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.

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.

Participants are being sought for a new study on the possible benefits of an aspirin-like medication for people with type 2 diabetes. The research, which is being funded by the National Institute of Diabetes and Digestive and Kidney Diseases, is aimed at determining if Salsalate, a drug that has been used for more than 40 years to treat pain associated with arthritis, can also be used to help manage diabetes.

Recent studies have linked chronic inflammation to the development of insulin resistance type 2 diabetes. To that end, researchers are looking for adults ages 18 to 75 whose glucose levels are not well controlled and who do not take insulin. Participants will be randomly assigned to either receive Salsalate or a placebo and will receive all medication related to the study at no expense to them. They will also be compensated for time and travel.

If you'd like more information, call 312-355-4442 and ask for Felecia Gilet.

Next month, 67-year-old Gary Stenlund is heading to the World Masters Championships in Riccione, Italy. He will compete against other senior javelin throwers for the World Masters crown. He's throwing with an arthritic knee and type 2 diabetes.

No stranger to the javelin, Stenlund set the world junior record in high school and was a two-time NCAA runner-up at Oregon State University. In 2003, he nailed the 60-to-64 World Masters top spot with a record throw of 191 feet. Here's one good reason to age, Stenlund topped the world record in the 65-to-69 age division three times last summer.

A sober alcoholic since 1984, he is no stranger to facing life challenges. I shouldn't complain about my sore knee, Stenlund competes with a bone growth on his right knee big enough to fit in the palm of your hand. The article does not mention much about his type 2 diabetes, but he keeps his 6' 1", 185-pound frame healthy through calisthentics, stretching and throwing that skinny metal rod. Go get 'em Gary! Read more in The Portland Tribune.

Do not miss this recent NY Times article by Gina Kolata, Looking Past Blood Sugar to Survive With Diabetes. It is a must read for anyone associated with type 2 diabetes, including patients, family caregivers and doctors. I am very encouraged to see a feature on type 2 diabetes in such a well-read newspaper. Many doctors are uninformed on the best ways to treat a person with type 2 diabetes, they spend much more time with type 1 patients. Furthermore, type 1 and type 2 are very different diseases, but since they both end in 'diabetes' there is deep confusion -- see Diane's previous post on this topic. Undoubtedly, we need Big Media to provide greater coverage on the differences and unique treatments for both type 1 and type 2 diabetes.

First off, type 2 diabetes is a form of the disease that usually appears in adulthood where the body does not produce enough insulin or the cells are resistant to insulin. Kolata's article focuses on one man's battle with type 2 diabetes, as well as the importance of other treatments beyond blood sugar control that can markedly prevent heart disease -- the number one threat to a person with type 2. Dave Smith, a pastor from Fairmont, Minnesota, has dealt with type 2 diabetes for nine years. From the start, his doctor advised him to control his blood sugar, so he was a faithful carbohydrate counter, finger pricker, type 2 pill taker. Nothing worked, so he added insulin.

Unfortunately, his fixation on controlling blood sugar ignored the most crucial treatment of all -- lowering cholesterol. According to Kolata's article, heart disease kills nearly everyone with diabetes. The second treatment Smith did not consider was the importance of controlling blood pressure. The third treatment is taking aspirin to control blood clots. Last October, Smith had a major heart attack and nearly died. He had never thought about heart disease, and his doctor never advised him to take a cholesterol-lowering statin or a blood pressure drug. The American Diabetes Association reports only 18 percent of people with diabetes know their increased risk for cardiovascular disease. Grrrr! This lack of awareness among patients and doctors must change for lives to be saved. It took a near-fatal heart attack for Smith to receive the combination of drugs he should have been prescribed at diagnosis: a statin, two drugs to lower blood pressure, aspirin, insulin and two drugs to reduce his blood sugar level.

The article also points out the myth of obesity and type 2 diabetes. While obesity does increase the risk for type 2, only 5 to 10 percent of obese people have the disease, and many people with type 2 are not obese. Genetics is a big determiner. Losing weight can definitely improve type 2 control, but most are not cured. Smith lost 40 pounds and still has type 2.

Dr. Irl B. Hirsch, a professor of medicine and director of the diabetes clinic at the University of Washington, stated it plainly. The first priority for a typical middle-age person with type 2 diabetes is to take a statin and lower the LDL cholesterol level. FYI, a person with diabetes should keep LDL cholesterol below 100 milligrams per deciliter, ideally 70 to 80. Keep in mind, this is even lower than the recommended LDL levels of 100 to 139 for a healthy person. Dr. Michael Brownlee, director of the JDRF International Center for Diabetic Complications Research at the Albert Einstein College of Medicine in New York, stated beyond a statin, blood pressure control and taking an aspirin to prevent blood clots are two other important measures.

The title of Kraft Foods' press release this morning was Good Eating, Good Living Radio Show and Website Aim to Clear Up Confusion and Isolation Often Associated with Diabetes. The radio show and Website will provide diet and exercise tips for people with diabetes. Recipes, a meal and fitness planner, product nutrition info, logs/journals, articles, etc ... will be offered. Amy Hendel, a registered physician assistant and Edye Wagner, a registered dietitian and certified diabetes educator, will host the 22 episode radio show beginning August 25 in 30 cities across the country.

