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Diabetes Update: Hypoglycemic Supplies

Number 55; February 14, 2003

By David Mendosa


On the Buligi Circuit At the Headwaters of the Nile

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:

  • Hypoglycemic Supplies
    When you get an insulin reaction, you often feel so miserable that you want to treat it as fast as possible. But if you overtreat it, you run the risk of rebounding too high.

    Fortunately, I don't take insulin or one of the oral medications that can cause us to go low. But people who use insulin can treat the inevitable lows it by taking about 15 grams of glucose tablets. Yet people often do that reluctantly.

    Why are they reluctant? They know that nothing worked quicker and that the standardized dose would not lead to high blood sugar. Yet they know that the glucose tabs don’t taste all that good. Besides, they may want the excuse to eat some tasty bread that normally they can’t get enough of.

    The problem with bread is that, while it’s glycemic index may be quite high (white wheat flour bread has a mean GI of 70), it is not high enough to treat an insulin reaction as quickly as possible. For that we need glucose. It’s GI is 100.

    These people are typical. And their reluctance to take glucose tabs when they need them is just one more sign of the unwarranted lack of respect that they get from us. Read all about these wonder sweets at http://www.diabetes.org/main/community/info_news/web/default.jsp .

  • Menus
    My Web site has just become a lot easier to use. There’s one major difference and one minor one.

    The big difference is that I have added a menu of most of my diabetes articles. The menu appears on these articles, including the Web version of this newsletter, http://www.mendosa.com/diabetes_update_55.htm .

    Previously, the best way to find my articles was to go to my Diabetes Directory page at http://www.mendosa.com/diabetes.htm . That page could have been better organized from a user’s point of view.

    The menu does not require frames. It uses JavaScript instead. One of my correspondents, Steve Dryja, provides the script and taught me how to enter the names and URLs of my articles in it.

    Steve says that he found my site from the 2001 paperback version of Dr. Julian Whitaker’s book Reversing Diabetes. Dr. Whitaker wrote, “Medical writer David Mendosa’s web site contains extensive lists of the glycemic indexes of specific foods. He also has links to many excellent articles explaining the glycemic index.”

    Steve is 43 and has had type 2 diabetes for about four years. For the past six years he has been a software tester. “But my forte,” he says, “is writing automated scripts to test web sites.”

    I have wanted to have a menu on my site for years. I appreciate Steve’s help and advice more than you can imagine.

    The less important improvement for surfing my site is the use of Google’s search engine instead of the inadequate search engine that my ISP made available. Correspondent Ted Quick told me exactly where to get the code from the Google site. And I thought that I was an expert on Google....

    You can see what I mean about this search engine by looking at one of the pages where I have installed it. It’s on my home page, http://www.mendosa.com, my Diabetes Directory page, www.mendosa.com/diabetes.htm, and many other pages on my site with a lot of traffic.

Research Notes:

  • Edmonton Protocol
    This week’s New Yorker has an important article on the nearest thing to a cure for diabetes. Known as the Edmonton Protocol, after the University of Alberta in that Canadian city, it has had great success in keeping people off of insulin after islet cell transplants. Under the direction of Dr. James Shapiro, a transplant surgeon, the Edmonton Protocol relies on using lots of islet cells and a combination of newer immunosuppressive drugs, such as tacolimus and sirolimus, that people had previously thought were incompatible.

    The author of the new article is Jerome Groopman, an M.D. professor of medicine at the Harvard Medical School. The article, “Annals of Medicine: The Edmonton Protocol: The search for a cure for diabetes takes a controversial turn,” appears on pages 48 through 57 in the February 10 issue of The New Yorker.

    The article is not on-line. In fact, the publisher wrote a friend of mine, Dr. Bill Quick, that “This article is under embargo until April 4, 2003 and may not be reprinted before then.” The New Yorker is my favorite magazines, and I have subscribed to it for years. If by some fluke, however, you don’t have a subscription, the article is worth reading at your local library. This issue is probably no longer available on newsstands.

    My column for the American Diabetes Association in June 2000, http://www.diabetes.org/main/community/info_news/web/june1500.jsp , reviewed the work of Dr. Shapiro and his associates soon after the team’s initial announcement. At that time they reported a 100 percent success rate—10 attempts and 10 successes.

    Until I read Dr. Groopman’s article, I had not been able to find out current statistics on the success rate of the Edmonton protocol. While the initial announcements were all that the success rate was 100 percent, a little later it became clear that there were some failures too. But nowhere could I find how many. Dr. Groopman’s article is useful in noting that by Thanksgiving 2001 that, “In Edmonton, [Jonathan] Lakey and Shapiro had carried out more than two dozen transplants, with enduring success for all but four patients, who had to begin insulin injections again, two years later.”

    Elsewhere, however, the article notes that more than 150 patients had gone through the protocol, ”Three and a half years after Bryon Best had the first successful human islet-cell transplant.” His transplant, Dr. Groopman says elsewhere in the article, was on March 11, 1999. So his statistics are up to the later part of last year. Unfortunately, he doesn’t say what the success rate was at that time or now.

