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

Does Caffeine Cause Blood Sugar Changes?

May 17th, 2011 · 7 Comments

The first thing I did after reading the new study that caffeine can increase our blood glucose level was to switch to drinking green tea. The second thing I did was to switch again — this time to decaffeinated green tea.

I overreacted. Several years ago I had switched from coffee to Darjeeling tea, which has about half the caffeine per cup. While green tea has even less, I don’t like it much and only drink it rarely. I disliked the decaffeinated green tea so much that I threw out the package after taking the first sip.

Now, I’m almost entirely back to Darjeeling tea. People call it a black tea, although it is light-colored and is technically more oolong than black and is therefore lower in caffeine than true black teas.

While I control my blood glucose level, I’m not a purist. I have to enjoy everything that I eat or drink. While my diet includes no starch, sugar (no sucrose or high-fructose corn syrup), salt, or alcohol, except occassionally when I eat out, I don’t miss any part of this standard American, or SAD, diet. My recent A1C result was 5.3 percent.

Caffeine may well raise my blood glucose level. But after carefully reading the new study, I doubt it.

[Read more →]

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Posted in: Diabetes Diet

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

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 was originally published on Health Central.

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Posted in: Diabetes Diet

Super Salads

September 28th, 2010 · 5 Comments

When we follow a low-carb diet to control our diabetes and to lose weight, the first carbohydrates to go are starchy foods. Then, we reduce two sugars, sucrose (table sugar) and fructose.

Starchy foods have a high glycemic index, particularly tubers like potatoes and grains like wheat and wheat products, including bread, bagels, and baguettes. The trouble with sucrose is that it’s half fructose (the other half is glucose). And the trouble with fructose, including high-fructose corn syrup and agave nectar, is its impact on the liver, which metabolizes it. That raises our triglyceride levels and leads us to secrete more insulin, which in turn leads to more insulin resistance. Fructose also leads to high blood pressure.

What’s left? Fiber, of course. In the U.S. we count fiber as a carbohydrate, although much of the rest of the world counts it separately. Having some fiber in our diet is probably a good thing, but we can’t live on it.

But beyond starch, sugar, and fiber are the green leafy vegetables. The mainstay of salad. That’s what’s left.

Even Dr. Richard K. Bernstein, the leading exponent of a very low-carb diet for controlling diabetes, thinks that it makes sense for us to eat some slow-acting carbohydrates. While “there is no such thing as an essential carbohydrate,” as Dr. Bernstein writes in Dr. Bernstein’s Diabetes Solution, he also writes that “it seemed reasonable to conclude that, since our prehistoric ancestors consumed some plants, plant foods might well contain essential nutrients that were not yet present in vitamin supplement and not even been discovered.”

All of a sudden Dr. Bernstein found that he was eating salads as well as cooked vegetables. He says that he now relishes salads.

I certainly do too. A big salad is my main meal, which I eat at lunchtime giving my body enough hours to digest it before going to bed.

A couple of years ago I wrote here about what I put in my salads. But I keep discovering new ingredients that I relish.

My best find, I think, is BroccoSprouts, which just like the name indicates is sprouted broccoli. I wrote about BroccoSprouts here a year ago and still add them to almost every salad.

More recently I found a preparation of one of my favorite vegetables. Whole Foods markets now usually have artichoke hearts. In the produce section you can find “ArtiHearts Fresh Natural Artichokes” from Monterey Farms.

Five years ago I wrote in my “Diabetes Update” newsletter reviewing a book, Prickly Pear Cactus Medicine. Many people in Mexico use it to prevent high blood glucose levels, and it has one of the lowest glycemic indexes of any food. When I reviewed that book, I was concerned that the prickly pear cactus sold here was the species that tastes better than the one studied more for its glucose-lowering effect. Of course, it’s probably the former, but I now eat and enjoy it anyway, because it is undoubtedly low carb and good tasting. Sold in bottles or cans as “Tender Cactus” and “Nopalitos,” the prickly pear cactus that Whole Foods and major supermarket chains sell isn’t prickly. Someone else has removed the thorns for us.

I happened to have planned to write this much about salads anyway. But this morning I ran across a new study in BMJ, originally called the British Medical Journal. It is among the world’s most influential and widely read peer-reviewed general scientific journals in the field of medicine. Just yesterday BMJ published “Fruit and vegetable intake and incidence of type 2 diabetes mellitus: systematic review and meta-analysis.”

The study concluded that their meta-analysis supported recommendations to promote the consumption of green leafy vegetables in the diet for reducing the risk of type 2 diabetes. My conclusion is that something that can reduce the risk of our getting type 2 diabetes can’t be harmful for those of us who are already living with this condition.

This is a mirror of one of my articles that was originally published on Health Central.

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Potato Poison

August 30th, 2010 · 2 Comments

Many people with diabetes have already stopped eating potatoes for several reasons. Now we have one more.

Some varieties of potatoes raise our blood glucose level faster and higher than just about anything. The glycemic index of a baked russet potato is 111 on the scale where glucose equals 100.

