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

Study: Healthy Fasting Reduces Risk of Heart Disease, Diabetes

May 11th, 2011 · 5 Comments

Regular readers may remember that I reported here on earlier studies about some benefits from intermittent fasting. But a study reported yesterday shows that fasting also lowers the risk of heart disease and diabetes and increases the good HDL cholesterol and reduces triglycerides, weight, and blood glucose levels. It also increases the bad LDL cholesterol.

Research cardiologists at the Intermountain Medical Center Heart Institute in Murray, Utah, reported these finds at the annual scientific sessions of the American College of Cardiology in New Orleans. Tomorrow’s issue of the Journal of the American College of Cardiology will print the results of this study led by Dr. Benjamin D. Horne, Intermountain’s director of cardiovascular and genetic epidemiology.

LDL went up by 14 percent and HDL by 6 percent. But the increase in cholesterol from fasting is probably not a bad thing, as Dr. Horne explains.

“Fasting causes hunger or stress,” he pointed out. “In response, the body releases more cholesterol, allowing it to utilize fat as a source of fuel, instead of glucose. This decreases the number of fat cells in the body. This is important because the fewer fat cells a body has, the less likely it will experience insulin resistance or diabetes.”

Dr. Horne’s team conducted two fasting studies. One included more than 200 people. Another included 30 people who only had water for 24 hours and then studied for another day. During this additional 24-hour period the researchers subjected the subjects to blood tests and other physical measurements.

Now I have the incentive to get back to intermittent fasting. Just as soon as I finish the fish in my fridge.

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, Diabetes Diet

Embrace Diabetes Support Groups for a Healthy Lifestyle

May 11th, 2011 · No Comments

If you have ever participated in a diabetes support group, you probably know that it helps you to stay in control of your diabetes. While I don’t know of any research that will prove this, a new study shows that group support meetings offer remarkable benefits for people who have pre-diabetes. If group support helps people who have pre-diabetes, it is probably much more likely to help those of us who are already burdened with this condition. For most people I know who have pre-diabetes this is just one more thing to deal with. Sometime.

Those of us who have diabetes know that we have to deal with it. Every day. But some people who have diabetes still don’t take advantage of the support that other people can give them. For some of us diabetes is something to keep quiet about, either out of shame or concern that our employers might cause them problems. Or because their health insurance rates might go up.

Some of these concerns are certainly legitimate. But when we ignore the social advantages of sharing, we ignore the support we can get from friends in similar situations.

More and more of us are choosing a third alternative, online support. Groups like MyDiaBlog can help anyone with diabetes, even those among us who can’t or won’t share with local groups.

The study of people with pre-diabetes who have benefited from support groups that prompted these thoughts comes to us from Australia. Between 2005 and 2009 the Victorian Department of Health recruited 300 people from both the big city of Melbourne and the rural community of Shepparton to see if community meetings are as good for health as they are for making friends.

They are. The bottom line is that people who attended regular meetings had a 43 percent success rate in reversing their pre-diabetes within six months of learning that they had it. By comparison, only one quarter of the people who had learned that they have pre-diabetes in that time but only had the support of their doctor succeeded.

Swinburne University of Technology in Melbourne evaluated the study and reported it in the March 2011 issue of Swinburne Magazine. This article says that the Victorian Department of Health is taking these positive findings a step further by rolling out a state-wide program.

The question is whether people here who already have diabetes will take the further step to get valuable support from others.

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: Psychosocial

Which Blood for Checking Glucose

April 5th, 2011 · 2 Comments

The blood that we need to use to check our blood glucose levels may seem obvious. After all, it’s a check, not a test to pass or fail. We need to use our own blood, not blood borrowed from a friend or foe.

But until now some basic questions about blood glucose testing haven’t had a tested answer. They do now with the publication of a study in this month’s issue of Diabetes Care, a professional journal of the American Diabetes Association.

