Number 69; April 1, 2004

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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.

Updates:

• Meters
  Blood glucose meter technology is the fastest developing diabetes field. I seem to be updating my meters page almost every day. This month saw several important developments.

  Two meter manufacturers just sent me new or updated meters. The newest meter on the market in the EasyGluco, manufactured in Korea for US Diagnostics Inc. in New York City. Its specs aren’t bad — accurate results in 9 seconds with just a three microliter drop of blood. But what sets it apart from most other meters is the price. This system is value priced with a box of 50 strips selling for $17.95. The starter package including the meter, lancing device, 150 test strips and 150 lancets, is $49.95. The URL is
  http://www.usdiagnostics.net/index.php

  Meanwhile, Deb Edgecombe, associate product manager for the Accu-Chek Advantage, sent me their newest Accu-Chek Advantage meter. It has several new or improved features, including expanded memory to 480 values, 7,14, and 30 day averaging, downloading 3 ways: IR key; stereo jack cable; Accu-Chek Advantage cable, hypo indicator at a self-set level, and event marker.

  “The event marker on the Accu-Chek Advantage is an asterisk that I liken to a rubber band on your wrist,” Deb replied to my question about it. “It’s just a little flag that help you remember something was going on when you tested your blood sugar at that particular time. Much less sophisticated than [some] other meters, but on the other hand, much simpler!”

  The “other meters” that Deb referred to are the Accu-Chek Complete, the One Touch Profile, and One Touch UltraSmart. The Complete has eight programmable time blocks. Until the release of the UltraSmart, Profile was the only meter on the market that uses event markers help you flag test results with activities that affect blood glucose levels. These three meters offer a major advantage to anyone who tracks his or her blood glucose levels with diabetes software. Only when you key your readings to your activities — particularly meals and exercise — will the trends in your blood glucose levels make sense.

  Some 13 companies currently market a wide range of blood glucose meters. That’s a lot more than were available just five or ten years ago. But an astounding 50 plus companies have websites detailing their forthcoming non-invasive or minimally-invasive meters.

  One of the most recent such sites is that of DexCom, which is developing the first long-term implantable sensor for continuous monitoring. The March 2004 issue of Diabetes Care reported its first published results in “Improved Glucose Excursions Using an Implantable Real-Time Continuous Glucose Sensor in Adults With Type 1 Diabetes.” Full Disclosure: As of January 18, 2006, I own stock in DexCom (ticker symbol DXCM).

  Other new sites range from as far away as Israel to as close to home as the Central Coast of California. OrSense Ltd. in Rehovot, Israel, stops the flow of blood at the index finger by pressuring it gently, and then examining it with an optical probe using sophisticated algorithms. GluMetrics LLC in Marina, California, has developed a novel optical glucose sensor that glows in the presence of glucose. This technology can be used to measure blood sugar without the typical use of enzyme-based chemical reactions.

• Protein Drinks
  In my review of Lucy Beale’s great new cookbook, The Complete Idiot’s Guide to Low-Carb Meals, in the previous issue of Diabetes Update, I mentioned in passing that Catherine and I usually have protein powder shakes for breakfast. Several people wrote to ask about them.

  Even though we don’t like a big breakfast, we love these shakes so much that we drink a big 16-ounce glass full each morning. They give us a high-protein start on the day with few carbs. In fact, we get less than 1 gram carb from the protein powder. The fruit that we add to it, however, adds somewhat more.

  Catherine likes frozen raspberries best. But I prefer frozen organic wild blueberries, for three reasons: taste, fewer carbs, and high ORAC value.

  ORAC? That’s the abbreviation of oxygen radical absorbance capacity, which quantifies the antioxidant capacity of foods. Dr. Guohua Cao, a physician and chemist at the Jean Mayer Human Nutrition Research Center on Aging at Tufts University, in Boston, developed the standardized ORAC assay, which measures the degree to which a sample inhibits the action of an oxidizing agent and how long it takes to do so.

  Dr. Cao and his associates have tested more than 40 foods for their ORAC values. Dr. Cao and Ronald Prior have demonstrated that blueberries have the highest antioxidant capacity of the different fruits and vegetables tested, although it might appear at first glance that prunes and raisins might be higher.

  The Drs. Eades in their book, The Protein Power LifePlan, have a most interesting section entitled "You Deserve ORAC Today" (pp. 120-123). They show the 10 fruits and 10 vegetables highest in oxygen radical absorbance capacity. While prunes rate highest with 5770 ORAC units per 100 grams and raisins are second with 2830, they say essentially that it’s comparing apples and oranges, because by having the water removed they are denser than other foods and that really the food highest in ORAC is blueberries, 2400.

  In March 2000 I wrote Dr. Cao to ask him about this interpretation. He replied the next day, “The information that the Drs. Eades present is correct.”

  The following table comes from “Can Foods Forestall Aging?” by Judy McBride, Agricultural Research, February 1999:

  Top Antioxidant Foods
  ORAC Units per 100 Grams
  

  Fruits		Vegetables
  Prunes	5,770	Kale	1,770
  Raisins	2,830	Spinach	1,260
  Blueberries	2,400	Brussels sprouts	980
  Blackberries	2,036	Alfalfa sprouts	930
  Strawberries	1,540	Broccoli florets	890
  Raspberries	1,220	Beets	840
  Plums	949	Red bell pepper	710
  Oranges	750	Onion	450
  Grapes, red	739	Corn	400
  Cherries	670	Eggplant	390

  The ORAC value of blueberries is only one of three reasons why I prefer blueberries in my shake. One of the two other reasons — taste — is subjective. You preferences may differ as much from mine as my wife’s do. But the third reason, carbs, is objective. The half-cup of blueberries in my drink adds only 7 available carbs.

