Number 50; December 2, 2002

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My Little Chimp Friend Upcountry Liberia, 1971

This newsletter keeps you up-to-date with new articles, columns, and Web pages that I have written. I list and link most of these on my Diabetes Directory at www.mendosa.com/diabetes.htm

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

My most recent contribution is:

on December 2, 2002

• A1c<7
  The folks who sponsor the Diabetes A1c Initiative failed to ask for my support, so I will try to help with what I write about it. The campaign features a team of patient advocates known as A1c Champions who will tour the country and give tips about keeping diabetes under control. If I believe in anything, it is the importance of controlling my diabetes and that regular A1c tests are the best measure that I have to make sure that I am doing that.

  My A1c had crept up to 6.8 last year. That was enough to get me to ask my endocrinologist to prescribe metformin. My most recent test a few months ago came in at 6.2, precisely the point where the U.K. Prospective Diabetes Study says that complications begin.

  Those A1c Champions who are fated to have to campaign without me seek to persuade the world—or at least all Americans with diabetes—that we have to bring down our A1c levels. Nobody knows exactly, but those levels are typically 8.5 to 9. The Diabetes A1c Initiative that they are campaigning for seeks to bring those levels down to 7. Why not to 6.2 or below?

  The answers to that are in my column. You can find it at http://www.diabetes.org/main/community/info_news/web/default.jsp

Updates include:

  on November 20, 2002
• GLP-1
  One of the most exciting drugs on the horizon for people with type 2 diabetes is AC2993, which in April I wrote about in Diabetes Update Number 36 and my “About the Internet” column for the American Diabetes Association. Amylin Pharmaceuticals now has AC2993 in Phase 3 clinical trials.

  AC2993 is certainly a bland, bureaucratic name for a drug with such an interesting origin and great promise. It is based on Gila monster venom. An extended release form, AC2993 LAR, may offer allow once-a-month injection of AC2993. It is currently in Phase 2 evaluation.

  These drugs are peptides that exhibits several anti-diabetic actions of the mammalian hormone glucagon-like peptide (GLP-1). But unlike GLP-1, which has activity measured in minutes, AC2993 and particularly AC2993 LAR have a prolonged duration of action.

  Several other companies are racing to develop sustained release formulations of GLP-1 analogs. However, Lilly is no longer one of these companies. In September Lilly announced that it was discontinuing its GLP-1 analog program at the time it announced a partnership with Amylin for the development and marketing of AC2993 and AC2993 LAR. Lilly has invested $110 million in Amylin, according to this SEC filing.

  A Novo Nordisk candidate, NN2211, is another once-a-day formulation of a GLP-1 analog. Two studies reported this year in professional publications of the American Diabetes Association, Diabetes Care and Diabetes, had promising results in trials with eight and 11 subjects respectively.

  ConjuChem Inc., a biotechnology company based in Montreal, in July announced the start of a Phase 1 clinical trial for a GLP-1 analog. The company says that they anticipate that the optimal dosing regime will be no more frequent than once per week.

    on December 1, 2002
  

• Forthcoming Meter
  Months ago I picked up rumors of a new LifeScan system that combines everything I ever wanted in a blood glucose meter. My requirements are the capability to use it on alternative sites where we have few nerve endings, a small drop of blood, fast results, and event codes such that only the One Touch Profile has had. Now a German site has a picture and description of the meter that makes me think we will have it soon. It’s the One Touch UltraSmart and you can read all about it at http://www.diabetes-kids.de/pics/onetouch_ultrasmart.jpg and http://www.fda.gov/cdrh/pdf2/k021819.pdf. I updated my On-line Diabetes Resources Part 14: Blood Glucose Meters page accordingly.

Research Notes:

  on November 19, 2002

• More AGEs
  I sense extraordinary resistance to the recommendation that we reduce our intake of advanced glycation end products (AGEs) in order to limit the damage to our blood vessels that they may cause. Helen Vlassara, M.D., a professor at the Mount Sinai School of Medicine in New York, is the lead author of a research report that says we have to radically change the way we cook our foods.

  Some of us are quite interested in Dr. Vlassara’s findings, judging from the number of questions I have received. I passed on the questions to her and her associates. They initially replied by sending me a Microsoft Word file, “Low AGE Meal Plan Instructions.” So that everyone can read it, I used Adobe Acrobat to convert it to a PDF, which I uploaded to my site as http://www.mendosa.com/Low AGE Meal Plan Instructions.pdf.

