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Diabetes Developments - A blog on latest developments in diabetes by David Mendosa
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The Trouble with Naps

May 28th, 2010 · No Comments

My most recent post here reviewed a new study indicating that resting after meals is hard on the pancreas, could lead to diabetes, and could make existing diabetes worse. This is an interesting hypothesis and one that you can check out yourself.

But one of my correspondents suggests that the results might be related to the fact that overweight people who overeat at a meal are more likely to lie down. “Edgy thin people probably jog instead,” she says.

That’s a good suggestion, and I’m not sure that the authors of the new study controlled for weight. But now comes a closely related study that indirectly offers support for the hypothesis that lying down after we eat isn’t a good idea.

People in China in the 50s and over who regularly take naps after a meal increase their risk of diabetes by 28 to 36 percent, according to a study just published in Sleep, the official publication of the Associated Professional Sleep Societies, a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society. The authors of the study are associated with universities and hospitals in China and the U.K.

Correlation, of course, doesn’t prove causality. It is suggestive and may be a good suggestion to follow, because the only downside is probably being a bit tired, which in fact could lead to a better night’s sleep. Anyway, a little jog after a meal will do a lot more to reduce blood glucose than lying down ever will.

The authors of the study that I review last week are in Kazakhstan and Ukraine, while the new study is China-based. Some of the most interesting research on diabetes now seems to be coming from countries that hadn’t been at the forefront of diabetes research. This Internet age seems to be leveling the playing field.

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: Food

Diabetes Rising Book Review

February 17th, 2010 · 3 Comments

Diabetes Rising is a strange name for the most readable book ever written about diabetes. But diabetes is a strange disease, as Dan Hurley shows in the book that Kaplan published yesterday.

The publisher sent me galley proofs of the new book several months ago. I’ve been waiting to review it until it became generally available.

Of the hundreds of books on diabetes that publishers and authors send me every year, I don’t usually review any of them. I’ll keep one or two of them in my bookshelf for reference, but I give away the vast majority of them, usually to my local library.

Diabetes Rising is the exception because its author has exceptional qualifications to write about it. Dan Hurley is a medical journalist who regularly contributes to the science section of The New York Times as well as to many other major publications. He earned his other relevant qualification 34 years ago at the age of 18. That’s when he got type 1 diabetes. [Read more →]

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Posted in: Book Reviews

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: 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.
[Read more →]

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Posted in: Medication

Bad Science

December 11th, 2009 · 2 Comments

Whenever I become conscious of a word or concept new to me, I began to notice it everywhere. All of you probably have had this experience.

It is so common that we even have a nice big word for it thanks to the great Swiss psychiatrist Carl Jung: Synchronicity.

A couple of weeks ago a member of the diabetes support group that meets in my apartment loaned me a book called Bad Science. A practicing physician in the U.K.’s National Health Service and newspaper medical columnist named Ben Goldacre wrote it and Fourth Estate published it last year in the U.K.

The book is a detailed indictment of the British press for its woeful ignorance of some basic scientific concepts. Like one of my favorites, “regression to the mean.” This sounds complicated. But it is simply the fact that everything, including our health, has a natural cycle. Since we tend to see a doctor when we feel the worst, we think that his or her treatment helped us, while we would soon feel better no matter what the treatment was. [Read more →]

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Posted in: Basics

Two Easy Ways to Control Blood Pressure

October 30th, 2009 · 1 Comment

High blood pressure is part of the metabolic syndrome. This means that almost all of us who have diabetes also have high blood pressure.

We have lots of ways to help us control our blood pressure, including pills. But if you, like me, prefer to avoid taking prescription medicine, researchers have now discovered two ways that seem much better.

The researchers reported their findings Thursday at the American Heart Association High Blood Pressure Research Conference in Chicago. Formal papers will probably follow.

One study shows that younger women tripled their risk of having high blood pressure later in life when their levels of vitamin D were low. Those who were deficient in vitamin D — that is with less than 80 nanomoles per liter of blood — when the Michigan Bone Health and Metabolism Study measured it for 559 women in 1993 were more likely to have high blood pressure when researchers followed up with them 15 years later. Even adjusting for the effects of age, obesity, and smoking, the women who had been deficient in vitamin D at the start of the study were three times more likely to have high blood pressure in 2008. [Read more →]

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Posted in: Complications

Are You a Noncompliant Diabetic?

October 30th, 2009 · 2 Comments

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 →]

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Posted in: Psychosocial

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: Complications

Inflammation: The Root of Diabetes

June 7th, 2009 · 2 Comments

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?
[Read more →]

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Posted in: Food

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.
[Read more →]

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Posted in: Medication