Medical News Today: Type 2 diabetes: Blood sugar pill shows promise

diabetes equipment
Semaglutide in the form of a pill may help type 2 diabetes patients to achieve better glycemic control.
The pill form of the drug semaglutide is worth pursuing as a way to control blood sugar in patients with type 2 diabetes, say researchers.

So concluded a phase II clinical trial that found that the pill was better at glycemic control than a placebo over a 26-week period.

A report on the trial — by lead author Dr. Melanie Davies, of the Diabetes Research Centre at the University of Leicester in the United Kingdom, and colleagues — has been published in JAMA.

The results justify phase III trials to assess the longer-term effects and safety of semaglutide in pill form to help patients with type 2 diabetes to control blood sugar, note the authors.

More than 90 percent of the 30 million people living with diabetes in the United States have type 2 diabetes, which is a condition that develops when the body cannot use insulin properly to help cells turn blood sugar, or glucose, into energy.

Many patients can manage their type 2 diabetes by eating a healthful diet, partaking in exercise, and taking medications to help control blood sugar, or achieve glycemic control.

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Need for pill form of semaglutide

To select the right medication, doctors need to consider the complexity of the treatment and the risk of side effects, such as low blood sugar, or hypoglycemia, and weight gain.

One option is the glucagon-like peptide-1 (GLP-1) receptor agonist semaglutide, which is currently administered as an injection.

However, the authors suggest that a pill version of semaglutide might be more acceptable for some patients and thus increase the number of people who follow the recommended regimen to reduce their risk of complications.

Before a new version of a drug can be approved, it must undergo a series of clinical trials. In a phase II trial, different doses of the drug are compared with a “dummy,” or placebo. Then, if the results are favorable, the drug progresses to a larger, phase III trial to test its effectiveness and safety.

For their phase II trial of the pill version of semaglutide, Dr. Davies and her colleagues enrolled 632 type 2 diabetes patients whose current treatment was not achieving sufficient glycemic control, for instance through diet and exercise, or through use of metformin.

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‘Significantly’ better than placebo

The researchers randomly assigned the patients to several groups, all of which underwent treatment for 26 weeks. Some groups received a daily pill version of semaglutide or a placebo, while others received a weekly injection of semaglutide. Those who received the pill version were in groups that received different fixed daily doses, or gradually escalating daily doses.

The main measure used by the team to evaluate the effectiveness of the drug was the effect on patients’ hemoglobin Alc (HbA1c) levels. The HbA1c test checks the amount of glucose that is attached to hemoglobin, which is the oxygen-carrying protein in red blood cells.

The results showed that the average change in HbA1c over the 26 weeks of the trial fell in all the groups, with the biggest fall being in the group that received semaglutide by injection.

However, all dosages of the pill form of semaglutide reduced average HbA1c “significantly more than placebo by week 26,” note the authors.

The reduction in average HbA1c in the oral semaglutide groups ranged from -0.7 percent to -1.9 percent, depending on dosage, while reductions in the placebo group were -0.3 percent. In the group that received semaglutide by injection, the average reduction was -1.9 percent.

Of the patients who received the pill form of semaglutide, between 44 and 90 percent (depending on dosage) achieved the target level of HbA1c of under 7 percent, having started at an average of 7.9 percent at baseline.

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‘Clinically relevant’ weight loss

The results also show that 71 percent of patients on the pill form of semaglutide achieved a “clinically relevant” weight loss of 5 percent or more. Overweight and obesity are significant contributors to type 2 diabetes.

The side effects of taking the oral version were similar to those that occur with the injectable form of semaglutide.

The authors conclude that, in the type 2 diabetes patients on whom they tested it, the pill form of semaglutide achieved better glycemic control than placebo over 26 weeks. They say:

These findings support phase III studies to assess longer-term and clinical outcomes, as well as safety.”

They note that the study has several limitations, with the main one being that it only lasted for 26 weeks. The team suggests that future studies should also test the effect of oral semaglutide in participants with higher levels of HbA1c “to explore its potential in patients who are less well controlled, and in combination with other glucose-lowering agents.”

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Medical News Today: How is breast cancer related to the axillary lymph nodes?

The lymphatic system is one of the body’s chief infection fighters. This system contains lymph, which is a type of fluid, and lymph nodes, which are positioned in key areas in the body.

Lymph nodes are responsible for filtering lymph fluid and detecting chemical changes that signal if an infection is present.

Cancer cells can also get into the lymphatic system and get lodged in lymph nodes. When they are in the armpit, these filter points are called axillary lymph nodes.

Axillary lymph nodes and breast cancer

Sometimes, breast cancer can spread to the axillary lymph nodes, which are in a person’s armpits.

The number of axillary lymph nodes can vary from person to person, ranging from 5 nodes to more than 30.

When someone is diagnosed with breast cancer, knowing if cancer has spread to their axillary lymph nodes can determine the type of treatment they have, as well as their prognosis.

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The connection between axillary lymph nodes and breast cancer

women holding breast cancer ribbons
Knowing whether cancer has spread to the axillary lymph nodes can impact both treatment and prognosis.

