prevented up to 85 percent of the time with early diagnosis and proper care.

Now Thai researchers and physicians have shown using a patient's own stem cells can effectively heal chronic foot wounds. Diabetes patients with chronic foot wounds, aged 50-72, were injected with stem cells obtained from their own blood. Most excitedly, the wounds healed nicely within three to four months. The stem cell treatment also makes fiscal sense. According to this article, stem cell treatment for wounds in a patient with diabetes costs about $6,000, one-fifth the cost of conventional treatment for a leg wound.

Studies have shown primary care physicians often fail to examine the feet of patients with diabetes. It's a shame, as this step is the least costly and most effective way to prevent foot wounds and potential amputations. But at the same time, it is nice to know there is a promising, cheaper treatment utilizing patient-donated stem cells.

Aaaahh ... fall will soon deliver golden trees, crisp autumn air, piles of fallen leaves begging to be jumped in, and the stick of the flu vaccine.

The National Foundation for Infectious Diseases (NFID) recently issued a report calling for greater influenza vaccination rates among Americans with diabetes. Turns out more than 50 percent of the 21 million people with diabetes do not receive an annual influenza vaccination. This is contrary to the recommendations of the Centers for Disease Control and the American Diabetes Association.

According to Dr. William Schaffner, NFID's vice president, the impaired immune systems of people with diabetes can result in a higher risk of serious complications from influenza, including impaired blood sugar control. Annually, this infectious disease strikes up to 60 million Americans and kills an average of 36,000 people -- more than all other vaccine-preventable diseases combined. Over 10 percent of deaths linked to influenza and pneumonia are due to diabetes. There are studies citing the benefits of the vaccine for people with diabetes, including reduced hospitalization and death by 72 percent for those with diabetes 18 to 64 years of age, and 80 percent less hospital admissions for children and adults with diabetes.

I'm just speculating, but lack of awareness, lack of access to an affordable vaccine or just plain philosophical disagreement with the need for the vaccine (among other factors) may all play a role in the low influenza vaccination rates for people with diabetes. Just an example, my parents both have type 1, and my mom will stand in line for hours to get a shot (she was hospitalized for influenza in her pre-diabetes days), while my dad always refuses -- he's never had influenza. Read more at Infection Control Today.

Back in 2000, researchers at the University of Alberta in Edmonton, Canada transplanted islet cells in the livers of people with type 1, known as the Edmonton Protocol. Each islet transplant required several cadaver donors. The transplants worked for awhile, but approximately 80 percent of patients required insulin after a couple years. It was assumed the transplanted cells were rejected, but new research points to a new possible culprit -- fat.

Dr. Roger Unger and colleagues of the University of Texas Southwestern Medical Center in Dallas performed the Edmonton Protocol in rats with type 1. Fat built up around the transplanted cells in only a month. The cells stopped producing insulin and the rats died after 15 weeks. Dr. Unger explained the liver creates fatty acids from food, and islet transplants in the liver are surrounded by too much fat. He proved his point by repeating the transplant in a separate group of type 1 rats, but this time the rats were on a strict diet. A third group of rats received leptin, a hormone involved in increasing metabolism and decreasing appetite. These rats had an improved response, although the Reuters story does not provide specifics. Here's the study abstract in Diabetes, but ya gotta pay for the full text article.

Bummer. You get an islet cell transplant, but still have to stay away from the Ben & Jerry's. A next step could be testing this theory in human islet cell transplants via a low-calorie, low-sugar diet following transplantation. Read more in Reuters.

New research finds tuberculosis (TB) is more difficult to treat if the patient has type 2 diabetes. The study examined 737 Indonesians with tuberculosis screened for type 2. Nearly 15 percent had type 2, and initially, their TB was as severe as the non-diabetics. After two months of treatment, TB sputum tests were positive 18.1 percent for those with type 2 and only 10 percent in non-diabetics. At the six month mark, 22.2 percent of type 2s had positive sputum results compared to 9.5 percent of the non-diabetics.

The story in Reuters does not address why people with TB and type 2 diabetes do not respond as well to TB treatment. Tuberculosis is a serious infectious disease. Over one-third of the world carries the TB bacterium, and one in ten latent infections will progress to active TB disease. Untreated, active TB is a real threat, it kills more than half of its victims. Experts are examining how rising rates of type 2 are impacting TB control and prevention worldwide.

I just finished reading an excellent book about Dr. Paul Farmer's inspirational work treating tuberculosis in impoverished communities worldwide -- Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, A Man Who Would Cure the World -- masterfully written by Tracy Kidder. I wonder what Dr. Farmer has to say about people with type 2 and TB.