  Readers wanted to know how cooking in crockpots or in pressure cookers would affect the formation of AGEs. There is also a question about coffee. The “Low AGE Meal Plan Instructions” say, “Limit hot cocoa mixes or chocolate drinks. All others are allowed as desired. Examples are coffee, tea and sodas.”

  But the AP article says, “Vlassara said that coffee, cola and chocolate drinks also are loaded with AGEs.” Should we drink it or not?

  When I asked Dr. Vlassara about these questions, I received this reply from Teresia Goldberg, MS, RD, CDE, the research dietitian who works with her:

  "Regarding AGEs in coffee and colas: These beverages contain higher levels of AGE as compared to milk, water, and juices. Consuming large quantities of these beverages will add to the AGE load, but the major contributors will be protein foods. However, these beverages can be consumed if the major contributors are controlled.

  "We have not tested foods prepared in crockpots or in pressure cookers. However, from the data we do have we know that time is also a factor in AGE generation. The longer cooking time would be expected to increase AGE content. Pressure cooking does reduce cooking time, but pressure also changes protein conformations and may promote more rapid AGE formation."

Book Review:

on November 20, 2002

• Nutrients for Neuropathy
  The third volume in John Senneff’s "Numb Toes Series," Nutrients for Neuropathy doesn’t quite have the catchy title of its predecessors, Numb Toes and Aching Soles and Numb Toes and Other Woes. Yet the more limited scope of the current book allows John to go into even greater depth.

  These books come from the patient standpoint. John, a retired attorney, suffers from peripheral neuropathy. But don’t be concerned about legalese here. John writes with extraordinary clarity in this 172-page paperback book. This is an easy read on a hard subject. Just published by http://www.medpress.com, Nutrients for Neuropathy lists for $19.95.

  The main divisions of the book are vitamins, minerals, and other supplements. In each of these areas I appreciated John's precision and at the same time found myself wishing that he had gone a bit further. Among vitamins, for example, he recognizes that Vitamin E contains four different tocopherols only in a footnote, and even there says that "Commercially available vitamin E supplements contain primarily alpha-tocopherol." The people at TwinLab and NOW Foods who sell mixed tocopherols might be surprised to hear that.

  Likewise, he has an excellent discussion of the efficacy of magnesium, but ignores the question of what balance it needs to have with calcium intake. For omega-3 fatty acids he recommends more and for omega-6 less, consistent with what most of the experts say.

  But I wonder about his recommendation of 1800 mg of EPA and 900 mg of DHA, the two main omega-3 oils we get from fish. I wish that he had considers some recent studies that may show better results with DHA alone.

  In spite of these, er, peripheral reservations, I provide a positive link to John’s new book on my neuropathy links page, On-line Diabetes Resources Part 15: Diabetic Neuropathy.

Announcement:

on November 21, 2002

• Help in Getting Around My Web site
  

  Recently, somebody complained on the Diabetes mailing list that my Web site was confusing. In my reply I tried to help as much as I could. Later, I realized that some of you reading Diabetes Update may share that confusion. This is essentially what I wrote:

  I am sorry that you find my Web site to be confusing. Please let me know just what you find to be confusing about it.

  Part of the problem, I’m sure, is that my website covers a very wide range of my interests. So it is both a highly personal site and a diabetes resource at the same time.

  For people who are just interested in diabetes and don’t want to know about me or my other interests, the place to start is:

  David Mendosa's Diabetes Directory
  www.mendosa.com/diabetes.htm

  This page lists and links most of my articles, columns, and Web pages about diabetes. I admit that it could be easier to get around, but I have it divided into a dozen sections:

  1. Advice for Newbies
     
  2. Information about me and why I maintain the Web site.
     
  3. On-line Diabetes Resources (15 pages of links and descriptions of all the substantive sites dealing with diabetes)
     
  4. The Glycemic Index
     
  5. My “About the Internet” column on the American Diabetes Association website (116 columns to date)
     
  6. Articles for NutriNews (the site is dead, but I saved the articles)
     
  7. eCharged Newsletters for LXN (the site and the company is dead, but I saved the articles)
     
  8. Articles for DiabetesWebSite (the site is dead, but I saved the articles)
     
  9. Articles in Diabetes Wellness News (formerly Diabetes Wellness Letter)
     
  10. Other articles about diabetes
      
  11. Articles about chana dal (a very low glycemic bean)
      
  12. A link to my “Diabetes Update” newsletter (what you are reading right now)

  Boilerplate:

  • I send out Diabetes Update e-mail in HTML format, which all Web browsers and most modern e-mail 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.

