It appears that you are currently using Ad Blocking software. What are the consequences? Click here to learn more.
Advertisment
Shop At The Mendosa Store
Diabetes Developments - A blog on latest developments in diabetes by David Mendosa

Entries Tagged as 'Diabetes Medication'

Why Vitamin D Isn’t Snake Oil

September 28th, 2010 · 3 Comments

Vitamin D seems to prevent many of our ills. Some studies show that taking large doses of it will treat just about everything from building strong bones to protecting us from strokes and heart failure to reducing our risk of cancer and on to helping us regulate our immune system and control inflammation, our blood pressure, and even our blood glucose. Higher levels of vitamin D is associated with reduced risks for multiple sclerosis, rheumatoid arthritis, and type 1 diabetes.

Reports of the value of vitamin D for preventing even more conditions continue to appear regularly. Low levels of vitamin D are associated with poor lung function among children with asthma, leading them to use more medication to treat it, as the Journal of Allergy and Clinical Immunology recently reported. Vitamin D might treat or prevent allergy to a common mold that can complicate asthma and frequently affects patients with cystic fibrosis, according to a study that the Journal of Clinical Investigation published a few days ago.

As I wrote here last year we nevertheless might have good reason to wonder if all the current hype over vitamin D is nothing more than a resurgence of snake oil claims.

How could just getting out into the sun more or taking just one inexpensive and tiny pill each day work such magic? It seems to be too good to be true. It doesn’t seem to pass the smell test.

Yet we already had a hint to the solution of this major nutritional puzzle when we learned that what we call “vitamin D” isn’t really a vitamin. When scientists discovered vitamin D in the 1920s and 1930s it seemed to work like a vitamin, so that’s what the called it.

“We have confirmed with our recent research that vitamin D isn’t a vitamin at all,” says Professor Trevor Marshall of the school of biological sciences and biotechnology at Murdoch University in Western Australia. It’s a hormone that is made by the body itself.”

And today the other shoe dropped. Several days ago the Wellcome Trust sent me under embargo the advance word on the latest study that journalists could print this evening. The Wellcome Trust is a global charity headquarters in Britain dedicated to improvements in human and animal health.

The main conclusion of this study goes a long way to explaining why vitamin D seems to work its magic throughout our bodies. The journal Genome Research will publish a study led by Sreeram Ramagopalan and Andreas Heger at the University of Oxford.

Using new DNA sequencing technology, they identified more than 200 genes that vitamin D directly influences and created a map of vitamin D receptor binding across the genome. Vitamin D attaches itself to DNA, thus influencing what proteins we make from our genetic code byactivating this receptor.

The researchers discovered 2,776 binding sites for the vitamin D receptor along the length of the genome. These were unusually concentrated near a number of genes associated with susceptibility to autoimmune conditions and to certain cancers. They also found that vitamin D had a significant effect on the activity of 229 genes including PTPN2, associated with Crohn’s disease and type 1 diabetes.

“Vitamin D status is potentially one of the most powerful selective pressures on the genome in relatively recent times,” says Professor George Ebers of the University of Oxford and one of the senior authors of the paper. “Our study appears to support this interpretation and it may be we have not had enough time to make all the adaptations we have needed to cope with our northern circumstances.”

Seldom does basic science like this make the headlines. But this research certainly warrants that. If vitamin D is snake oil, I’ll drink it.

This article is based on an earlier version of my article published by HealthCentral.

Share

Tags: ,
Posted in: Diabetes Medication

Drug Interactions

August 30th, 2010 · 2 Comments

My friends at Diabetes in Control have just updated their valuable list of drugs that can cause us problems. The URL is http://www.diabetesincontrol.com/images/tools/druglistaffectingbloodglucose.pdf

They sent their list to me in their weekly email, but it’s also available on their website as a PDF. The list, which shows both the generic and brand names, includes those drugs that can cause us to have either low blood glucose levels or  high blood glucose levels. It also includes a short list of other drugs that can mask hypos.

This is a good list for all of us to keep handy.


This article is based on an earlier version of my article published by HealthCentral.

Share

Tags: , ,
Posted in: Diabetes Medication

Byetta Vindicated

August 9th, 2010 · 3 Comments

Yesterday Medco Health Solutions presented a study at the Scientific Sessions of the American Diabetes Association. The study found that, contrary to warnings from the Food and Drug Administration, neither Byetta or Januvia increase the risk of acute pancreatitis.

