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Diabetes Update: Third-Generation Meters

Number 54; January 31, 2003

By David Mendosa


Sunset
Typical California Sunset

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 contributions are:

  • Third-Generation Meters
    The third generation of blood glucose meters is here. These meters check our blood glucose level continuously. The payoff is much better control than we have ever had possible before.

    Two third-generation meters are already on the market. While so far they have serious limitations, at least 10 other companies are working as fast as they can to overcome these handicaps.

    Continuous testing is really the meter Holy Grail. It’s a giant step beyond the essentially painless alternative site meters that I dubbed “second-generation meters” in my September 15, 2001, column on the Web site of the American Diabetes Association. The first of these meters, Amira Medical’s AtLast, hit the market in December 1999. Like all revolutionary products, this meter had some limitations and is no longer available.

    First-generation meters—the traditional finger-stick devices—were the greatest advance in the treatment of diabetes since the discovery of insulin when the first person with diabetes started to test his blood with one in January 1970. I happen to know him and interviewed him for a March 2000 article in Diabetes Wellness Letter called “Meter Memories”. The first person with diabetes to use a blood glucose meter was then an engineer and is now a well-known endocrinologist, Dr. Richard K. Bernstein.

    You can see a picture of me holding that large first meter, the Ames Reflectance Meter, at “History of Blood Glucose Meters: Transcripts of the Interviews.” The Ames company no longer exists. It is now part of Bayer Corporation, which still makes blood glucose meters under the Ascensia name.

    The URL for my column is http://www.diabetes.org/main/community/info_news/web/default.jsp

Updates include:

  • Peanut Butter
    In December I reported that a Harvard study found that women who eat at least five ounces of peanuts and peanut butter a week reduced their risk of developing type 2 diabetes by 21 percent. That got me interested in the history of peanut butter, and I found many Web sites that said Dr. John Harvey Kellogg and his brother, William K. Kellogg, in Battle Creek, Michigan, received the first patent for peanut butter. All these sites say that the Kelloggs’ 1895 patent for “a pasty adhesive substance that is for convenience of distinction termed nut butter” but this didn’t pass my smell test. It sounded too much like an urban legend for me. The brothers did, of course, invent Kellogg’s Corn Flakes and many other foods.

    I told you then that I would continue to research the history of peanut butter and would report back to you. I discovered that Richard W. Schwarz had written his Ph.D. dissertation on Dr. John Harvey Kellogg. This 1964 University of Michigan dissertation was the basis of Schwarz’s book John Harvey Kellogg, M.D., 1970, Southern Publishing Association. My local library obtained the book for me from the University of California College of Medicine Library on inter-library loan.

    In the event, I was vindicated. “Another important item in the modern American diet which Kellogg first introduced was peanut butter,” Schwarz wrote on pages 120-121. “Shortly after 1890, he had a quantity of roasted peanuts ground up into a paste for use by patients who had difficulty in masticating nuts or peanuts...Making no attempt to secure patents which would let him control the production of either peanut butter or any of his nut butters, he announced that they were products that ‘the world ought to have; let everybody that wants it have it, and make the best use of it.’”

Book Review:

  • Diabetic Eye Disease
    Diabetic Eye Disease It’s a thrill for me to discover a great book about diabetes. It’s a thrill that is all too rare.

    That’s why I am so excited about a book that is scheduled to be published in the next couple of months. The publisher just sent me advance uncorrected proofs, and I am racing to publish one of the first reviews of this important book. As soon as the book is published I will add it to my list of a baker’s dozen books that I think are worth the attention of most anyone with diabetes.

    And unlike those books, several of which deal in general with diabetes, this new book zeros in on one of the worst complications of the disease, diabetic eye disease. In fact, there is nothing in the published literature that comes close to what Dr. A. Paul Chous offers us.

    His book, Diabetic Eye Disease: Lessons From a Diabetic Eye Doctor, is one of those rare books that is simultaneously told from both a professional and patient perspective. Like Steven Edelman, Richard K. Bernstein, and Lois Jovanovic—and no one else whom I can think of—Dr. Chous is a specialist who himself has diabetes. He is an optometrist with a doctor of optometry (O.D. degree) from the University of California, Berkeley, School of Optometry in 1991. He has had type 1 diabetes since 1968 when he was five years old.

    Dr. Chous didn’t become an optometrist because his vision was so good. In fact, he writes that, “After spending so much time in the eye doctor’s office, and having my life so profoundly affected by my eye doctors, I decided that I wanted to be an eye doctor and work diligently to reduce the eye complications of diabetes.”

    When the future Dr. Chous was a college senior, his optometrist told him that he had background retinopathy. The following year, just prior to graduate school, he saw a retinal specialist at his brother’s urging. That doctor informed him that the disease had progressed to proliferative retinopathy requiring immediate laser treatment. He didn’t have the time or money for the treatment, but his older brother, who was already a third year optometry student, insisted.

    “My brother held my hand while the laser treatment was performed,” Dr. Chous writes. “As I left the exam room, the specialist remarked that my brother’s words had probably saved my sight. Knowing what I know now, I am sure he was right.”

    The book starts with Dr. Chous’s story. Only about 11 years ago did he discover an outstanding endocrinologist, who taught him how to manage his diabetes. Treatment with an ACE inhibitor reversed the beginning stage of diabetic kidney disease. He now watches his diet closely, “eating foods with a low glycemic index whenever possible, and began exercising regularly.”