The axillary lymph nodes are usually the first set of lymph nodes where breast cancer will spread.

And because the breast and armpit are close to each other, the lymph nodes are a common place where this type of cancer spreads.

As a general rule, the more a cancer has spread from its starting point, the worse the prognosis may be for a person.

Also, if the cancer has spread to the axillary lymph nodes, a doctor will usually recommend removing the lymph nodes during the surgery to remove the originating tumor.

Lymph nodes are responsible for draining lymph fluid, so their removal can cause some side effects after surgery. One side effect can be lymphedema of the arm, which is a chronic swelling of the arm.


Axillary lymph nodes often feel like small, round “sponges” under the skin. Sometimes they are painful to the touch. A doctor will investigate if the cancer may have spread to the lymph nodes by doing a physical examination.

The doctor will feel around the collarbone and neck for signs of enlarged lymph nodes, as well as underneath the arm.

According to the Susan G. Komen Breast Cancer Foundation, one-third of women who do not have lymph nodes that can be felt in a physical exam are found to have cancerous lymph nodes after further testing. As a result, it is usually vital to conduct more testing after the initial physical exam.

A doctor has several different diagnostic methods to determine if the cancer has spread to the axillary lymph nodes. These include:

Sentinel node biopsy

A sentinel node biopsy involves injecting a radioactive substance or dye into the breast. A doctor will then use imaging to identify the lymph nodes the dye goes to first. These first lymph nodes are known as the sentinel lymph nodes.

A doctor will remove one and send it to a pathologist who specializes in identifying types of cancerous cells. This approach can save a person from the side effects of removing multiple axillary lymph nodes.

According to the Susan G. Komen Foundation, sentinel node biopsy correctly predicts the status of further lymph nodes in 96 percent of women with breast cancer.

Axillary dissection

Axillary dissection is a procedure that involves removing more lymph nodes under the armpit. This is done by removing an area of fat that contains many or all of the lymph nodes. A doctor will then test these for cancer to determine if it has spread beyond the sentinel lymph node and, if so, how far it has spread.

After surgery, sometimes the lymph nodes are radiated along with breast radiation to target any possible remaining cancer cells.


doctor examining woman's neck
A doctor will check for signs of enlarged lymph nodes around the collarbone and neck.

The staging of a person’s cancer is a part of the TNM system, which stands for Tumor, Nodes, and Metastasis.

Some doctors use the TNM system to help them provide a prognosis or an outlook for how likely they are to be able to treat a person’s breast cancer successfully.

The N staging categories include:

  • NX: Axillary lymph nodes cannot be assessed, for example, if they were previously removed.

  • N0: Cancer has not spread to the lymph nodes. However, a doctor may choose to perform other types of tests to determine if microscopic amounts of cancer cells are present in the lymph nodes. These cells are known as micrometastases.

  • N1: Micrometastases or cancerous cells are present in 1 to 3 axillary lymph nodes, or the internal mammary nodes have tiny amounts of cancerous cells.

  • N2: In this stage, 4 to 9 axillary lymph nodes have cancer present, or the internal mammary nodes have cancer

  • N3: This stage has a broad spectrum, as follows:

    • cancer has been found in 10 or more axillary lymph nodes

    • cancerous lymph nodes are found under the clavicle

    • internal mammary nodes have cancer plus one or more axillary lymph nodes are cancerous

    • four or more axillary lymph nodes are cancerous and internal mammary nodes have micrometastases

    • cancerous nodes are detected above the clavicle

The more nodes and types of nodes involved, the higher the staging category for axillary lymph node status.

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The prognosis is poorer when a person’s cancer has spread to their lymph nodes, especially when it has spread to more of these.

However, lymph node staging is only one piece of the puzzle for cancer prognosis.

A doctor will also consider the overall size of a person’s tumor, the type of cells present, and if the cancer has spread to other organs.

These factors and other considerations, such as a person’s overall health and medical history, can further affect the prognosis they will receive.

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Medical News Today: Leukemia: Cancer cells killed off with diabetes drug

leukemic cell
Researchers may have found a way to suppress leukemic cells (shown here) while preserving healthy red blood cells.
Scientists may have found an innovative way to kill off cancer cells in acute myeloid leukemia, all the while preserving and regenerating healthy red blood cells.

The new study was carried out by researchers from the McMaster Stem Cell and Cancer Research Institute at McMaster University in Ontario, Canada.

Mick Bhatia ” a professor of biochemistry and biomedical sciences at McMaster University and director of the McMaster Stem Cell and Cancer Research Institute ” led the investigation, and the findings have been published in the journal Nature Cell Biology.

As the scientists explain, conventional methods for treating leukemia focus on targeting leukemic cells, paying little attention to preserving red blood cells.

But the production of healthy blood cells in the bone marrow is crucial for preventing leukemia patients from having anemia or fatal infections.

First study author Allison Boyd ” a postdoctoral fellow at the McMaster Stem Cell and Cancer Research Institute ” says, “Our approach represents a different way of looking at leukemia and considers the entire bone marrow as an ecosystem, rather than the traditional approach of studying and trying to directly kill the diseased cells themselves.”

