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Diabetes Developments - A blog on latest developments in diabetes by David Mendosa
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Prepare to See Your Diabetes Doctor

March 15th, 2014 · No Comments

When we learn how to manage diabetes without drugs, we rarely need to see an endocrinologist, a doctor who specializes in diabetes and the rest of the endocrine system.

I haven’t had an appointment with an endocrinologist in more than 10 years. I do have regular checkups that we all need with an opthamologist, a dermatologist, a podiatrist, and a dentist. I also go to my primary care physician at least once a year to get an annual physical examination and to help me manage my other chronic medical condition, hypothyroidism.

Not all of us who have diabetes need to see an endocrinologist, but certainly some of us do. All children with diabetes need a pediatric endocrinologist, and other people will benefit from a referral to an endocrinologist in eight different situations. My friend and colleague at HealthCentral, Dr. William Quick, suggests “When to Go to an Endocrinologist.” He is both an endocrinologist and someone who himself has diabetes.

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Drugs or Blood Sugar Control for Diabetic Neuropathy

March 8th, 2014 · No Comments

Is managing diabetic neuropathy so difficult that we need more drugs? Some, but not all, of our diabetes professionals say that it is.

“We have no licensed treatment for diabetic neuropathy,” Rayaz A. Malik, professor of medicine at the University of Manchester, in December told the World Congress of the International Diabetes Federation World. “We have witnessed failure after failure of numerous clinical trials despite great experimental data. None of these drugs has been translated into therapies that we can prescribe to our patients.”

He explained that the treatments we have for neuropathy offer only symptomatic relief. He says that at best only half of the people with diabetic neuropathy get just 50 percent pain relief. And the drugs we have don’t reverse the nerve damage that causes the pain.

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Help Arrives for Diabetes Supplements

March 1st, 2014 · 3 Comments

Most of us take some supplements every day. But few of us have any idea what we are taking.

Help has begun to arrive.

Shopping for Supplements

Sixty-eight percent of American adults take nutritional or dietary supplements, according to a 2012 customer survey by the Council for Responsible Nutrition. I’m sure that the proportion is even higher among those of us who have diabetes.

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Why and How to Track Diabetes Health

February 23rd, 2014 · 2 Comments

Most people who have diabetes track their blood sugar levels. Lots of us also track our weight, what we eat, and our exercise. But not many of us do anything useful with these numbers.

If we want to improve any of them, just writing them down and studying them will get us part of the way there. That’s because of the observer effect where simply observing something changes what we see.

Tracking Bears and Tracking Diabetes Have Lots in Common

But only when we act in response to our health tracking, does it began to be worth the effort. People with diabetes who don’t use insulin are wasting their time and money when they test their blood sugar, according to a study by the Cochrane Collaboration, the most respected group that reviews scientific studies. Two years ago I wrote about and linked that study in my post, “The Trouble with Glucose Testing.” The problem is that our medical professionals don’t usually teach us what our blood sugar levels should be and how to get there.

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Seven Diabetes Challenges When You Low Carb

February 18th, 2014 · No Comments

Those of us who have diabetes have many good reasons to eat few carbohydrates. Two of the best reasons are better blood sugar control — getting a very low A1C level — and losing weight — getting down to a low BMI.

But getting started has its challenges. Here are some tips to make it easier.

1. Decide why you want to follow a very low-carb lifestyle. It can be to reduce your blood sugar or your weight. It does both. It will also make you healthier and happier. Decide which of these aspects is important to you.

2. Set a goal.  Very low-carb means 50 to 60 grams of carbohydrate per day. But you may prefer to set an intermediate goal of 100 or 120 grams per day. Set the goal in terms of total carbohydrates, not net carbohydrates. Total carbohydrates are starches, sugars, and fibers, while net carbs exclude fiber. But fiber does affect our blood sugar. Starches and sugars have 4 calories per gram; fiber has 2. See “The Trouble with Fiber.”

Whatever goal you set, you will need to measure the carb content of what you eat for a while until you know what your favorite foods contain. See “Nutrition Scales.”

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Diabetes Diets Don’t Work

February 17th, 2014 · No Comments

Diets are shortcuts to weight loss, which is to be high on the priority list of almost everyone who has diabetes. But like all shortcuts, they can take us astray and fail to get us to where we want to go.