  • This newsletter is free. Nor will I ever sell, rent, or trade your e-mail address to anyone without your permission.

  Archives:

  I send out Diabetes Update about twice a month. Previous issues are online:

  • Diabetes Update Number 1: Diabetes Genes of December 10, 2000

  • Diabetes Update Number 2: DiabetesWATCH of December 18, 2000

  • Diabetes Update Number 3: Starlix of January 3, 2001

  • Diabetes Update Number 4: Native Seeds/SEARCH, Tepary Beans of January 17, 2001

  • Diabetes Update Number 5: Insulin Makes You Fat of January 31, 2001

  • Diabetes Update Number 6: Available and Unavailable Carbohydrates of February 15, 2001

  • Diabetes Update Number 7: Dates of March 1, 2001

  • Diabetes Update Number 8: Quackwatch of March 15, 2001

  • Diabetes Update Number 9: The Cost of Insulin of March 30, 2001

  • Diabetes Update Number 10: Sof-Tact Meter of April 2, 2001

  • Diabetes Update Number 11: iControlDiabetes of April 16, 2001

  • Diabetes Update Number 12: Cinnamon, Tagatose of May 2, 2001

  • Diabetes Update Number 13: Glycemic Index of May 15, 2001

  • Diabetes Update Number 14: Eat Your Carrots! of May 31, 2001

  • Diabetes Update Number 15: Glycemic Load of June 21, 2001

  • Diabetes Update Number 16: Homocysteine of July 2, 2001

  • Diabetes Update Number 17: Chana Dal Tips of July 15, 2001

  • Diabetes Update Number 18: Lag Time in AlternativeLand of August 2, 2001

  • Diabetes Update Number 19: Fiber of August 15, 2001

  • Diabetes Update Number 20: How Diabetes Works of August 30, 2001

  • Diabetes Update Number 21: Insulin Resistance of September 14, 2001

  • Diabetes Update Number 22: Trans Fats, Honey, CU of October 1, 2001

  • Diabetes Update Number 23: Pedometer Power of October 15, 2001

  • Diabetes Update Number 24: Is Glycerin a Carbohydrate? of October 31, 2001

  • Diabetes Update Number 25: Kill the Meter to Save It of November 15, 2001

  • Diabetes Update Number 26: Protein, Fat, and the GI of December 1, 2001

  • Diabetes Update Number 27: Insulin Index of December 14, 2001

  • Diabetes Update Number 28: Fructose of January 4, 2002

  • Diabetes Update Number 29: Aspirin of January 14, 2002

  • Diabetes Update Number 30: Stevia of January 31, 2002

  • Diabetes Update Number 31: Gretchen Becker’s Book of February 19, 2002

  • Diabetes Update Number 32: The UKPDS of March 4, 2002

  • Diabetes Update Number 33: Financial Aid of March 18, 2002

  • Diabetes Update Number 34: Pre-Diabetes of April 1, 2002

  • Diabetes Update Number 35: More Glycemic Indexes of April 15, 2002

  • Diabetes Update Number 36: Gila Monsters of April 30, 2002

  • Diabetes Update Number 37: Is INGAP a Cure? of May 15, 2002

  • Diabetes Update Number 38: Native American Diabetes of June 3, 2002

  • Diabetes Update Number 39: FDA Diabetes of June 19, 2002

  • Diabetes Update Number 40: Diabetes Support Groups of July 1, 2002

  • Diabetes Update Number 41: New GI and GL Table of July 15, 2002

  • Diabetes Update Number 42: Diabetes Sight of August 1, 2002

  • Diabetes Update Number 43: DrugDigest of August 18, 2002

  • Diabetes Update Number 44: Hanuman Garden of September 3, 2002

  • Diabetes Update Number 45: Guidelines of September 16, 2002

  • Diabetes Update Number 46: Trans Fat of October 4, 2002

  • Diabetes Update Number 47: Nutrition.Gov of October 16, 2002

  • Diabetes Update Number 48: Our Hearts of October 31, 2002

  • Diabetes Update Number 49: Our Kidneys of November 15, 2002

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  © Copyright 2002 David Mendosa. All Rights Reserved.

  David Mendosa:
  A Writer on the Web: www.mendosa.com
  E-mail: mendosa@mendosa.com
  Office: 993 E. Moorhead Circle Suite 2F, Boulder, CO 80305