“These traditional approaches have not delivered enough new therapeutic options for patients,” she continues. “The standard-of-care for this disease hasn’t changed in several decades.”

The American Cancer Society (ACS) estimate that 21,380 people will be diagnosed with acute myeloid leukemia (AML) in 2017. Most of these will be adults, as AML tends to target seniors.

Almost half of these patients will die from the disease.

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How a diabetes drug kills off cancer cells

To change these dire survival prospects, Boyd and colleagues collected bone marrow samples from 34 “genetically diverse” patients with AML.

The researchers examined the patients’ blood cell formation process and compared it with that of healthy donors. Boyd and team then examined the behavior of individual cells both in vitro, or in cell cultures, and in vivo, or in mice that had human cells transplanted into them.

The researchers found that the disease “disrupts the adipocytic niche” in the bone marrow. And more specifically, they found that leukemia suppresses the bone marrow adipocytes ” or the cells that store fat.

This led to dysfunction in the stem cells and progenitor cells, which, in a healthy body, would later go on to form red blood cells. The maturation of red blood cells was therefore stopped.

To combat this, the researchers administered a so-called PPAR-gamma agonist ” a drug commonly used to treat type 2 diabetes ” to the mice, and they found that it restored the fat cells in the bone marrow.

This “rebirth” of fat cells “rescued healthy hematopoietic maturation while repressing leukemic growth.”

In other words, boosting the fat cells in the bone marrow regenerated the healthy blood cells while killing off the cancerous leukemic ones.

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Findings may lead to new therapies

Prof. Bhatia comments on the significance of the findings in the context of traditional anti-leukemia therapies, saying, “The focus of chemotherapy and existing standard-of-care is on killing cancer cells but instead, we took a completely different approach which changes the environment the cancer cells live in.”

“This not only suppressed the ‘bad’ cancer cells,” he explains, “but also bolstered the ‘good’ healthy cells, allowing them to regenerate in the new drug-induced environment.”

“The fact that we can target one cell type in one tissue using an existing drug makes us excited about the possibilities of testing this in patients,” continues Prof. Bhatia.

“We can envision this becoming a potential new therapeutic approach that can either be added to existing treatments or even replace others in the near future.”

The fact that this drug activates blood regeneration may provide benefits for those waiting for bone marrow transplants by activating their own healthy cells.”

Prof. Mick Bhatia

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Medical News Today: Could micronutrient supplements combat ADHD?

Angry boy with ADHD
The links between nutrition and ADHD deepen.
A recent study examined whether or not vitamin and mineral supplements might ease ADHD symptoms, and it yielded encouraging results.

Attention deficit hyperactivity disorder (ADHD) is characterized by hyperactivity, attention difficulty, and impulsiveness. Although estimates differ, ADHD is thought to affect around 5 percent of children in the United States.

ADHD increases the likelihood that a child will experience problems at school, and, later in life, they are more likely to develop substance addictions and have ongoing psychiatric problems.

Medications that minimize some of the symptoms of ADHD are available, but their side effects can be significant, and it is not clear that they make a substantial difference to long-term outcomes

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Diet and ADHD: What’s the connection?

Over recent years, interest has developed around diet and its influence on ADHD. For instance, a study looking at the diets of adolescents concluded that “[a] Western-style diet may be associated with ADHD.”

Similarly, the authors of a study looking at the potential benefits of the Mediterranean diet on ADHD wrote, “Our data support the notion that not only specific nutrients but also the whole diet should be considered in ADHD.”

Another research team — who investigated the relationship between vitamins and ADHD in young adults — found that lower concentrations of B-2, B-6, and B-9 were associated with ADHD, and B-2 and B-6 were linked to the severity of the symptoms.

In general, studies into the relationship between micronutrients and ADHD have concentrated on manipulating one specific nutrient at a time. This is generally the best method for scientific inquiry: change just one variable and measure the outcome.

However, the authors of the current study argue that the body needs a range of micronutrients to function, many of which interact with each other. They believe that changing just one might not be the best course of action in this case.

For the recent study, Julia Rucklidge and her colleagues from the University of Canterbury in New Zealand used Daily Essential Nutrients (DENs), which contain 13 vitamins, 17 minerals, and four amino acids. Their study was the first fully blinded randomized, controlled trial of children with ADHD who were not taking medication.

In total, 93 children aged 7–12 were involved. Roughly half of them received DENs, and the others took a placebo for 10 weeks. The results were published earlier this month in the Journal of Child Psychology and Psychiatry.

Across the study’s duration, the researchers collected data from doctors, parents, teachers, and the participants themselves. They measured ADHD symptoms, general functioning and impairment, levels of aggression, mood, and emotional regulation.

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The impact of micronutrients

According to clinicians ratings, 47 percent of the participants taking the micronutrients improved “much” or “very much.” This is compared with 28 percent in the placebo group. Nobody in the placebo group was identified as improving “very much,” compared with 11 percent of those receiving DENs.

Also, 32 percent of the participants receiving micronutrients showed improvements in attention, compared with 9 percent in the placebo group. There were no differences measured in hyperactivity or impulsivity.