Diets don’t work. But don’t give up, because we can still lose weight and keep it off. Whether you call it a behavioral change or a lifestyle adjustment, we have to dig deeper than just what we put in our mouths, although that is certainly important too. Only when we realize that we can’t have it all, that we face a tradeoff, can we lose weight and keep it off. Success comes to us only when we really appreciate that we must pass up transient pleasure to invest in our future well-being.

Diets are, at best, temporary fixes to long-term problems. As a society we know this is true. Dieting among Americans is at an all-time low, while the proportion of Americans who are overweight is at an all-time high. We have largely given up on diets.

Only about 20 percent of us told the market research firm NPD Group a year ago that they were on a diet. Yet the most recent count by the U.S. Centers for Disease Control and Prevention shows that 69.2 percent of us are overweight.

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Beginning Anew With Diabetes

February 16th, 2014 · No Comments

Each of us has the opportunity every day to begin life anew. But we usually grab that chance only at the beginning of the year. This is the time for resolutions. We make our resolutions in January, but to avoid breaking them in February, we have to accept where we are and know where we want to go.

The key to resolution success is to set our sights low. When we focus on one goal for one resolution, we are much more likely to achieve success than if we adopt the usual scattershot approach. We can concentrate on only a limited number of objectives at one time. That’s why people who meditate generally focus on the breath alone.

Take, for example, the very common resolution of losing weight this year. If we decide that we want to lose a lot of weight, exercise more, stop smoking and drinking, and get along with our mother-in-law, all at the same time, we are setting ourselves up for failure. That’s the main reason studies show that we generally keep on track for one month just 55 percent of the time, and for six months only 40 percent of the time.

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A Christmas Gift to People with Diabetes from Polymer

February 15th, 2014 · No Comments

The best way that we have to check our A1C level will live after all. In September I reported here in “The Key Diabetes Test Bites the Dust” that Bayer Diabetes Care would stop making the A1CNow device at the end of this year.


At that time I asked a Bayer spokesperson whom I had known for years if Bayer might sell the facility that makes the A1CNow device to another company. “Our business plans are confidential,” she replied.

But yesterday, December 23, Polymer Technology Systems Inc. in Indianapolis, Indiana, announced that “it has acquired the A1CNow family of products from Bayer Diabetes Care.” The announcement was a brief, six-paragraph press release to PR Newswire, and I have not been able to reach anyone at Polymer.

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Twin Diabetes Highs: Blood Pressure and Blood Sugar

February 14th, 2014 · No Comments

In December, a panel of experts released new guidelines regarding when people over 60 should take drugs to reduce their blood pressure. But the guidelines for those of us with diabetes remain the same.

The panel of 17 academics reported its findings in the Journal of the American Medical Association, after reviewing data from the last five years. The full text of its report, “2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults,” is free online. It concluded that people over 60 need to keep their blood pressure below 150/90, rather than the 140/90 level previously recommended.

The guideline for people with diabetes remains at 140/90, meaning a systolic blood pressure of no more than 140 and a diastolic pressure of less than 90. The systolic pressure reflects the pressure on our blood vessels when our hearts contract, while the diastolic number reflects the pressure when our heart relaxes between beats.

This is actually less stringent than some experts had previously recommended. Many doctors tell those of us with diabetes to keep our blood pressure at a level no higher than 120/80.  And if we don’t, they will tell us to take our medicine, usually angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs).

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The Dawn Phenomenon: A Diabetes Puzzle Solved

February 13th, 2014 · 13 Comments

The dawn phenomenon is one of the most disturbing challenges for those of us who have diabetes. Many of us wonder about the puzzle of why our blood sugar level spontaneously rises during the last hours of sleep each night.

This has also mystified our doctors and medical researchers, so much that they have published at least 187 articles in the professional literature during the past three decades since the first study of the subject appeared. But four new studies by European researchers just published in American professional journals have shown a bright light that clarifies the major questions we have had about the dawn phenomenon. We now know who gets it, how bad it is, how much it impacts our A1C levels, and how to prevent it.

Whether you have type 1 or type 2 diabetes you are likely to have the dawn phenomenon. However, dawn levels among people who don’t have diabetes rise only slightly, if at all, “because they secrete insulin to prevent it,” according Francesca Porcellati, MD, and her associates at Italy’s University of Perugia. Their study, “Thirty Years of Research on the Dawn Phenomenon: Lessons to Optimize Blood Glucose Control in Diabetes,” appears in the December 2013 issue of Diabetes Care, a professional journal of the American Diabetes Association. The full-text of this study is free online.

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