Byetta and Januvia are two of the most important medications for type 2 diabetes, since they reduce blood glucose without increasing weight, which all the other diabetes drugs (except metformin, Victoza, and Symlin) do. In fact, Byetta is proven to reduce weight, and that’s why I wrote a book about it, Losing Weight with Your Diabetes Medication.

Due to reported cases of acute pancreatitis, several years ago the FDA added warnings to the labels for Byetta and Januvia.

However, Medco’s study indicates that patients taking either of these medications were no more likely to develop acute pancreatitis than patients taking other drugs to control diabetes. The study indicates there is an increased risk of acute pancreatitis for people with diabetes. But that it is not associated with the particular diabetic medication the patients are using.

“While cases of acute pancreatitis have been reported in patients using Byetta and Januvia, diabetic patients who are not taking these drugs also have been reported to have an increased risk for pancreatitis,” says Merri Pendergrass, MD, PhD, national practice leader of the Medco Therapeutic Resource Center for Diabetes, who conducted the study. “The major question has been are these medications causing the pancreatitis or are they innocent bystanders? Our findings are reassuring in that they did not reveal any increased risk of acute pancreatitis with Byetta and Januvia.”

Medco released even more good news for people taking Byetta. Another one of its studies presented at the ADA’s Scientific Sessions found that, despite FDA warnings, Byetta is not associated with an increased risk of acute renal failure in people with type 2 diabetes. This Medco analysis indicated that while there is an increased risk of acute renal failure in people with diabetes, the diabetes drug they are taking does not appear to impact that risk.

Medco Health Solutions Inc. conducted the study in association with the Medco Research Institute and the University of Texas Southwestern Medical School. Medco Health Solutions is a major pharmacy, ranking 35th on the Fortune 500. The study analyzed Medco’s pharmacy and medical claims data for more than 786,000 adult patients between January 2007 and June 2009.

They divided the people with diabetes into three groups based on whether they were taking Byetta, Januvia, or other diabetes drugs. A group of people without diabetes served as the control.

While the risk for acute pancreatitis was essentially the same among the three groups of people with diabetes, the average risk for all the diabetes groups was higher than that for the control group. Medco used comparable methodology and study parameters in the two studies.

The lack of increased risk of renal failure was news to me. But I’ve known for years that Byetta doesn’t pose an additional risk of pancreatitis, and I wrote about it here in October 2007. Now it’s time for the FDA to catch up.

This article is based on an earlier version of my article published by HealthCentral.

Share

Tags: ,
Posted in: Diabetes Medication

Short Needles

August 9th, 2010 · No Comments

Sometimes it’s superior to be short. Especially if it’s a needle.

Now, the company that makes some of the highest quality needles and lancets has gone even further. Becton, Dickson and Company, which many of us know simply as BD, announced a few days ago that it has produced a pen needle that is even smaller and thinner than anything available before.

BD says that it BD Ultra-Fine Nano is the “world’s smallest pen needle” and is proven to be as effective as longer needles for anyone — big or small, thin or fat. These new needles promise to be less painful for any one of the 5 million Americans who inject insulin or GLP-1 to manage their diabetes.

Please catch the reference to GLP-1. This means that not only insulin users but also those of us who use Byetta or Victoza. These are the newest class of diabetes drugs that people with type 2 diabetes can use to reduce their A1C and their weight at the same time.

This shorter needle is just 4 mm long and has a thin 32 gauge. It provided equivalent glycemic control compared to 31 gauge needles that are 5 mm or 8 mm long and had “reduced pain, no difference in insulin leakage and was preferred by patients,” according to a study reported in Current Medical Research and Opinion. While five of the seven authors of this study work for BD, which raises a red flag, two of them are independent researchers. And one of them, Timothy Bailey, M.D., the director of the AMCR Institute in San Diego, I greatly respect and know personally.

Even though this needle is only 4 mm long, it reaches the subcutaneous tissue — the layer of fat that all of us have below our skin — that is the recommended site for injections of insulin and GLP-1s. And it’s not too long to mean a risk of injecting into muscle, where we can absorb insulin too fast, increasing the risk of hypos. So this new needle promises better glycemic control.

With this needle we don’t have to pinch-up the skin. And it fits all of the insulin pens and dosers sold here.

As I writer, I don’t like to admit that pictures can sometimes be superior to words. Even photos that I have taken myself, like this one. They seldom are, but this is an exception.

Here is one of those new needles mounted on a saline pen. You can see for yourself how short it really is.

A BD Ultra-Fine Nano Pen Needle on a Saline Pen

This article is based on an earlier version of my article published by HealthCentral.