And, compared with the placebo, micronutrients were shown to improve participants’ control over emotion, aggression, and general functioning, according to reports from doctors, parents, and teachers. The authors write about the improvements in mood:

Twice as many of the children who entered the trial with severe mood dysregulation, and were randomized to micronutrients, showed a clinically significant improvement in emotional dysregulation compared with placebo (41 percent vs. 20 percent).”

They point out that the “direct benefit for core ADHD symptoms was modest, with mixed findings across raters.” However, because the intervention had very few adverse reactions, is relatively cost-effective, and makes differences across a range of ADHD functions in just 10 weeks, it warrants further investigation.

This is not the first time that vitamin and mineral supplements have been found to positively influence ADHD. More studies are guaranteed to follow, and, although ADHD is a complex problem, this relatively simple intervention may hold real promise.

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Medical News Today: Dietary supplement may help to prevent seizures

glucosamine supplements
Researchers found that a dietary supplement called glucosamine helped to reduce neural excitability in rodents.
A new study reveals how a dietary supplement could be used to reduce excitability in brain cells ” a known trigger of seizures ” opening the door to possible new treatments for epilepsy.

Researchers speculated that reductions in a protein modification called O-GlcNAcylation in the brain cells of rats and mice might lead to neural excitability, which is a known trigger of seizures.

In the new study, increasing levels of this protein with glucosamine ” which is a supplement used to help reduce pain in osteoarthritis, among other conditions ” was found to reduce neural excitability in rodents.

The findings not only help to shed light on the processes behind neural excitability, but they may also have identified a new treatment target for epilepsy.

Study co-author Prof. John Chatham, of the Department of Pathology at the University of Alabama at Birmingham, and colleagues recently reported their findings in The Journal of Neuroscience.

Epilepsy is a neurological disorder that is estimated to affect around 3 million adults and 470,000 children in the United States.

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The condition is characterized by unpredictable, recurrent seizures, which can occur when brain cells become hyperactive. This may cause surges of electrical activity that disrupt signaling between brain cells.

In a previous study, Prof. Chatham and team found that increases in protein O-GlcNAcylation are associated with a reduction in the strength of synapses in the hippocampus of the brain. Synapses are structures that allow neurons to transmit signals to each other.

The team notes that neural excitability in the hippocampus ” or the learning and memory region of the brain ” is often implicated in people with epilepsy.

Given their previous findings, the researchers hypothesized that increasing O-GlcNAcylation levels could help to reduce neural excitability, thereby preventing seizures.

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O-GlcNAcylation levels and neural activity

The researchers tested their theory with their latest research, by monitoring the effects of the dietary supplement glucosamine against neural excitability.

The team explains that glucosamine blocks an enzyme that clears O-GlcNAcylation from the brain, which leads to a rapid increase in levels of the protein.

For their study, Prof. Chatham and colleagues first applied glucosamine ” alongside another compound that inhibits the O-GlcNAcylation-clearing enzyme ” to hippocampal brain slices derived from rats and mice. Neural excitability in the brain slices was induced by drugs.


Treatment with the two compounds prompted an increase in O-GlcNAcylation levels, which led to a reduction in surges of electrical activity in a hippocampal region called CA1.

What is more, the researchers found that treatment with glucosamine alone for just 10 minutes was enough to reduce drug-induced neural excitability.

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Interictal spikes reduced in mice

The scientists also identified a decrease in spontaneous firing of pyramidal brain cells in the CA3 region of the hippocampus in response to an increase in O-GlcNAcylation levels.

Since the CA3 region regulates neural firing in the CA1 region, the team speculates that reduced spontaneous firing in the CA3 region is likely what reduces neural excitability in CA1.

In mouse models, the researchers found that increasing O-GlcNAcylation levels also led to a reduction in brain activity spikes related to epilepsy, which are known as interictal spikes.

Taken together, the researchers believe that their findings may point to a novel target for the treatment of epilepsy. The team concludes:

Our findings support the conclusion that protein O-GlcNAcylation is a regulator of neuronal excitability, and it represents a promising target for further research on seizure disorder therapeutics.”

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Medical News Today: Urine test for diabetes: What you need to know

Urine tests can check for a range of things, including blood in the urine, infection, and other systemic conditions. They are frequently used for diagnosing and monitoring diabetes.

In this article, we look at types of urine tests for diabetes and how to understand the results.

What is a urine test for diabetes?

Urine sample for a test in a collection tube, in a clear plastic bag.
A urine test is when a urine sample is analysed. It may reveal a number of things, including the presence of glucose.

Urine tests are important for both the diagnosis and monitoring of diabetes. Urine testing is less accurate than blood testing but is useful as a screening test for people who already know they have diabetes.

Urine tests can also be used to check for glucose in the urine of people who are undiagnosed.

A urine test will be looking for three things: glucose, ketones, and protein.


Having glucose in the urine may indicate diabetes, although it can also be caused by other conditions. For example, pregnant women who do not have diabetes may have glucose in their urine.

Glucose is not normally found in urine, but it can pass from the kidneys into the urine in people who have diabetes.


Ketone is a chemical that the body produces when there is a shortage of insulin in the blood. It is a by-product produced when the body starts to break down body fat for energy.