The abstract of the study, “Self-Monitoring of Blood Glucose: The Use of the First or the Second Drop of Blood” is free online. My friend Dr. Bill Quick, who also writes about diabetes for HealthCentral, sent me the full text of the study.

The seven Dutch diabetes professionals who researched basic questions about blood glucose testing recruited 123 people with diabetes. They checked the variability of their blood glucose testing results in four different situations:

1. When they did or did not wash their hands

2. After they handled fruit (specifically apples or bananas)

3. After washing their fingers that had touched the fruit

4. And two different amounts of pressure applied to their fingers — squeezing

Their conclusions were simple and straightforward. But now for the first time we have them based on the actual experience of real people who have diabetes:

1. We don’t have to waste a drop of blood to use a second drop — but only if we wash our hands first.

2. But when we aren’t in a position to wash our hands and they aren’t particularly dirty or exposed to something that has sugar in it, testing with a second drop of blood will work.

3. Which finger we use doesn’t matter.

4. When we apply heavy pressure — meaning squeezing a lot — we can get unreliable results.

“The first choice is to wash the hands with soap and water, dry them, and use the first drop of blood,” the authors wrote. “Firm squeezing of the finger should be avoided.” The authors admitted that they had a hard time defining the difference between firm and light squeezing.

Strangely, the study did not look at the old recommendation that we should use alcohol to clean our fingers. Maybe they read my review of the Clever Chek meter, which I wrote here in November 2007. I hope that I disposed of the myth that it’s better not to use alcohol.

“The [Clever Chek] packaging includes a box of ‘Alcohol Prep Pads,’” I wrote then. But, “Any alcohol on the skin may interfere with your test result, so the experts don’t recommend that you use alcohol prep pads routinely. Only where you don’t have warm water is it a good idea to use alcohol to clean the test area. And be sure to air dry it well before testing.”

Now, let’s all go and test our blood glucose with confidence that we know what we are doing.

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

Indigenous Diabetes

January 16th, 2011 · 3 Comments

Diabetes is the scourge of civilization. A disproportionate number of people living in the most advanced societies suffer from it.

But the people who suffer the most are the original inhabitants of the lands that the Western societies occupied. Whether they are the Native Americans, people of Canada’s First Nations, Australia’s Indigenous population, or other conquered peoples, the result everywhere has been the same — lots of diabetes.

The reason why is no mystery. The conquerors destroyed the indigenous cultures, often intentionally but with what they thought were good intentions. By punishing students in native schools for using their own language, by attacking native religion, and by extolling the wonders of Western food, the victors hoped to integrate the defeated into mainstream culture. Instead, they marginalized the defeated from both their own culture and from that of the West.

Decrying their food choices of the defeated misses the point, as Sousan Abadian elucidates in her Harvard University Ph.D. dissertation. The point is that they suffer what she calls “collective trauma.”

Craig Lambert interviewed her for his brilliant article, “Trails of Tears, and Hopes,” for the March-April 2008 issue of Harvard Magazine. You can read the PDF of the full article online.

[Read more →]

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Posted in: Psychosocial

Another Nail in the SAD Coffin

January 14th, 2011 · 1 Comment

The standard American diet that our medical establishment so dearly loves is dying a slow, painful death. And it’s coming not a moment too soon. The diet’s death is arriving after it killed so many of us and crippled millions more with diabetes or obesity.

The Mediterranean diet is that standard American diet. Based on whole grains, low-fat dairy products, vegetables, fruit, fish, and oils and margarines, this diet fad owes everything to a gentleman named Ancel Keys. His masterpiece was the Seven Countries Study, which he launched in 1956 and published its results beginning in 1970.

The Seven Countries Study was, however, fatally flawed. Keys cherry picked data that fitted his preconceptions, ignoring data from more than a dozen other countries that wouldn’t support what he tried to prove. Our medical establishment believes to this day that he did prove the negative effects of fat on heart health. And thus the Seven Countries Study was the genesis of the Mediterranean diet that so many of us believe in to our detriment.

