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

Visualize Yourself

November 4th, 2010 · No Comments

My friend Jay has type 2 diabetes and is a member of the diabetes support group that meets every month in my apartment. But he is also a primary care physician, and almost half his patients have diabetes.

Jay is therefore uniquely qualified to help us. At the most recent meeting of our support group we were already  running overtime. But it was Jay’s turn to speak, and he wanted to share with us the “shock treatment” that he uses with his new patients who have diabetes. I’m glad that he did and that I can share this treatment with you.

Jay starts by explaining that diabetes, high blood pressure, and heart disease are the three main silent killers. Because they usually don’t offer us any advance warning of the hidden damage that they do to our bodies, these diseases are truly insidious.

Then, he suddenly turns off the lights in the windowless office. “Visualize yourself 15 years from now,” he says. “This is what you might be seeing then, if you don’t control your diabetes.”

This is Jay’s shock treatment. But any technique that will get us to open our eyes to the consequences of uncontrolled diabetes is better than none, he says.

Jay asked each of the members of our support group to look in the mirror each morning and visualize ourselves 15 years later. For me this gave me one more piece of encouragement to eat right, stay slim, and exercise so I will still be able to see my face in the mirror 15 years from now when I will be 90. If I’m still around then, I hope to continue seeing a computer monitor so I that I will still be able to write you.

As Jay left my apartment that day, I took him aside and told him that I already could visualize his shock treatment. My ophthalmologist had just told me after my semiannual checkup that I have two small micro-aneurysms in my left eye that he hadn’t seen before.

Jay’s shock treatment worked especially well because I was already shocked. Micro-aneurysms can lead to diabetic retinopathy, which can, of course, lead to blindness, the complication of diabetes that I have always dreaded the most.

Now I have even more incentive to keep my A1C level in the low 5 range, if not down to 4.5, which is my goal. I hope that you don’t need any more incentives to control your own diabetes.

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.

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Posted in: Diabetes Complications

Water and Weight

November 4th, 2010 · No Comments

We are more interested in water than we are in Obesity. Yet they are connected.

A year ago the professional journal Obesity published the results of a randomized, controlled clinical trial that compares weight loss among dieters who drink water before meals with those who do not. When the people in the trial drank just two 8-ounces of that simple stuff right before each of their three daily meals, they lost about 5 pounds more than those in the trial who didn’t increase how much water they drank. The trial lasted just 12 weeks.

But almost nobody noticed that study. As much as I am personally and professionally interested in weight loss, I sure didn’t.

The senior author of the study, Brenda Davy, is associate professor of nutrition at Virginia Tech in Blacksburg, Virginia. She tried again to get the word out last week, and this time she succeeded.

This time she presented her research at the national meeting of the American Chemical Society in Boston. That’s how I and just about everyone else learned about it.

At first, I decided not to write about this study, figured that it was old news. But when I read about it in the current issue of The Economist yesterday, I knew that this was a hot topic.

Few of the more than 300 articles in the press that covered Professor Davy’s talk mentioned that this was old news. The American Chemical Society’s press release didn’t bother to tell us that.

But when I asked Dr. Davy when a professional journal would publish her research, she told me that Obesity already had published it. This is important, because publication in a peer-reviewed journal like Obesity gets a lot more credit from the scientific community than something that some professor says at a meeting.

My guess is that you too didn’t notice the report in Obesity or even one of the many articles in the press reporting on Dr. Davy’s talk. Even if you did, a gentle reminder here might be enough for some of us to take a little action.

Personally, I’m more than interested in drinking water before meals to lose weight. I took action. While I am no longer obese, my current body mass index crept up a little from all of my travels this year. At 20.1 it is higher than where I feel the best.

So I have been drinking a lot more water ever since reading about this study. And in a week my weight is down to 161 from 163. It works for me.

Professionally, I know that almost everyone else who has diabetes also struggles with his or her weight. That’s why I’m recommending that you add this simple and inexpensive appetite control to your current strategy.

All I’m asking is that you drink two 8-ounces of water before every meal and keep track of your weight. One more thing — please let this community know if it works for you too.

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.

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Posted in: Diabetes Diet

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

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Posted in: Diabetes Medication

Shameless Self-Promotion

September 28th, 2010 · 2 Comments

If you decide that this post is shameless self-promotion, you would be half right. The people at Diabetes PowerShow say some nice things about me on their website.