The presence of ketones in a person with diabetes may indicate a high blood glucose level, usually because a person with diabetes cannot use glucose as energy and has to use fat instead. Ketones in the blood can then spill into the urine.

Ketones in the urine are more common in people who have type 1 diabetes but can occur in those with type 2 diabetes as well.


A doctor will check for the presence of protein in the urine of people with diabetes, as this can indicate kidney problems or a urinary tract infection.

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Types of tests

Young male patient speaking with female doctor in her office.
A urine test may be referred to as a “dipstick test.”

If someone is concerned that they may have diabetes, they should see a doctor as soon as possible. The doctor will ask about a person’s symptoms and often take a blood and urine test.

The urine test used may be referred to as the “dipstick test” as it involves dipping a strip into the urine and reading the results using a color chart.

People who already have diabetes may be advised to test their urine for glucose or ketones at home. This urine test is very similar to the one used by doctors and can be purchased, without prescription, from a pharmacy.


During a urine test the doctor will give the person a clean and clear container and ask them to do the following:

  • urinate a little first before filling the container, as a mid-stream specimen gives the most accurate reading

  • fill three-quarters of the container and secure the lid

  • give the sample back to the doctor or place it in a specified area

A doctor will dip a strip into the urine that will change color according to the levels of various substances in the urine. The doctor will measure the strip against a color chart to determine the level of glucose, ketones, and protein in the urine.

The procedure will be slightly different for a person already diagnosed with diabetes who is conducting a urine test at home.

A person doing a home test should do the test in the morning before eating breakfast. They should also empty their bladder immediately after getting up and test during the next time they pass urine.

The person will also be able to use a color strip and reference chart to check the levels of ketones, proteins, and glucose in their urine.

It is important to note that urine tests will not show if blood glucose levels are too low, which can be important for people on insulin or using specific medication.

A doctor may want to conduct a urine test if people with diabetes are experiencing any of the following symptoms:

  • high blood glucose levels

  • nausea, vomiting, or abdominal pain

  • cold or flu symptoms

  • persistent fatigue

  • very thirsty or has a parched mouth

  • flushed skin

  • difficulty breathing or breath smells unusual

  • confusion

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Urine sample being tested with an indicator strip.
A strip will be dipped into the urine sample during the test. The different blocks of color change indicate levels of substances such as ketones or glucose.

The test results will identify the levels of glucose, ketones, and protein in the urine.


If a urine test finds glucose, then a specialized blood test, known as glycated hemoglobin (HbA1c), will be used to determine if a person has diabetes.

A glucose tolerance test (GTT) may also be carried out to see whether the body is having problems processing glucose.

High blood glucose is known as hyperglycemia and is common in people with all types of diabetes.


If a person has small traces of ketones in their urine, it may be a sign that ketones are building up and the person should take another test in a few hours.

If there are moderate or large amounts of ketones in the urine, then the person may have diabetic ketoacidosis (DKA), which is a potentially life-threatening complication of diabetes that requires urgent treatment.

Ketoacidosis is a chemical imbalance in the blood that can poison the body. It is a sign that a person’s diabetes is out of control.

Some extremely low carbohydrate diets can cause the body to break down fat and produce ketones for fuel. A low carb diet alone does not cause ketoacidosis and is different to DKA. People with diabetes should discuss any diet changes with their doctor before beginning.


Protein in the urine can also be a sign of kidney disease (or diabetic nephropathy) and affects around 1 in 3 people with diabetes.


A person newly diagnosed with diabetes will start treatment immediately.

Children with type 1 diabetes and their parents or guardians will usually be introduced to a specialist diabetes care team who will teach them how to manage the child’s condition.

Lifestyle changes, a healthful diet, and regular exercise can help a person with type 2 diabetes manage their symptoms. Medication will usually be prescribed to help lower blood glucose levels and keep it under control.

If a urine test has shown high blood glucose levels in someone who has diabetes, a doctor will advise them to:

  • avoid food and drinks high in sugar or carbohydrates

  • drink plenty of water

  • exercise regularly

  • possibly adjust insulin dose

People with diabetes who get a positive ketone test should contact their doctor immediately, as they may need more insulin. They should also drink plenty of water, not exercise, and keep testing for ketones every 3 to 4 hours.

Treatment for kidney disease will depend on its stage but can range from simple lifestyle changes to dialysis or a transplant.

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Medical News Today: Cribriform breast cancer: What to know

Cribriform breast cancer is a rare form of breast cancer that is often combined with another form of breast cancer. It is typically a low-grade and slow-growing cancer with a better outlook than most other types of invasive breast cancer.

In this article, learn about the grading and types of cribriform breast cancer, as well as how it is diagnosed.

What is cribriform breast cancer?

Pink breast cancer ribbon on women's vest.
Cribriform breast cancer is one of the less common forms of breast cancer, and has a generally good outlook in comparison to others.

According to one study, an estimated 0.3 to 3.5 percent of people with breast cancer have cribriform breast cancer.

This type of cancer is characterized by breast cancer cells that feature a pattern of holes between the cancer cells. According to, these holes closely resemble Swiss cheese.