    My biggest reservation about Dr. Groopman’s article is that he overstates the previous degree of failure with islet cell transplants. His quote of Dr. Shapiro on page 50 (third column, last paragraph) implies every previous one of the 450 transplants was a failure. Again, on page 51, Dr. Shapiro told Dr. Groopman, “Yes, there had been four hundred and fifty prior failures of islet transplantation, and this gave everyone pause.” That is not true.

    The International Islet Cell Registry at Germany’s University of Giessen maintains the official statistics. Newsletter No. 8 says:

    From 1893 through December 1998, a total of 405 adult islet allograft allotransplantations including historical cases have been performed at 42 institutions worldwide, including 202 at 15 institutions in North America, 198 at 25 institutions in Europe, and five elsewhere. The total number of diabetic patients reported to be insulin independent for 1 month, 3 months, 6 months, 12, 24, 36, and 48 month(s) through December 31, 1998, is 50, 47, 41, 33, 20, 9, and 3, respectively.
    More recently, in June 2001, Newsletter No. 9 says:
    From 1893 through December 2000, a total of 493 adult islet allograft allotransplantations including historical cases have been performed at 51 institutions worldwide, including 241 at 18 institutions in North America, 246 at 30 institutions in Europe, and six elsewhere. The total number of diabetic patients reported to be insulin independent for 1, 3, 6, 12, 24, 36, 48, and 60 month(s) through December 31, 2000, is 66, 62, 54, 40, 22, 11, 6, and 2, respectively.

    This is saying that of the 493 transplants a total of 81 had been insulin independent for a year or more. It is true that before Dr. Shapiro came along the record was pretty bad. A professor and two research fellows from the University of Oxford’s Department of Surgery say:

    Only 8% of recipients were insulin independent at one year. The longest duration of function of an islet allograft as defined by C peptide production is now over 8 years, and insulin independence has been maintained for over 5 years.

    The article reads like a puff piece for Dr. Shapiro and the Juvenile Diabetes Foundation, which is funding his work in part. It minimizes the efforts of others doctors who collaborated with Dr. Shapiro, particularly Dr. Camillo Ricordi of the Diabetes Research Institute at the University of Miami. Nor does it give any credit to other centers that are implementing the Edmonton Protocol.

    But, overall it is reasonably accurate and an important article for people with type 1 diabetes, parents of children with diabetes, and for opinion leaders everywhere.

  • Conjugated Linoleic Acid (CLA)
    They used to say simply that fat was bad for you. But the list of good fats keeps growing. They are not just monounsaturated and polyunsaturated fats. One type of polyunsaturated fat, omega-3, is especially good for us. But even the saturated fatty acid in palm and coconut oil—mainly palmitic acid—seems to be good for us.

    There are probably many more good fats. Conjugated linoleic acid (CLA) certainly seems to be in this group, now that a new study suggests that it may help people with diabetes reduce their weight and blood glucose levels. CLA can be found in foods such as beef, lamb, and dairy products. These are precisely the foods most suspect for their saturated fat content.

    The study appeared in the January issue of the Journal of Nutrition, pages 257S-260S. The lead author is Martha A. Belury, an associate professor of human nutrition at Ohio State University. The snappy title of the article is “Symposium: Dairy Product Components and Weight Regulation: The Conjugated Linoleic Acid (CLA) Isomer, t10c12-CLA, Is Inversely Associated with Changes in Body Weight and Serum Leptin in Subjects with Type 2 Diabetes Mellitus.” The abstract is online .

    The researchers also found that higher CLA levels in the bloodstream meant lower levels of leptin. The significance of leptin is that it is the hormone believed to regulate fat levels. High leptin levels may play a role in obesity, which is a major risk factor for type 2 diabetes.

    Fasting blood glucose levels decreased in nine of the 11 people taking the CLA supplement, compared to two of the 10 people in the control group taking the safflower supplement. In fact, fasting blood glucose levels decreased nearly fivefold in the people taking CLA compared to those taking the safflower supplements.

    As they always say, more research is needed.

  • Acrylamide Update
    If you stopped eating everything that is supposed to be bad for you, then you would get a lot thinner and your blood glucose levels would drop to normal or lower. You would probably also starve to death.

    As I reported in Diabetes Update #52, last April Swedish scientists discovered high levels of a potentially cancer-causing chemical called acrylamide in fried or baked foods that have starch in them. These include french fries, potato chips, bread, crackers, and breakfast cereals.

    Now, a follow-up study in the January 13 issue British Journal of Cancer, pages 84 to 89, shows that there is no link between acrylamide and the increased risk of cancer, at least for humans. Electronic publication was delayed until January 28, but the full text of the article is online at http://www.nature.com/cgi-taf/DynaPage.taf?file=/bjc/journal/v88/n1/full/6600726a.html.

    So relax. As the headline writer for the Ottawa Citizen neatly summarized the state of our knowledge, “Fries won’t kill you, just make you fat.”

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