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.

“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:
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  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.

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