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Diabetes Update 104: Salt

March 1, 2007

By David Mendosa


Good Morning

Good Morning

My most recent articles are:

  • David Mendosa’s Diabetes Blog
    Most of my new articles appear first on the HealthCentral website. Today the long-awaited redesign of the site went live. The new site looks different and, I think, better.

    One vast improvement that they tell me they have made is that your comments will go live immediately upon your posting them. Another is that I will be able to post my articles as soon as I am finished writing them. Right now, for example, they are six articles behind in posting them. So my site will be a lot more current. The new links are also shorter.

    Of course, there will be bugs in the new system. I think the typeface they use is too light for easy reading. The new command to print an entire article to the screen in one long page is a bit too wide for my monitor. You may well see others. Please let us know about them.

    Each month I describe and link these new blog articles here in Diabetes Update. But there is an easier way to find all of my blog articles since October 2005.

    The easiest way to read this and any blog is to use a blog reader. I use Bloglines, as I describe in my blog article, “Reading Health Blogs.”

  • My New Diabetes Blog Articles
    HealthCentral.com published five of my new diabetes blog articles in February:

    1. Take This with Just a Grain of Salt. The Food and Drug Administration doesn’t have any problem with us taking in 2,400 milligrams of salt (sodium) daily. But more and more experts are cautioning us that less is better. The trouble is that most of us in America get about 4,000 milligrams each day. Here’s what you can do about it to reduce your blood pressure, which can lead to heart problems, one of the most common complications of diabetes.

    2. Naked Barley: The Best Grain. Whole grain barley goes by many names. Most common is “hulless barley.” I prefer to call it by the term barley growers use, “naked barley.” No matter what you call, it there is no better grain.

    3. Splenda or Stevia. I just switched back to stevia. Here’s why.

    4. The Rise And Fall Of Nutritionism. Food is disappearing from the American supermarket and it’s being replaced by what marketers call nutrients. Nutritionism is good for business. But probably not for us mere people. It’s led to every sort of fad diet, from low-fat to low-carb.

    5. Commanding Telemedicine. A telemedicine device and data management system called the Commander that can save health insurance company’s money and might also save your life.
OneTouch Strip Problem:

    “My whole-blood Profile meter used to read 12 to 25 percent lower than my Ultra,” my friend Gretchen Becker writes me. Gretchen is the author of one of the very best books about diabetes. “Recently, it’s been giving the same readings, sometimes even higher than the Ultra. Customer service was no help.

    “So I did some research and discovered that OneTouch actually manufactures plasma-calibrated strips for the OneTouch Profile meter, but they’re designed for sale overseas. Also, there are some counterfeit strips on the market that measure plasma values. LifeScan shows the batch numbers of these counterfeit strips on its website.

    “A customer service rep finally answered my e-mail note about counterfeit strips (my lot number was not on their list):

    Thank you for taking the time to write to us. We are sorry to learn that you are experiencing a problem with your test strips. Please note that the lot number you provided has not been identified as a counterfeit product at this time. Also, please note that plasma-calibrated OneTouch Test Strips are manufactured and sold by LifeScan in a number of countries where plasma-calibration is the accepted standard. Therefore, while the package you purchased may not be counterfeit product, it may have been intended for sale outside of the United States.”

    I think people need to know about this. If you’ve always used a whole-blood meter and suddenly your readings are higher, it might be because of strips calibrated for plasma. It would be very easy for a shipment intended for overseas use to be shipped to distributors in the U.S.

Continuous Glucose Meters:

    Gretchen Becker wrote me with another excellent suggestion to share with all of you.

    “You should really think about buying a continuous monitor,” she writes. “I think the DexCom is now around $500 including five sensors. I’m learning a tremendous amount from the one I’m using, enough that I spent $200 of my own money to buy five more sensors.

    “They’re $35 each, to last three days, but most people are finding they can use them longer than that. One guy who writes on software or hardware for the diabetes mags says his usually work for three weeks. That's $1.60 a day for the sensors. Less than the cost of two extra strips, although the strips are usually covered by insurance.

    “I think the CGM companies are catching on to the fact that patients are using the sensors “off label,” and the next generation may have automatic cutoffs, so it might make sense to try them now.

    “Everyone says the Abbott Navigator will be much more accurate, but no one knows what that will cost, and no one knows when it will be approved.

    “These things can be very frustrating when the become uncalibrated and wake you up saying you’re low when you’re not or buzzing at a social event when they don’t need to. But I think the trade-offs are worth it.