Seems like Kraft is spinning a public relations campaign to help pardon the junk food they're hawking to kids and adults. They also are boldly advertising Kraft Foods products in the name of helping people with diabetes. This new program is more about food sales and rationalization against potential future litigation by showing Kraft stands by healthy eating. The press release even included a quote from Amy Hendel, "The good news for the millions with this disease is that by choosing Kraft products they don't have to deprive themselves of their favorite foods or sacrifice flavor."

If Kraft Foods truly wanted to help the millions of people in the United States with diabetes they should stop selling the junk such as Oreos, Fruity Pebbles and Chips Ahoy cookies. Although I do applaud many of their healthier products -- Triscuits, Post Shredded Wheat and Breakstone's Cottage Cheese. Also, in 2005, Kraft did stop advertising some junk food products to kids under age 12. But how about kids over 11? Kraft should also stop being a player in the Big Food lobbying games. The last Bush/Cheney campaign reaped thousands of dollars in donations from a lobbyist for Altria (the company formerly known as Philip Morris), which formerly owned 85 percent of Kraft Foods. (Kraft became a fully independent company March 30, 2007.) Altria also handed the Bush inauguration $250,000 in 2005. It's time for our government to stop taking Big Food's money and start regulating the junk out of Big Food's product lines. But Kraft is smart, if they appear like they're regulating themselves, the government and litigators are less likely to step in. Philip Morris executives know all about tobacco litigation.

This is not to say the radio show or Website will not be decent sources of information for people with diabetes. But as you tune in, keep in mind Kraft's intention may not be that altruistic. Don't miss this informative article on the deceptive tactics of Big Food, Kraft included.

I have the utmost respect for golfers with disabilities. In a conference match in high school, I played against an opponent missing her right hand and most of her forearm. As a right-handed golfer, her swing arc was primarily guided by her left arm, so she didn't miss a beat when it came to form. Whatever yards she lost on her long game were covered by a pretty mean short game.

I couldn't help but smile wide after hearing this story yesterday about Sheila Drummond, a golfer blinded by diabetes 26 years ago. She may have lost her eyesight to diabetes, but nothing can take this golfing accomplishment away. Last Sunday in a steady rain, 53-year-old Drummond teed off with a driver on the 144-yard, par-3 fourth hole at Mahoning Valley Country Club in Pennsylvania. She smacked it over a water hazard, between the sand traps and onto the green. Her ball hit the flagstick and dropped into the cup. A hole-in-one!

As her drive took off, Drummond's husband Keith, and two other players rounding out the foursome, told her it was a great shot -- then she heard the ball hit the stick. This story will be shared by many golfers gathering round the water cooler this season. Drummond is also on the board of directors of the United States Blind Golfers Association.

The odds of an amateur sinking a hole-in-one are estimated at 1 in 12,750. A few months ago, my mom played in a foursome just behind a friend of hers who teed off on her very first golf hole ever. She hit a hole-in-one. No kidding. What are the odds?

Diabetes rates skyrocketing! is a unified message plastered across the daily news. I've often wondered how improved diagnosis and awareness of diabetes has impacted this incessant news alarm.

Federals scientists analyzed a data set from the National Health and Nutrition Examination Survey to find the total proportion of the population with diagnosed and undiagnosed diabetes. Statisticians found the overall age-adjusted proportion of the population with diabetes has not really changed much from 1988 to 2002, the most recent year of available federal data. Katherine M. Flegal, an epidemiologist at the National Center for Health Statistics, published the results in Diabetes Care last year.

Two subgroups (men and non-Hispanic blacks) did have a small, yet statistically significant increase in the diabetes rate. Dr. James Smith, a senior economist at the Rand Corporation, took an independent look at the male data from the national survey to find out why. He stated the data were distorted by inconsistent surveying of gestational diabetes in women. After removing it from the data, similar rises were seen across both genders.

Dr. Smith does not want to minimize the serious problem of diabetes in this country. But he believes the perception that diabetes is rapidly rising is exaggerated due to confusion over diagnoses versus the actual number of people with the disease. We may need to turn off that rising diabetes news alarm. Read the full story and view a helpful graph on diabetes rates in the NY Times.

Japanese researchers published an interesting case in the Journal of Neurology, Neurosurgery and Psychiatry. The case involved a wheelchair-bound 57-year-old man with serious diabetic neuropathy. The patient had type 2 diabetes for 10 years, and experienced pain and progressive loss of muscle and strength in both legs. He also lost a lot of weight.

Researchers at Nagoya University School of Medicine treated this gentleman with intravenous immune globulin (IVIg) for 5 days. The patient initially realized marked improvements in pain and muscle weakness, but the pain crept up again over the following three weeks. A repeat course of IVIg infusions reduced the pain once again. For a man who could not previously stand, he can now walk with a cane. Dr. Gen Sobue stated IVIg therapy can treat some diabetic patients with nerve damage whose pain can be ameliorated. I wonder how the patient will respond long-term.

Intravenous immune globulin is currently used for a variety of FDA-approved indications, as well as many off-label conditions such as chronic inflammatory demyelinating polyneuropathies and multifocal motor neuropathy. I don't know, but is IVIg a potential new therapy for certain diabetics with nerve damage? Read more in Reuters.