But when they interviewed me last week, somehow I thought that I might have said a thing or two that would interest you. Since I went on and on for an hour and one-half, my message has to contain some meat.

You can go directly to their interview with me here. Fortunately, it’s only an audio interview, so you don’t have to watch me.

The Diabetes PowerShow team is four people with diabetes doing this work as a labor of love out of their Las Vegas studio. They interviewed me by phone, so I didn’t have to go to Vegas in the heat of the summer.

Producer Charlie Cherry, who has type 2, recruited me to the show after we met at the past two Social Media Summits hosted by Roche Diabetes Care. Charlie’s partners are a co-hosting couple, Chris Moore, who calls himself type 3, i.e. a spouse of someone with diabetes, and his wife Theresa, type 1. A fourth team member, Chris Daniel, also has type 1, but was missing in action.

When Charlie approached me to do the interview, the hot button that he pressed was for me to talk about my twin passions of photography and hiking. I write about them on my “Fitness and Photography for Fun” blog.

Near the end of the interview he asked me about those passions of mine. Before that we talked about my life with and without diabetes and my other passion, spreading the word about controlling diabetes, which I know can make us healthier and happier than ever before.

You can listen to my interview on your computer. But if you have an iPhone, an iPod, iPad, or other MP3 player, you have a better option. After you get iTunes on your computer, you can subscribe to Diabetes PowerShow for free and get all of the shows delivered automatically. This is better, because you can listen while you are on the go, instead of sitting at your desk.

I hope that at least one of you gets something out of listening. As I told Charlie by email, the Talmud says that “to save one person is to save the world.” That’s all I want to do with my 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.

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Posted in: People With Diabetes

Tiny tiniBoy Lancets

September 14th, 2010 · 2 Comments

Even though Dr. Stanley Kim isn’t a diabetes specialist, he had plenty of motivation to invent the thinnest and shortest lancets ever. Dr. Kim is a hematologist and oncologist who is a member of the board of trustees of San Antonio Community Hospital in Upland, California, and president-elect of the hospital’s medical staff.


Stanley Kim, M.D.

The story started, he told me, about three years ago when he learned that he had type 2 diabetes. “The lancets that I used hurt too much for me,” he said. “I resisted whenever I had to check my blood glucose and knew that something wasn’t right.”

The story continued when he went to the hospital’s pediatrics and neonatal departments. “The lancets that they used were pretty thick, and the babies would cry. You could tell that the babies were suffering. So I thought that I could make a very thin and short lancet that wouldn’t hurt as much.”

Like firefighters who rescue people out of burning houses, this was something that he had to do. “This was my  motivation.”

Like most people, I learned about Dr. Kim’s lancets by word of mouth. A correspondent named Ashique Iqbal recently brought them to my attention. Dr. Kim has actually been marketing them since late October of last year, he told me.

“I never advertised them,” he continued. He did go to the Children with Diabetes Friends for Lifeconvention in late  June and early July 2010 at Disney World. “We tested 200 to 300 children, and they all said it was wonderful. It is now being sold mostly for children.

Dr. Kim calls his tiny lancets “tiniBoy” and says that although the tiniBoy lancet is very beneficial for diabetic kids and  babies, it still works well for adults like me, as I also do not like pain.

He currently markets then through the tiniboy.comwebsite and Amazon. A box of 100 lancets goes for $9.95, and Dr. Kim tells me that he is working to broaden his outreach through Medicare and private insurance. “We would like to be able to provide tiniBoy lancets for whatever the insurance would pay.”


Comparative Lancet Sizes

The tiniBoy lancets are compatible with most of the current lancing devices. The exceptions, Dr. Kim tells me, are the Accu-Chek Multiclix and Softclix devices.

Dr. Kim’s technical review of the tiniBoy lancets appears in the January  28, 2010, issue of Clinical Medicine Insights: Endocrinology  and Diabetes. You can read the abstract online at “A Pain-free Lancet  with a Small Needle for Glucose Measurement.”

But perhaps even more persuasive are the positive comments by people with diabetes who have purchased tiniBoy lancets from Amazon. My guess is that you have as much motivation to switch to these tiny lancets as the Amazon reviewers and Dr. Kim had.

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.

