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Diabetes Update: Detemir

Number 65; December 1, 2003

By David Mendosa


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

  • 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:

  • Insulin Detemir
    It was five years ago that I started to learn about the next hot new insulin to hit the market. It isn’t here yet, but its time is nigh, and I think that it was worth the wait.

    If you now take insulin, think that you might someday, or know somebody that does, it will probably be worth your while to read my article about insulin detemir. Like Lantus, this is a very long-acting insulin. Furthermore, it may have some distinct advantages.

Book Reviews:

    Using Insulin Cover

    John and Ruth Update their Insulin Bible

  • Using Insulin
    If they think about it at all, most folks assume that only people with type 1 diabetes take insulin, while the rest of us get by on oral medications or sometimes just diet and exercise. The confusion is understandable, because until just a few years ago the name for type 2 diabetes was non-insulin-dependent diabetes mellitus (NIDDM).

    The only extensive analysis of people with diabetes is still the 1989 National Health Interview Survey. For everyone with diabetes older than 18, that survey found that 43 percent were treated with insulin, according to Chapter 25: Therapy For Diabetes in the second edition of Diabetes In America. Of course, everyone with type 1 diabetes uses insulin.

    However, a large number of people with type 2 do too. “The proportion of NIDDM patients treated with insulin increased with longer duration of diabetes, from 22% at 0-4 years to 58% at more than 20 years.”

    That’s why Using Insulin is not just for people with type 1 diabetes. Most people with type 2 diabetes will find themselves gladly using insulin as they get older. And like all people who use insulin, they will have many questions about how to make the best of it.

    This book is the best place to turn for any of those questions. After I reviewed a draft of the book a few months ago, I wrote the authors that I consider it the bible of insulin.

    The authors are lead by John Walsh, a Certified Diabetes Educator who himself has diabetes and has used a pump for more than 20 years. Listed second is John’s wife, Ruth Roberts. Together they maintain The Diabetes Mall. Two endocrinologists are also listed as authors.

    This book is so up-to-date that it includes one insulin that the FDA hasn’t even approved yet. This is Novo Nordisk’s Detemir, a long-acting insulin like Lantus.

    Many people will find the most valuable part of the book to be the chapters about your “Total Daily Dose” consisting of your basal dose plus your carb bolus and correction bolus. Then, you can determine your carb factor—how many grams of carb are covered by one unit of Humalog or Novolog insulin.

    The general rule is that one unit of insulin covers 15 grams of carbohydrate. This rule is a rough estimate—too rough. Most people need one unit of insulin for six to 20 grams of carbohydrate, the book says. The ratio can vary, they continue, from one unit for 25 grams to one unit for every 2 grams.

    This points out how individual the insulin/carb ratio is and how important it is for you to be able to calculate your own ratio. This book shows you how to do this better than anything else I know.

    Using Insulin by John Walsh et al. is a trade paperback of 344 pages with a list price of $23.95. Torrey Pines Press in San Diego published it last month.

     The ADA Calls it Low-Carb

    The ADA Calls this Low-Carb!

  • Quick and Easy Low-Carb Cooking for People with Diabetes
    The title alone almost makes my mouth water. When I opened the envelope I was delighted. This new book, scheduled to be published this month by the American Diabetes Association and written by Nancy S. Hughes, sounded like just what I wanted. To think that such a conservative organization would even recognize the existence of low-carb diets is amazing. Alas, this is not a low-carb recipe book, no matter what they call it. Its recipes have up to 57 grams of available carbohydrate per serving. Even without regard to how many carbohydrates these recipes have, none of them attracted my attention enough to try them. At $16.95 for a trade paperback of 120 pages this book is a total waste of money.

    This cookbook is as useless as Dana Carpender's 500 Low-Carb Recipes, reviewed here last month is useful. That book is getting the recognition it deserves. It is this year’s third best-selling cookbook, according to USA Today on November 5. Only Dr. Atkins New Diet Cookbook and Rachel Ray’s 30-Minute Meals 2 sold more copies.