When I read the headline in this Yahoo! news, Obesity rates climb in most states, I took a stab at guessing the leanest and fattest states in America. My favorite state, Colorado, immediately came to mind for the fittest state. Ding, ding, ding ... that is correct! But I had no clue on the fattest state, West Virginia was a shaky guess. I heard the buzzer on that one, Mississippi became the first state to break the 30 percent barrier for obese, adult residents. But hey, I wasn't far off, West Virginia and Alabama are slightly behind the double-letter state.

Colorado has an obesity rate of 17.6. Yikes, this is the leanest state in the nation. Statistics were provided by the Trust for America's Health. They analyzed state health department-generated telephone surveys of height and weight, combining three years of data (2004-2006) for improved projections. No one denies obesity increases the risk for diabetes and chronic diseases. Jeffrey Levi, executive director, stated everyone believes obesity is an epidemic, but political and policymaker attention is lacking. Levi agrees weight is a personal choice and responsibility, but he wants societal improvements to help people make better choices, such as healthier school lunches and safer places to be active across all classes.

The report is not intended to stigmatize fat states, but motivate them to action. Is this honestly a good way to do it? We should be talking about poverty in Mississippi, not scolding them. The five poorest states were in the top 10 when it came to obesity rates. I'm sure the Mississippi fat jokes have already begun. This country loves to categorize, from Money's Best Places to Live to U.S. News & World Report's America's Best Colleges. Now we'll be adding an obesity category to all these reports. I can see it now, some diet rag will announce the Top 100 Thinnest Universities.

A new study by Kaiser Permanente's Center for Health Research carries both good news and bad news. Bad news first -- research of 9,439 mother-child pairs shows maternal blood sugar is tied to a future risk of obesity in offpsring. Pregnant women with above-normal blood sugar levels were twice as likely to have overweight kids. Across all racial and ethnic groups, the higher the mother's blood sugar during pregnancy, the greater the chance her offspring would develop obesity by 5 to 7 years of age.

Now if you're pregnant and you've been diagnosed with high blood sugar, take a deep breath. The good news is the risk of childhood obesity is reversible if elevated sugars are treated through diet, exercise and insulin (if required). At particular risk are women with sugar levels higher than normal, but not high enough to be deemed gestational diabetes. They were more likely to have obese children than women treated for gestational diabetes or those with normal sugars.

Borderline blood sugars are nothing to ignore. I shared in a previous post that moderately elevated glucose during pregnancy is associated with other problems such as cesarean section and heavier babies. Gestational diabetes criteria may widen. Also, Deanna reported earlier this month that gestational diabetes is linked to pancreatic cancer.

I realize Halloween isn't even upon us, but if you're one of those organized early holiday shoppers consider the American Diabetes Association Gift of Hope. Every penny of profit from this gift catalog funds diabetes research. You're spending your money on a gift and research for a cure. Choose from over 30 holiday cards, a 2008 calendar and 40 gifts. Hmmm ... the Striped Barnstorm Frame caught my eye.

Gift of Hope has been around since 1971, when a group of Minneapolis-area parents of children with diabetes started selling holiday cards to raise money for diabetes research. Now under the American Diabetes Association (ADA) name, Gift of Hope has raised over $22 million to date.

If you're a budding artist, check out ADA Gift of Hope's 2008 Holiday Art Search. Artwork must be created by or dedicated to a person with diabetes. Winning entries are used to produce the holiday cards and gifts. Deadline is November 1, 2007.

Recently I posted on the California Department of Education's recent lawsuit settlement with the American Diabetes Association. CDE promised students would have access to legally-required diabetes care on campus. With a shortage of school nurses, CDE agreed caregivers could include trained volunteers. I came away from the agreement thinking, "Good! It may have taken a lawsuit, but problem solved." But this settlement is hardly a neatly wrapped package.

Liability drives many decisions. Now the California School Nurses Organization has advised school nurses to seek guidance from district lawyers before training volunteers. Nurses are concerned they could lose their licenses if they train non-medical staff. Executive Director Nancy Spradling stated insulin injections should be monitored by licensed personnel -- incorrect calculations can be fatal or trigger a coma. They've got a point.

Student diabetes care varies widely in California. With a student population of 22,000, Lake Elsinore Unified School District is doing a good job. They have eight nurses taking care of 70 students with diabetes. Last year, Palm Springs Unified School District had only 3 nurses for 24,000 students, requiring parents to visit district schools daily to inject children too young to handle the task themselves.