A cup of hashed brown potatoes has 46 grams of carbohydrate. That’s more than a whole day’s ration of carbohydrates for people following the best known very low-carb diet for people with diabetes.

About 80 percent of a potato’s carbohydrate comes from starch, a white, tasteless, and odorless powder. But starch is cheap, and adding salt and fat can make it palatable.

Since hashed brown potatoes and french fries count as a vegetable, the potato is America’s most important vegetable crop. More than 30 percent of the vegetables that we eat are potatoes, and we eat 142 pounds of them each year.

Maybe people with diabetes eat fewer potatoes than other Americans. I hope so. But everyone who eats lots of potatoes not only indulges in a very high glycemic and very high carb food but also is at risk of potato poisoning.

Potatoes are a member of the deadly nightshade family. This family includes Jimson weed, mandrake, belladonna, tobacco, as well as potatoes and tomatoes. While potatoes, tomatoes, and other members of the nightshade family are important food sources, they are often rich in alkaloids, which are toxic to humans and animals and can range from being mildly irritating or fatal, depending in part on how much we eat. By affecting the nervous system, this poison causes weakness and confusion. Some people are especially sensitive to foods in the nightshade family and experience allergy-like symptoms from the alkaloids. These alkaloids protect the plant from attacks by microbes and insects by dissolving their cell membranes.

But this poison hasn’t discouraged us from eating lots and lots of potatoes. Cooking them long enough and avoiding the green parts and sprouts reduces their toxicity. But when people eat foods in the
nightshade family, the alkaloids can create pores in the lining of the gut. This increases intestinal permeability, and if enough of the alkaloids gets into our bloodstream, this destroys the cell membranes of our red blood cells.

The large amount of potatoes that we eat is what makes them a concern to Loren Cordain, who has been has been a professor in the Department of Health and Exercise Science at Colorado State University since 1982. His new paper, “Consumption of Nightshade Plants, Human Health and Autoimmune Disease Implications,” interested me so much that I bought a copy for $21.29. It was worth the money.

We eat somewhat less tomato products, and relatively few bell peppers, chili peppers, and eggplants, some of the other food crops in the nightshade family.

“When the gut becomes ‘leaky,’ it is not a good thing,” Dr. Cordain writes, “as the intestinal contents may then have access to the immune system, which in turn becomes activated, thereby causing a chronic low level system inflammation.” The increased intestinal permeability, particularly in people with diseases of chronic inflammation — like type 1 diabetes — and diseases of insulin resistance — like type 2 diabetes — particularly troubles Dr. Cordain.

His conclusion is “to eliminate or drastically reduce potato consumption, and for autoimmune and allergy patients to be cautious with the consumption of tomatoes, chili peppers, and eggplants.”

Until recently, I had a weakness for hashed brown potatoes, as I have written here. Even though I knew that potatoes are both high glycemic and high carb, that wasn’t enough to stop me. But knowing that they are poisonous did.

This is a mirror of one of my articles that was originally published on Health Central.

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Byetta Vindicated

August 9th, 2010 · 3 Comments

Yesterday Medco Health Solutions presented a study at the Scientific Sessions of the American Diabetes Association. The study found that, contrary to warnings from the Food and Drug Administration, neither Byetta or Januvia increase the risk of acute pancreatitis.

Byetta and Januvia are two of the most important medications for type 2 diabetes, since they reduce blood glucose without increasing weight, which all the other diabetes drugs (except metformin, Victoza, and Symlin) do. In fact, Byetta is proven to reduce weight, and that’s why I wrote a book about it, Losing Weight with Your Diabetes Medication.

Due to reported cases of acute pancreatitis, several years ago the FDA added warnings to the labels for Byetta and Januvia.

However, Medco’s study indicates that patients taking either of these medications were no more likely to develop acute pancreatitis than patients taking other drugs to control diabetes. The study indicates there is an increased risk of acute pancreatitis for people with diabetes. But that it is not associated with the particular diabetic medication the patients are using.

“While cases of acute pancreatitis have been reported in patients using Byetta and Januvia, diabetic patients who are not taking these drugs also have been reported to have an increased risk for pancreatitis,” says Merri Pendergrass, MD, PhD, national practice leader of the Medco Therapeutic Resource Center for Diabetes, who conducted the study. “The major question has been are these medications causing the pancreatitis or are they innocent bystanders? Our findings are reassuring in that they did not reveal any increased risk of acute pancreatitis with Byetta and Januvia.”

Medco released even more good news for people taking Byetta. Another one of its studies presented at the ADA’s Scientific Sessions found that, despite FDA warnings, Byetta is not associated with an increased risk of acute renal failure in people with type 2 diabetes. This Medco analysis indicated that while there is an increased risk of acute renal failure in people with diabetes, the diabetes drug they are taking does not appear to impact that risk.

Medco Health Solutions Inc. conducted the study in association with the Medco Research Institute and the University of Texas Southwestern Medical School. Medco Health Solutions is a major pharmacy, ranking 35th on the Fortune 500. The study analyzed Medco’s pharmacy and medical claims data for more than 786,000 adult patients between January 2007 and June 2009.