    Next, the book moves logically into a short section laying out the fundamentals of diabetes in about 34 pages. The bulk of the book and its real meat is the following section on diabetic eye disease. It’s a complicated subject, but Dr. Chous is absolutely lucid in presenting the basics of eye anatomy and then seven chapters on all the eye diseases associated with diabetes. Here is diabetic cataract, glaucoma, diabetic keratopathy, diabetic ischemic optic neuropathy, diabetic cranial neuropathy, diabetic retinopathy, and other retinal diseases. Whew! I never knew there were so many!

    About this point I became very concerned personally about what I was doing to avoid going blind myself. When I was diagnosed with diabetes in 1994, the fear of complications was my primary motivator. The fear of blindness was at the top of my list. It is still the top reason why I control my blood glucose and religiously keep my annual appointment with my eye doctor, as the American Diabetes Association recommends.

    But what else am I doing to prevent going blind? At this point in my reading I wondered if I was doing enough. And just then come Dr. Chous’s recommendations for preventing and minimizing diabetic eye disease. The first two were no surprise—to keep blood glucose levels as close to normal as possible and regularly check blood glucose and A1c levels. I had forgotten that high blood pressure and lipid (cholesterol and triglycerides) levels were important to the eye. If you smoke, quit. Get that annual eye exam. Take your vitamins, especially 800 IU of Vitamin E, and ask your doctor about a daily baby aspirin. Reduce stress. Seek out knowledgeable and helpful health care professionals. In fact, I do all those things, and therefore have a sound hope of retaining my vision as long as the rest of my body keeps functioning.

    The book concludes with two more useful chapters. They are about what to expect from an eye exam and how to deal with low vision, if your eye disease has progressed that far.

    Dr. Chous has registered an address, diabeticeyes.com, which will have more information about diabetic eye disease, the book, and ordering particulars. Meanwhile, Fairwood Press in Auburn, Washington, will publish Diabetic Eye Disease by A. Paul Chous in March or April 2003. The ISBN is 0-9668184-7-4. This trade paperback is 164 pages and lists for $15.99. Buy it as soon as you can.

Research News

  • Potential Misfolded Protein Cure
    Scientists at the Scripps Research Institute in San Diego have discovered how to prevent proteins in our bodies from clumping together. This causes 20 or more diseases, including type 2 diabetes, they now believe. Clinical trials are about to begin for two forms of heart disease that these misfolded proteins cause. Small molecule drugs stop the misfolding process, according to the report “Prevention of Transthyretin Amyloid Disease by Changing Protein Misfolding Energetics,” by R. Per Hammarström, R. Luke Wiseman, Evan T. Powers, and Jeffery W. Kelly in today’s Science, pp. 713-716. Sandra Blakeslee has an excellent article “Treatment Found for 2 Heart Ailments,” in today’s New York Times.

    Maggot
    Your Friend The Maggot

  • The Latest Technology
    Two new reports in the professional literature describe the benefits of using maggots to treat stubborn wounds and ulcers that refuse to heal as a result of infection or other problems. This promises to be especially exciting to people with diabetic neuropathy because maggots digest dead tissue and destroy bacteria.

    Maggots are the worm-shaped larva of various members of the fly family found in the decaying matter that they just love. When doctors put maggots on an open wound, the maggots secrete proteins that break down dead tissue fragments, creating a soup that the maggots ingest. They also release substances that help protect the injured skin from becoming re-infected, and their crawling on the wound may also encourage the growth of new tissue.

    G.N. Jukema and his associates at Leiden University Medical Center in the Netherlands published their findings in “Amputation-sparing treatment by nature: ‘surgical’ maggots revisited” in the December 2002 issue of Clinical Infectious Diseases, pages 1566-1571. At practically the same time, Ronald A. Sherman of the Veterans Affairs Medical Center, Long Beach, California, and the Department of Medicine, University of California, Irvine, California wrote about “Maggot Therapy for Treating Diabetic Foot Ulcers Unresponsive to Conventional Therapy” in the February 2003 issue of Diabetes Care, pages 446-451.

    Dr. Jukema says that all of his patients were very enthusiastic about using maggots. Of course, none of his patients were Americans.

    Each of his patients got at least 100 so-called “sterile” maggots on their wounds. After a few days, they began to report feeling pain from the biting and crawling of the maggots. Anesthesia helped.

    Likewise, Dr. Sherman wrote that maggot therapy was more effective and efficient than conventional care in removing damaged tissue from nonhealing foot and leg ulcers. His patients were male veterans with diabetes.

    What can possibly be next? Blood letting? Leeches?

  • Sat Fat Breakthrough
    Biochemist researchers from Colorado State University have identified a saturated fat byproduct as a potential contributor to the development of type 2 diabetes. Their research results show that a saturated fat metabolite called ceramide contributes to the development of insulin resistance in cultured cell experiments. Furthermore, the lab studies indicate that excess accumulation of ceramide in the body is a necessary link connecting saturated fats to insulin resistance.

    Their studies show that the saturated fats palmitate and stearate—but not their mono-unsaturated counterparts oleate and palmitoleate—blocked insulin activation while concomitantly promoting the accumulation of ceramide and diacylglycerol. Abnormal ceramide accumulation is unlikely to account entirely for the diverse array of defects found in insulin-resistant tissues. But the team’s findings connect ceramide as a vital factor explaining some of the harmful effects that saturated fats have on our bodies.

    The study by Jose Antonio Chavez and six co-authors, “A Role for Ceramide, but not Diacylglycerol, in the Antagonism of Insulin Signal Transduction by Saturated Fatty Acids,” is posted on the Web site of the Journal of Biological Chemistry at http://www.jbc.org/cgi/reprint/M212307200v1.pdf. It’s is expected to be published in the journal’s April print edition.

Boilerplate:

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