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

A Diabetic Brain is a Grain Brain

November 15th, 2015 · 1 Comment

David Perlmutter’s 2013 book Grain Brain has a prominent place in my diabetes bookshelf. Grain Brain is one of the important books ever. This book that the renowned brain specialist wrote two years ago holds a prominent place on my diabetes bookshelf.

Re-reading it recently reminded me how closely connected that our brain health is to excellent care and treatment of diabetes. The book is about how wheat, carbs, and sugar are destroying our brains. This connection with diabetes is far too close for comfort. These are the same things that raise our blood glucose the most.

grain brain cover

The higher the A1C level we have, the greater is our risk of Alzheimer’s disease, the most dreaded form of dementia. As I wrote here last month at “High Blood Glucose Can Lead to Dementia,” people with type 2 diabetes who had A1C levels of 10.5 percent or higher are 50 percent more likely to get a diagnosis of dementia than those with levels of 6.5 percent or less. In fact, one M.D., Suzanne M. de la Monte, has named Alzheimer’s disease as “Type 3 Diabetes.”

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Blood Glucose Meters from Roche Rank Highest in Survey

November 14th, 2015 · 14 Comments

Of the four companies that dominate the blood glucose meter business in the United States, we are happiest with Roche Diagnostics, according to a new scientific survey. Number two was Abbott Laboratories, third was Bayer, and pulling up last was LifeScan.

meter study

But two of the particular meters that LifeScan makes rank among the three favorite meters. Those few people in the survey who use the OneTouch UltraLink or the OneTouch Vario liked it a lot as did the small sample size of people who rated Bayer’s Contour Next Link.

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Is a Lower A1C Level Better or Worse?

November 13th, 2015 · 14 Comments

It seems logical that the lower our blood glucose levels are the better we will be. Most of us have always assumed that lower blood glucose levels would protect us better from the complications of diabetes. In fact, during the past two decades several studies showed a linear relationship between blood glucose, as measured by A1C levels, and worsened health.

glucose meter

But now, several recent A1C studies have shown a J-shaped relationships, in which at the lower end some bad things happen, at the center things are better, and at the top end things are terrible. While linear relationships are the rule in observational studies, U-shaped and J-shaped curves aren’t uncommon, and some authors lump both of these shapes as U-shaped.

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When You Control Your Diabetes, You Aren’t at Risk for Dementia

October 26th, 2015 · 2 Comments

One of the largest studies of the connection between diabetes and dementia has just confirmed what we have suspected for several years. There isn’t one.

But high blood glucose levels are connected to dementia, according to a new study of 353,214 people with type 2 diabetes. Researchers reported that people with type 2 diabetes who had A1C levels of 10.5 percent or higher were 50 percent more likely to get a diagnosis of dementia than those with levels of 6.5 percent or less. The higher the A1C level the greater the risk of dementia.

Hypoglycemia is also connected with dementia, according to studies. A recent meta-analysis in Diabetes, Obesity and Metabolism shows a bi-directional relationship between cognitive impairment and hypoglycemia in older people who have diabetes. Another new study, a population-based study in Canada reported in Diabetes Care, found that preexisting vascular disease and severe hypoglycemia were the greatest risk factors for dementia in seniors with diabetes.

Glucose Meter

Aidin Rawshani, M.D., of Sweden’s University of Gothenburg, and his colleagues identified everyone with type 2 diabetes who was registered in the Swedish National Diabetes Registry between 2003 and 2012 and who did not have dementia at enrollment. Their observational study adjusted for factors such as age, gender, and weight.

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NPH Insulin Works Well — If You Mix It Enough

October 25th, 2015 · 1 Comment

The variability from day to day might alarm you if you manage your diabetes with one of the intermediate acting insulins. The problem could be that you aren’t mixing it well enough.

The type of insulin that we call NPH can take one to three hours to start working. But it lasts for 12 to 16 hours.

