Number 61; August 1, 2003

This newsletter keeps you up-to-date with new articles, columns, and Web pages that I have written.

Along our Garden Path

• I list and link most of these on my Diabetes Directory at www.mendosa.com/diabetes.htm and in the site’s menu.

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

My most recent contributions are:

• Traveling with Insulin
  It’s not too late to start thinking about a summer vacation. In fact, if you can swing it, the best time might be after Labor Day, when the kids are back in school.

  However, if you think that adventure travel is out for you because you need to keep your insulin cool in a refrigerator, you now have choices that can free you to wander as you would. My new article on insulin carrying cases sounds mundane when you put it that way, but not when you think of the freedom that these carrying cases can give you.

  

  Finally, the revised edition of the low-carb bible for people with diabetes

• Dr. Bernstein’s Diabetes Solution
  This is a review of a new book, so maybe I should list it in the book review section below. But it’s here because it is an article separate from this newsletter. You can’t read it here, because it’s too long.

  It’s not only long but also reviews an important book. This one of those rare books about diabetes that I include in my essential books list.

  Later this month the revised and updated edition of his classic Solution will be in bookstores. The first edition came out in May 1997 and had a tremendous influence on the diet of thousands of people with diabetes.

  Dr. Bernstein’s diet is rigorously low carb. It is hard to follow, unless you are motivated to get excellent control and otherwise never found the means. If you thought that eating low glycemic was difficult, just try a diet where you generally can’t eat more than 42 grams of carbohydrate in a whole day.

  For all the details, including Dr. Bernstein’s patented weight-loss program and his attack on the glycemic index (plus a rebuttal from Professor Jennie Brand-Miller, the leading glycemic researcher), please read my article.

Research News:

• A molecule that “stages a two-pronged attack on diabetes” sounds like something worth the long wait that discoveries inevitably take before we can use them. Sarah Graham writing in Scientific American.com thus best captured the sexy significance of research announced in the July 18 issue of Science.

  A large group of scientists at Hoffmann-La Roche in Nutley, New Jersey, reported on “Allosteric Activators of Glucokinase.” An allosteric site is a drug-binding pocket somewhere other than the active site of the glucokinase enzyme. The most remarkable thing about their report is that 19 people wrote it. Like any committee report, it’s not the most exciting prose.

  But Science writer Jennifer Couzin in the same issue explains that glucokinase is an enzyme that regulates

  Two key functions that fail in diabetics, secretion of insulin by the pancreas and production of glucose by the liver. Boosting glucokinase activity, they believed, might normalize both—something no diabetes drug can do.

  The reality, however, is a good deal less exciting than Jennifer seems to think. I don’t know anybody who has been waiting for that particular “one-two punch,” as she terms it.

  Three drugs—the sulfonylureas, Prandin, and Starlix—already stimulate insulin secretion from the beta cells of the pancreas. In fact, many people including Richard K. Bernstein in the book reviewed here believe that the sulfonylureas cause beta cell burnout.

  In fact, we have no evidence that sulfonylureas cause beta cells to burn out, maintains another endocrinologist, Edward S. Horton, director of clinical research at the Joslin Diabetes Center in Boston. He was the lead investigator of one the Starlix clinical trials and spoke with me for my “Smart Drugs” article. “I know that it is a popular conception that people have,” he says, “but it is not true.”

  Another diabetes drug, metformin, decreases the liver’s glucose production, Jennifer’s second prong or punch. Metformin, sold here as Glucophage, Glucophage XR, and generic metformin, in fact was the original diabetes one-two punch—however with different targets. It actually has three targets, none of which is the controversial stimulation of insulin secretion.

  “Metformin decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and utilization,” according to prescribing information for Glucophage and Glucophage XR.

  While the potential for the drug that activates glucokinase is probably not too exciting, it is intellectually interesting. Until now, every drug that targets an enzyme has been an inhibitor rather than an activator, notes chemist Derek Lowe in his Corante blog “In the Pipeline.” The compound that the Roche group discovered is probably the first enzyme activator ever discovered.

Book Reviews:

Truly, a fun book—and not just for monkeys.

• If your monkey has diabetes, this is the book you have been waiting for. No, I’m kidding, kids. This book, I Have Diabetes Too! Molly’s Story, is really for you and your parents.

  Molly is a spot-nosed monkey. She is the animal companion to Camille R. Dorian, who wrote this book with Moshe Shifrine, and Dr. Randy Dorian. In February 2000, I met Randy in South San Francisco. At the time Islet Sheet Medical LLC, now named Cerco Medical, where he is the chief science officer, was recruiting me to write a column for one of their Web sites, GoodBloodSugar.com. It turned out that an existing contract prevented me from accepting their offer, but I have kept in touch with the people there and reviewed another of the company’s Web sites, Hanuman Garden for the American Diabetes Association’s Web site. That column is now online at http://www.mendosa.com/hanuman.htm.

  I also reviewed I Have Diabetes Too! Molly’s Story, when Randy sent me galley proofs. I had forgotten what I told Randy and Camille, but they reprinted my comments on the book’s praise page:

  “This book fills a real gap. People who have diabetes need something like this to help them understand what they are going through. The monkey is so cute that people of all ages will enjoy it!”

  Published in May 2003 by Basic Health, I Have Diabetes Too! is 132 pages of delightful text and pictures for $12.95. The Amazon.com listing includes two customer reviews, both with the maximum of five stars.

Announcements:

• The Odyssey Ends:
  Readers who have been carefully tracking the location of my biggest and most popular glycemic index pages are aware that in the past three months I have had to move them from server to server. I can’t afford to keep them on Mendosa.com any more, because my ISP charges too much for the bandwidth.

  Now, thanks to Paula Ford-Martin, the editor of About Diabetes, these files have finally found a home. Their new addresses are:

  1. http://diabetes.about.com/library/mendosagi/nmendosagi.htm for my main Glycemic Index article.

  2. http://diabetes.about.com/library/mendosagi/ngilists.htm for the Glycemic Index and Glycemic Load Lists.

  3. http://diabetes.about.com/library/mendosagi/DiabetesAndDiet.pdf for Diabetes and Diet: A Type 2 Patient’s Successful Efforts at Control, a 32-page book by Derek Paice, which he authorized me last year to put online.

     Derek, a research engineer who has had type 2 diabetes for more than a decade, has been able to get excellent control of his diabetes by diet alone. Derek developed an alternative method to glycemic index for characterizing the glucose-raising effect of food. This “substance glycemic index” is based on a fixed weight of foods, independently of its composition in terms of carbohydrate, protein, and fat. By means of charts and graphs, he summarizes and discusses more than 50 of his experiments.

     My article about Derek’s success in dominating his diabetes is online at http://www.mendosa.com/paice.htm.

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