    “One caveat: the DexCom can be inaccurate in an absolute sense. Yesterday I had a low carb lunch and then went for a walk. When I got back Dex said my BG was 156. I was really discouraged. I double-checked with Ultra and it said 119. I’ve also had it tell me I was low at 53 when I was 80 according to Dex. However, it does show you trends. If it shows a peak after eating something you thought was fine, like chana dal, you know to check into your reaction to that food with a meter next time you eat it.

    “Other times it can be incredibly close. I woke up with a 92 and Dex said 94. My Ultra can vary more than that.

    “Right now I’m trying to restart a sensor. I started the 2-hour “warm-up” time before I got up, so it was ready to go at 7 a.m. when I got up, and I figured BG was pretty steady. I did the required two fingersticks and uploaded them to the Dex and then had breakfast. After 15 minutes, the thing beeped and said it wanted another two drops of blood. By this time I figured my BG would be moving and it’s not wise to calibrate then, so I'll have to wait until before lunch. Then another two fingersticks. Medicare says I need only 3 strips a day…

    I call it my Vampire meter.”

    I told Gretchen that she has a very good point. Even a low A1C can mask glycemic excursions.

    I’ve written about this problem several times. This includes on my blog and my website. By far the best way to control those highs and lows is to use a continuous monitor.

    Full disclosure: I own 150 shares of DexCom stock.

Christina’s CGM Spreadsheet:

    Christina Davis gives us the Excel spreadsheet she developed for using her new continuous glucose monitor. “I recently started on a CGM and became very frustrated with the lack of data management options/software,” she writes. “I have all this new data and no good or intuitive way to manage it, and easily enter my own data. So I created a pretty nifty Excel file with a table and graph that I think is visually intuitive. I wanted a graph that showed a downward influence on my BG from insulin delivered, and upward influence from carbs, and that also was able to distinguish between pure carbs and mixed carbs/fat/protein. So I came up with this and thought I would send it to you for you to share with everyone, since I spent a ton of time on it and also on your website investigating my various options. It’s in Excel format. I tried opening it in OpenOffice and it sort of works but the chart gets really distorted.” It is available at http://www.mendosa.com/cgm_spreadsheet.xls

Taking Control Of Your Diabetes:

    Taking Control Of Your Diabetes, (TCOYD), a nationally recognized not-for-profit diabetes educational organization, invites people with diabetes, as well as those at risk for diabetes and their loved ones, to a full day of seminars, workshops, and one-on-one opportunities with leading experts in diabetes care to conferences across the country in 2007. TCOYD’s mission is to educate and motivate people with diabetes and their loved ones to take a more active role in their condition in order to live healthier, happier, and more productive lives.

    The 2007 TCOYD conference schedule is under way. Here it is:

    March 10, Las Vegas - Riviera Casino
    April 28, Native American Program - Southern California
    May 19, Minneapolis - Minneapolis Convention Center
    June 2, LA - Los Angeles Convention Center
    September 15, Silicon Valley - Santa Clara Convention Center
    October 6, Little Rock - Statehouse Convention Center
    October 20, Kalispell - West Coast Outlaw Hotel
    November 17, Milwaukee - Midwest Airlines Center
    December 8, San Diego - San Diego Convention Center

New Reuable Insulin Pens:

    Lilly is launching two new reusable insulin pens that can help people simplify their diabetes control:

    The high-tech HumaPen Memoir is the first insulin pen that actually “remembers” multiple insulin doses. It became available on February 22.

    The HumaPen Luxura HD allows for half-unit dosing. This can help those who don’t require large amounts of insulin or parents of some children with diabetes. It will become available in April.

    Both pens also bring something new to the medical device market, a Lilly representative wrote me. Their sleek styling resembles a writing pen, offering the potential for less noticeable injections in public.

    A national survey of 1,000 insulin users showed that two-thirds surveyed would be interested in using a pen with memory. Nearly 1 in 3 reported forgetting whether they took their insulin at least once a month, and 38 percent were most interested in using the memory function to compare doses to food. And 44 percent said a stylish-looking pen would make them feel more comfortable injecting insulin in a public place or around family and friends.

Announcements:

  • This Newsletter
    Diabetes Update keeps you up-to-date with new articles, Web pages, and books that I have written about diabetes.

    I list and link most of these on my at Diabetes Directory and in the site’s menu at the upper left of all my Web pages.

