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

Good Drugs, Bad Drugs

January 21st, 2010 · 3 Comments

We know that the only person who can tell us what to eat and exercise is ourself. But most of us need a third leg of diabetes control — one or more of the prescription drugs — and we usually leave that decision up to our doctor.

Often this is a big mistake. Many of our doctors are too set in their ways. The problem is simply that doctors too are human.

Older doctors have practiced most of their lives with a Hobson’s choice of one oral diabetes drug. In 1957 the first sulfonylureas became available by prescription in the United States. Not until about 40 years later did the Food and Drug Administration approve a second diabetes drug, metformin.

Until we could get metformin, we did have the opportunity to take insulin instead of a sulfonylurea. And we had a lot of different sulfonylureas to choose from, making it appear that our choice was greater that it really was. Brand names include Amaryl, Glucotrol XL, Diaßeta, Glynase, Micronase, as well as Dymelor, Diabinese, Orinase, and Tolinase. Combination drugs like Metaglip, Glucovance, Avandaryl, and Duetact also are part sulfonylurea. [Read more →]

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Posted in: Diabetes Medication

The Big Ds: Diabetes, Depression, and the D Vitamin

January 8th, 2010 · 9 Comments

Since alliteration helps us to remember connections, we’re lucky that diabetes, depression, and the D vitamin all start with the same letter. We aren’t lucky that diabetes and depression are so closely connected, as I wrote in my essay on “Diabetes and Depression” here a year ago. But we’re in luck that vitamin D might treat both conditions, killing two birds with one stone, as our less technologically powerful ancestors used to say.

“About 70 percent of the population of the United States has insufficient levels of vitamin D,” says Adrian Gombart, a principal investigator with the Linus Pauling Institute at Oregon State University. “This is a critical issue as we learn more about the many roles it may play in fighting infection, balancing your immune response, helping to address autoimmune problems, and even preventing heart disease.”

People with diabetes may have even lower levels of vitamin D, according to a review last year in The Diabetes Educator. People at risk of diabetes and the metabolic syndrome (or syndrome x) also have low vitamin D levels.

Recent research found that 19 percent of people with type 2 diabetes probably suffer from major depression and an additional two-thirds of us have at least some depressive symptoms. People with diabetes are twice as likely to be depressed as other people.
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Posted in: Diabetes Medication

How Much Omega-3

October 11th, 2009 · 2 Comments

Considering all the supplements that most of us take, we have surprisingly little evidence that the overwhelming majority of them do anything for us. The two biggest exceptions are vitamin D and omega-3 oil, which I have written about here.

Even with these well-tested supplements, the experts have little advice to give us. Now, however, a team of scientists from the University of Lyon in France just reported on how much of one type of omega-3 oil to take so that we can prevent heart attacks and strokes, the major complication of diabetes. This is the first study to identify how much omega-3 oil we need to promote optimal heart health.

They studied DHA or docosahexaenoic acid, which some studies suggest have more potent and beneficial effects than the other omega-3 oil that we usually take, EPA or eicosapentaenoic acid, according to their research communication in September issue of The FASEB Journal,  which the Federation of American Societies for Experimental Biology publishes.

Only the abstract of the study is online. But one of the study’s authors, Evelyne Véricel, was kind enough to send me the full text. [Read more →]

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Posted in: Diabetes Complications

My Neuropathy

June 22nd, 2009 · 20 Comments

A few days ago when I finally was able to see a neurologist for the headaches that started four months ago, the first part of his examination was of my feet. I had heard of referred pain, but this seemed extreme to me, and I told him so.

The doctor replied that he would get to my head. In the meanwhile he gave me a complete examination. He used a tuning fork, similar to what musicians use. I could feel it as he went down my legs. But when he got to each of my feet, I felt nothing.

Then he worked down my legs to my feet with the side of a pin. Again, my feet I had no sensation.