They divided the people with diabetes into three groups based on whether they were taking Byetta, Januvia, or other diabetes drugs. A group of people without diabetes served as the control.

While the risk for acute pancreatitis was essentially the same among the three groups of people with diabetes, the average risk for all the diabetes groups was higher than that for the control group. Medco used comparable methodology and study parameters in the two studies.

The lack of increased risk of renal failure was news to me. But I’ve known for years that Byetta doesn’t pose an additional risk of pancreatitis, and I wrote about it here in October 2007. Now it’s time for the FDA to catch up.

This is a mirror of one of my articles that was originally published on Health Central.

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Posted in: Diabetes Medication

Is Gastric Bypass Surgery a Cure?

May 28th, 2010 · 1 Comment

Gastric bypass surgery is getting more and more attention as a potential cure for type 2 diabetes. For example, Dan Hurley’s outstanding recent book Diabetes Rising, which I reviewed here, included it in the author’s section on cures for diabetes.

Usually people define a cure based on fasting blood glucose and A1C tests. Anna L. Marina, M.D., a primary author of the case study, and her associate, Dace Trence, M.D., described a case that met those criteria, “but did not support remission of diabetes on further evaluation.”

Dr. Marina is a senior clinical research fellow in the division of metabolism, endocrinology, and nutrition of the University of Washington. Dr. Trence is associate professor of medicine there.


Dr. Anna Marina

Dr. Marina presented her findings at a press briefing during the annual meeting and clinical congress of the American Association of Clinical Endocrinologists in Boston today. I am attending this meeting to represent Health Central.

The subject of Dr. Marina’s presentation was a 55-year-old man who was morbidly obese with a BMI of 45.2 and who had had type 2 diabetes for seven years. He had undergone Roux-en-Y gastric bypass surgery, by far the most commonly performed bariatric procedure in the United States.

The surgery obviously helped him a lot. Right after his operation he was able to cut his insulin injections from 100 to 30 units a day. After four months he had lost more than 100 pounds and his A1C went from 9 to 6.1 percent. At that point he and his doctor decided that he didn’t need insulin any more.

But after seven months he started having post-meal blood glucose levels in the 180 mg/dl range. Then, as tested with a continuous blood glucose monitor, they could see that his post-meal levels were often in the 200 mg/dl range — all the way up to 294 mg/dl. Those levels are consistent with a diagnosis of diabetes.

This is also consistent with another recent study, Dr. Marina said. Dr. Mitchell Roslin and two associates reported at last year’s annual meeting of the American Society for Metabolic and Bariatric Surgery. They performed glucose tolerance tests on 38 people more than six months after they had Roux-en-Y gastric bypass surgery.

“They found that six out of these 38 people still had diabetes,” Dr. Marina said. She concluded that “fasting blood glucose and normal A1C are insufficient to establish that gastric bypass surgery is a cure for type 2 diabetes.”

Gastric bypass surgery is a last resort. It can work for some people with diabetes who are morbidly obese. But unfortunately not for all.

This is a mirror of one of my articles that was originally published on Health Central.

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Limiting Test Strips

January 21st, 2010 · 4 Comments

Today people who have diabetes can be thankful that the United States doesn’t have a single-payer health care system. Based on two Canadian studies released today, most of us could face the prospect that our health insurance would soon cease to cover the cost of testing with blood glucose strips.

The studies both proposed that Canada could save money by cutting benefits to people with type 2 diabetes who are using drugs other than insulin. Last year 63 percent of people with diabetes in the province of Ontario who weren’t using insulin used on average 1.29 test strips per day. Although many of us would say that’s too little, one of the studies concluded that it’s too much.

The Canadian Medical Association Journal CMAJ on December 21 released these studies subject to revision. You can read the full-text of one study at “Blood glucose test strips: options to reduce usage.” The full-text of the other new study is at “Cost-effectiveness of self-monitoring of blood glucose in patients with type 2 diabetes mellitus managed without insulin.”

Each article recognizes that those of us who inject insulin have to test regularly to avoid hypos, if for no other reason. All type 1s and about one-fourth of type 2s inject insulin. [Read more →]

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Posted in: Diabetes Testing

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

Losing Weight to Reverse Sleep Apnea

December 11th, 2009 · No Comments

Obstructive sleep apnea is one of the most common complications of diabetes, especially among people who are overweight. A recent study of 306 obese people with type 2 diabetes who wanted to lose weight found that more than 86 percent of them had sleep apnea.

The standard treatment for sleep apnea is wearing a CPAP machine for continuous positive airway pressure when we sleep. People who don’t control sleep apnea are much more likely to have high blood pressure, strokes, impaired quality of life, and a shorter life.

When I had sleep apnea, I was afraid that it will kill me. My sleep apnea was so severe when I did a sleep study in a hospital that they found I had 84 apneic episodes per hour. Before I wore a CPAP machine, I knew that I risked falling asleep at the wheel, as I wrote five years ago in Diabetes Wellness News. [Read more →]

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Posted in: Diabetes Complications

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