As well as these cells, cribriform cancer can also include features from other types of breast cancers.

A person can have more than one type of cancerous cells in a particular tumor. A doctor may also diagnose a person with invasive mammary carcinoma of no special type, which means the cancer cells do not resemble any specific cancerous cells.

Different cancer cell types

Several different types of cells grow in breast cancers, including:

  • tubular

  • mucinouscribriform

  • micropapillary

According to the American Cancer Society, cribriform breast cancer is a less common type of cancer than a typical invasive ductal carcinoma, and people with this kind of cancer have a much better outlook than, for example, people who have micropapillary breast cancer.

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Cribriform breast cancer grading

Grading a tumor means that a doctor will look at the cell types and describe the cancer cells as grade 1, 2, or 3. Grading is important because it tells other doctors how different the cancerous cells are from healthy breast cells.

The higher the grade, the faster the cancer cells usually grow. The grading of breast cancer is: 

  • Grade 1: The tumor cells are slow-growing and closely resemble those of normal breast cells. 

  • Grade 2: The tumor cells are moderately different from normal cells.

  • Grade 3: The tumor cells are very abnormal and appear to be growing quickly.

As well as the grading, a doctor will also need to take staging into account when considering prognosis and treatments.

Cribriform breast cancer staging

Young male doctor discussing results with female patient.
There are four different stages for cribriform breast cancer, which describe different stages of progression.

Staging refers to the extent of the cancer, including how far it has spread and how large the tumor is. Staging for cribriform breast cancer is as follows:

  • Stage 0 (carcinoma in situ): At this stage of breast cancer, the cancerous cells have not spread beyond the ducts of the breast into the fatty part of the breast.

  • Stage 1: The tumor at this stage is 2 centimeters (cm) or less in diameter and has not spread beyond the breast.

  • Stage 2: Tumors at this stage are smaller than 2 cm with spread to 1-3 lymph nodes under the arm, OR between 2 and 5 cm with or without spreading to lymph nodes, OR larger than 5 cm without spreading to lymph nodes.

  • Stage 3: The tumor is any size in diameter and has spread to more than 3 lymph nodes or into the chest wall, OR the tumor is larger than 5 cm with spread to 1-3 lymph nodes.

  • Stage 4: The cancer has spread outside the breast and to other organs. This is known as metastasis.

The stage of cancer can help doctors make treatment recommendations. As a general rule, the lower the stage, the more treatable the breast cancer.

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Treatment for cribriform breast cancer

Female surgeon in operating theater.
If the cancerous cells can be removed, surgery may be recommended. This may involve a lumpectomy or mastectomy.

Knowing a woman has cribriform breast cancer impacts on what treatment recommendations a doctor may make.

According to an article published in the journal Oncology Letters, cribriform breast cancer type does not usually metastasize or spread to lymph nodes under the arm. As a result, the prognosis for cribriform breast cancer is often “favorable” or good.

This cancer type is often influenced by hormones, especially estrogen and progesterone, but there are currently no standard treatment protocols specific to cribriform breast cancer. As a result, a doctor will consider the cancer’s stage and discuss treatment options.

Examples of the treatments for cribriform breast cancer include:

  • Surgical removal: A doctor may recommend a lumpectomy or mastectomy to remove some or all breast tissue and ensure all the cancerous cells are removed.

  • Chemotherapy: Chemotherapy helps to kill fast-multiplying cancer cells.

  • Radiation: Radiation involves exposing the tumor to high-energy radiation to kill cancerous cells.

  • Hormone therapy: These drugs inhibit the action of hormones known to contribute to breast cancer, such as estrogen and progesterone. A typical example is Tamoxifen, which keeps estrogen from binding to cancer cells.

Each of these treatments has side effects that range from mild to severe. A person should discuss all treatment options with their doctor.


A doctor will usually order a mammogram, which is an X-ray image of the breast. A doctor may also order an ultrasound scan, which utilizes sound waves to identify tumors or masses in the breast. Sometimes a doctor may order other imaging studies, such as computed tomography (CT) or magnetic resonance imaging (MRI) scans to get a clearer picture.

Cribriform breast cancer does not typically cause symptoms. The cancerous lesions also are not always easily seen on a mammogram. However, other imaging studies, such as an ultrasound, can help doctors identify a potential cribriform breast cancer. 

When a doctor identifies a potentially cancerous lesion in the breast, they will often recommend a biopsy. A pathologist will examine the cells under a microscope to identify different types of cancerous cells. One example of the cancerous cell types is cribriform breast cancer.

When a surgeon performs a biopsy of the breast or removes the tumor entirely, they review the tumor under a microscope. The tumor with cribriform cells will have holes between the cancer cells, resembling Swiss cheese.

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The incidence of cribriform breast cancer is between 0.3 and 3.5 percent. This cancer type does not usually metastasize or spread to lymph nodes under the arm. As a result, the prognosis for cribriform breast cancer is usually favorable.

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Medical News Today: All you need to know about dysesthesia

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Medical News Today: Why does my tongue hurt?

The tongue is a muscular organ in the mouth that is important for eating, swallowing, and speaking.