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Posted in: Diabetes Testing

A New Talking Meter

September 14th, 2010 · 6 Comments

At least 38 companies now offer us meters that we can use to test our blood. I list and link them in my web page “Blood Glucose Meters,” Part 14 of the On-line Diabetes Resources.

Almost all of those 38 companies sell their meters in the U.S., and most of them have several different meters for sale here. So why would we ever need a new one?

For one thing, meters are getting better. While they still aren’t good enough, higher standards of accuracy and precision may be coming soon, as I wrote here a year ago.

Instead, meter manufacturers focus on adding features. Many of these features are just nice bells and whistles. But one feature is essential for some of us.

Since loss of vision is all too common a complication of diabetes, many of us need a blood glucose meter that will talk to us. Not only people who are totally blind but the much larger number of us who have limited vision need a meter that they can listen to rather than look at.

Actually, we have had talking meters for many years. Diagnostic Devices in Charlotte, North Carolina, has offered two different Prodigy meters for at least five years, as I indicate on my “Blood Glucose Meters” web page. Diabetic Supply of Suncoast in Vega Baja, Puerto Rico, offers two different versions of the Advocate blood glucose meters that talk. Last year Omnis Health in Natick, Massachusetts, became the third company to currently offer a talking meter, the Embrace Blood Glucose Monitoring System.

And now here is BioSense Medical Devices in Duluth, Georgia, with another talking meter, the Solo V2. We all the choices already available, does anyone need the new meter?


The Solo V2 Talking Meter [Read more →]
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Posted in: Diabetes Testing

Sugar-Free Chocolate

September 14th, 2010 · 1 Comment

If you don’t like chocolate, you can leave now and read my other posts. But if you do like chocolate,  please stick around.

Everybody still here? I thought so. Chocolate is most people’s top comfort food.

But many of us who have diabetes do all we can to avoid sugar. Regular sugar, or sucrose, is half fructose. And fructose has lately earned a bad rap. If you wonder why, you might want to check out a couple of my reviews, one from 2007 and another from 2008.

Most of us have tasted enough sugar-free chocolate to doubt that it anybody can make it taste right. But somebody has. So now you can eat your chocolate without the sugar and enjoy the great taste. Kiss chocolate guilt goodbye!

In the interest of science I have been taste-testing chocolate bars that Mary Jo Kringas sent me at no charge. Somebody had to test them!

Mary Jo started the conversation by telling me that she developed a chocolate bar sweetened with inulin from chicory root and from erythritol. They are 60 percent cocoa solids.

Inulin is soluble fiber. It passes through much of our digestive system intact and therefore doesn’t raise our blood glucose level.

Erythritol is one of the sugar alcohols. But unlike the commonly used maltitol, it has a glycemic index of zero.

That sounded good enough for me to go to the trouble of asking Mary Jo to send me a case of her chocolate bars and to eat them. I knew that I had to do a taste test on your behalf.

Since my rather mature taste buds might be fallible, I convened a tasting panel of three younger testers. The panel consisted of a 20-year-old university student named Rachel, a 21-year-old manager of an ice cream store named Lauren, and a 58-year-old psychotherapist named Barry.

[Read more →]

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Posted in: Diabetes Diet

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

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Posted in: Diabetes Medication

Standing Up for Your Heart

August 30th, 2010 · 4 Comments

You don’t have to exercise to help your heart. Sure, exercise will probably make your heart last longer, but it’s not the only thing you can do to avoid the biggest complication of diabetes.

Just standing up — otherwise known as giving your butt a rest — now seems to work independently of physical activity to reduce your chance of dying from heart disease. A new study that the American Journal of Epidemiology published online in advance of print on July 22 indicates that the less leisure time we spend sitting the better it is for our hearts.

You can read the abstract of the study, “Leisure Time Spent Sitting in Relation to Total Mortality in a Prospective Cohort of US Adults,” online. The lead author, Alpa Patel, Ph.D., of the American Cancer Society’s epidemiology research program, sent my the full-text of the study when I requested it.

Dr. Patel and seven of her associates explored the connection between sitting and mortality by analyzing the survey responses of 123,216 people who had no history of cancer, heart attack, stroke, or emphysema or other lung diseases. These were people who enrolled in the American Cancer Society’s 1992 Cancer Prevention II study.

