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Diabetes Developments - A blog on latest developments in diabetes by David Mendosa

The First Five Questions You Must Ask Your Doctor

August 21st, 2015 · 3 Comments

Did a doctor just tell you that you have diabetes? If so, it was probably during a short appointment. Only if you were awfully lucky, did you find out the most important things that you will have to do to manage it well.

Instead, you were probably in shock, and because of that you probably missed what the doctor told  you. So you’ve got to be prepared for the next appointment, and this is what you need to ask:

When I see a doctor, my first question is, “How much time do we have for this appointment?” Our doctors tend to dominate the time that we have together, so asking this will give put him or her on notice that you have your own questions.

Consider yourself lucky if your appointment is for 20 minutes. I still remember when in 1994 a doctor told me I had diabetes. I didn’t know a thing about it and started to ask him questions. But he cut me off, saying that my appointment was limited to 14 minutes.


You can read dozens of websites that will list the 10 or more questions for you to ask your doctor. That’s nonsense! You will be lucky to have time to ask more than one of them and get a solid answer. In my experience, your doctor will go on and on in answering your first question, getting into details that you aren’t ready to understand yet.

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The Tasty Bean that Doesn’t Raise Your Blood Sugar

August 17th, 2015 · 23 Comments

It would be great if you could eat tasty meals that are high in carbohydrates while keeping your blood sugar low. Actually, even if you have diabetes and otherwise follow a very low-carb diet, you can do precisely this.

If you have had diabetes for a while, you know that when you chow down on carbs, your blood sugar level is sure to go up. But there’s an exception. In the United States this food is a little-known secret, but in India it’s well-known.

It’s my fault — at least in part — for keeping this special carbohydrate food a secret. I have known about it ever since 1994 when I began to gather information on the Glycemic Index. I’m not sure when I first wrote about it on my own website, but it was in 1998 or earlier, and I have eaten it since then even as I otherwise follow a very low-carb diet. I have mentioned this food in passing here at, but I just realized that I never previously gave it the attention here that it deserves.

Chana Dal

Now the secret is out: I’m talking about chana dal, which in India is sometimes also known as Bengal gram dal (or dhal) or chholar dal. Its scientific name is Cicer arietinum Linn, which actually doesn’t help us, because this the same scientific name as that of garbanzo beans (chick peas), which have a higher Glycemic Index.

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The Insulin Index Is Better for Managing Your Blood Sugar

August 15th, 2015 · 20 Comments

The Insulin Index is better for managing your blood sugar that the Glycemic Index. It is more recent than the Glycemic Index, which dates from the publication of  “Glycemic index of foods” in 1981. The first publication of the Insulin Index came in 1997 with “The insulin index of foods.”

The insulin index is broader than the Glycemic Index, which shows only the effect of carbohydrates on our blood sugar. The Insulin Index takes into account not just carbohydrate but also of all the dietary factors and their interactions that influence insulin demand.

Most of the current research on the Glycemic Index and essentially all of it on the Insulin Index comes from Dr. Jennie Brand-Miller and her laboratories in Australia. Among her other titles, she is a professor of molecular biosciences and director of the Sydney University Glycemic Index Research Service. I’ve known her for more than 20 years, and we wrote my first book, What Makes My Blood Glucose Go Up…and Down? together.


Dr. Brand-Miller and Me

International Diabetes Federation Convention, Busan, Korea

The original article that I published back in 2003 on the Insulin Index included only 38 foods that Dr. Brand-Miller and her colleagues studied then. Yet few of my older articles generated more interest than this limited study.

The most interesting finding of that early study, published in a 1997 issue of The American Journal of Clinical Nutrition, was that foods rich in protein and baked foods rich in fat and refined carbohydrates elicited “insulin responses that were disproportionately higher than their glycemic responses.”