Arlene Mayerson, directing attorney with the Disability Rights Education and Defense Fund (they represented the ADA in the lawsuit), stated California has one of the lowest nurse-to-student ratios. Perhaps a new certification for a 'School Diabetes Specialist' is on the horizon. Regardless, I hope the CDE figures out a solution to honor the settlement. I bet school districts across the country are watching -- the health of students with diabetes is at stake. Don't forget the nurses' concern. Beyond losing their licenses, no one wants to see a student with diabetes hurt or killed due to an improperly trained, unlicensed adult volunteer. Read the full story in The Press Enterprise.

How come type 2 diabetes does not affect all obese people? A study recently published in the Journal of Clinical Investigation may explain why. Adiponectin is a hormone that controls insulin sensitivity. Leptin is a hormone which lessens appetite. Too much adiponectin allows mice to store excess calories in fat tissue instead of in more dangerous areas -- the liver, heart or muscle tissue -- where extra fat may lead to inflammation, diabetes and heart disease. Unfortunately adiponectin levels decline as people get fatter. So researchers wondered "what if overeating mice had high levels of adiponectin?"

Researchers genetically engineered mice to produce lots of adiponectin and a lack of leptin. The mice overate and became obese, but their high levels of adiponectin enabled them to dump their fat into fat tissue, which has antidiabetic effects. Dr. Philipp Scherer, senior author, stated the inability to appropriately expand fat mass while overeating may be an underlying cause of insulin resistance, diabetes and cardiovascular disease. Low adiponectin levels don't allow fat cells to accept fat, so the fat builds up in inflammatory locations.

Considering 66 percent of American adults are overweight or obese, Dr. Scherer stated researchers need to find way to deposit extra calories in the least harmful places. He plans to investigate how to maximize good fat areas and shrink bad ones. This solution is disturbing to me -- don't we need to get rid of the fat in the first place? Read more in Health News Digest and check out Diane's recent post on upper body fat's link to insulin resistance.

Now 40 years old, Jay Hewitt was diagnosed with type 1 diabetes at the age of 24. What did he do then? He started entering Ironman Triathlons. You've probably heard of these gargantuan events -- a mere 2.4 mile swim, followed by a 112 mile jaunt on the bike, capped off with a marathon run (26.2 miles). Nuts! I did a mini-sprint triathlon in my 20s and cannot imagine setting off on an Ironman.

An elite triathlete, Jay enters Ironman races regularly. Showing the world type 1 diabetes has not stopped him from achieving his goals, Jay has finished 13 Ironmans and is racing in the Louisville Ironman right now. Actually, he's biking -- as of 9:30 am CST he had finished the swim in 1:09:32, ranked 422. Click on the Louisville Ironman website and read updated race coverage, view photos and even track Jay's progress. Cool.

Hewitt is the Captain of Team Joslin, and he is wearing the Joslin Diabetes Center's High Hopes Fund logo on his jersey to support the fight against diabetes. He ran with Team Joslin in the Boston Marathon this past year and traveled to Camp Joslin to train kids with diabetes in a swim/run biathlon. Be like Jay! You, too, can compete for Team Joslin in your next individual or team sporting event. Hewitt is also a member of the U.S. National Team for Long Course Triathlon, a motivational speaker inside and outside the diabetes community and a practicing attorney. Check out Jay's website to learn more. Is there anything he cannot do? What a role model for kids and adults with diabetes alike!

Way back in my middle school years, students taking Home Economics had to carry around a five pound sack of flour for a week to illustrate mother/fatherhood. Kids drew cute baby faces on their lumpy sacks and proudly carried them around. It was novel for a day or two, then you'd start to see the flour babies left in lockers or simply forgotten at home. Parenthood sounds easy, until you have to rise to the responsibility day in and day out. Same with diabetes.

This past week, Representative Michael Castle (R-DE) and Representative Zack Space (D-OH) signed on for the American Diabetes Association's "Day With Diabetes" -- a demonstration designed to raise awareness of the immense personal impact of the disease. Castle was 'diagnosed' with type 1 and Space with 'type 2.' Both met with a certified diabetes educator and a registered dietician to devise a treatment plan. The Representatives attempted to control their 'diabetes' for a day -- pricking their fingers for blood glucose checks, taking their medications and considering every meal choice. They were also shadowed by people with the real deal -- CJ Jones has had type 1 for 30 years and Berth Garbrandt, has had type 2 diabetes for nine years.

Next month Castle and Space will hold a Congressional briefing to report on their experiences living with diabetes for a day. Space has a good idea, his son has type 1 diabetes. Castle is co-chair of the Congressional Diabetes Caucus. A pretty interesting publicity stunt for diabetes awareness. We need to keep diabetes funding and research on the top of every legislator's mind. Here is the full story.