    From time to time Diabetes Update may also include links to other Web pages of special interest.

  • HTML Format
    I send out Diabetes Update email in HTML format, which all Web browsers and most modern email programs can display. HTML has live links to all the sites named in the text so that with a simple click of a mouse you can connect to the site you have just been reading about.

  • My Guarantee
    This newsletter:
    1. Is and will remain free.
    2. Will never include advertising (except targeted Google ads at the bottom of the web page and not in the email newsletter).
    3. Nor will I ever sell, rent, or trade your email address to anyone.
    4. I will link sources of information.
    5. I will disclose any conflict of interest.
    6. If and when I learn of any errors of fact, I will correct them.

Archives:

I now send out Diabetes Update once a month. Previous issues are online:

  1. Diabetes Update Number 1: Diabetes Genes of December 10, 2000
  2. Diabetes Update Number 2: DiabetesWATCH of December 18, 2000
  3. Diabetes Update Number 3: Starlix of January 3, 2001
  4. Diabetes Update Number 4: Native Seeds/SEARCH, Tepary Beans of January 17, 2001
  5. Diabetes Update Number 5: Insulin Makes You Fat of January 31, 2001
  6. Diabetes Update Number 6: Available and Unavailable Carbohydrates of February 15, 2001
  7. Diabetes Update Number 7: Dates of March 1, 2001
  8. Diabetes Update Number 8: Quackwatch of March 15, 2001
  9. Diabetes Update Number 9: The Cost of Insulin of March 30, 2001
  10. Diabetes Update Number 10: Sof-Tact Meter of April 2, 2001
  11. Diabetes Update Number 11: iControlDiabetes of April 16, 2001
  12. Diabetes Update Number 12: Cinnamon, Tagatose of May 2, 2001
  13. Diabetes Update Number 13: Glycemic Index of May 15, 2001
  14. Diabetes Update Number 14: Eat Your Carrots! of May 31, 2001
  15. Diabetes Update Number 15: Glycemic Load of June 21, 2001
  16. Diabetes Update Number 16: Homocysteine of July 2, 2001
  17. Diabetes Update Number 17: Chana Dal Tips of July 15, 2001
  18. Diabetes Update Number 18: Lag Time in AlternativeLand of August 2, 2001
  19. Diabetes Update Number 19: Fiber of August 15, 2001
  20. Diabetes Update Number 20: How Diabetes Works of August 30, 2001
  21. Diabetes Update Number 21: Insulin Resistance of September 14, 2001
  22. Diabetes Update Number 22: Trans Fats, Honey, CU of October 1, 2001
  23. Diabetes Update Number 23: Pedometer Power of October 15, 2001
  24. Diabetes Update Number 24: Is Glycerin a Carbohydrate? of October 31, 2001
  25. Diabetes Update Number 25: Kill the Meter to Save It of November 15, 2001
  26. Diabetes Update Number 26: Protein, Fat, and the GI of December 1, 2001
  27. Diabetes Update Number 27: Insulin Index of December 14, 2001
  28. Diabetes Update Number 28: Fructose of January 4, 2002
  29. Diabetes Update Number 29: Aspirin of January 14, 2002
  30. Diabetes Update Number 30: Stevia of January 31, 2002
  31. Diabetes Update Number 31: Gretchen Becker’s Book of February 19, 2002
  32. Diabetes Update Number 32: The UKPDS of March 4, 2002
  33. Diabetes Update Number 33: Financial Aid of March 18, 2002
  34. Diabetes Update Number 34: Pre-Diabetes of April 1, 2002
  35. Diabetes Update Number 35: More Glycemic Indexes of April 15, 2002
  36. Diabetes Update Number 36: Gila Monsters of April 30, 2002
  37. Diabetes Update Number 37: Is INGAP a Cure? of May 15, 2002
  38. Diabetes Update Number 38: Native American Diabetes of June 3, 2002
  39. Diabetes Update Number 39: FDA Diabetes of June 19, 2002
  40. Diabetes Update Number 40: Diabetes Support Groups of July 1, 2002
  41. Diabetes Update Number 41: New GI and GL Table of July 15, 2002
  42. Diabetes Update Number 42: Diabetes Sight of August 1, 2002
  43. Diabetes Update Number 43: DrugDigest of August 18, 2002
  44. Diabetes Update Number 44: Hanuman Garden of September 3, 2002