Now 18 years later, the Insulin Index includes 120 foods in 1000 kJ servings. This study confirms that the Insulin Index of these foods eaten alone and in mixed meals better predicts the insulin demand than either the Glycemic Index or the Glycemic Load (which is measures the effect of the glycemic index of a food multiplied by its available carbohydrate content in grams in a standard serving).

You Can See the Entire List Here

This greatly expanded list of foods tested for their Insulin Index is freely available online. The Glycemic Index, the Glycemic Load, and the Insulin Index for these 120 foods are in Table 1. I found it to be too difficult to read online, but printed it out and studied it on paper.

The five foods highest in their Insulin Index are these:

  • Jellybeans, 117
  • The Aunt Jemima Original Pancake & Waffle Mix, 110
  • Honeydew melon, 93
  • Boiled russet potatoes, 88
  • Baked beans, 88

No big surprises, except for the baked beans, which has an Insulin Index exactly twice as high as its Glycemic Index. But all of these foods are high in carbohydrates.

Foods that Are Much Higher in Their Insulin Index

Several foods in addition to baked beans have an Insulin Index that is at least twice as high as their Glycemic Index. I exclude here a few foods that have quite low indexes):

  • Low-fat strawberry yogurt, Insulin Index 84, Glycemic Index 31
  • Skim milk, 60, 29
  • Kraft low-fat processed cheese, 42, 10
  • Low-fat cottage cheese, 52, 10
  • Reduced fat cottage cheese, 40, 10
  • 93% fat-free cheddar cheese, 20, 0

Each of these foods are high in protein. Previously we have known that protein has a moderate influence on the glycemic index, while fat has no influence.

Dairy is the Difference

The conclusion that I draw from the expanded Insulin Index reinforces  part of the findings from the original 1997 study: we need to take into account the protein in dairy products.

Cheese, milk, and yogurt stimulate a rise in our blood sugar that is considerably more than predicted by the glycemic index alone.

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


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The Myth of the Weekly Weigh In

August 9th, 2015 · 4 Comments

It’s a myth. Did you really believe that you could manage your weight better when you step on the scales just once a week instead of every morning?

It’s a sad fact that most of the so-called experts tell us that it’s a mistake to weigh daily. “In most instances, weighing yourself every day is unnecessary and unhealthy,” is supposedly one of the “10 Common Mistakes” we make about weighing ourselves. Actually, suggesting that weighing daily is a mistake is itself one of the most common mistakes you can read about and hear.

Girl with a pearl earring

When I learned I have type 2 diabetes, my doctors and nurses told me to weigh myself once a week because the inevitable daily fluctuations would discourage my weight loss efforts. They probably told you the same thing. They were ignoring two small studies “Charting of daily weight pattern” and “The efficacy of a daily self-weighing.” But they can’t ignore a large, new study that shows that daily weighing helps us take off the pounds and keep it off.

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Should You Use Hyperbaric Oxygen to Cure Diabetic Foot Ulcers?

July 31st, 2015 · 3 Comments

We seem to have been successful in using hyperbaric oxygen therapy for more than 40 years. Yet we still don’t know if it works and for what conditions.

Many of our doctors use it to cure chronic diabetic foot ulcers that otherwise could lead to amputation. Since these ulcers are a common complication of diabetes, and when you lose a foot your life will be so seriously impacted, this therapy, known as HBOT, is something we need to carefully consider.

I have been convinced that the use of hyperbaric oxygen might offer many benefits ever since I visited an 82-year-old man named John Erb in Costa Rica two years ago. He is an expatriate American who took me inside his hyperbaric oxygen chamber and showed me to what he attributes his strength. I took the photo below, as I wrote in my photo essay “Rancho Naturalista,” the fantastic ecolodge that he owns.

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Foods Addicts Have Help Here

July 23rd, 2015 · 4 Comments

When I joined a meeting of Food Addicts in Recovery Anonymous recently I introduced myself by saying, “My name is David and I am a food  addict.”

