Is It Really True?

Children that suffer from the chronic illness of type 1 diabetes mellitus have a diminished bone marrow density because of insulin deficiency.  Maggio et al. (2011) note that their research attempts to look at the dose and type of exercise needed for a child with type 1 diabetes mellitus (T1DM)  that will optimize bone mineral acquisition because research in this area is still not well defined. Thus, the main aim of their study determines what the effects of weight-bearing physical activity on bone mineral mass and bone turnover markers in young children with type 1 diabetes mellitus in comparison to those of healthy children.

Twenty-seven chidren who were diabetic were recruited from the Unit of Pediatric Endocrinology and Diabetology of the University Hospitals of Geneva between  the ages of 8-12. Thirty-two healthy children, also between the ages of 8-12 were recruited as peers of the diabetic children or from local schools. Both the diabetic and healthy candidates for this study were excluded for the following reasons: presence of other chronic disease, medications, hormones other than insulin or calcium preparations, presence of nephropathy, systematic disease or hospitlization for more than 2 weeks in the preceding year, and participation in competition sport (Maggio et al., 2011).

Participants with T1DM and healthy participants were randomized by gender to groups: the exercise diabetic group and the exercise healthy group (experimental groups) and the control  diabetic group and the control healthy group. Maggio et al. (2011) note that this randomization process resulted  in a similar girls/boys ratio within each group.  Children (healthy and diabetic) who were in the exercise group were instructed to go to two 90-minute exercise sessions per week for the period of 9 months. Maggio et al. (2011) demonstrate that the exercise sessions were supervised by two physical education teachers as well as, a pediatrician with experience in T1DM. Participants took part in various weight-bearing activities such as jump rope, jumping, and gymnastics. Maggio et al. (2011) also increased intensity and difficulty levels as the months progressed. The researchers (2011) also accounted for  physical leisure activity for the past 12 months via questionnaire.

All the young children that participated were tested at baseline, prior to the study, and after the 9 months had elasped during the same period (Maggio et al., 2011).  This was done to reduce some extraneous variables such as leisure time for physical activity and vitamin D concentrations. Body weight, height, body mass index (BMI), pubertal development, and lead body mass were all measured. Maggio et al. (2011) also, assessed areal bone mineral density (aBMD), lumbar spine, right femoral nech and greater trochanter.

As for the main results, researchers (2011) found that T1DM children that were in the exercise group (180 minutes of weight bearing activity/week) had improved their total body and lumbar spine bone mineral densities compared to those  diabetic patients within the control group.  What Maggio et al. (2011) find interesting is that total body and lumbar spine bone mineral densities were improved in healthy children as much as they were in participants with T1DM. Researchers (2011) also found that physical activity has different influences on different bone sites in regards to gender and pubertal stages. There are factors such as type of exercise, training duration and volume that physical activity is dependent on, as well.

What is limiting in Maggio et al. (2011) study is that their sample size was relatively small, therefore, generalizations towards the public in regards to the findings can not be made with complete assurance. Researchers (2011) further note that due to the small sample size,  a sub-analysis cannot be conducted to evaluate other factors (age and puberty) on the different variables.

This study is, however, interesting because of the quality of the researcher’s (2011) study design and the fact that there were no drop outs from the study. Also, researchers (2011) looked at something that still needed defining, which will yield an additional amount of research conducted in this area.

These findings suggest that there are positive effects of weight-bearing physical activity on total body and lumbar spine bone mineral aquistion with T1DM.Therefore, the take home message of this study conducted by Maggio et al. (2011) is that weight-bearing sports (ball games, jumping activities, gymnastics) should be encouraged and become prevalent in children with Type 1 Diabetes Mellitus in so that bone mineral acquisition is optimized during growth. Maggio et al. (2011) also make note that physical activity within these diabetic patients will prevent the development of osteoporosis later in life.

References  

Maggio, Albane B., Laetitia M. Marchand, Serge Ferrari, René Rizzoli, Maurice Beghetti, and Nathalie J. Farpour-Lambert. "Physical Activity Increases Bone Mineral Density In Children With Type 1 Diabetes: A Randomized Controlled Trial." Medicine & Science in Sports & Exercise 41.Supplement 1 (2011). PubMed. Web. 17 Mar. 2012. 

Controversies, Controversies

Thinking of Type 1 Diabetes, the word controversy is not the one that immediately comes to mind only because Type 1 Diabetes is a type of chronic disease that you either have or you don't. Simply, uou're either born with it or you're not, so there can`t be any sort of controversy, right? However, the controversy arises within the treatment/therapeutic aspect of this chronic disease. There is a heated debate over whether or not  pancreas transplants are an effective therapeutic method to treat Type 1 Diabetes. The following will further discuss the nature of the controversy and both sides of the arguments:

Essentially,  as previously noted, the main controversy here is whether or not pancreas transplants are an effective therapeutic method for Type 1 Diabetes in the IDDM (insulin dependent melitus) diabetic patients. Paul Robertson (1998) notes that there are two opposing sides to this: simple approach or circumspect approach.

