One little problem with disasters is that when they strike it’s too late to start preparing for them. You never know when or where they will hit.

Those of us who have diabetes are particularly vulnerable, because we have so many things that we have to consider. That’s why the American Association of Clinical Endocrinologists working with Eli Lilly and Company created the “Power of Prevention: Diabetes Disaster Plan.”

Todd Frieze, M.D., who practices diabetes, endocrinology, and metabolism in Biloxi, Mississippi, spoke on the organization’s disaster plan for those of us with diabetes this morning at a media briefing during the last full day of the AACE’s annual meeting in Boston. He said that they developed this checklist of items that we need to plan for after thousands of people were caught unprepared as a result of Hurricane Katrina in 2005.

Dr. Frieze Plans

In such an emergency we may well be totally on our own. “When something does happen, access to medical care may be curtailed or absent completely,” Dr. Frieze said. He noted that in 2005 his patients were out of touch with him for seven weeks.

Here is the checklist. As the Boy Scouts say, “Be Prepared:”

Prepare a portable diabetes disaster kit that is both insulated and waterproof containing the following items:

• List of all medical conditions and prior surgeries.
• Information about your diabetes, including past and present medications, any adverse reactions to medications, and past and present complications.
• List of all your health care professionals with their contact information.
• Letter from your diabetes health care professionals detailing most recent diabetes medication regimen (especially for insulin) and containing most recent laboratory results.
• List of all medications, which should also include pharmacies and active prescription information and eligible refills.
• A 30-day supply of medications for diabetes and all other medical conditions. This should include insulin, oral anti-diabetic agents and severe hypoglycemia emergency kit (if prescribed by your physician).
• Blood glucose testing supplies including lancets, test strips and preferably at least two glucose meters with extra batteries.
• A cooler and at least four refreezable gel packs for storing insulin (do not use dry ice when storing your medication).
• Empty plastic bottles and/or sharps container for syringes, needles, and/or lancets.
• Source of carbohydrate to treat hypoglycemic reactions (e.g. glucose tablets). Ideally should also have one or two day’s supply of food that does not require refrigeration (e.g. non-perishable).
• At least a three-day supply of bottled water.
• Pen and/or pencil and notepad to record blood glucoses and any other test results and any new signs/symptoms suggesting medical problems.
• Additional medical/first aid supplies like bandages, cotton swabs, dressings, and topical medications (antibiotic ointments or creams) to treat cuts or abrasions.

Other recommendations:

• Wear shoes at all times and examine your feet often for infection.
• Make sure that all immunizations including tetanus are updated.
• Pack extra comfortable clothing including undergarments.
• Take a cellular phone with extra batteries for you and family members.
• Consider choosing a designated meeting place in case you are separated from your family and unable to reach them by phone.

This is a mirror of one of my articles that Health Central published. You can navigate to that site to find my most recent articles.

If you never heard about Atul Gawande, M.D., you don’t know the best medical writer in the world. As a medical writer myself, I consider my naming him that to be about the highest praise I can offer.

When the people at the American Association of Clinical Endocrinologists told me that Dr. Gawande would be the keynote speaker at this year’s meeting in Boston, I didn’t think twice about accepting their invitation. Listening to his address this morning, I was as impressed by his talk as I was earlier by reading his three books and his many articles in the New Yorker magazine.

But if Dr. Gawande were just a writer, this organization of practicing endocrinologists wouldn’t have made him their keynote speaker today. This incredibly talented young man, born in 1965, also happens to be associate professor of surgery at Harvard Medical School and a general and endocrine surgeon at Brigham and Woman’s Hospital in Boston — two list just two of his many positions.

At least he didn’t have to travel far in order to speak to speak to about 1,000 of us today. I made sure to get to the auditorium early so I could sit in the front row to photograph him.

Dr. Atul Gawande Speaking This Morning to Endocrinologists

I also wanted to take a close look at Dr. Gawande to see if he looked frazzled from all his work. As you can see from my photo, somehow he looks quite relaxed.