I’m a food addict and I am in recovery, but I’m not anonymous. I lost half of my body weight and have kept it off. It has been a struggle and continues to be one that almost all of us with type 2 diabetes share. Until I went to the annual convention of the American Diabetes Association in June, I didn’t know about Food Addicts in Recovery Anonymous. Had I found it soon my journey to a normal weight would have been much easier.


These are before and after pictures of someone I am calling “Eric, because in public members of FA don’t use their full names or reveal their faces.

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Why Insulin Costs So Much

July 19th, 2015 · 8 Comments

Everyone who has type 1 diabetes has to use insulin, and about 25 percent of the people who have type 2 diabetes rely on it to control their blood sugar. But its costs are skyrocketing and no end is in sight.

At the annual convention of the American Diabetes Association in Boston this June I listened with perhaps 1,000 other diabetes professionals to one of the world’s top experts on diabetes talk about insulin costs.  Irl Hirsch, MD, is the professor of medicine at the University of Washington School of Medicine, also treats patients with diabetes, and has type 1 diabetes himself.

insulin costs history

For several years, readers of my articles have written me to complain about the rising cost of insulin. Because I know how expensive that insulin has become, I made sure to hear Dr. Hirsch’s presentation. But I was surprised to see that he cited one of my articles in a slide that he presented.

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Eat Mindfully to Lose Weight

July 18th, 2015 · 2 Comments

Do you eat when you aren’t hungry? Do negative emotions or responding to external food cues drive you to eat? Are you obsessive about food? Or do you sometime go on a food binge

Many of us who have diabetes have these forms of disordered eating, says Carla Miller, a professor of human nutrition at Ohio State University. The diabetes professionals who stayed to the final day of the American Diabetes Association’s annual convention in Boston in June were able to hear her presentation of “Mindful Eating — Am I Hungry?” I was there.

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Why Diabetes Drugs Are Expensive

July 16th, 2015 · 3 Comments

Practically everyone who has diabetes uses one or more drugs to help to manage it. But most of these medications are expensive, and the U.S. Food and Drug Administration approved far fewer diabetes drugs in the past 10 years than between 1995 and 2004.

At the annual meeting of the American Diabetes Association in Boston earlier this month, thousands of diabetes professionals listened with interest as four experts explained why. I represented during the entire conference and made a point to be in the audience as four experts brought us up to speed about the “Costs of Medications for Diabetes.”

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Reducing Pain with Better Lancets

July 13th, 2015 · 9 Comments

Dr. Christopher Jacobs Ph.D.,
Biomedical Engineering
CEO, Genteel LLC


Genteel LLC neither makes nor markets lancets; however, the company does manufacture and sell a vacuum-assisted lancet holder (poker), so it is in the company’s best interest for its customers to use the best possible lancet. Genteel undertook this study so its customers would have a better lancing experience; however, because Genteel uses regular square shaft lancets, it follows that what makes a lancet optimum with Genteel will, in almost every case, ensure it also works best regardless of which poker a person chooses. It is Genteel’s hope that use of a better lancet, which will lower pain and increase blood draw consistency, will encourage users to test more often, because the proper lancet will significantly decrease the discomfort and pain.

Figure 1: Genteel LLC engineer doing close-up examination of lancets to be rated

Figure 1: Genteel LLC engineer doing close-up examination of lancets to be rated


At Genteel’s laboratory, we performed a “Consumer Report” type study on many brands and models of lancets, commonly referred to as “square shaft.” These are the most popular individual lancets, found worldwide(see Figure 2). If the shaft is viewed horizontally, as an arrow would fly, the base would appear to be square, with no flanges or rings. Genteel purchased and tested thousands of these, and after examination, found the need for considerably more reliable engineering and production quality control to make a really good lancet. There was sufficient difference found between brands and models such that the user could have a noticeably improved lancing experience just by changing to a better brand and model. While this study was undertaken on square shafts lancets, the knowledge gained could apply to many other types.

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