Share

Tags: , ,
Posted in: Diabetes Medication

Is Gastric Bypass Surgery a Cure?

May 28th, 2010 · 1 Comment

Gastric bypass surgery is getting more and more attention as a potential cure for type 2 diabetes. For example, Dan Hurley’s outstanding recent book Diabetes Rising, which I reviewed here, included it in the author’s section on cures for diabetes.

Usually people define a cure based on fasting blood glucose and A1C tests. Anna L. Marina, M.D., a primary author of the case study, and her associate, Dace Trence, M.D., described a case that met those criteria, “but did not support remission of diabetes on further evaluation.”

Dr. Marina is a senior clinical research fellow in the division of metabolism, endocrinology, and nutrition of the University of Washington. Dr. Trence is associate professor of medicine there.


Dr. Anna Marina

Dr. Marina presented her findings at a press briefing during the annual meeting and clinical congress of the American Association of Clinical Endocrinologists in Boston today. I am attending this meeting to represent Health Central.

The subject of Dr. Marina’s presentation was a 55-year-old man who was morbidly obese with a BMI of 45.2 and who had had type 2 diabetes for seven years. He had undergone Roux-en-Y gastric bypass surgery, by far the most commonly performed bariatric procedure in the United States.

The surgery obviously helped him a lot. Right after his operation he was able to cut his insulin injections from 100 to 30 units a day. After four months he had lost more than 100 pounds and his A1C went from 9 to 6.1 percent. At that point he and his doctor decided that he didn’t need insulin any more.

But after seven months he started having post-meal blood glucose levels in the 180 mg/dl range. Then, as tested with a continuous blood glucose monitor, they could see that his post-meal levels were often in the 200 mg/dl range — all the way up to 294 mg/dl. Those levels are consistent with a diagnosis of diabetes.

This is also consistent with another recent study, Dr. Marina said. Dr. Mitchell Roslin and two associates reported at last year’s annual meeting of the American Society for Metabolic and Bariatric Surgery. They performed glucose tolerance tests on 38 people more than six months after they had Roux-en-Y gastric bypass surgery.

“They found that six out of these 38 people still had diabetes,” Dr. Marina said. She concluded that “fasting blood glucose and normal A1C are insufficient to establish that gastric bypass surgery is a cure for type 2 diabetes.”

Gastric bypass surgery is a last resort. It can work for some people with diabetes who are morbidly obese. But unfortunately not for all.

This article is based on an earlier version of my article published by HealthCentral.

Share

Tags: ,
Posted in: Diabetes Medication

Losing Weight with a Hydrogel

May 28th, 2010 · 7 Comments

Today, after 15 years of work, a Boston-based company focused on obesity and diabetes came out of stealth mode. Gelesis Inc. unveiled something that promises to make losing weight a lot easier.

Nothing on the immediate horizon could be more important for most of us who have diabetes. More than 85 percent of us are overweight or obese, according to a survey by the U.S. Centers for Disease Control and Prevention.

While I lost a lot of weight by using the first GLP-1 mimetic, Byetta, and then more by following a very low-carb diet, it wasn’t easy. That personal experience is in part what makes me so excited about the product that Gelesis presented to the public for the first time today.

The company made its presentation at a media briefing that I was privileged to attend. Health Central sent me to Boston this week to attend the 19th annual meeting and clinical congress of the American Association of Clinical Endocrinologists. About 1,700 doctors from all over the world are here for the association’s largest meeting ever.

I arrived in Boston yesterday evening, and for me the meeting started with the media briefing this morning. It started with a bang as two doctors presented the results of their efforts to date. After the briefing, I cornered four other experts involved with the development of their product.

Dr. Hassan Heshmati, the chief medical officer for Gelesis, kicked off the presentation. He announced that they have developed the first superabsorbent hydrogel composed entirely of food components. They call it Attiva.

It swells up after people swallow it, making people feel full. This feeling of satiety lasts even after it goes through the stomach into the intestines. Then it safely degrades in the colon and releases the liquids that it absorbs, one of Attiva’s important safety features.

They designed Attiva to have the same physical properties as masticated food. The most common side effect was nausea. But only about 7 percent of the people in their clinical trial experienced it, Dr. Heshmati said.

After Dr. Heshmati’s introduction of Attiva, Eric Elenko, Ph.D., showed us what Attiva can do. Dr. Elenko is a partner in Puretech Ventures, which co-founded Gelesis.