Earlier in one of my articles here I named Dr. Gawande as as inspiration for my writing style. He even takes time to answer my emails when I write him. No wonder that the John D. and Catherine T. MacArthur Foundation a few years ago named him a MacArthur Fellow, which well deserves its nickname, “the genius award.”

President Obama cited Dr. Gawande’s article last year in the New Yorker, “The Cost Conundrum,” which used as an example the town of McAllen, Texas, to argue that unnecessary medical tests and procedures were a primary factor in driving up the cost of health care in this country. That article affected the President’s thinking dramatically, according to Senator Ron Wyden, and soon after its publication, he showed the article to a group of senators including Wyden and said, “This is what we’ve got to fix.”

Today, Dr. Gawande spoke on “Beyond Reform: Facing the Complexity of Health Care.” The key word is complexity.

He mentioned diabetes a couple of times in his talk. But for now please think of diabetes as subsumed within our country’s much broader health care problems. Here are some of the passages of Dr. Gawande’s talk that immediately caught my attention as I recorded them.

“The deepest struggle of health care is its complexity,” he said. “This is the reason why health care often doesn’t work. Just half a century ago medicine wasn’t either expensive nor effective.

“We have identified now more than 13,600 diagnoses. And for each of them we have identified steps in their care that can reduce people’s suffering, if not actually cure their disease. But that arsenal has now accumulated to become more than 6,000 drugs currently that you and I can prescribe and more than 4,000 medical and surgical procedures that we can provide.

“It’s incredibly hard. There is no industry in the world that has to provide 13,600 different service lines to every community in the country, let alone the world, and customize it to every customer. It is man’s most ambitious endeavor.

“The value it’s producing, though, is already excellent. Life expectancy has increased five years since 1960 and nearly all of it has accumulated after the age of 65. It’s brought longer lives and later disability, and that has produced its own problems, because during that same time period we have reduced the average retirement age from 67 to 61. Somewhere this is not going to add up (he smiles).

“We are at the point where the volume and complexity of the discoveries we have had in the last century has now exceeded our ability as individuals to delivery optimal care reliably and safely. I think we were fooled by penicillin. It was miraculous for a couple of reasons: number one was the idea that you could treat this incredible range of infectious disease that could never be reliably treated before, and the second thing was that this took only an injection.

“It was that simply. And it led us to imagine that the future of medicine would look like that. There would be an injection for cancer. There would be an injection for heart disease. But it hasn’t turned out to be anything like that at all.

“We were fooled into imagining that discovery was the only hard part and that execution would be easy. And that couldn’t be further from the truth.

“What’s missing is innovations for great care. It’s innovations not as we are used to thinking, where we think of drugs and devices as the sole carrier of innovation; it’s about systems innovation in health care.

“Making food of higher quality at lower cost was the fundamental question of the 20th century. Now, we are coming to a basic understanding of how we will make better care at lower cost. This is the fundamental issue of the 21th century.”

This is a mirror of one of my articles that Health Central published. You can navigate to that site to find my most recent articles.

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 is a mirror of one of my articles that Health Central published. You can navigate to that site to find my most recent articles.

Health Central sent me to the meeting, where I interviewed Dr. Sachmechi this morning. He is clinical associate professor of medicine at Mount Sinai School of Medicine in New York City and Queens Hospital Center in Jamaica, New York.
Dr. Sachmechi presented his poster and abstract, “Impact of Diabetes Education on HbA1C and Weight Reduction at the meeting.” He told me that he designed the study and involved the chief resident and one of his colleagues. Certified Diabetes Educators and nutritionists provided the diabetes education.

Dr. Sachmechi Supports Diabetes Education

Don’t people with diabetes generally get diabetes education? “No,” Dr. Sachmechi replied. “In many areas of the country people with diabetes don’t get nutritional advice or see CDEs. The CDEs show them how to do home glucose monitoring, how to prevent hypoglycemia, the importance of exercise, and other things that are needed for the care of diabetes.”

But doesn’t it cost a lot of money? “I don’t think so,” Dr. Sachmechi replied. “Certainly, a session with a CDE costs less than a session with a physician!”

