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

Comparing Type II Diabetes Pills: Metformin and the Insulin Secretagogues

May 17th, 2011 · 2 Comments

When people with type 2 diabetes could take a pill instead of insulin to help us control our diabetes, smiles must have appeared on many faces. The pill was tolbutamide, and in the mid-1950s it became the first of the sulfonylurea class of drugs.

But that was more than half a century ago. Meanwhile, we now have choices of pills we can use. In fact, we now have nine other classes of oral diabetes medication plus several combinations.

The sulfonylureas force the beta cells in the pancreas to pump out the insulin that our body makes there. That’s why we call these drugs insulin secretagogues. For years many of us have been concerned that they will eventually burn out whatever beta cells we have left.

About a dozen years ago I voiced this suspicion to Edward S. Horton, who was then the director of clinical research at the Joslin Diabetes Center in Boston. In reply he told me that we have no evidence for this belief.

“You are not whipping the beta cells to death,” he said. “There is evidence that the beta cells do fail gradually over time. But there is no evidence that drugs hasten the process. I know that it is a popular conception that people have, but it is not true.”

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Posted in: Diabetes Medication

Preventing Blindness with Omega 3

April 28th, 2011 · No Comments

Diabetic retinopathy is a leading cause of blindness, one of the most serious complications of diabetes. But omega 3 fatty acids can help protect us from it. Fish oil, particularly from fatty fish like salmon and sardines, is our best food source of omega 3. Capsules of fish or krill oil are a good choice for people who don’t eat much fish.

Omega-3 fatty acids are highly concentrated in the retina, the light-sensitive tissue that lines the inner surface of our eyes. But the typical American diet is awfully low in omega-3 and high in omega 6, which competes with omega 3 to get into the cells of our bodies, as I wrote here last year.

We’ve known from studies of mice that omega 3 can prevent retinopathy. When researchers fed mice diets rich in omega 3, the mice had nearly 50 percent less pathologic vessel growth in the retina than mice fed diets rich in omega 6. But many of us, myself included, discount mice studies, because we are men and women, not mice, and all of us are much bigger and many of us are much brighter.Now a study from a research team at Children’s Hospitl Boston shows the way omega 3 protects mice — and hopefully us people — from blindness. A recent issue of Science Tranlational Medicine reported this study. The researchers isolated the specific omega-3 compound that has beneficial effects in mice. Technically, it is a metabolite of the omega-3 fatty acid DHA, known as 4-HDHA), and the enzyme that produces it (5-lipoxygenase, or 5-LOX.

For people with diabetes this is important research. “Between 40 to 45 percent of Americans diagnosed with diabetes have some stage of diabetic retinopathy,” according to the National Eye Institute. “The longer someone has diabetes, the more likely he or she will get diabetic retinopathy.”

Now, we have a much better chance of stopping diabetic retinopathy in its tracks. The first line of defense is our diet, specifically increasing the amount of omega 3 and reducing how much omega 6 fatty acids we eat.

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

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.
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Posted in: Diabetes Diet

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

Omega-3 for Fatty Liver

March 3rd, 2010 · 7 Comments

Fatty liver disease is one of the most common complications of diabetes. About 50 to 70 percent of those of us who have diabetes may have this potentially dangerous complication. But now we may have a way to treat it and stopping it from progressing to liver failure.

The first time I wrote about fatty liver was in 2005 when I had it myself. Fortunately, I have since been able to reverse it with diet and exercise.

My late wife Catherine wasn’t so fortunate. Her fatty liver progressed to liver failure, which led to her death in early 2007.

Catherine had type 2 diabetes and was seriously overweight, and neither of us knew at the time that this is the cause of most cirrhosis of the liver. We had always assumed that drinking too much alcohol was the cause — but she never drank any.

Since then I’ve learned a lot about the dangers and other causes of fatty liver disease. Just recently, in fact, Swedish researchers reported that people with nonalcoholic fatty liver disease have a higher overall mortality rate compared with the general population. [Read more →]

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Posted in: Diabetes Complications

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

Testing Omega 3

January 8th, 2010 · 6 Comments

If we can easily test our blood glucose and cholesterol levels, why can’t we test the level of omega 3 fatty acids in our blood? Nothing — not cholesterol or even C-reactive protein levels — is better at predicting sudden cardiac death, which still causes about 60 percent of cardiac disease death in the United States, according to an analysis by Centers for Disease Control researchers.

For years this lack of an omega 3 blood test puzzled me. No more. It has finally arrived.

The HS-Omega-3 Index uses a standardized methodology to measure the percentage of eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA) in red blood cells. It also measures the ratio of omega 3 to omega 6.

Some cold water fish like salmon, mackerel, herring, albacore tuna, and sardines have a lot of this healthy omega 3 fat. I follow the standard recommendation to eat one of these fish at least twice a week. I supplement my fish with krill oil capsules for even more omega 3. [Read more →]

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Posted in: Diabetes Testing

Fructose and High Blood Pressure

December 11th, 2009 · 7 Comments

If you have high blood pressure, your doctor has probably told you a dozen times to cut way back on salt (sodium). But this works only for people who have a “salt-sensitive phenotype,” which results from both genetic makeup and environmental influences.

New preliminary research offers another strategy that might work for more of us. If we cut back on the fructose that we eat from added sugars, we may be able to control high blood pressure.

Most people with diabetes have high blood pressure, or to use the technical name, hypertension. High blood pressure is, after all, one of the key components of the metabolic syndrome, or syndrome x, that leads to diabetes.

When doctors talk about our blood pressure being high they mean a level of more than 120/80 mmHg. Those numbers are shorthand for a systolic or peak pressure of 120 and a diastolic or minimum pressure of 80 millimeters of mercury. [Read more →]

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Posted in: Diabetes Diet

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

Intensive Glucose Control Works

July 28th, 2009 · 2 Comments

The American Medical Association today published the results of a large and long study that is good news for anyone who has diabetes. The study shows that intensive control substantially lowers the risk of some serious complications of diabetes.

No surprise that intensive control works. But the surprise is how well it works.

The study followed 1,375 people with type 1 diabetes for 30 years of their diabetes. The complications measured were proliferative retinopathy, nephropathy, and cardiovascular disease. Conventional treatment led half of them to proliferative retinopathy, one-quarter to nephropathy, and 14 percent to cardiovascular disease.

Those in the intensive therapy group has substantially lower rates of these complications — 21 percent, 9 percent, and 9 percent respectively. Fewer than 1 percent became blind, required kidney replacement, or had an amputation because of diabetes during those 30 years. [Read more →]

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Posted in: Diabetes Complications

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