The researchers examined how much time those people sat down after work as well as how much exercise they got between 1993 and 2006. The results were clear.
How much time they spent sitting was associated with an increased risk of death from heart disease for both men and women. Women — but not men — who sat less had a smaller risk of dying from cancer.

Women who reported that they sat for more than six hours a day during their leisure time versus those who sat for fewer than three hours a day had a 37 percent higher death rate from all causes. For men it was about 18 percent higher.  After adjusting for the amount of physical activity these people got, the researchers found that the association remained virtually unchanged.

But when people sat more and exercised less, the difference was even greater. Women had a 94 percent highr death rate from all causes. For men it was 48 percent higher.

“Several factors could explain the positive association between time spent sitting and higher all-cause death rates,” Dr. Patel says. “Prolonged time spent sitting, independent of physical activity, has been shown to have important metabolic consequences, and may influence things like triglycerides, high density lipoprotein, cholesterol, fasting plasma glucose, resting blood pressure, and leptin, which are biomarkers of obesity and cardiovascular and other chronic diseases.” [Read more →]

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Posted in: Diabetes Complications

Potato Poison

August 30th, 2010 · 2 Comments

Many people with diabetes have already stopped eating potatoes for several reasons. Now we have one more.

Some varieties of potatoes raise our blood glucose level faster and higher than just about anything. The glycemic index of a baked russet potato is 111 on the scale where glucose equals 100.

A cup of hashed brown potatoes has 46 grams of carbohydrate. That’s more than a whole day’s ration of carbohydrates for people following the best known very low-carb diet for people with diabetes.

About 80 percent of a potato’s carbohydrate comes from starch, a white, tasteless, and odorless powder. But starch is cheap, and adding salt and fat can make it palatable.

Since hashed brown potatoes and french fries count as a vegetable, the potato is America’s most important vegetable crop. More than 30 percent of the vegetables that we eat are potatoes, and we eat 142 pounds of them each year.

Maybe people with diabetes eat fewer potatoes than other Americans. I hope so. But everyone who eats lots of potatoes not only indulges in a very high glycemic and very high carb food but also is at risk of potato poisoning.

Potatoes are a member of the deadly nightshade family. This family includes Jimson weed, mandrake, belladonna, tobacco, as well as potatoes and tomatoes. While potatoes, tomatoes, and other members of the nightshade family are important food sources, they are often rich in alkaloids, which are toxic to humans and animals and can range from being mildly irritating or fatal, depending in part on how much we eat. By affecting the nervous system, this poison causes weakness and confusion. Some people are especially sensitive to foods in the nightshade family and experience allergy-like symptoms from the alkaloids. These alkaloids protect the plant from attacks by microbes and insects by dissolving their cell membranes.

But this poison hasn’t discouraged us from eating lots and lots of potatoes. Cooking them long enough and avoiding the green parts and sprouts reduces their toxicity. But when people eat foods in the
nightshade family, the alkaloids can create pores in the lining of the gut. This increases intestinal permeability, and if enough of the alkaloids gets into our bloodstream, this destroys the cell membranes of our red blood cells.

The large amount of potatoes that we eat is what makes them a concern to Loren Cordain, who has been has been a professor in the Department of Health and Exercise Science at Colorado State University since 1982. His new paper, “Consumption of Nightshade Plants, Human Health and Autoimmune Disease Implications,” interested me so much that I bought a copy for $21.29. It was worth the money.

We eat somewhat less tomato products, and relatively few bell peppers, chili peppers, and eggplants, some of the other food crops in the nightshade family.

“When the gut becomes ‘leaky,’ it is not a good thing,” Dr. Cordain writes, “as the intestinal contents may then have access to the immune system, which in turn becomes activated, thereby causing a chronic low level system inflammation.” The increased intestinal permeability, particularly in people with diseases of chronic inflammation — like type 1 diabetes — and diseases of insulin resistance — like type 2 diabetes — particularly troubles Dr. Cordain.

His conclusion is “to eliminate or drastically reduce potato consumption, and for autoimmune and allergy patients to be cautious with the consumption of tomatoes, chili peppers, and eggplants.”

Until recently, I had a weakness for hashed brown potatoes, as I have written here. Even though I knew that potatoes are both high glycemic and high carb, that wasn’t enough to stop me. But knowing that they are poisonous did.

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.

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Posted in: Diabetes Diet

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