The study group of 150 people included people with type 2 diabetes who their primary care physician referred to two CDEs and a dietitian. A control group of 150 people with type 2 diabetes didn’t get to see either a CDE or a dietitian.

The researchers compared the A1C and weight of the study participants before and then six months after the study. A1c went down 1.02 percent in the study group but only 0.59 percent in the control group. The average weight went down 2 pounds in the study group but only 0.71 pounds in the control group.

“This is one of the few studies demonstrating a measurable improvement in diabetes control and weight loss solely due to diabetes education and diet counseling in a municipal hospital with limited resources,” Dr.Sachmechi concluded. Dr. Sachmechi’s study worked with people with diabetes who are largely uninsured and generally have poor health literacy. My conclusion is if diabetes education works there, it can work for you too.

Dr. Sachmechi tells me that he is now working on the impact of support groups on the impact of A1c and other measures of diabetes control. Do support groups help us? That’s what he hopes to find out, and I will let you know here the results of that study.

This is a mirror of one of my articles that Health Central published. You can navigate to that site to find my most recent articles.

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 →]

When I had elective surgery a year and one-half ago and then when I had an emergency operation about six months ago, I told the hospital that I wanted them to provide me with a diabetes diet. Big mistake. They have no idea what a proper diabetes diet is.

At that time I had read the book by Richard K. Bernstein, M.D., Dr. Bernstein’s Diabetes Solution. But I hadn’t focused on his guide to hospitalization. You can be sure that if I have a chance, the next time a hospital tries to run my diabetes life, I will guide it with a letter to them like the one here.

This week he told me that I was free to reproduce that guide here. What happened was this.

One of the regular readers of my articles here sent me a copy of a letter that she had written protesting the awful treatment that she had received in a hospital in Wyoming and in another hospital in Colorado. She wanted to get the letter to Dr. Bernstein, who she and I both look to for guidance on controlling our diabetes.

When I passed on her letter to him, Dr. Bernstein was sympathetic. But he added that he gets even worse horror stories from other people who run into our American health care system.

“They all relate to the ignorance and lack of compassion of physicians and hospital personnel,” he said. “I asked my literary agent if we should transcribe them for a book. I was told that people don’t want to read depressing stories, and no publisher would be interested. If you think this kind of thing would serve a purpose on your blog, just post a request for stories about interactions with medical personnel and you’ll be overwhelmed.” [Read more →]

Sometimes the best way to understand something is to look at it from the other side. Those of us who have diabetes think a lot of the time about the special problems that we face. This makes thinking and acting as if we didn’t have diabetes all the more necessary. We all feel better when, for example, we can say that I am a lucky man or woman.

Yet sometimes it can help us to see the dark side of things. When we can fully envisage what we know in our hearts is what we want to avoid, we can move away from that negativity.

Someone who once was very close to me rarely if ever got excited about anything. In an emergency situation she was great, because she was always unflappable. But when things were great, by the same token she seldom if ever showed any enthusiasm. I admired her stoicism at the time, but now I feel sorry for her inability to experience emotion.

She came to mind today when I sat down to share a poem with you. This poem helped me see more clearly the value of emotion in our lives, and I think that it can help you too.

The author of this poem is the daughter of a friend of mine, and I reproduce it here with their permission. She wrote it as her essay to gain admission into an honors program at a Boston college. After you read it, I’m sure that you will appreciate that they accepted her application.

Life Without Emotion
By Ashley Adamson

Cones without ice cream
Sleep without sweet dreams
Beginning without end
Email without send
Stars without night
Wrong without right
A watch without time
Punishment without crime
Sports without competition
Practice without repetition
Studying without learning
Separation without yearning
Color without eyes
Graduation without good-byes
Birds without calls
Triumphs without falls
Sand without an ocean
Kids without commotion
Marriage without devotion
Life without emotion
Life without emotion?!?
Then you realize;
Dying is only one of many ways
You can lose your life.

This is a mirror of one of my articles that Health Central published. You can navigate to that site to find my most recent articles.

My most recent post here reviewed a new study indicating that resting after meals is hard on the pancreas, could lead to diabetes, and could make existing diabetes worse. This is an interesting hypothesis and one that you can check out yourself.