  45. Diabetes Update Number 45: Guidelines of September 16, 2002
  46. Diabetes Update Number 46: Trans Fat of October 4, 2002
  47. Diabetes Update Number 47: Nutrition.Gov of October 16, 2002
  48. Diabetes Update Number 48: Our Hearts of October 31, 2002
  49. Diabetes Update Number 49: Our Kidneys of November 15, 2002
  50. Diabetes Update Number 50: A1C<7 of December 2, 2002
  51. Diabetes Update Number 51: Diabetes Searches with Google of December 16, 2002
  52. Diabetes Update Number 52: e-Patients of January 2, 2003
  53. Diabetes Update Number 53: Email News of January 16, 2003
  54. Diabetes Update Number 54: Third Generation Meters of January 31, 2003
  55. Diabetes Update Number 55: Hypoglycemic Supplies of February 14, 2003
  56. Diabetes Update Number 56: Food Police of March 1, 2003
  57. Diabetes Update Number 57: Vitamins of April 1, 2003
  58. Diabetes Update Number 58: Lancets of May 1, 2003
  59. Diabetes Update Number 59: Accurate Meters of June 1, 2003
  60. Diabetes Update Number 60: Chromium of July 1, 2003
  61. Diabetes Update Number 61: Traveling of August 1, 2003
  62. Diabetes Update Number 62: My Book of September 1, 2003
  63. Diabetes Update Number 63: Hot Tubs of October 1, 2003
  64. Diabetes Update Number 64: Home A1C Testing of November 1, 2003
  65. Diabetes Update Number 65: Detemir of December 1, 2003
  66. Diabetes Update Number 66: Erectile Dysfunction of January 1, 2004
  67. Diabetes Update Number 67: Acidic Foods of February 1, 2004
  68. Diabetes Update Number 68: Net Carbs of March 1, 2004
  69. Diabetes Update Number 69: Glycemic Index of April 1, 2004
  70. Diabetes Update Number 70: Dreamfields Pasta of May 1, 2004
  71. Diabetes Update Number 71: Cholesterol of June 1, 2004
  72. Diabetes Update Number 72: Meter News of July 1, 2004
  73. Diabetes Update Number 73: Pill Splitting of August 1, 2004
  74. Diabetes Update Number 74: GlucoMON of September 1, 2004
  75. Diabetes Update Number 75: Coding of October 1, 2004
  76. Diabetes Update Number 76: Sleep Apnea of November 1, 2004
  77. Diabetes Update Number 77: Keynote Address of December 1, 2004
  78. Diabetes Update Number 78: Mangosteen of January 1, 2005
  79. Diabetes Update Number 79: Noninvasive Dream of February 1, 2005
  80. Diabetes Update Number 80: Pelikan Sun of March 1, 2005
  81. Diabetes Update Number 81: Medtronic Monitors of April 1, 2005
  82. Diabetes Update Number 82: ExtendBars of May 1, 2005
  83. Diabetes Update Number 83: GlycoMark of June 1, 2005
  84. Diabetes Update Number 84: My British Book of July 1, 2005
  85. Diabetes Update Number 85: Disintegrating of August 1, 2005
  86. Diabetes Update Number 86: Meter Research of September 1, 2005
  87. Diabetes Update Number 87: Evaluating Meters of October 1, 2005
  88. Diabetes Update Number 88: When to Test of November 1, 2005
  89. Diabetes Update Number 89: Blogging of December 1, 2005
  90. Diabetes Update Number 90: RSS Feed of January 1, 2006
  91. Diabetes Update Number 91: An Uncommon Doctor of February 1, 2006
  92. Diabetes Update Number 92: More Blog Entries of March 1, 2006
  93. Diabetes Update Number 93: Talking Meters of April 1, 2006
  94. Diabetes Update Number 94: Navigating of May 1, 2006
  95. Diabetes Update Number 95: Measuring Sweat of June 1, 2006
  96. Diabetes Update Number 96: The Future of Pumps of July 1, 2006
  97. Diabetes Update Number 97: Pumping in Real Time of August 1, 2006
  98. Diabetes Update Number 98: The DexCom Sensor of September 1, 2006
  99. Diabetes Update Number 99: GlucoTel of October 1, 2006
  100. Diabetes Update Number 100: Discovery of Byetta of November 1, 2006
  101. Diabetes Update Number 101: My Diabetes Blog of December 1, 2006
  102. Diabetes Update Number 102: Stress of January 1, 2007
  103. Diabetes Update Number 103: UltraMini of February 1, 2007

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