Type 2 diabetes has previously been associated with obese people in the U.S and other rich countries, but it's beginning to hit the developing world hard, with 80 percent of sufferers in low and middle income brackets, according to the International Diabetes Federation.

A report in the British newspaper the Telegraph suggests that as poorer countries rapidly urbanize and experience other changes to traditional diet and ways of life, type 2 diabetes will become a much bigger problem. In the next 20 years, diabetes is expected to soar by 80 percent in Africa and 100 percent in Latin America, while growth in the US will be 43 percent, according to the same report. And, this year, diabetes will kill about 3.8 million people worldwide, about the same amount that will die of AIDS.

Bad news you say? Well, not if you're an insulin or diabetes drug manufacturer. "Diabetes is growing fastest in Africa, Asia and Latin America," said Lars Rebien Sorensen, chief executive of Novo Nordisk, the world's largest maker of insulin. "At the same time we are seeing pressure on the US health care system, where there could be price controls. That is going to put pressure on global growth."

Hot on the heels of my previous cat-related post comes yet more kitty news from the UK. This time it's about the extent to which diabetes is affecting British cats, and the news isn't good. A study conducted at Edinburgh University reports that one in 230 pet cats in the UK is diabetic. Neutered, overweight male cats are most at risk, apparently. Hmm, at least our hefty male friends don't have to contend with the one of those risk factors! Like humans, however, the more sedentary the cat, the greater the risk.

Overall, being overweight ups the risk of diabetes in felines by three times. There are now around five times more diabetic cats in the UK than there were back in the 1970s. Says Professor Danielle Gunn-Moore of the veterinary program at Edinburgh University, "The lifestyle of cats, just like their owners, is changing. Unfortunately, just like people, cats will overeat if they are offered too much tasty food, particularly if they are bored. While cats would naturally exercise outside, many cats are now housebound, so they have little to do all day but eat, sleep, and gain weight."

Yikes, this describes our own chunky kitty Kato to a T. He is getting older, is sedentary, and weighs in at around 19 pounds last time I checked. Like many people, I'm reluctant to let my cats out in case they get lost, hit by a car, stolen, trapped and impounded...the list goes on and on. Then there's the killing of backyard birds to consider. So: what's a cat lover to do?

On the 18th of July I blogged about a study that aims to explain how dogs are able to detect approaching hypoglycemic episodes in diabetic humans. Well, reader Margaret from Cumbria, in the UK, posted a comment about her dog, Sally, who is one of these amazing hypo-detecting dogs. I asked Margaret to tell us more and she obliged. Here is Sally's story:

Sally is a thirteen and a half-year-old Border Collie mix who lives with human "parents" Margaret and Alan, and canine buddy Poppy, who is a Cocker Spaniel. That's Sally (right) and Poppy (left) in the picture. Margaret and Alan adopted Sally from an animal shelter when she was just a tiny pup. Little did they know that Sally came complete with a special gift: she knows when Margaret, who has type 1 diabetes, is heading dangerously low.

"She has always been a sensitive dog," writes Margaret. "She gets very upset when there is thunder in the air. She shakes uncontrollably - even if we never even hear the thunder, but she knows it is about somewhere." As for detecting oncoming hypos, Margaret says: "my husband, perhaps more than me, notices her reaction. I can be just sitting staring into space, not doing anything, and Alan comes in, sees me and sees Sally acting strangely, by which I mean slinking around, really unhappy and just looking so miserable, trying to hide in a corner and she doesn't do that for any other reason, not even for the thunder."

I asked Margaret if Sally had received any training or if they rewarded or encouraged her reaction in any way. No, replied Margaret. "We certainly don't reward her for this. I really don't want her to be so unhappy about me! But, according to my husband, it is pretty obvious when he sees Sally behaving in this way - even though it is not obvious by my actions - that I am hypo, and this has been proved to be so." She adds, "Sally is very close to me. She is with me all the time and she has done this for as long as we can remember."

Margaret has had type 1 for thirty-five years. She was nearly twenty years-old when diagnosed. She also writes that one of her three sisters was diagnosed with type 1 at age seven, but is still going strong - fifty-seven years later.

Thanks, guys, for sharing your story!

British watchdog group The Healthcare Commission just gave diabetes care in the UK a lukewarm review. Its study of the facilities in which British diabetics receive care concludes that care levels overall are basic, at best. Most of the places (73%) surveyed in the study were rated "fair," meaning patients know what medications they are supposed to be on and when they should be taking them. They also know they should be getting annual checkups. Only five percent of facilities were rated "excellent by the Commission.

The system is lacking, however, when it comes to anything beyond those most basic of services. Just like here in the US, most British people with diabetes are not receiving help with diabetes management. Studies suggest that regular consultations with a health "coach" on an individual basis could really improve patient outcomes. One reason they are helpful is because they get patients to come up with a care plan tailored for each person, making it more likely he/she will be able to stick with it.

