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type 2

Diabetes Medication

Is Gastric Bypass Surgery a Cure?

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 article is based on an earlier version of my article published by HealthCentral.

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Diabetes Testing

Limiting Test Strips

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. Continue Reading

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Diabetes Medication

Good Drugs, Bad Drugs

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. Continue Reading

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Diabetes Complications

Losing Weight to Reverse Sleep Apnea

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. Continue Reading

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Diabetes Complications, Exercise For Diabetes

A Short Walk Goes a Long Way

We can reverse one of the most common and insidious complications of diabetes when we walk just a little more. From 50 to 70 percent of people with type 2 diabetes and 95 percent of those who are obese have fatty liver. But up to 77 percent of people who have fatty liver don’t have any symptoms.

A study that the journal Hepatology just published in its July issue put 141 participants through an exercise program for three months. The participants had nonalcoholic fatty liver disease (NAFLD), sometimes called nonalcoholic steatohepatitis (NASH).

If it leads to cirrhosis of the liver, it’s fatal, unless you are lucky enough to get a liver transplant. Liver transplants may be available for people under 70 and my wife was only 69 when her doctor told her that she had cirrhosis. But he also told her that her weight makes a successful transplant unlikely, so two years ago she died from this awful complication of diabetes. Continue Reading

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Diabetes Diet

Inflammation: The Root of Diabetes

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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