Its generic name is NPH; Novo Nordisk sells it as Novolin N and Lilly as Humulin N. NPH is also available premixed with short acting insulin.

insulin-syringe

But NPH insulin is itself a mixture, and that’s the problem. Its cloudy part is rich in insulin crystals while its clear part isn’t. Before you inject it, you have to mix these parts.

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If Pesticides Cause Diabetes, Will Organics Help Us?

October 24th, 2015 · 1 Comment

The pesticides in our food may explain why some of us have diabetes, a new study suggests. You still have time to switch to eating organic food, which has much less pesticide residue in it than conventionally grown food does. Pesticides that you eat seem to explain why some of us have diabetes, according to a new study.

usda organic

Even when we have diabetes we can benefit from eating organically grown food. What leads to our diabetes in the first place can make it harder to control when we have to manage it.

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The Food Insulin Index Trumps Carb Counting

October 19th, 2015 · 24 Comments

The new food insulin index can work much better than carbohydrate counting, which for years has been considered to be the gold standard for improving glycemic control. For those of us who have diabetes, this index is also a more comprehensive guide to blood sugar control than the glycemic index.

For years the limitation of the food insulin index (also known as just the insulin index) was the few foods tested. The original 1997 study, which in 2003 I reviewed in detail for the first time in the article “Insulin Index”on my personal website, tested only 38 foods.

We had to wait until 2011 for the index to grow to about 120 foods in “Prediction of postprandial glycemia and insulinemia in lean, young, healthy adults.” I reviewed that study here at “Manage Your Blood Sugar Better with the Insulin Index.”

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Use this Device if Needles Frighten You

October 18th, 2015 · 8 Comments

Does your fear of needles makes it difficult or impossible for you to manage your diabetes? Do you have a child who is afraid of them? Many of us have this fear, but we now have a way to cope with it.

All of us who have diabetes need to draw blood regularly with lancets for our blood glucose meters and for A1C testing. Everyone who has type 1 diabetes and about one-fourth of people with type 2 need to inject insulin at least once a day. A growing proportion of us are injecting GLP-1 analogues like Bydureon and Victoza to help keep blood glucose levels in check.

But many adults and even more children don’t do this often enough because of pain. As a result, they needlessly suffer.

insulin

Now, an inexpensive device called the Buzzy can block that pain. Some hospitals are already using it, and you can buy one without a prescription to use anywhere.

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Deprescribing Diabetes Drugs

October 11th, 2015 · 14 Comments

Do you wonder why your doctor keeps telling you to take more and more drugs to manage your diabetes? Many people with diabetes take three or even more prescriptions for it every day.

A new article in the BMJ, which is the journal of the British Medical Association, reviewed the case of a British man who has had diabetes for 14 years and wondered if his stomach upset problems might be from the drugs he was taking for diabetes, cholesterol, high blood pressure, and coronary artery disease. He “asked if he could cut down on any if they weren’t all needed,” but didn’t want to jeopardize his diabetes control.

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In the article by Doctors David Unwin and Simon Tobin, “A patient request for some ‘deprescribing’” they reported what happened next. They felt that “none of his drugs is essential — they have all been prescribed to reduce his risk of cardiovascular events and the complications of diabetes, not to treat an actual disease.” They appreciated that a better diet and more exercise were alternatives to the drugs.

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Watch Out for Dangerous Drug Interactions

September 29th, 2015 · No Comments

Do you take drugs? I’m asking mainly about the prescriptions that your doctor prescribed. But that’s only the tip of the iceberg for some of us.

It’s easy to forget to consider some of the drugs that you take. Of course you included your prescriptions, but did you remember to include those that you buy over the counter? Also, some people don’t realize that herbal supplements are drugs. When you include these sources, it’s not uncommon for some people with diabetes to be taking three or even more drugs for their condition.

drugs

Drugs in any of these categories have side effects, some of which nobody discovers until many people start taking them. For example, half a million people were taking the prescription diabetes drug Rezulin 15 years ago when the U.S. Food and Drug Administration banned it after at least 63 of us died from the liver failure that it caused.

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