Fortunately for all of us, Gary Taubes has demolished this myth. His masterpiece is Good Calories, Bad Calories. I think everyone who can read English needs to master this work, which is far too detailed for me to even attempt to summarize here.
[Read more →]

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Posted in: Diabetes Diet

Meeting the tiniBoy Lancet Inventor in Korea

November 30th, 2010 · 1 Comment

Stanley Kim is a practicing physician in Southern California who recently invented the smallest and painless lancets for testing our blood glucose. I wrote about this invention here this August.

At that time Dr. Kim and I hadn’t met. I interviewed him on the phone from my home office in Colorado.

We had to travel all the way to South Korea to meet in person. We are in Busan, Korea’s second largest city with about 3.6 million residents. Specifically, we are both attending the International Diabetes Federation’s Western Pacific Region Congress along with about 3,000 other people who work with diabetes. This congress is taking place in Busan Exhibition and Convention Center (BEXCO) in the most modern part of the city near Haeundae, the most famous and frequented beach in all of South Korea.

As modern as Korea is — particularly in this part of the country — it is naturally quite different from what I normally experience in Colorado. But for Dr. Kim, Busan is quite familiar. He grew up in Busan and has a condo here.

Until I mentioned the meeting during the course of the interview for the article I wrote here in August, Dr. Kim didn’t know that it was happening in his hometown this year. He then arranged to attend the meeting. And at the last minute the conference organizers approved his poster presentation for the tiniBoy lancets. [Read more →]

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Posted in: Diabetes Medication

Test Strips and Meters from South Korea

November 30th, 2010 · No Comments

Greetings from the bottom of my heart and the top of Seoul. I am writing you from South Korea where I am for two weeks at the invitation of one of the largest blood glucose meter and test strip manufacturers in the world.

People from i-SENS Inc., a company headquartered in Seoul that designs and manufacturers blood glucose monitoring systems, asked me to visit them this fall. In fact, they originally invited me to come last October. But I had to postpone my visit because I had an emergency operation for twisted small intestines at the beginning of that month, and my surgeon said I couldn’t travel.
For the first few days of my trip I am staying on the top floor of a hotel in the Seongbuk district of Seoul, near the company’s headquarters. With 24.5 million inhabitants Seoul is the world’s second largest metropolitan areas in population (after Tokyo and ahead of Mexico City, New York City, and Mumbai, in that order). Seoul has been Korea’s capital for more than 600 years.
On Friday I left Seoul for the day to visit the new factory that i-SENS built in Wonju city four years ago to make test strips for its blood glucose meters. I went with my friend and hostess, Margaret Leesong. The i-SENS director of international business relations, Margaret visited me in Boulder a couple of years ago, when we had a great hike together in the foothills of the Rockies.

Margaret lived in the States from 1973 to 1978 and then again from 1988 to 1996, when she moved to Australia, remaining there until 2005. After her college years at Seoul National University, she earned a Ph.D. in biophysics from Purdue University in Indiana and then an LLB (law degree) from the University of Sydney. She speaks flawless English.
When Margaret met me at the hotel on Friday morning, we took a taxi to the bus station, where we took a two-hour ride to Wonju, a much smaller city of about 300,000 people in northeastern Korea. From there a staff member who helped us as driver and tour guide from the company picked us up and took us to the factory.

[Read more →]

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Posted in: Diabetes Medication

Eating Blueberries with a Smile

November 4th, 2010 · No Comments

Those of us who have diabetes have something to smile about when we learn that a tasty food we love to eat but we thought was bad for us is actually good. As I ate my blueberries this week I experienced those smiles.

Nobody likes blueberries more than I do. But the few times I have eaten them lately have been guilty pleasures. That’s because blueberries are high in carbohydrates, which can wreck havoc with our blood glucose control.

