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Diabetes Update: Traveling with Insulin

Number 61; August 1, 2003

By David Mendosa


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

Our Garden Path

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.

    Dr. Bernstein's Diabetes Solution

    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:

    Molly

    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.

  • HTML Format
    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.

  • My Guarantee
    This newsletter is free and will never include advertising. Nor will I ever sell, rent, or trade your e-mail address to anyone.

Archives:

I now send out Diabetes Update once a month. Previous issues are online:

  1. Diabetes Update Number 1: Diabetes Genes of December 10, 2000
  2. Diabetes Update Number 2: DiabetesWATCH of December 18, 2000
  3. Diabetes Update Number 3: Starlix of January 3, 2001
  4. Diabetes Update Number 4: Native Seeds/SEARCH, Tepary Beans of January 17, 2001
  5. Diabetes Update Number 5: Insulin Makes You Fat of January 31, 2001
  6. Diabetes Update Number 6: Available and Unavailable Carbohydrates of February 15, 2001
  7. Diabetes Update Number 7: Dates of March 1, 2001
  8. Diabetes Update Number 8: Quackwatch of March 15, 2001
  9. Diabetes Update Number 9: The Cost of Insulin of March 30, 2001
  10. Diabetes Update Number 10: Sof-Tact Meter of April 2, 2001
  11. Diabetes Update Number 11: iControlDiabetes of April 16, 2001
  12. Diabetes Update Number 12: Cinnamon, Tagatose of May 2, 2001
  13. Diabetes Update Number 13: Glycemic Index of May 15, 2001
  14. Diabetes Update Number 14: Eat Your Carrots! of May 31, 2001
  15. Diabetes Update Number 15: Glycemic Load of June 21, 2001
  16. Diabetes Update Number 16: Homocysteine of July 2, 2001
  17. Diabetes Update Number 17: Chana Dal Tips of July 15, 2001
  18. Diabetes Update Number 18: Lag Time in AlternativeLand of August 2, 2001
  19. Diabetes Update Number 19: Fiber of August 15, 2001
  20. Diabetes Update Number 20: How Diabetes Works of August 30, 2001
  21. Diabetes Update Number 21: Insulin Resistance of September 14, 2001
  22. Diabetes Update Number 22: Trans Fats, Honey, CU of October 1, 2001
  23. Diabetes Update Number 23: Pedometer Power of October 15, 2001
  24. Diabetes Update Number 24: Is Glycerin a Carbohydrate? of October 31, 2001
  25. Diabetes Update Number 25: Kill the Meter to Save It of November 15, 2001
  26. Diabetes Update Number 26: Protein, Fat, and the GI of December 1, 2001
  27. Diabetes Update Number 27: Insulin Index of December 14, 2001
  28. Diabetes Update Number 28: Fructose of January 4, 2002
  29. Diabetes Update Number 29: Aspirin of January 14, 2002
  30. Diabetes Update Number 30: Stevia of January 31, 2002
  31. Diabetes Update Number 31: Gretchen Becker’s Book of February 19, 2002
  32. Diabetes Update Number 32: The UKPDS of March 4, 2002
  33. Diabetes Update Number 33: Financial Aid of March 18, 2002
  34. Diabetes Update Number 34: Pre-Diabetes of April 1, 2002
  35. Diabetes Update Number 35: More Glycemic Indexes of April 15, 2002
  36. Diabetes Update Number 36: Gila Monsters of April 30, 2002
  37. Diabetes Update Number 37: Is INGAP a Cure? of May 15, 2002
  38. Diabetes Update Number 38: Native American Diabetes of June 3, 2002
  39. Diabetes Update Number 39: FDA Diabetes of June 19, 2002
  40. Diabetes Update Number 40: Diabetes Support Groups of July 1, 2002
  41. Diabetes Update Number 41: New GI and GL Table of July 15, 2002
  42. Diabetes Update Number 42: Diabetes Sight of August 1, 2002
  43. Diabetes Update Number 43: DrugDigest of August 18, 2002
  44. Diabetes Update Number 44: Hanuman Garden of September 3, 2002
  45. Diabetes Update Number 45: Guidelines of September 16, 2002
  46. Diabetes Update Number 46: Trans Fat of October 4, 2002
  47. Diabetes Update Number 47: Nutrition.Gov of October 16, 2002
  48. Diabetes Update Number 48: Our Hearts of October 31, 2002
  49. Diabetes Update Number 49: Our Kidneys of November 15, 2002
  50. Diabetes Update Number 50: A1C<7 of December 2, 2002
  51. Diabetes Update Number 51: Diabetes Searches with Google of December 16, 2002
  52. Diabetes Update Number 52: e-Patients of January 2, 2003
  53. Diabetes Update Number 53: Email News of January 16, 2003
  54. Diabetes Update Number 54: Third Generation Meters of January 31, 2003
  55. Diabetes Update Number 55: Hypoglycemic Supplies of February 14, 2003
  56. Diabetes Update Number 56: Food Police of March 1, 2003
  57. Diabetes Update Number 57: Vitamins of April 1, 2003
  58. Diabetes Update Number 58: Lancets of May 1, 2003
  59. Diabetes Update Number 59: Accurate Meters of June 1, 2003
  60. Diabetes Update Number 60: Chromium of July 1, 2003


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