News You Can Use:

  • A few days ago BD (Becton, Dickinson and Company) introduced two new needle insulin syringes. Its BD Ultra-Fine II Short Needle Insulin Syringes are 31 gauge. That’s the thinnest insulin syringe needles available in the U.S. Its new 30-gauge BD Ultra-Fine Needle Insulin Syringes are the thinnest insulin syringe needles available in the most widely used length in the U.S., ½ inch (12.7mm).

    The thinner the needle the less the pain. I already use BD’s Ultra-Fine 33 Lancets, which at 33 gauge are the thinnest. Since they is so thin, they won’t work with most blood glucose meters, but they work great with the BD Logic meter, which needs only 0.3 microliters of blood.

  • The name of the website could not be more modest. They call it simply “A Diabetes Website.” No more promising Internet resource for people with diabetes has, however, made its debut in years. And its name does guarantee that it will come first on any alphabetized listing of diabetes sites.

    The promise of the site comes from its founders. They are William Quick, MD, FACP, FACE and his wife, Stephanie Schwartz, RN, MPH, CDE. I have worked closely with them since 1995, when I started this website and shortly thereafter they started Diabetes Monitor.com.

    Later, they sold Diabetes Monitor to Children with Diabetes.com, where Bill formerly was medical director and Steph was associate editor. A few days ago, however, Bill and Steph parted company from Children with Diabetes and quickly established their new site at http://www.adiabeteswebsite.com.

Research News:

  • A Great Use for Spleen Cells
    If we aren’t too sure what function the spleen plays as an organ of our body, we really had no idea what the cells in the spleen that lack a surface molecule called CD45 were good for. Research reported November 14 in the journal Science indicate that these cells could be good for nothing less than a cure for type 1 diabetes.

    This is surprising news, not only to us but to the researchers themselves. The researchers worked with young mice in which autoimmunity had begun, but had not yet developed into diabetes. They injected spleen cells into these mice, knowing that these cells play a key role in teaching new immune cells to recognize normal tissue. The researchers thought that if the spleen cells could stop an autoimmune attack, they could later transplant islet cells to restore production of insulin.

    Then came a huge surprise. The mice didn’t need any transplants, because normal islet cells unexpectedly appeared, and they started to produce insulin. The few remaining islet cells in the diabetic mice regenerated and began to multiply.

    That alone surprised the researchers. Next, however, they got an even bigger surprise. The discovered that some of the spleen cells that they had injected into the mice had somehow transformed into islet cells. “That was kind of amazing to us,” says Denise Faustman, MD, PhD, director of the Massachusetts General Hospital Immunobiology Laboratory and principal investigator of the study.

    Not all of the injected spleen cells turned into islet cells in the mice. Those with a surface molecule called CD45 are destined to become immune cells. It was the cells without CD45 that transformed themselves.

    “It’s the cells without CD45 that are the precursors for pancreatic islets,” Dr. Faustman says. “They have a distinct function that has not previously been identified for the spleen.”

    This transformation could help explain the very existence of the spleen, she says. This organ, which acts as a filter against foreign organisms that infect the bloodstream, is not considered essential. People can live without a spleen, because its function can be taken over by other organs.

    ”The lowly spleen has a unsuspected job assignment other than representing a useless bag of white blood cells,” she continues. “The spleen is a source of adult precursor cells that accelerates the insulin-secreting islet regeneration.”

    Previous research concentrated on embryonic stem cells. This breakthrough may be the first study in a wave of research about the capabilities of other types of cells. This research is, of course, at a very early stage, and will require a lot of time and money.

    The abstract of the study is online at Islet Regeneration During the Reversal of Autoimmune Diabetes in NOD Mice by Kodama S, Kuhtreiber W, Fujimura S, Dale EA, Faustman DL, Science. 2003 Nov 14;302(5648):1223-7.

  • Continuous Sensing Meters
    After years of false starts, continuous sensing meters seem on the verge of being ready for prime time. In the past I have reported on them as “Third-Generation Meters.”

    The first of these meters to come to market—MiniMed’s Continuous Glucose Monitoring System and the Cygnus GlucoWatch (and GlucoWatch G2)—have serious limitations.