  We sweeten our drink with Splenda, which adds essentially zero carbs. A heaping tablespoon of ground flax meal doesn’t add any carbs either, while providing Omega 3 fatty acid and fiber.

  The protein powder that we buy comes from the Protein Factory in Brick, New Jersey. This company has excellent prices, top quality, and a wide variety (the downside is that they seem slow to ship and the powder comes in a heavy plastic bag instead of regular containers). I prefer their breakfast formula, unflavored but sweetened with Splenda. It has only one gram of carbohydrate per half cup, and we use about half of that amount per drink.

  I suppose that you could use water to make this drink, but that has never sounded appetizing enough for me. Catherine uses Lactaid (milk with its lactose broken down into glucose and galactose), but it has the same number of carb grams as regular milk, 13 grams per cup. I prefer to use Westsoy Unsweetened Soymilk, because it has only 1 gram of available carbohydrates per cup.

  All together I get less than 9 grams of available carbohydrate in my breakfast shake. That’s close to the 6 grams of carbohydrates for breakfast recommended by Dr. Richard K. Bernstein in the strictest low-carb diet.

  Neither Catherine or I look for variety in our breakfast shake. But one friend of mine has experimented a lot more, because his wife likes variety. Instead of blueberries or raspberries they add:

  1. Chocolate peanut butter — using chocolate powder and peanut butter
     
  2. Maple spice — using maple (no stevia) and cinnamon
     
  3. Almond spice (same as above with no maple)
     
  4. Coffee — usually made with chocolate as well
     
  5. Vanilla — good with a little nutmeg
     

  Just one more tip: Don’t even try to make these shakes with a hand-held (stick) blender. We have tried several, but none are strong enough to do it easily. Instead, use a good countertop blender.

• Lacto-fermentation
  My recent article on Acidic Foods also generated a lot of email. I thought that messages from Kay Schmidt in Washington state were so interesting that we edited them into a single online update to the article. Kay says that using lacto-fermentation (pickling using whey instead of vinegar) lowers the carb contents of certain foods so much that it has little or no effect on blood glucose.

Diabetes Supplies:

• BD Insulin Syringe with the BD Ultra-Fine II Short Needle
  Becton Dickinson is the leader in syringes and lancets. Never the cheapest, it is usually the quality producer. Again, it takes the market lead with the first 31 gauge syringe needles. Earlier, it introduced 31 gauge pen needles.

  The 31 gauge syringe needles are 8mm or 8 5/16", which is 37 percent shorter than the standard 12.7mm needle. BD emphasizes that you should consult with your health care professional before using the short needle and carefully monitor your blood glucose when changing to a shorter needle. That’s because it is possible that your jab won’t reach the muscle tissue it needs.

  Because the needles are shorter, it is possible to make then almost vanishingly thin with a special surgical grade of stainless steel. Catherine just got some of new needles and marveled to me how painless they are.

  These syringes are available in three barrel sizes — 1 cc, ½ cc and 3/10 cc. People who use the 3/10 cc version of this syringe can choose between a barrel with full-unit markings and BD’s new 3/10 cc barrel with a unique half-unit scale, which could help you make small insulin doses more precise.

• A Promising Treatment for Neuropathy
  The original part of my website is a series of 16 long pages consisting of nothing but descriptions of and links to relevant diabetes websites and other online resources. The meters page mentioned above is one of them. Another is my neuropathy page. This is one of only two of these pages dealing with complications (the other is retinopathy).

  The neuropathy page is the first page dealing with complications that I added. There are two reasons for that: (1) it is probably the most common complication of diabetes and (2) one of the most intractable.

  My neuropathy page links many treatments for neuropathy. They range from tricyclic antidepressants, antiseizure drugs, opiates, capsaicin, and transcutaneous electrical nerve stimulation (TENS) to many rather far-out ideas. Some of these work some of the time for some people, but none of them are consistently helpful. Therefore, the medical establishment falls back to saying that the best thing is to bring down your A1C level.

  But one treatment that is receiving more and more attention is the use of monochromatic infrared energy to increase blood circulation to the nerves and the surrounding tissues. Anodyne Therapy LLC in Tampa, Florida manufacturers the Anodyne Therapy System, an FDA-approved device that uses a single wave-length of near-infrared energy. The site lists some one thousand centers throughout the U.S. that offer this treatment.

  There are now three clinical studies reported in peer reviewed medical journals that demonstrate the effectiveness of the Anodyne Therapy System in treating sensory peripheral neuropathy. I list these in the bibliography below.

  But what about the cost? If you are being treated by a physical therapist, Medicare and most private insurance carriers will cover this therapy (after normal deductibles and co-payments).

  Bibliography
  

  1. Kochman AB, Carnegie DH, Burke TJ. “Symptomatic reversal of peripheral neuropathy in diabetes,” Journal of the American Podiatric Medical Association, 2002 Mar, 92(3):125-30. Abstract online at http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11904323&itool=iconabstr

  2. Leonard DR, Farooqi MH, Myers S. “Restoration of sensation, reduced pain, and improved balance in subjects with diabetic peripheral neuropathy,” Diabetes Care, 2004 Jan;27(1):168-72. Abstract online at http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14693984&itool=iconabstr

  3. Prendergast JJ, Miranda MA, Sanchez M. “Improvement of sensory impairment in patients with peripheral neuropathy,” Endocrine Practice, 2004 Jan-Feb;10(1):24-30. Not yet online.

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David Mendosa:
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