When we don’t get our blood glucose levels low enough or take the diabetes medicine that our doctors prescribe, they often complain about our noncompliance. Particularly when we follow a very low-carb diet and are unlucky enough to have a nutritionist on our medical team, she is almost certain to give us a hard time.

When doctors and nutritionists do that, they are forgetting their place. The doctor-patient relationship is a status thing. While medical professionals usually earn more money than we do, they work for us. We are the ones who make them well off, if not rich.

We hire our doctors. We can fire them too. Several years ago when Byetta first came on the market, I knew that taking it would help me control my blood glucose and lose weight. The doctor I saw at the time had never heard of Byetta, so he had to read up on it. When he did, he refused to give me a prescription for it because he was sure that I would lose only a few pounds. I fired him and proved him wrong after I hired a compliant doctor. [Read more →]

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 →]

More and more research pinpoints inflammation as a root cause of type 2 diabetes. Being overweight makes it harder for us to control our diabetes, but that can’t be what causes it. Since a lot more people are overweight or obese than have diabetes, weight alone can’t lead to diabetes.

No one ever demonstrated that obesity causes diabetes or even insulin resistance. In my most recent book, Losing Weight with Your Diabetes Medication, I speculated that essentially it might be the other way around: That what makes so many of us overweight could be insulin resistance or impaired beta cells.

Type 2 diabetes generally results from the combination of impaired beta cell function and insulin resistance acting on susceptible genes. Why then is there such a large overlap between being heavy and type 2 diabetes?
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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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When he examined the young lifeguard, he saw that almost every square inch of her body was well tanned. She had been wearing practically nothing when she worked at the beach.

Neil Binkley, M.D., told me about his patient because she had the highest physiologic level of vitamin D in her system of anyone he ever saw. Her level was 80 ng/ml.

I had to look up the word “physiologic” to make sure what Dr. Binkley meant. Physiologic in the sense that he’s using it is “something that is normal, neither due to anything pathologic nor significant in terms of causing illness,” according to a medical dictionary.
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The annual convention of the American Association of Clinical Endocrinologists — those medical specialists who treat diabetes — is underway in Houston. I’m covering the event for The Health Central Network.

The convention took over the George R. Brown Convention Center in the downtown of America’s fourth largest city. The convention center is so big that after Hurricane Katrina 7,000 refugees lived here.

In the mob of today’s convention you might imagine my surprise that the first person I made eye contact with asked if I was David Mendosa. The person who asked was Sarah Senn, who I had sent several photos for an article that she wrote about me. But we had never previously met in person.
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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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Few of us can afford the insane cost of health care without health insurance. But in this sinking economy more and more of us have lost that safety net.

The good news is that some strands of the net remain in place. I’m lucky to be old enough to hang on to the biggest one, Medicare.

In November when I had to spend one night in the local hospital, they billed my insurance $2,310 for the room. But that was a minor part of the $11,518 bill. And it didn’t include bills from two doctors.

Because of the deal that my insurance company cut with the hospital, that was a lot less than the room rate and other hospital charges they would have billed me as an uninsured patient. Is that unfair or what! I was lucky that my co-pay was only $450.
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Some of our doctors don’t help us when they use insulin as a threat: “Unless you reduce your blood glucose, I am going to have to put you on insulin.”

So it’s no surprise that many of us who have type 2 diabetes think we have failed when our doctors prescribe it. This comes from thinking of injecting insulin as a last resort.

It isn’t. More and more of us are now starting to take insulin as soon as our doctors have diagnosed our type 2 diabetes. Probably half of the men in my diabetes support group started taking insulin as a first choice.
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