Title: Forensic aspects of hypoglycaemia

Abstract:

Diabetes complications of hypoglycaemia, hypoglycaemia unawareness and neuroglycopenia are often encountered by patients treated with insulin.  It is feared by patients and families often leading to emotional and mental scars and can affect lifestyle and confidence.  Hypoglycaemia can occur in premature babies, persons with hypopituitarism and Addison’s Disease.  Low blood glucose can affect athletes and the elderly leading to falls.   Cases are individual and often difficult for families, clinicians, lawyers and courts to understand. Temporary mental impairment and PTSD injury may occur requiring counselling to overcome hypoglycaemia. 40 years T1D insulin treatment and personal hypoglycaemia experience following wrong insulin care 1987 - 94 led the author to research published reports.  The first hypoglycaemic event was described by Banting, Best and Macleod at the time of insulin discovery as a treatment for diabetes in 1921/22.  This review includes observations from ‘Forensic Aspects of Hypoglycaemia’ by Prof Vincent Marks, 629 case references, February 2019. Complications affecting stable Blood Glucose levels include Otitis Externa, Osteomyelitis, Neuropathy pain, infection treatment by IV antibiotic delivery, periodontal dental link with gum disease, inflammation, chemical change reducing insulin effectiveness, calcium stones in the saliva duct, sodium, calcium, magnesium electrolyte imbalance, Omega 3 deficiency, night saliva duct cortisol secretion, depression.Use of insulin and C Peptide assay is beneficial in forensic investigations following unexplained death or insulin use as a weapon in alleged criminal matters.  Society can learn from this research to provide improved diabetes care for patients to achieve good health and long life despite the daily burden of managing a condition with no cure.A duty of care exists to a person in a state of hypoglycaemia to summons paramedic help when the person is unable to help themselves because of temporary mental hypoglycaemia.

Biography:

Derek Beatty gained his BSc in Biological Science & Business Studies, Edinburgh University, 1972, and his Diploma in Marketing, Slough College, 1977. He has been a Director of Aston Clinton Scientific Ltd since 1997 supplying respiratory nebulisers and specialising in diabetes. He is a Consultant to PolyPhotonix Medical.  He recently founded Mobile MedTech Ltd to offer a Mobile Diabetes Service in Scotland involving NHS Scotland with experience in the team launching Europe’s First Mobile MRI Service in 1990. He has had T1D for 40 years and overcome diabetic retinopathy. Published featured articles include ‘Shared Mobile Services’ Medical Focus 1990; ‘Sharing in Caring’ The Health Service Journal, 1990; ‘Shared Mobile Services Save Money for Providers’, European Congress of Radiology, Vienna 1991; ‘Mobile MRI, Safety and Operational Guidelines’ 1992; ‘A Listening Ear’ 2017; www. DRI-FT.co.uk Diabetes Research Information – Facts for Treatment

Title: Diabetes and obesity: Weight, Stigma, blame and shame

Abstract:

For many people, living with diabetes can be stigmatizing. Understanding social stigma and self-stigma and its potential to negatively impact diabetes management will be reviewed.  Included in this examination is the common misconception  that stigma might help motivate individuals with obesity to lose weight and improve their health. However, it generally has the opposite effect. The general public should be aware that blaming and shaming people with obesity is not an effective tool for promoting weight loss, and it may contribute to poor health. Negative attitudes toward obesity by healthcare professionals can also act as a barrier to successful diabetes self-management. When people feel shamed because of their weight, they are more likely to avoid exercise and consume more calories to cope with stress. Disparagement of others due to their weight and messages that perpetuate blame and shame, if internalized, can cause harm to the physical and mental health of individuals with obesity. People who report feeling stigmatized may have more feelings of psychological distress and a greater tendency to self-isolate. Stress from feeling blamed for diabetes can ultimately worsen someone’s condition, as counter hormones (i.e. cortisol and adrenaline) when produced, may increase blood glucose if a person does not have enough insulin in their system to offset the additional hormones.  The “diabetes blame game” is not appropriate and not helpful at all. Strategies to eliminate stigmatism will then be discussed. Included in the assessment of stigma is the lack of knowledge about diabetes in general. Education about diabetes is important. While lifestyle factors such as physical activity and weight may increase the risk of developing type 2 diabetes, age, race and genetics also play a large role. These additional factors involved in the onset of diabetes are not necessarily in one’s control. Also important to the understanding of type 2 diabetes is that it is a progressive disease. The development of insulin resistance and the need to inject insulin should not be seen as a failure on the part of the person with type 2 diabetes. Healthcare professionals can educate patients about the complex biological and environmental factors that contribute to obesity. Studies show that empathy from providers can break down stigma. They need to treat patients with respect, discuss weight with sensitivity and without judgment, and give support and encouragement to patients who struggle with weight management, instead of focusing on what patients did “wrong.” Getting support from other people with diabetes is another way to overcome blame and shame. Others who understand the daily experiences of life with diabetes can help make somebody else feel less alone with their condition and provide emotional support. Working with diabetes educators, people with diabetes can learn strategies for successful behavior change. People with diabetes can try to make positive changes, utilize self-compassion and feel good about themselves. Empowering patients with diabetes to manage it well is the antidote to stigma, blame and shame.