Autism is a bio-neurological disorder typically appearing in children before the age of 3. Individuals with autism usually have difficulties in verbal and non-verbal communication, social interaction, play and cognitive function, as well as certain physical ailments. Severity of autism can vary widely. One in 150 now have autism, and boys are diagnosed four times more often than girls.

Alternative treatments for autism are growing (chelation and dietary therapies), but I've never heard of this one -- the type 2 diabetes drug Actos. Dr. Marvin Boris of Autism Associates, stated his office prescribes Actos to children with autism. Remember, Actos just received the black box warning from the Food and Drug Administration for risk of heart failure. Dr. Boris prescribes Actos in an "off-label" use, which is legal. He believes autism is an autoimmune disorder with a genetic predisposition and a biochemical bases.

Actos is a peroxisome proliferator-activated receptor (PPAR) agonist, found to reduce inflammation in the brain's glial cells. These same cells are inflammed in children with autism. Autism Associates has treated over 350 children with Actos, seeing significant subjective responses in over 75 percent, including improved speech/language, focus and socialization skills. They are participating in ongoing clinical trials with the University of Illinois to treat multiple sclerosis and autism spectrum disorder patients with Actos.

My heart goes out to parents and children dealing with autism. Parents have watched pieces of their child disappear before their own eyes, and alternative therapies provide hope. Dr. James Mulick, professor of pediatrics and psychology at Ohio State University, stated autism is "a magnet for all kinds of unsupported or disproved therapies." Dr. Joel Bregman, medical director of the Fay J. Linder Center for Autism in Bethpage, said he had never heard of Actos prescribed for autism. Since 2001, Dr. Boris has been involved with DAN! Protocol (Defeat Autism Now), for those not regarding psychotropic drugs as the best or only means of treating autism. Obviously, physician opinion differs. Read more in Newsday and more about Actos and autism at Autism Associates.

You've probably heard it in the news lately. The number of overweight children and teenagers aged 6-19 has nearly tripled over the last 40 years. Type 2 diabetes is not an adult-only disease anymore, adolescents are developing it. If we don't turn this trend around, many kids will have heart trouble by the age of 30 or 40. Healthier school fare is a part of the solution, but I believe parental influence on meal and snacking habits is most crucial. As your children head off to school in the coming days, do not forget about packing a healthy school snack (if required) ... I'll write later on healthy school lunches.

My little guy will step on the bus today for his first day of kindergarten. He is thrilled. He is ready. We walked the school hallways during an orientation earlier this week, and yesterday we had a kindergarten briefing where we learned all about school policies. The policy-chat was briefly interrupted by a tornado warning, where the entire school hit the deck in the hallways for 20 minutes, but luckily, no twisters!

As the policy-talk ensued, the teacher announced daily snacks must be healthy. Juice boxes were not allowed. A water bottle was fine, but the drinking fountain even better. Geez, I was starting to really like this school. Fruit and vegetables were strongly suggested, but no cookies, mile-high frosted cupcakes or sugary fruit snacks. I nearly stood up and clapped, but I didn't want to freak out a roomful of mommy strangers. After reading Allie's recent post on water, I will definitely pack a water bottle.

Yesterday afternoon we headed to the store and Frank picked out his snack -- he searched and searched until he found a perfectly shaped green apple. It's in his backpack, ready and waiting for his first day of big kid school. If you're shopping for school snacks, here is a helpful list of ideas to bring. Think fruits and vegetables. Don't throw those sugary graham crackers in your shopping cart. Stay away from the processed carbohydrates. This is your chance to develop healthier habits for a lifetime. Hey, you might not even need to be the fall guy -- hopefully it's "school policy."

Our guts don't really have a tongue, but researchers have identified two taste receptors in the human intestines -- T1R3 and G protein gustducin. The receptors operate within taste cells that sense glucose within the intestine. These same receptors are used by our tongues to taste sugary stuff, even artificial sweeteners. Turns out the research team hypothesized the sugar sensors in the tongue might also be the same ones in the gut. They were right. Hey, nice guess!

That Snickers bar you're eating? Your gut tastes it, too. Even the artificially sweetened glass of chilled Crystal Light is tasted by the gut. It is important to understand how the gut is sensing, since these taste cells regulate secretion of insulin and hormones that control appetite.

Researchers say discovering the identity of the gut's sweet tooth receptors may pave the way for new treatments for obesity and diabetes. Lead author, Dr. Robert F. Margolskee, stated the study may explain why today's artificial sweeteners may not help with weight loss. New zero-calorie sweeteners could be developed to better control weight. The findings were published online in the August 20, 2007 "Early Edition" of the proceedings of the National Academy of Sciences. Read the full article in Medical News Today.