Diabetes UK head of healthcare policy, Bridget Turner, agrees with the Commission's conclusions: "The NHS [National Health Service] has to focus more on...self-care. For people with diabetes, 95% of diabetes management is self-care."

To read more, click here or visit the Healthcare Commission's own web summary of the report.

Bad headline for the week: "Does Diabetes Have a Canine Cure?" This, from the Lincolnshire Echo in the UK. Well, no. Of course dogs can't cure diabetes! However, they can do more than just roll their lovable brown eyes at you. Specifically, dogs can be trained to detect building hypoglycemic episodes caused by perilously low blood sugar levels. Dogs that have received such training will then try and sound the alert in various ways like pawing and whining, or pouring you a glass of orange juice (joke). Heck, I think there was even one dog that was trained to dial 911 for his owner, and saved the guy from going into a coma, might I add.

This is what this Echo article is really all about. Professors and students at the University of Lincoln have set out to examine the use of dogs to predict hypos. The study is being run in conjunction with Queen's University in Belfast, and has received funding from Diabetes UK. Says research team member Dr. Niro Siriwardena, "We are not yet sure whether dogs detect this [hypos] by smell or because they are much more adept than humans in detecting change. That is something we are looking into."

Stay tuned for details when this study is complete. "Dog people" like myself will be excited to hear what they discover. Wouldn't you like to know what enables dogs to be so super-sensitive? And doesn't it make you wonder: if dogs can detect something like low blood sugar, what else are they noticing about us as we go (obliviously) about our daily lives?

UK couple Suzanne and Julian Meredith went for an evening stroll one night, but their outing ended in disaster. A driver lost control of the wheel and ploughed his car into the two, killing Mrs. Meredith, who was fifty-two years old. The driver, an aircraft engineer named Phillip Willey, is now defending himself in court against a charge of dangerous driving causing death. Turns out, though, Willey is diabetic and he's using that as his defense, saying he blacked out while behind the wheel. Well, that was his defense until the prosecution turned the argument on its head and used it against him, alleging the accident was one hundred percent Willey's fault because he had a "cavalier attitude" to his condition and did not check his blood sugar levels before driving.

Dangerous driving causing death is what it is. Or...should some consideration be given if diabetes is a factor? Maybe. But realize this would not necessarily swing a decision in favor of the diabetic. In this case, for instance, the driver may lose out if the prosecution is successful in proving he was lax in managing his diabetes. Although, of course, the family and friends of Mrs. Meredith are the ones who really lose, no matter how this is settled.

It's a fact that personal injury and wrongful death lawsuits are common as muck here in the US. That's why this news story from the UK should serve as a warning to diabetics over here. Not only could an episode while driving cause hurt or even death to you, a loved one, or an innocent third party, it could get you sued too if you survive the accident.

Any headline that features die is bound to grab your attention. The headline appeared in an article published by The Scotsman. What the title lacks in sensitivity it makes up for in reader feedback. Both, statistically eye-popping and universally alarming, I give you extracts from the article and a few passionate responses from readers. How does it make you feel?

Research from Edinburgh University reveals the number of people diagnosed with type-2 diabetes will soar by 60% within the next ten years. This is mainly due to the obesity crisis, with current estimates showing a quarter of the population is likely to be classed as obese by 2018. Doctors say they are treating an increasing number of teenagers for type-2 diabetes, which traditionally only develops in older people. Being overweight is a strong factor in becoming a type-2 diabetic, which can lead to complications of diabetes like blindness, amputations, cardiovascular disease and kidney failure. Diabetes and complications therein are estimated to costs the NHS nearly a tenth of its yearly budget. With future expectations of diagnosis -- the strain on the NHS will get worse. Andy Kerr, the health minister, admitted diabetes would prove to be a time bomb if the Executive's healthy eating initiatives failed. But he ruled out screening children for diabetes or rationing healthcare for people diagnosed with type-2 because of their unhealthy lifestyles.

And now for the comments:

Commenter #3 says I daresay the Scottish obesity/diabetes problems predates devolution.
Commenter #9 says, The statistical analysis regarding type 2 diabetes is flawed; the medical profession have been guilty in prescribing drugs and reissuing prescriptions for drugs that are only safe for short periods. One such drug has had its usage limited by the authorities within the past 3 years in Scotland and has only been reclassified in England and Wales in the past 6 months. This drug is now listed as causing type 2 diabetes, how many more are there out there? Hence the statistical analysis is being used to cover a grave error that is to be covered up.
Commenter #20 says, Perhaps we should take a closer look at why our kids are obese. They are marooned in the house for most their lives and when they actually do go out mum or dad are suckered into driving them everywhere. Tackle the fear which causes this situation and you are half way to solving the obesity problem of our youngsters.