Blueberries seemed to decrease inflammation when researchers tested them in animals. In spite of their carb content animals appeared to have lower BG levels when they ate their berries.

But until now we didn’t know much about what blueberries would do for people. So Drs. William Cefalu and associates set out to study what blueberries might do for us. They work at the Pennington Biomedical Research Center, a part of the Louisiana State University System.

They didn’t study people with diabetes. Instead, for six weeks they studied 32 obese people who have prediabetes, or insulin resistance.

So, is this work relevant to those of us who have gone all the way into diabetes? I think so, because the difference between prediabetes and diabetes comes down to whether we have burned out lots of the beta cells in our pancreas or not. Like us, people with prediabetes already have a lot of insulin resistance that can eventually burn out the beta cells.
This study meets the highest standards of clinical trials — it is a double-blind, randomized, and placebo-controled clinical study design. The Journal of Nutrition will publish their findings in its October 2010 issue. Meanwhile, however, the journal has already published the study, “Bioactives in Blueberries Improve Insulin Sensitivity in Obese, Insulin-Resistant Men and Women,” online. While only the abstract is free online, I got the full-text through my subscription.

The people in the study who ate the blueberries had significantly improved insulin sensitivity compared to those in the control group who weren’t so lucky. Changes in body fat, calorie intake, or inflammation were not at work here.

Researchers guess that the health benefits of blueberries might come from their phenolic bioactive compounds like anthocyanins, which are also anti-oxidant. They are red, purple, or like blueberries in particular, blue. Dark blue.

The people in the study got their blueberries from frozen powder in a smoothie. The control group got their smoothies without the blueberries but with the same taste and calories.

Not increasing our calories — and the amount of carbs we eat — is also our challenge when we add blueberries to our diet. After all, one cup of them has 12 grams of carbs, the maximum amount those of us who eat low-carb will want to have in any meal.

When we add blueberries to what we eat, we can remove something else. This way we can keep smiles on our faces as we consume a delicious and healthy food.

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

Fish, Inflammation, and Insulin Resistance

November 4th, 2010 · No Comments

Omega-3 fats reduce chronic inflammation and insulin resistance. Now we know why.

Tomorrow the journal Cell will publish a report telling how researchers at the University of California, San Diego identified the molecular mechanism that omega-3 uses. The full-text of the article by Jerrold Olefsky, M.D., and his associates is online.

They found a key receptor on macrophages, which are specialized white blood cells that engulf and digest cellular debris and pathogens. Omega-3 fats activate this macrophage receptor with broad anti-inflammatory effects and improved insulin sensitivity.

When we have insulin resistance, insulin doesn’t regulate our blood glucose levels as well, and it often leads to type 2 diabetes. “Chronic, low grade tissue inflammation is an important cause of obesity-related insulin resistance,” the study states. As I have reported here previously, Dr. Olefsky has been working to see how we can “block or disarm this macrophage inflammatory pathway in humans,” preventing insulin resistance and type 2 diabetes.

Dr. Olefsky’s group used cell cultures and mice. They didn’t use people. But by using mice they were able to “knock out” or turn off specific genes. “Mice are currently the most closely related laboratory animal species to humans for which the knockout technique can easily be applied.” Doing this to humans would not be practical, and if it were, it wouldn’t be ethical.

I applaud this research. But not Dr. Olefsky’s proposed solution.

“These results,” the study says, “strongly argue that anti-inflammatory effects can ameliorate insulin resistance in obesity.” But then the study’s authors go on to say that this knowledge “may prove useful in the future development of new therapeutic approaches for the treatment of insulin resistant diseases.”

As I wrote in review of Dr. Olefsky’s earlier research, “He’s thinking drugs to reverse a sad situation.” He still is, but we can think diet now.

We can simply increase the level of omega-3 fats in the tissues of our bodies. Cold-water fish like salmon and sardines are the most effective. Fish or krill oil works too. But, as I have written here, we need to cut back on omega-6 fats first.

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

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