But one of my correspondents suggests that the results might be related to the fact that overweight people who overeat at a meal are more likely to lie down. “Edgy thin people probably jog instead,” she says.

That’s a good suggestion, and I’m not sure that the authors of the new study controlled for weight. But now comes a closely related study that indirectly offers support for the hypothesis that lying down after we eat isn’t a good idea.

People in China in the 50s and over who regularly take naps after a meal increase their risk of diabetes by 28 to 36 percent, according to a study just published in Sleep, the official publication of the Associated Professional Sleep Societies, a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society. The authors of the study are associated with universities and hospitals in China and the U.K.

Correlation, of course, doesn’t prove causality. It is suggestive and may be a good suggestion to follow, because the only downside is probably being a bit tired, which in fact could lead to a better night’s sleep. Anyway, a little jog after a meal will do a lot more to reduce blood glucose than lying down ever will.

The authors of the study that I review last week are in Kazakhstan and Ukraine, while the new study is China-based. Some of the most interesting research on diabetes now seems to be coming from countries that hadn’t been at the forefront of diabetes research. This Internet age seems to be leveling the playing field.

This is a mirror of one of my articles that Health Central published. You can navigate to that site to find my most recent articles.

Learning that you have diabetes can be overwhelming. All at once your life has changed.

In fact that is really good. Now you can be healthier than you ever were — if you get more active, lose weight, take your medicine, and cut your stress.

Those are the essentials. The rest are optional tweaks and theory.

Like this one today. The journal Medical Hypotheses deals only in theory, as its title implies.

This journal has an “article in press” that it will publish soon. It’s not online yet.

One of the authors, Alexander Dynyak, M.D., lives and works in Almaty, Kazakhstan. If you don’t know where that is, join the crowd. But Kazakhstan is in Eurasia and is the ninth largest country in the world in land area. It is also the world’s largest landlocked country.

Another author, Andrey Dynyak, is currently pursuing his M.D. degree in Ukraine. Andrey also publishes their research findings on diabetesnewfrontiers.org and sent me a copy of the Medical Hypotheses study.

The study has the usual technical title: “Diabetes mellitus: Hypoxia of the islets of Langerhans resulting from the systematic rest prone on the back after a meal?” In plain English, that means that the islet cells in our pancreas might not get enough oxygen and cause diabetes if we lie down in the two hours after we eat.

Who would have thought of that! I certainly never did. But the islets are especially susceptible to oxygen deficiency. This study investigated whether the pressure on the pancreas of food in the stomach after a meal might be related to diabetes. To test their hypothesis, the authors surveyed people with diabetes compared with a control group. The people with diabetes numbered 91 and those in the control group numbered 20. Every one of the people with diabetes had been resting after eating at least three or four times each week. But only 2 of those in the control group, or 10 percent, did.

Then the researchers attempted to get the people with diabetes to change their resting behavior. The researchers recommended that the people with diabetes not lie down within two hours of a meal. That’s because this is the average time it takes for food to pass through our stomachs.

But only 20 percent of the people with diabetes were consistent in not resting during those two hours. Of those, however, the researchers found general improvements, an increased capacity for work, better blood glucose control, and less need for diabetes medication.

The article indicates that resting during the two hours after a meal might lead to diabetes. I wondered if this might, however, imply that people who already have diabetes should also avoid resting then.

“Yes, that is basically what it implies,” Andrey Dynyak replied. “In general, a passive rest within one to two hours after a meal in a recumbent position should be avoided. However, being more specific for diabetes, a passive rest after a meal prone on the back or reclined is what should be avoided.

“Unfortunately, it is becoming such a common and usual behavior that by many is regarded as normal. Fortunately, it is easy to test, and positive results can be seen shortly after changing this specific behavior.”

I think that these far-off researchers might be onto something. It’s definitely worth testing if you have been lying down during the two hours that it takes for your stomach to digest your food. It won’t make your life worse, and could well make it a lot better.

This is a mirror of one of my articles that Health Central published. You can navigate to that site to find my most recent articles.