Hypoglycemia, an attack of low blood sugar, doesn't just happen. It takes a complex chemical reaction involving the brain and hormones - the brain's chemical messenger pigeons. We can now understand this incredible process and the body's response to it thanks to the work of a research team led by neuroscientist Arshad Khan, of the University of Southern California, and colleagues. Part of the study was also carried out in conjunction with the University of California at Riverside.

A feature on the LiveScience website handily explains what Khan et al found and why it's important. Basically, the hormone norepinephrine plays a critical role in hypoglycemia, effectively sending messages to the brain that the body is experiencing dangerously low blood sugar. When the body tells the brain that low glucose levels are afoot, norepinephrine shoots out of the hindbrain and into another area of the brain called the paraventricular hypothalamus. Its presence triggers the release of stored energy to make up for the shortfall. This step in the process involves the release of more hormones, this time from the pituitary gland. Khan describes norepinephrine as the "emissary" in this sophisticated chain of events, informing the brain about what is going on.

Why does this matter? Simple: understanding how hypoglycemia unfolds is a window into understanding how the brain senses glucose in the blood and, in particular, how it senses changing glucose levels. This, after all, is at the very heart of the physical changes associated with diabetes.

The results of this study were published in The Journal of Neuroscience (July 4, 2007).

Researchers found that using a systematic approach for the treatment of depression in diabetics will not increase health care spending, and might actually decrease the overall costs.

Researchers evaluated the cost and cost-effectiveness of a systematic depression treatment program versus the usual care for 329 outpatients with diabetes and depression. The intervention involved specialized nurses who provided a 12-month stepped-care depression treatment program using psychotherapy or antidepressant drugs or both. Systematic depression treatment significantly reduced the patients' average depression scores after 6 and 12 months, and these improvements were maintained at 24 months.

Outpatient depression treatment costs were approximately $700 higher in the intervention group during the first year, the results indicate. However the general medical outpatient costs in this group were lower, and offset most of the difference. During the second year, the approximately $100 in higher outpatient depression treatment costs in the intervention group was more than offset by lower outpatient costs of approximately $1400.

The study was designed with the hope of alleviating human suffering caused by diabetes. If reducing the burden of suffering also reduces costs of care, then depression management programs should be routinely integrated into diabetes care. Preempt this mission with the fact that the systematic depression treatment programs were associated with an increase of 61 depression-free days and an estimated cost savings of $300 - that's a monthly stipend of 20% more Happy Days and a half tank of gas. That'll give you something to smile about!

Just another reason to be nice...a study reveals that people with high stress and high hostility levels have an increased risk of developing insulin resistance. This means that the body's response to insulin begins to slow down and blood sugars rise. This increases the likelihood of developing diabetes.

Previous research has shown that insulin resistance is associated with stress and certain personality factors, including hostility. Researchers hypothesized that hostility may interact with stress to affect insulin resistance. The study measured levels of norepinephrine in the urine. Norepinephrine is an indicator of stress. The Cook-Medley Hostility scale was used to measure hostility. (What kind of world do we live in that actually warrants a scientific scale to measure hostility!?!?) Insulin resistance was measured by the homeostatic model assessment index, 2-hour post-challenge glucose, and insulin levels after factoring in the influence of nine other risk factors. The study found that there is a statistical interaction between hostility and stress level in gauging insulin resistance. People with higher levels of hostility don't always have worse insulin resistance, but they do when they are under stress, especially high levels of chronic stress.

The team also found that not all components of hostility are related to insulin resistance. For instance, cynicism is a personality trait that is strongly related to insulin resistance. I'm telling you, the more I read into this study, the more I realize I need an attitude adjustment. And it continues.... because people with high hostility (especially high cynicism) tend to have worse insulin resistance under stress, it is important to target this population for preventive interventions. Anytime the severity of a situation rises to "intervention" status -- it takes on a whole new meaning. This begs the question -- who wants to brave an intervention for a hostile and stressed looming diabetic? Not it!