Biography:

I am a licensed Clinical Psychologist and Certified Diabetes Educator in Private Practice specializing in treating the emotional issues of patients with diabetes utilizing a cognitive-behavioural orientation. I provide individual, family, and/or group therapy sessions. I am the author/editor of MY SWEET LIFE: Successful Women with Diabetes and the editor of MY SWEET LIFE: Successful Men with Diabetes. Each chapter, written by a highly respected and successful woman/man with diabetes, shares their heart-warming stories leaving the reader to feel inspired and empowered to find balance in their personal, professional, and spiritual lives.

Title: The study of platelets behavior in type 2 diabetes mellitus environment via continuous ADP stimulation

Abstract:

Biography:

Razie Mahmoodian is a hematologist and works as head of department of hematology in Mehragin Medical Diagnosis Laboratory. Also she teaches practical hematology in Azad university, Tehran Medical Branch. She holds a BSc in Medical Laboratory and then a Master of hematology and Blood Banking degree in School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences. She has worked for 5years in Tehran Amiralam Hospital and many other medical diagnosis laboratories as a hematologist. She has published some papers in the field of hematology about platelets and platelets microparticles formation in patients with type 2 diabetes mellitus. She has presented two abstracts in the 10th international congress of laboratory and clinic and ICIA 2018 in Tehran. She grew up in Isfahan and now lives in Tehran with her husband. She is interested in research about blood cells behavior in diabetes and other endocrine disorders.

Title: The associations of total physical activity intensity and insulin resistance syndromes in obese adults

Abstract:

Background: The association between obesity and insulin resistance syndromes (IRS) has long been established (1-2). Nevertheless, limited data regarding the effect of physical activity (PA) intensity and its ability to modulate IRS. We aim to determine whether obese individuals would benefit more from engaging in light activity throughout the day compared to single bout of acute exercise of moderate or vigorous activity for a shorter period per day

Methods: A total of 60 obese participants with a BMI ≥ 30 (30 males and 30 females) were enrolled for this study. Activity levels were measured through an accelerometer worn except when bathing for seven consecutive days. Habitual activities were self-reported, and fasting glucose, insulin, and lipid profile were measured. Monocytic inflammatory markers expression was analyzed by flow cytometry analysis and cytokines secretion was investigated by ELISA. Multiple regressions controlling for significant variables in univariate regression were performed to evaluate the association between the actigraphy-assessed activity measures, inflammatory cytokines, and insulin resistance.

Results: The percentage of total individual activity showed a significant negative correlation to lower lipid profile, HOMA-IR and monocytes inflammatory production. A higher daily percentage of moderate to vigorous physical activities was significantly negatively correlated with body fat percentage, yet, only high volume of total activity and  total light activity throughout the day seemed beneficial for better insulin sensitivity (light % P= 0.0042, r= -0.377; moderate % P= 0.962, r= 0.064; vigorous % P= 0.923, r= 0.013). Total physical activity had positive correlation to monocytic expression of M2 marker regardless of physical intensity. Yet, only higher volume of light activity was found negatively correlated to the surface expression of nonclassical monocyte expression (CD14dim CD16++; P =0.01, r = -0.48). in a similar manner all intensities of physical activities were shown to associate negatively with TNF-a secretion. Yet, only IL-17A and MCP-1 were found significantly negatively associated with higher volume of lighter activity through the day.

Conclusions: Maintaining general light movements throughout the day can be beneficial when compared to a short period of stringent workout. This provides a better understanding of how to implement effective approaches to lifestyle change in preventing IRS and T2D.

Biography:

Fatema Al-rashed, Ph.D, is a post-doc researcher at the immunology unit of dasman diabetes institute in Kuwait.  She hold a B.Sc in Microbiology with immunology from Leeds University , and both MRes and a Ph.D in biomedical science from Glasgow and Nottingham University, respectively . From 2005 to 2010 she worked as medical technician at the immunology unit of Mubarak al Kabeer hospital, Kuwait. And after obtaining her Ph.D in 2016 she decided to switch to research were here research interests span both lipotoxicity and para-inflammation. Much of her work has been on improving the understanding, design, and performance of lipid metabolism, mainly through controlling bioactive lipids and the manipulation of nuclear factors regulators. Before joining Dasman diabetes institute, her research examined the impact of phycology on insulin sensitivity. After joining Dasman diabetes instituete, her work has focused on the impact of obesity in obesity and diabetes related inflammation. She has explored the effect of bioactive lipids in obesity induced inflammation. In 2017 she received L'OréalUNESCO For Women in Science award, for her research on the effect of lipid metabolites in monocytic lipotoxicity and inflammatory responses.