The simple approach basically states that yes and only because "pancreases are being transplanted therapeutically all over the United States and Europe on a daily basis" (Robertson, 1998, p.1868). Robertson (1998) describes that the process for pancreatic transplants became feasible in 1978 and since then almost 10000 have been transplanted. Pancreas survival after transplant has a fairly high rate at 70-90% with even higher rates being reported because some groups are highly selective of their recipients (Robertson 1998). What is important to note here that Robertson (1998) discusses is that when the procedure is successful, "recipients are totally insulin-dependent, have normal levels of glycemia and...report improved qualities of life" (p. 1868). However, there is a patient mortality rate of 12%. Having said this, this rate, as pointed out by Robertson (1998), is "uninterpretable because it resembles the natural history of IDDM [for over a] 20 year duration" (p. 1868). No case-matched study regarding pancreas transplantation has been performed and most deaths occur beyond 3 months post-transplant (Robertson 1998). Is this a really reliable and valid argument then?

Thus, because there have been no controlled studies regarding pancreas transplants in diabetic patients there has to be a more circumspect explanation, as well. Robertson (1998) points out that "[s]urgical history is replete with examples of operative procedures, some good, some bad, that were developed to the
point of daily use by the trial and error approach with rarely a thought about including sham operations or controls" (p. 1868). Such is similar with pancreas transplants. Yes, doctors want to relieve human suffering but this is not a method to evaluate therapeutic efficacy. When pancreas transplantation is successful, insulin independence and normoglycemia is reestablished and improves quality of life measures, there is undoubtedly less certainty about its impact on chronic diabetic complications inclusive of retinopathy, nephropathy and neuropathy (Robertson 1998). Essentially, there are some benefits but they cannot be conclusive only because of the fact that there have been no controlled studies conducted. Therefore, "[i]n the absence of randomized trials, this makes drawing defensible conclusions difficult, if not impossible" (Robertson, 1998, p. 1868).

Personally, I believe that the simple approach lacks validity and reliability just because pancreatic transplants have not been tested under controls. Conclusions are made tentatively. I don't think that pancreatic transplants are wrong, however, it is almost similar to giving a child a herbal remedy and telling them "I do not know if this will cure your cold or not, but we can try". To a certain extent, it is risky. Therefore, I think that it is quite important to test this therapeutic method under controls to make sure conclusions are reached as specifically as possible because human lives are at stake. Robertson (1998) notes that "[p]ancreas transplantation is here to stay until something better—presumably islet transplantation—comes along and is proven to be more efficacious" (p. 1869). I believe this is true but as I've argued, I do think that it is quite crucial that it is tested to provide concrete conclusions until the point comes whereby another therapeutic method for Type 1 Diabetes is found.

References

Robertson, P.R. (1998). Has pancreatic transplantation arrives as a therapeutic option in IDDM. The Journal of Clinical Endocrinology and Metabolism, 83(6), 1868-1869. 

Which Sites Can You Trust?

There are unreliable sites all over the web that provide curious readers with limited and incorrect information. Undoubtedly, the case is similar for chronic illnesses, specifically being Type 1 Diabetes. It is easy for readers to browse through unreliable information in search for something that may help them. Coming across such sites is common and here is an example of one:

This site, http://www.selfgrowth.com/articles/Diabetes_Diet_Plan_The_Good_The_Bad_and_The_Ugly.html, is unreliable for a number of reasons and the following will discuss why:


What is the source?


Since this is a .com website it cannot be defined as a completely reputable source because anyone can make  a website without having any prior knowledge on the subject. Information would be held in much higher regard if the site was from a .org, .gov, .ca, or .edu source. The author of this article could have easily copied and pasted information from another source. He does not reference any of his information whereas other credible sources will cite where they have received their information from.


What is the date?


The actual date of when the article was published is not found, therefore, it can be led to believe that maybe the information presented is outdated and therefore, not in effect anymore.


Who is saying it?


The author is an individual named Aron Wallad. There is nothing to suggest that the author has any doctorate certification or obtained a higher degree of any type.

This screenshot shows that this is something that the author has tried himself and is now attempting to sell  the diabetes natural solutions so that others can have similar effects and lower their blood sugar by over 50%. This information cannot be relied upon because the evidence is anecdotal and the reader doesn't know very much at all about the author. Does the author even suffer from the chronic illness? What evidence, other than that it has worked for him, does he have or even provide?


What evidence is provided?


As previously noted, the evidence provided seems to be purely anecdotal. The author makes suggestions to help people with their diets and discusses the glycemic index very briefly, not really mentioning what it is in detail. There is no experimental or referencing evidence to supplement the author's claims. Again, the author is publishing information based off his own personal experiences through "diabetes natural solutions" (Wallad 2012).


Is their a potential bias?


Yes, there is. A reader will notice the amount of advertisements scattered all over the website. This suggests that if readers click on these ads that the author will most likely benefit financially from them. Moreover, the site's main focus is not even on diabetes as it is titled as a self growth site and focuses a lot more on individual spirituality.