A sore or painful tongue may be alarming but is usually not a cause for concern. Most instances of a sore tongue are minor problems that go away on their own or need minimal treatment.

Bites or injuries

Woman sitting on a park bench holding her cheek in pain, because of a toothache or sore tongue.
A common cause of a sore tongue is accidentally biting the tongue when chewing food, or biting down suddenly.

Most people have experienced the sharp pain that comes from accidentally biting their tongue. Because the tongue shares mouth space with the teeth, it is not uncommon for a person to bite it while chewing.

The tongue can also become injured if the teeth clamp shut on it during an impact. This sometimes happens during contact sports or as a result of an accident, such as a slip or fall or a car accident.

Seizure disorders, such as epilepsy, can also result in tongue injuries, or lacerations when the teeth bite down on the tongue during a seizure.

It may take several days or more than a week for the sore spot to heal completely. Gargling a warm saltwater solution may help ease pain and aid with healing.

Severe bites or injuries to the tongue, however, may need medical attention.

Tongue injuries, or lacerations, are common in children. Deciding whether to repair them with stitches or surgery depends on the age of the child and the severity of the injury, according to a study in the International Journal of Clinical Pediatric Dentistry.

If the injury looks deep or large or there is excessive bleeding, emergency care may be needed.

Oral thrush

The fungus Candida is present in the mouth, throat, and digestive tract. If the body is not able to keep the fungus in check and it overgrows, Candida causes a fungal infection. This happens more often in newborn babies and people with weakened immune systems.

When Candida overgrows in the mouth, this is known as oral thrush. It can cause painful yellow or white patches to form on the tongue and inside the mouth.

Treatment for thrush may include prescription antifungal medicines. It usually gets better about 2 weeks after a person starts the medication.

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Canker sores

Canker sore on the tip of a persons tongue.
Canker sores are a painful type of spot that may occur inside the mouth. Usually, these will pass by themselves.

Most people have experienced a painful canker sore in the mouth. Known medically as aphthous ulcers, they may appear inside the lips or cheeks and under the tongue.

A canker sore looks like a small, round, white spot with a red border, and it can make eating or talking painful.

Experts do not know exactly what causes canker sores but think they may be due to:

  • spicy or acidic foods

  • emotional stress

  • physical stress from an illness

  • hormonal changes, especially in women

In most cases, canker sores will heal on their own. Treatments include over-the-counter topical pain medicines, saltwater rinses, or a prescription mouthwash.

If canker sores occur more than 3 times per year or cause significant pain, people should consult a doctor or dentist. Canker sores are not contagious.

Cold sores

Not to be confused with canker sores, cold sores are caused by the herpes simplex virus and are highly contagious. They are spread via skin-to-skin contact and appear as fluid-filled blisters that ooze and form a crust as they heal.

Even a person who does not have an active cold sore can spread it to others. Many children get cold sores from adults who may kiss them, share a drink or utensils with them, or touch their face.

Cold sores often appear on the outside of the mouth, but they can affect the tongue and cause pain, tingling, and burning.

Some doctors prescribe antiviral medicines to help lessen the severity of the sores and help them go away faster. Cold sores may return later, however, as the herpes virus never goes away once a person becomes infected with it.

Burning mouth syndrome

Burning mouth syndrome is a painful condition that causes a burning, numb, or tingling feeling on the tongue. The pain may last months or years, but the mouth will not have any visible problems, such as sores or redness.

Doctors cannot diagnose burning mouth syndrome during a mouth exam so they may have to base a diagnosis on symptoms alone.

It is not always possible to identify a cause, but burning mouth syndrome may be triggered by:

Treatment for this condition will depend on a person’s medical history and the severity of pain.

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Glossitis means inflammation of the tongue. There are several different types of glossitis, but almost all of them can cause a sore or painful tongue.

Treatment varies, depending on the cause of the glossitis and the level of pain it causes.

Geographic tongue

The medical term for geographic tongue is benign migratory glossitis.

This condition occurs when the tiny, finger-like bumps on the tongue known as papillae disappear in small patches. This results in a smooth, red lesion on the tongue that is usually surrounded by a white border, giving the tongue a map-like appearance.

Some people experience a burning or painful sensation on the tongue. If this happens, topical numbing medications or prescription cortisone medicines may help with the pain.

The cause of geographic tongue is not known. There may be a link between geographic tongue and psoriasis, but people without psoriasis may still get geographic tongue. It is not contagious and does not lead to other health problems.

Median rhomboid glossitis

A smooth, red, flat area in the middle of the tongue is usually median rhomboid glossitis. It often causes no symptoms, so a person may not realize they have it unless a doctor or dentist finds it. It can, however, cause tongue pain, especially when eating certain foods.

Median rhomboid glossitis is thought to be caused by a fungal infection, so it is usually treated with antifungal medicine if the pain is bothersome. It is not contagious.

Other glossitis causes

The tongue can become inflamed and painful due to many different factors. Other common causes of glossitis include:

Allergic reactions

People who have a severe reaction to certain foods, insect bites, or other things may develop acute or sudden glossitis. This can cause swelling of the tongue, which may interfere with breathing.