Eric Elenko Shows How Absorbent Attiva Really Is

To measure Attiva’s effect on satiety, doctors at the Gemelli Hospital in Rome, Italy, gave it to 95 people. While some of them had a normal weight, others were overweight or obese, and they had an average body mass index of 31. [Read more →]

Share

Tags: , ,
Posted in: Diabetes Medication

Good Drugs, Bad Drugs

January 21st, 2010 · 3 Comments

We know that the only person who can tell us what to eat and exercise is ourself. But most of us need a third leg of diabetes control — one or more of the prescription drugs — and we usually leave that decision up to our doctor.

Often this is a big mistake. Many of our doctors are too set in their ways. The problem is simply that doctors too are human.

Older doctors have practiced most of their lives with a Hobson’s choice of one oral diabetes drug. In 1957 the first sulfonylureas became available by prescription in the United States. Not until about 40 years later did the Food and Drug Administration approve a second diabetes drug, metformin.

Until we could get metformin, we did have the opportunity to take insulin instead of a sulfonylurea. And we had a lot of different sulfonylureas to choose from, making it appear that our choice was greater that it really was. Brand names include Amaryl, Glucotrol XL, Diaßeta, Glynase, Micronase, as well as Dymelor, Diabinese, Orinase, and Tolinase. Combination drugs like Metaglip, Glucovance, Avandaryl, and Duetact also are part sulfonylurea. [Read more →]

Share

Tags: , , , , ,
Posted in: Diabetes Medication

The Big Ds: Diabetes, Depression, and the D Vitamin

January 8th, 2010 · 9 Comments

Since alliteration helps us to remember connections, we’re lucky that diabetes, depression, and the D vitamin all start with the same letter. We aren’t lucky that diabetes and depression are so closely connected, as I wrote in my essay on “Diabetes and Depression” here a year ago. But we’re in luck that vitamin D might treat both conditions, killing two birds with one stone, as our less technologically powerful ancestors used to say.

“About 70 percent of the population of the United States has insufficient levels of vitamin D,” says Adrian Gombart, a principal investigator with the Linus Pauling Institute at Oregon State University. “This is a critical issue as we learn more about the many roles it may play in fighting infection, balancing your immune response, helping to address autoimmune problems, and even preventing heart disease.”

People with diabetes may have even lower levels of vitamin D, according to a review last year in The Diabetes Educator. People at risk of diabetes and the metabolic syndrome (or syndrome x) also have low vitamin D levels.

Recent research found that 19 percent of people with type 2 diabetes probably suffer from major depression and an additional two-thirds of us have at least some depressive symptoms. People with diabetes are twice as likely to be depressed as other people.
[Read more →]

Share

Tags: , , ,
Posted in: Diabetes Medication

The Case for More Vitamin D

December 28th, 2009 · 4 Comments

Are you suspicious of snake oil claims that something will treat a whole lot of health problems? I sure am.

The newest entry on the snake oil scene would seem to be vitamin D. I’ve lost track of all that this vitamin is supposedly good for — everything from building strong bones to protecting us from strokes and heart failure to reducing our risk of cancer and on to helping us regulate our immune system and control inflammation, our blood pressure, and even our blood glucose. Recently, some people are even recommending it for respiratory problems ranging from the common cold to the H1N1 (swine) flu virus.

If even half of this is true, vitamin D must be the biggest health discovery since aspirin. But so far we have only a few generally accepted uses of vitamin D.

We’ve known since the early 1920s that vitamin D cures rickets and other diseases that soften our bones, including osteomalacia and osteoporosis. The U.S. Food and Drug Administration in 1994 approved a vitamin D preparation to treat psoriasis. [Read more →]

Share

Tags: ,
Posted in: Diabetes Medication

Why Glucose Tabs are Better

June 15th, 2009 · 2 Comments

This weekend my friend Mark and I drove about 120 miles from our homes in Boulder to Leadville in Central Colorado. Mark is a member of the diabetes support group that meets monthly at my apartment, and we are both avid hikers and nature photographers.

On Friday as we set off on the Turquoise Lake trail near Leadville, Mark checked his blood glucose. It was about 75 mg/dl so he ate a chocolate bar that he had in his pack.

“I figure that as long as I have to eat something to raise my level, I may as well eat something that tastes good,” he commented.

Maybe my body language showed my disagreement. So he asked me why I didn’t like his solution. [Read more →]

Share

Tags: , ,
Posted in: Diabetes Medication, Diabetes Testing

HONcode certification seal.