As much as their are unreliable sources of information out there, there are also a wide variety of credible information that proves to be very useful for readers and individuals wanting to learn more. Here are a couple that counter what the above unreliable source contains:

1) The Canadian Diabetes Association

http://www.diabetes.ca/diabetes-and-you/

Unlike the unreliable site, this one is a .ca which means the nation (in this case Canada) has gathered research from reliable and valid people and places. Since this is not a .com site, it is not trying to sell something to you as is quite apparent in the source mentioned above. The information that this source provides will be more accurate as its main intention is to inform readers and not reach into their pockets. 

2) Vancouver Coastal Health

http://vch.eduhealth.ca/PDFs/FL/FL.860.G525.pdf

The unreliable source mentions the benefits of using the glycemic index to track diet plans if diabetic yet does not go into much detail explaining it. Additionally, because the above-mentioned site cannot be trusted for its credibility due to the fact it has potential biases, readers will tend to be skeptical about the information provided about the glycemic index. This site can be relied on its credibility because it provides charts that convey to readers the effects of consuming food with high GI's in contrast to low GI foods and gives you examples of what foods to eat and when to eat them. Essentially, it is helping one to make an ideal meal plan. The information, again, is intended to educate and does not have ulterior motives as it is not attempting to sell anything. 

This just goes to show that despite the amount of information that may be out there, there is a lot of it that is not credible in what it informs its readers. Hopefully, this has helped some of you realize what to look out for when trying to decide if a source is reliable and valid. 

References

Canadian Diabetes Association | Diabetes & You. (n.d.). Canadian Diabetes Association | Home. Retrieved February 22, 2012, from http://www.diabetes.ca/diabetes-and-you/

Glycemic Index & Diabetes. (n.d.). Vancouver Coastal Health. Retrieved February 19, 2012, from http://vch.eduhealth.ca/PDFs/FL/FL.860.G525.pdf

Wallad, A. (n.d.). Diabetes Diet Plan. The Good The Bad and The Ugly. Self Improvement from SelfGrowth.com. Retrieved February 22, 2012, from http://www.selfgrowth.com/articles/Diabetes_Diet_Plan_The_Good_The_Bad_and_The_Ugly.html

Type 1 Diabetes: Think You're Immune? Think Again.

Hey there! I'm Vameesha Patel, an undergraduate student at Simon Fraser University. I would like to welcome you to my blog discussing a chronic illness that goes by the name of Type 1 Diabetes. WAIT! Before dragging your mouse to the "back" icon in the upper left hand corner, just take another minute to read the next paragraph. If that doesn't interest you, then by all means go back to checking your Facebook and updating your Twitter.

Why Type 1 Diabetes, you may ask yourself? The reason I chose this is goes back to about a year ago. Coming home one day from school, with my best friend, essentially my other half, Melissa, everything seemed to be perfectly fine. It wasn't until we were climbing up the stairs, heading to my room, that Melissa broke down and started bawling. Completely baffled, I called for my mom as she rushed to console Melissa. Through deep breaths and tears streaking her face, we found out that Melissa's 9-year-old brother Matt had just been diagnosed with Type 1 Diabetes the previous day. I stood there dumbfounded, thinking to myself, how in the world? Matt is one of the most active kids I know, always outside whenever he got the chance and so young too! There was no way...

Obviously, my uneducated assumption was wrong. Melissa told me that Type 1 Diabetes occurs at any age, particularly in children. It sunk in: Matt, who was almost like my own brother had been diagnosed with a chronic illness. Life for Melissa's family  and many of my assumptions about chronic illnesses were about to change dramatically.

Over a year later, Melissa's family is still educating themselves about this chronic illness that does not have a cure and to which the exact cause is unknown. I think it is important to educate myself as much as I can about Type 1 Diabetes because it is a scary thought to think that one day, you  can be perfectly healthy and the very next day be told that you have a chronic illness. With no cure. With no known exact cause. Imagine being a naive 9-year-old child at that, just like Matt was! Hard to wrap your head around, right? I know it was for me.

Type 1 Diabetes can generally be defined as a life long chronic disease  whereby there are  excess amounts of glucose within the body. The beta-cells that usually produce insulin, in this case, are unable to thus the blood sugar cannot be moved to cells to be used as energy later on. 

Here are some possible symptoms:

And these are some ways that you can control your chronic illness if diagnosed:

With this blog, I hope to target individuals who find that they are diagnosed with Type 1 Diabetes, individuals who have loved ones, like myself, that suffer from the chronic illness and others who are simply curious and want to learn more.

That is why I created this blog: to educate people, and to continue to educate myself, to the best of my ability about a chronic illness that can, literally, unexpectedly show up. I am hoping my readers will come to realize its severity. I know that before, I was completely oblivious to the idea of chronic illnesses. I thought that because I was young and superior that no illness could touch me. 

However, when Matt was diagnosed,  it hit me like a brick: this can happen to ANYONE of any age, of any ethnicity, of any social class. The fact that I was misinformed about Diabetes made me realize that there so many other people out there that probably think the same way I do. This needs to change and people need to be aware of the right information. And that is what my main message is to you readers out there. Educate others and most importantly educate yourself because you, just like that active 9-year-old boy, are not immune.