All things considered, what if this headline was featured in the New York Times or more revealing - the 5 o'clock news? How would you react to it?

There was a close call for a sixty-eight year-old gentleman in the UK yesterday. The man in question has diabetes. According to a report in the British paper The News Shopper, he was cooking dinner for himself at his home in Charlton when he went into a diabetic coma. Now, often in stories like this, there always seems to be an adorable child or super-smart dog who dives in and dials 911. In this case, however, the man's dinner saved the day! Yes, his dinner, which was cooking on the hob (don't you love the British?) of his stove and was left unattended after he collapsed. Eventually it went on fire and very fortunately this set off his fire alarm. Phew! A monitoring system also alerted a council worker who assists this fellow. Paramedics rushed over and took him off to hospital. No word on how he's doing now, but that's what you call a close one. Also, a good reminder on the value of smoke alarms. Get 'em. They're cheap and easy to install.

Scientists have mapped the genes responsible for causing type 2 diabetes. This new research is giving hope to new tests that can predict an individuals risk for developing the disease and future treatments.

The study compared the genetic make-up of 700 people with type 2 diabetes and a family history of the condition, with 700 diabetes-free people. Four points on the gene map linked to a person's diabetes risk and were confirmed with another group of 5,000 type 2 diabetics. The findings of this research could explain up to 70% of the genetics related to developing diabetes. A particular zinc transporter, known as SLC30A8, which regulates insulin secretion, was shown to have a mutation. Researchers feel they may be able to treat some cases of diabetes by correcting this mutation.

These findings will allow for the creation of a genetic test to predict people's risk of developing type 2 diabetes, as well as better treatments for the presiding cause of their diabetes. Nary a day passes that I am not motivated for the future of all diabetics. This is the type of research that strengthens my faith in the coming of a cure. Identify the nature of the problem and nip it in the bud.

Warning: the following blog deserves a strong caveat. I am utterly disgusted by the event leading to the story but nonetheless, I will convey the gist of it as tactfully as possible. A drunken diabetic who brutally raped a woman while in a hypoglycaemic state has been jailed indefinitely.

Steven Graham, a 20 year old from the UK, met his victim as she walked home one evening. Graham admitted to drinking 15 beers and skipping his evening injection. He reportedly suffers from a "Jekyll and Hyde" personality disorder. He had the audacity to pleas his behavior was due to the fact he was suffering a hypoglycaemic attack.

Prosecutors obtained a report which described hypoglycemia as causing mild mannered people to behave violent and abusive. They also may seem to have superhuman strength. Graham's attorney told the court: "Hypoglycaemia is one of those conditions capable of transforming honest and decent people into violent and aggressive people." Excuse me, but hypoglycemia can transform honest and decent people into disoriented honest and decent people. It does not transform them into superhuman strength rapists. Call me stupid -- but wouldn't those conditions to which he referred be psychological?

The Judge ruled the facts of this case clearly demonstrate Graham is capable of extreme violence and he is a danger to women. Justice is served.

So the price of drugs just seems to keep on climbing. And sometimes I wonder if the sky really is the limit in terms of the prices we are expected to pay. I, for example, just filled a prescription and received a tiny bottle the size of a purse-pack-sized bottle of eye drops. And how much did I pay? $25. Yes, and that's with insurance. It's insane. But it's not happening everywhere. In western Europe, where publicly-owned, government-run health care systems are the norm, people are putting the squeeze on the big pharmaceutical companies.

Let's look at insulin. A while ago there was a kerfuffle in the UK when government advisers overseeing the National Health Service basically said "no, thanks" to Pfizer's inhalable insulin, Exubera. Too expensive, they said. Now, Germany. This week, the biggies - Eli Lilly, Novo Nordisk and Sanofi-Aventis - decided to slash the cost of their insulin products in Germany. Why? Officials from Germany's health ministry say the new fast-acting versions of insulin just aren't worth the money. That left Big Pharma with little option but to play ball anyway, by cutting prices by up to thirty percent. For Novo Nordisk, this means a projected loss of $14.5 million in sales this year, reports Bloomberg.com. According to this article, the German government is, in this regard, following in the footsteps of the UK and the US. In effect, this means trying to cut spending by carefully weighing the costs of specific drugs against their benefits, rather than just picking up the tab willy-nilly.

Bottom line? Market expert Mark Belsey says the big drug producers will have to adapt as the tide turns, spending a lot more time and money justifying the worth of their products. This new strategy, he says, will come at the expense of what used to be their main focus: creating and marketing fancy new mega-drugs.