Celiac disease

A study in Journal of Medical Case Reports found that atrophic glossitis was the only sign of celiac disease in some people.

Nutritional deficiencies, such as low iron or vitamin B-12

A study in the Journal of Oral Pathology and Medicine found “a significant association of deficiency of hemoglobin, iron, and vitamin B-12″ with glossitis.

Similarly, a study in the Canadian Medical Association Journal discussed an individual who had a sore, burning tongue and was found to have a B-12 deficiency.

Tongue tumors

Dental surgeon speaking with patient.
Any unexplained bleeding should be assessed by a medical professional.

A tumor on the tongue is another possible cause of a sore tongue. A tumor may appear as a sore spot, lump, or red or white patch on the tongue that does not go away.

Other symptoms that may accompany a tumor on the tongue include numbness, pain while swallowing, and unexplained bleeding.

Tumors can be either benign or cancerous. If anyone believes that they have a tumor on their tongue, they should see a doctor immediately.

Good oral health habits and tongue care

A sore tongue is usually not caused by oral care habits. However, keeping the mouth healthy and looking for any changes in the tongue’s appearance can be helpful in treating problems early.

Good oral care typically includes:

  • brushing the teeth at least twice a day with fluoride toothpaste

  • flossing at least once a day

  • seeing a dentist at least every 6 months or as often as recommended

Brushing the tongue can help avoid bad-breath odor, but aggressive brushing or scraping is not necessary and can lead to irritation.

People should also avoid alcohol-based mouthwashes, especially if the tongue is sensitive or dry mouth is an issue.

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Though most tongue pain goes away without an issue, people should not ignore any changes in the tongue.

If a person experiences tongue pain does not have an obvious cause, they should consult a doctor or dentist. Tongue inflammation and pain can be a sign of an underlying condition or deficiency that needs treatment.

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Medical News Today: Ketone salts: Do they really improve athletic performance?

athlete taking supplements
Don’t always trust the label; ketone salt supplements may do more harm than good when it comes to athletic performance.
Ketone salts are a dietary supplement that “encourage” the body to derive its energy by burning fats. This supplement is meant to promote weight loss, and some say that it might boost athletic performance. But is that true?

You may have heard of the ketogenic, or “keto,” diet, which is based on fat- and protein-loaded foods and intented to eliminate carbohydrates as much as possible.

The keto diet works by causing ketosis, which is a process that relies on burning fat to derive energy, rather than taking the calories from carbohydrates.

Ketone salts are meant to increase the level of ketones in the blood, similarly to ketosis, so that the body will derive its energy from them. Numerous online resources suggest that this nutritional supplement can be used as an aid to weight loss, as well as acting as a reliable energy booster for athletes.

Researchers from the University of British Columbia’s Okanagan Campus in Kelowna, Canada, set out to test whether or not ketone salts could actually improve athletic performance.

As study co-author Prof. Jonathan Little notes, “We know from one previously published study that ketone supplements may improve long-duration endurance performance, but we’re interested [in] what happens during short-duration and high-intensity workouts, like running a 10 kilometers or cycling up a hill.”

The study’s findings were recently published in the journal Applied Physiology, Nutrition, and Metabolism.

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‘Athletic performance drops off’

The researchers explain that, while burning fat may be a reliable long-term energy resource, this is a long and complex process. What this means is that energy derived from fat may not be ideal for athletic pursuits, which usually tap into “quick” sources of energy such as blood glucose.

Elevated blood ketones seem to inhibit the body’s use of glycogen, the stored form of glucose, and favors burning fat instead. That means that the body’s quick-burning fuel cannot be accessed during high-intensity bursts of activity.”

Prof. Jonathan Little

This, he says, causes “athletic performance [to drop] off as a result.”

For the purpose of the new study, the researchers worked with 10 adult men matched for athletic performance and body mass index (BMI).

Following a period of fasting, the participants were given either beta-hydroxybutyrate ketone salts or a placebo on a random basis. Half an hour after having ingested either the supplement or the placebo, they engaged in a timed cycling trial.

The team found that compared with the day that they took the placebo, when taking the ketone salts, the participants’ performance – in terms of power output – was 7 percent lower.

“It turns out that ketone salt supplements actually impair high-intensity exercise performance,” says Prof. Little.

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Ketone salts should be treated with caution

Prof. Little emphasizes that the study’s findings do not support the notion that ketone salts should be used by athletes who want to boost their performance. In fact, the experiments so far seem to indicate the contrary.

He says, “Often these supplements are marketed as a means of improving athletic performance but in this case, the research tells a very different story.”

He also notes that ketone salt supplements may have other adverse effects that as yet remain unknown, and this is a further reason for caution.

“On top of that, the long-term impacts of artificially increasing blood ketone levels – essentially tricking the body into thinking it is in a state of starvation – is completely unknown,” warns Prof. Little.

He explains that the study’s findings should help athletes to gain a better understanding and awareness of the pros and cons of such supplements, which may be misguidingly advertised.

“I hope this helps athletes navigate the science of supplements rather than relying on label marketing alone,” he concludes.

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