    The most promising at this stage may be the Pendragon NI-CGMD or Pendra. Pendragon Medical Ltd. in Zurich, Switzerland, is the developer. Approved in May by the European authorities for adults (but not children), Pendragon says that it will be available in Switzerland, Germany, Austria, The Netherlands, and Greece during the first quarter of 2004. The introduction in other European countries will follow later that year. They don’t mention the United States.

    Pendragon’s meter is based on radio wave impedance spectroscopy. Unlike the GlucoWatch, it does not extract glucose or interstitial fluid. The company claims that it doesn’t cause skin irritation.

    A European correspondent says that the continuously sensing meter will sell for €3,000 (3,000 Euros), which is the equivalent of $3,448. The good news is that advanced electronics prices always come down. The URL is Pendragon Medical Ltd.

    Not far behind, TheraSense is poised to submit its FreeStyle Navigator to the Food and Drug Administration for approval this month. This continuous glucose monitor uses what the company calls “wired enzyme technology,” that supposedly offers a stable signal, minimal oxygen dependence, and minimal effect from inteferents.

    At this writing the company doesn’t mention the FreeStyle Navigator yet on its Web site. The site’s address is TheraSense.

    Meanwhile, A correspondent in Kuwait tells me that the local press there has reported on a Korean-made continuous sensor to be tested there. Its name translated from Arabic appears to be Glucool. That’s all the information I have on it. If anyone else knows about it, please write.

  • Does Buckwheat Reduce Glucose?
    Canadian researchers think that buckwheat will reduce blood glucose levels. They base their findings on a study of diabetic rats. Buckwheat extracts lowered their blood glucose levels by 12 percent to 19 percent after a meal.

    It is something called chiro-inositol that appears responsible here. It is one of the nine inositol isomers and is relatively rare. However, it has been previously shown in animal and human studies to play a significant role in glucose metabolism and cell signaling. Chiro-inositol is relatively high in buckwheat and rarely found in other foods. Of all the seeds analyzed, only mung beans have more.

    The researchers prepared an extract from the buckwheat variety Koto (Fagopryrum esculentum Moench). Kade Research Ltd. in Morden, Manitoba, Canada, provided the buckwheat. It happens that Kade Research also provided funding for the study, and one of the study’s authors is currently collaborating with the company to develop new buckwheat varieties that contain much higher amounts of chiro-inositol for food applications.

    Buckwheat is readily available here. My supermarket carries Wolff’s Kasha, which is nothing but roasted buckwheat. It is actually a fruit and not remotely related to wheat (or to bucks). Buckwheat is a great alternative to rice or potatoes, and I love its taste. It does not, however, bring down my glucose level.

    “We are using a concentrate that is enriched in the compound of interest [chiro-inositol],” according to email from Principal Investigator Carla Taylor. “We have not determined how this relates to how much buckwheat one would need to consume. Even if you don’t see any change in your blood glucose level, it is possible that the compound is still helping your body to use glucose more effectively. Also, note that there are a couple of small studies published in China and India that indicate that people with type 2 diabetes who consumed buckwheat scones or other products made with buckwheat flour had better glycemic control.”

    The glycemic index and glycemic load remain the best guide to blood glucose levels. Buckwheat’s glycemic index has been extensively tested. It is, in fact, rather low glycemic with a mean GI of 54 in three studies (a GI of 55 or less is low). Buckwheat’s GI is just above that of a banana. The glycemic load of buckwheat is 16, where a GL of 11 to 19 inclusive is considered medium.

    Obviously, neither buckwheat or a banana will reduce your blood glucose. We can only hope that the new buckwheat varieties under development will.

    This research will be reported in the December 3 issue of the Journal of Agricultural and Food Chemistry as “Buckwheat Concentrate Reduces Serum Glucose in Streptozotocin-Diabetic Rats” by Julianne K. Kawa, Carla G. Taylor, and Roman Przybylski. This publication is a peer-reviewed journal of the American Chemical Society, the world’s largest scientific society. Thanks to the society for providing an advance copy.

Updates:

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