Title: Efficacy of different prediabetes program models in improving clinical outcomes in people with prediabetes

Abstract:

Background: Educational programs in general seem to have a clinically significant beneficial effect among the T2DM population in terms of improved glycaemic control. However, few evaluations of interventions to delay or prevent type 2 diabetes mellitus (T2DM) in Saudi Arabia (SA) have been undertaken.

Objective: The present study evaluates for the first time, the differences in the effectiveness of the different educational programs [intensive lifestyle modification (Group Education Program, GEP), supervised education through social media (WhatsApp Education Group, WEP) and standard care via PHCCs (Control Group, CG)], among Saudi females with pre-diabetes.

Methods: This was a 6-month, multi-center, 3-arm cluster, randomised, controlled (1:1:1), multi-intervention study conducted from July 2018 until March of 2019 in Riyadh, SA. A total of 1140 females from SA were cluster randomised equally to three groups, out of which only 253 [N=100 GEP, N=84 WEP and N=69 CG] received intervention. Participants completed questionnaires including demographic, dietary and physical activity data. Anthropometrics, blood samples and dietary intake were collected at baseline and 6 months. A total of 120 [37 CG (age 50.9±7.1 years; body mass index (BMI) 31.6±5.8kg/m2), 40 GEP (age 42.9±12.2 years; BMI 34.8±9.0kg/m2) and 43 WEP (age 43.7±8.1 years; BMI 30±5.1kg/m2)] participants completed the study.

Results: Haemoglobin A1c (HbA1c; primary endpoint) significantly improved in all groups over time, with no difference in between-group comparisons. Between group comparisons adjusted for age revealed a clinically significant reduction in BMI in favour of GEP (p=0.02) post-intervention. A clinically significant reduction was also observed in favour of GEP in terms of weight (p=0.003), waist circumference (p=0.017), systolic and diastolic blood pressure (p-values <0.01), triglycerides (p<0.001) and caloric intake (p<0.005) over time.

Conclusion: Prediabetes education programs of 6-month duration, whether delivered through an intensive lifestyle modification, social media or standard care, are equally efficacious in improving HbA1c levels among Saudi women with prediabetes, but intensive lifestyle is superior in terms of weight reduction and over-all cardiometabolic improvement.

Biography:

I am Rasha Yousef Al-Hamdan. I graduated from king Saud University, College of Applied Medical Science, Riyadh, Saudi Arabia, with Bachelor degree of 4,47/5 in Clinical Nutrition since 2001. I worked in my field as a dietician in the private and government sectors.

Title: A Quantitative, Retrospective inquiry of the impact of a provider-guided low-carbohydrate, high-fat diet on adults in a wellness clinic setting

Abstract:

Biography:

Lisa M. Selby is a registered nurse and Simmons University graduate-level student in the family nurse practitioner program with an anticipated graduation date of August, 2020. A nurse of 11 years, she has gained clinical expertise in a variety of specialties across the lifespan, though has developed a passion and excitement in the fields of wellness and obesity medicine over the past couple of years. She is currently an integral member of the clinical team at Mountain View Wellness and Weight Loss Clinic in Las Cruces, New Mexico, United States, where she has led research development and dissemination.

Title: Disappointing worldwide obesity treatment statistics: The hCG method deserves an unbiased review

Abstract:

The obesity epidemic is devastating the Social and Healthcare structure of developed and underdeveloped nations. In developed countries, obesity accounts for 1 out of 3 individuals. The medical care costs of obesity in the United States, for example,  are high. In 2008 dollars, these costs were estimated to be $147 billion.  The annual nationwide productive costs of obesity obesity-related absenteeism range between $3.38 billion ($79 per obese individual) and $6.38 billion ($132 per obese individual). Despite this thrilling data, obesity treatment results remain disappointing: gathered data is depressing , from surgical to non-surgical procedures. Short term weight loss does not result in long term weight loss

The hCG method for obesity treatment: an overlooked alternative.

Despite their critics, the hCG (Human Chorionic Gonadotropin) + diet protocol survived for the past 65 years:  clear evidence that the procedure outpassed the test of time. About seventy years ago his author: Dr. ATW Simeons was the first Physician to suggest that the problem of obesity is not related to weight as registered on a bath scale, but in the increased amount of total body fat. The cause for that abnormal fat accumulation does not lies neither in the mouth or the stomach, but in a neuropeptide disorder at hypothalamic level. Recent research on leptins, adiponectins, and neuropeptides sustain his working hypothesis The method provided relief and excellent results to hundreds of thousands of overweight /obese patients worldwide. By 1991, I have developed and published my obtained results using an oral formulation of hCG. Consequently, I have reported over the Internet our research results, both in humans and experimental animals.