A dying myth: the United States has the best healthcare in the world. Americans have slowly started waking up to the fact that despite the immense quantities of cash they fork over in the form of taxes and in payouts to employers for medical insurance coverage, healthcare standards and access to care lag behind the rest of the developed world. Yet it never fails to amaze me that when medical experts and politicians shake their heads and bemoan the fact that many diabetics (especially Type 2 diabetics) are either undiagnosed or are diagnosed but not following a treatment plan, the state of our healthcare system is rarely mentioned as a cause. When will it be acknowledged that many diabetics find the cost of medications and diabetes-related devices like pumps and testing strips prohibitively expensive?

Some new research may help turn the tide. Researchers in the UK and the US compared the two countries' medical treatment for diabetes. The result, just published in the September issue of the Journal of the Royal Society of Medicine, states that British diabetics do better at managing the disease thanks to the universal healthcare system in that country. Yes, the National Health Service has its problems, but at the end of the day medical care costs the average diabetic a whole lot less than in the US, if not zip. Says Professor Arch Mainous, who helped conduct the study, "Our evidence shows that universal healthcare when treating a common disease like diabetes, works." Mainous went on to say, "The research shows that access to health coverage is a key determinant of quality of care for a chronic condition such as diabetes...A system like the NHS in the UK, which provides universal coverage free at the point of use, may be a model for the USA to examine more closely considering that is spends substantially more of its GDP on healthcare yet has approximately 44 million people without insurance"

According to new survey results, a majority of UK diabetics are not aware that failing to properly manage their condition could lead to very serious health consequences. How about a few examples? A third of those surveyed were unaware that diabetes is a life-long condition! One third were unaware that having diabetes is a big risk factor for heart conditions, while one fifth did not know that poor diabetes management can lead to limb amputations.

Experts blame this sort of patient ignorance for the fact that nearly two thirds of UK diabetics are not taking their prescribed medications. According to the study, one in five diabetics are suffering needlessly from conditions that could have been prevented if they'd taken their medicines. In addition, half are depressed.

The study was released by Diabetes UK, the Association of the British Pharmaceutical Industry, and another group, Ask About Patients. I think this is interesting and would be willing to bet that a similar study conducted here in the US would produce the same results.

Diabetes is turning into a disease that carries a potentially huge guilt factor for sufferers. That's the down side of the fact that how you deal with the problem has a big impact on how bad your diabetes gets. So we cheer on the star college athletes who excel at sports while keeping precise tabs on their diabetes. We also cheer on the former couch potatoes with Type 2 diabetes who shed pounds and exercise to reduce their need for meds. As for everyone else, there's a sense that having severe diabetes-related problems is kind of a personal failing, don't you think?

Now, where was I going with this? Oh, yes. It occurred to me that even when you do everything right to manage your diabetes, things can still go horribly wrong. A good example is a case in the UK that has gotten a lot of press coverage the last couple of days. A fifty-six-year-old diabetic man, Derek Atkinson, burned his toe on a hot water bottle. He did not leave it untreated because he understood the seriousness of foot injuries for diabetics. He should - he had already had two toes surgically removed due to the disease. Anyway, he sought help for the burn and ended up seeing a consultant five times to get his toe seen to. Turns out he should have chosen a different expert to treat it. Gangrene developed in that foot. By the time it was diagnosed properly, by the guy's GP, it was too late and Atkinson's lower leg had to be amputated.

The hospital's administration has admitted to failure on its part, but I doubt that's much comfort to Mr. Atkinson, huh? I guess the lesson is that if you have doubts that your condition - diabetes or otherwise - is not being properly treated by your doctor or hospital, it's time to look around for a second opinion.

The controversy continues in the UK over the introduction of the inhalable insulin product Exubera from Pfizer Inc. Well, really the source of the controversy is not the drug itself, but the fact that those who oversee treatments dished out by the nation's public health system (the National Institute for Health and Clinical Excellence) think Exubera is a big old waste of precious cash. The public health service people (although not all of them, by any means) say why waste money on a new-fangled insulin delivery method when the old-fashioned insulin shots are perfectly effective if they are used correctly. And anyway, they say, why should our taxpayers help line the pockets of Pfizer, which plans to charge a pretty penny for Exubera? Finally, they argue that there is no evidence to back up Pfizer's claim that Exubera will be more effective than using shots simply because it will be easier to use and pain-free.

The latest development is that the National Institute for Health and Clinical Excellence has backed off a little and has said the system will pay for Exubera to be given to diabetes patients who have a proven phobia of needles. While I hate to see the pharmaceuticals industry make mega-bucks, I don't see why you should have to have a proven phobia to get this drug. I actually suspect Pfizer may be correct in its claims that access to inhalable insulin will increase treatment compliance amongst diabetics. Bottom line: tons of people out there hate using needles. No, they may not have a diagnosed phobia about it, but aren't they entitled to the least painful treatments out there?