He told me that I had peripheral neuropathy. And I could see it for myself. None of my other doctors had ever told me that before. [Read more →]

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Posted in: Diabetes Complications

David’s Guide to Getting Our A1C Under 6.0

June 17th, 2009 · 49 Comments

The A1C test is our best scorecard to show how well we are controlling our diabetes. It measures how much glucose has been sticking to our red blood cells for the previous two or three months. Since our bodies replace each red blood cell with a new one every four months, this test tells us the average of how high our glucose levels have been during the life of the cells.

The experts recommend that we should get our A1C level tested at least twice a year. People who take insulin need to get it about four times a year.

If the test shows that our blood glucose level is high, it means that we have a greater risk of having diabetes problems. Think of the A1C as an early warning system for the insidious complications that we can get down the road when we don’t control our condition.

But what do we mean by a “high” A1C level? Here the experts disagree. [Read more →]

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Posted in: Diabetes Testing

Triglycerides and Neuropathy

May 30th, 2009 · 4 Comments

Until now our doctors have lacked an effective way to predict who is at the greatest risk of neuropathy. Usually we find out too late — when irreversible nerve damage has already occurred.

Diabetic neuropathy is the most common microvascular complication we have. More than half of all people with diabetes develop neuropathy. It is a complication in both type 1 and type 2 diabetes.

In the past few years the U.S. Food and Drug Administration approved two drugs — Cymbalta and Lyrica — for managing the pain of diabetic neuropathy. These drug help many of us. But wouldn’t it be a lot better for us if we could prevent diabetic neuropathy?
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Posted in: Diabetes Complications

Intensive Control Does Work

May 27th, 2009 · 1 Comment

All over the world people with diabetes are slacking off how well they control their diabetes. Their A1C levels are climbing to 7.0 percent or more, apparently blessed by scientific research.

Researchers designed the Action to Control Cardiovascular Risk in Diabetes trial, universally known as ACCORD, hoped to prove that we would have fewer heart attacks and strokes when we able to bring our A1C levels below 6.0 percent. Instead, they were surprised to discover that 257 patients in the intensive-therapy group died, compared with 203 patients in the standard-therapy group. Consequently, they terminated the intensive therapy regime 17 months before the scheduled end of the study.
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Posted in: Diabetes Complications

Welcoming Welchol

May 20th, 2009 · 7 Comments

A year ago the U.S. Food and Drug Administration approved a new drug to treat type 2 diabetes. But few of us ever heard of it.

Until now. Studies presented at the annual convention of the American Association of Clinical Endocrinologists in Houston on Friday finally caught our attention.

The senior author of one of those studies spoke at length with me at the convention. Yehuda Handelsman, an endocrinologist in private practice in Tarzana, California, led a 16-week multi-center international study comparing how well Welchol (colesevelam HCl), Avandia, and Januvia did. In the study they randomized 169 people to evaluate the effects of these three oral diabetes medications on glycemic control and lipid profiles when added to metformin.
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Posted in: Diabetes Medication

Choosing Exercise or Antioxidants

May 13th, 2009 · 8 Comments

Based on what I’ve read recently, some of which I have reported here, I’ve grown more and more wary of the wisdom of taking supplements. Few of the them seem to help.

And now comes a new study indicating that the two most common supplements can actually work against us. Those supplements are vitamins C and E.

It seems that we have a choice of exercising or taking large doses of those supplements. We know that exercise has lots of good effects like increasing our sensitivity to insulin, which is of great importance to all of us with diabetes.
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Posted in: Diabetes Medication, Exercise For Diabetes

Diabetes Drug Dangers

April 19th, 2009 · 8 Comments

A single research report that found risks in one of the medications that we take to control our diabetes would warrant our attention. But when three separate studies find serious side effects from all our major drugs, the time is right for us to reconsider how we control our blood glucose levels.

Most of us think of our diabetes drugs, diet, and exercise as the three basic ways we do that. But drugs come first. Maybe they should come last, at least for all of us with type 2 diabetes, who unlike type 1s have a choice.

Since March 10, studies have called into question the side effects of metformin, the glitazones, insulin, and the sulfonylureas.
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Posted in: Diabetes Medication

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