To summarize our conclusions:

In human volunteers:

1.         Compared to placebo-treated, volunteers submitted to the hCG+diet procedure lost more body fat than their placebo counterparts

2.         Perfectly tolerated a Very-Low-Calorie Diet.

3.         Rapidly improved their blood sugar levels and blood pressure.

4.         No side effects

In experimental animals: compared to placebo-treated: hcg+diet animals significantly:

1.         Lost more body fat.

2.         Decreased plasmatic Leptin levels

3.         Increased adiponectin levels.

4.         Decreased blood sugar levels.

Besides, hCG administration has a protective effect on pancreatic beta cells, improves intractable chronic pain, decreased blood pressure more efficiently than patients treated only with hypocaloric diet.

Biography:

Dr. Belluscio devoted most of his medical career to the study of hCG for weight loss.For several years he was a researcher at Bellevue Klinik, Switzerland, an institution with the most impressive records of treated patients with hCG (15,000) for obesity and overweight.He traveled to the U.S., Mexico, Sweden, Italy, Germany, and Israel, lecturing on the method. In 1987 he founded The Oral hCG Research Center, an institution devoted to the utility of hCG for obesity treatment. Records show that the center used the hCG Oral method in over 9.000 patients.Back in 1991, he developed an oral hCG formulation, which demonstrated its effectiveness in a series of Double-blind studies.Together with Dr. Vogt, Director of Bellevue Klinik, published several reports on the method aimed at Healthcare Professionals, and articles on the subject for the general public.OralhCG has been registered as a TM,with patents published and pending, both in Argentina and the United States. These patents and registrations include the brand: oralhCG, as well as various pharmaceutical sublingual formulations. These formulations have been used in his private practice for his patients for over 25 years.Currently, Dr. Belluscio participates in international medical congresses and gives lectures and lectures to the global medical community on the hCG Protocol and the formula he has developed.

Title: The relationship between plasma total testosterone and metabolic syndrome in male patients

Abstract:

We found that the Prevalence of Hypogonadism was 38.6%. There was a statistically significant correlation between TT and WC, BMI, Glu and decreased HDL-c. The relationships were not statistically significant between TT and TG or BP. so It is important to screen for hypogonadism in metabolic syndrome patients .The results of my study published in the Tishreen University Journal. Link: http://journal.tishreen.edu.sy/index.php/hlthscnc/article/view/8874 Pushed by my willingness to seek more knowledge about obesity, nutrition, and nutritional therapy, I enrolled in and completed many online courses through the Coursera platform. I completed "Easing The Burden Of Obesity, Diabetes And Cardiovascular Disease" offered by the University of Sydney, "Designing Your Personal Weight Loss Plan" offered by Case Western Reserve University, "Weight Management: Beyond Balancing Calories" offered by Emory University, "Nutrition And Lifestyle In Pregnancy" offered by Ludwig-Maximilians-Universität München, "Diabetes - A Global Challenge" and "Diabetes- the essential facts" offered by University of Copenhagen. And to improve my academic skills, I completed "Epidemiology: The Basic Science Of Public Health" offered by The University of North Carolina at Chapel Hill and "Introduction To Systematic Review And Meta-Analysis" offered by Johns Hopkins University. Now I am enrolled in a new course "Understanding Obesity" offered by the University of Edinburg, I am expected to finish this course by December 2019. I am interested in presenting the results of my study or talking about my experience in self-learning online and how that enhanced my everyday clinical practice .

Biography:

My name is Dr. Muhtadi Mansour. I got my master's degree in Endocrinology and metabolism in 2019. During my master's, I researched the relationship between total plasma testosterone and metabolic syndrome (Mets) in male patients. I was interested in the metabolic syndrome because it is more prevalent than before and a lot of patients achieve the criteria of this syndrome without complaining of major symptoms. It is estimated that the prevalence of metabolic syndrome (Mets) is 20-25% of adults worldwide. On the other hand, Hypogonadism is associated with Mets and it may be a risk factor for type 2 diabetes and cardiovascular diseases. My study aimed to estimate Hypogonadism prevalence in male patients with Mets and study the relationship between plasma total testosterone levels (TT) and the Mets components. It is a cross-sectional study that included 157 patients. Body mass index(BMI), waist circumference(WC), Blood Pressure(BP) and (TT), High-density lipoprotein cholesterol(HDL-c), Triglycerides (TG) and Glucose(Glu) were assessed.