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Ember at 7 Months

My most recent articles are:

• The first issue of new magazine called Type 2 Life includes two articles that I wrote. Novartis Pharmaceuticals, which markets Starlix (nateglinide), publishes it “to deliver objective, lifestyle-oriented information to people who have type 2 diabetes.” I guess that’s why they asked me to write for it. Novartis reps are providing the magazine to doctors so they can put it in their waiting rooms.
  1. My article on “When to Test and Why” points out the evidence for the current shift to testing after meals, rather than before breakfast, at least for people whose diabetes is well controlled. This shift is good for Novartis and its Starlix, because that drug can help control mealtime highs. The URL is
     http://mendosa.com/when_to_test.htm

  2. My other article in the first issue of Type 2 Life is about what is perhaps the most important treatment for diabetes — and probably the one most honored in the breach — exercise. Writing this article certainly was good for me, because I now exercise more. I hope that you will too. As I took a long, slow walk this morning (because of newly diagnosed arthritis in a knee), I remembered the maxim that I coined for the article:
     It’s the Deed
     Not the Speed
     That summarizes the article, but there is a lot more here for anyone with diabetes. The URL is
     http://mendosa.com/exercise_type_2.htm

• Evaluating Meters

  For my article about two organizations that evaluate meters please read my current “Meter News” column in the October issue of Diabetes Health magazine or read it on my website at http://www.mendosa.com/evaluating_meters.htm

Updates:

• Dawn Phenomenon
  In previous issues of this newsletter we have discussed several strategies for controlling the dawn phenomenon. Now, Ann Munroe, a scientific and medical editor in Warriewood, New South Wales, Australia, writes about something that works for her:
  I have known about my type 2 for about 6 months and follow Dr Bernstein’s philosophy as much as possible, with good results except for a persistent and unpredictable dawn phenomenon. I was still trying the green apple before bed (with variable results) when I stumbled upon Hi-Maize. Taking about one-third of a cup a day seems to have knocked the dawn problem on the head very effectively. It doesn’t seem to affect my blood sugar too much, either.

  I live in Australia, and here it is available as a type of cornstarch for cooking or as a powder that you can put in drinks. There is a reference that explains the mechanism of how this works (it is called Novalose 260 in the research article). Anyway, it seems far superior to anything else I have tried, and I highly recommend it. I have only so far used the cooking type of Hi-Maize, and I make a sort of sweet pancake with it using a Da Vinci syrup, or a savoury one with mushrooms, cheese, etc. It hasn’t yet let me down in 10 days of trying it.

  I think Hi-Maize was originally invented here in Australia by the CSIRO (Commwealth Scientific and Industrial Research Organization), but I am not sure. The brand I got is called Select, but it is also made by Goodman Fielder here for addition to bread, etc. I’ll be watching with interest to see how everyone else goes with it!

  A few days ago I wrote the Hi-Maize website asking about U.S. availability, but they haven’t answered.

Product News:

• Barley Cereal
  I just had a bowl of great barley cereal. It was really easy to make, tastes great, and is certainly healthy.

  I usually had McCann’s Irish Oatmeal for breakfast, as I have written on my website at My Favorite Low Carb and Low GI Foods. I serve both the barley cereal and the oatmeal with soymilk, stevia or sucralose, sliced almonds, and cinnamon.

  You probably know that barley is the lowest glycemic grain, even lower GI than oatmeal (porridge). Barley porridge has a GI of about 50.

  Currently it is only available on the Whole Control website, but the company hopes to get distribution in Vitamin Cottage, Wild Oats, and Albertson’s in the near future. Whole Control is in Denver, and its toll-free phone is 1 (888) 946-5326.

  Whole Control’s managing partner is Frank Harritt, who was diagnosed in 1987 with type 2 diabetes. Frank brings more than 20 years of successful marketing and sales experience on leading national brands.

  Its barley cereal is $3.95 for a one pound bag or $8.95 for a 2.5 pound bag, which comes to about $.25 per serving — not a bad deal for all the great health benefits.

  Whole Control golden barley cereal is nearly the perfect cereal for people with diabetes. Like oatmeal, it helps control blood glucose, blood pressure, and cholesterol — but with a much lower glycemic index. It tastes great, and I highly recommend it. In fact, I now have a bowl nearly every day!

Book and Magazine Reviews:

The Worst Pills for You


• Worst Pills, Best Pills

  Most Americans take a lot of pills, some prescribed by their doctors and perhaps just as many that we buy over the counter. Those of us with type 2 diabetes probably even take more than most people.

  Many pills are wonderful. Some may even be live-saving.

  And others can cause big problems. Personally, I have tried five different statin drugs to help control my cholesterol, and every one of them gave me excruciating muscle pains. I also can’t take Bactrim, a widely prescribed antibacterial combination drug. When I broke out in a rash all over my body, my doctor said, “Sorry that I poisoned you.”

  Every drug has a therapeutic dose and a toxic dose. For some people, like my experience with the statins and Bactrim, the two doses are the same. A more general example is the mineral vanadium, which people often recommend for those of us with type 2 diabetes. Vanadium might be valuable, but its therapeutic and toxic doses are awfully close together.

  Maybe even more common are unforeseen drug interactions. Fortunately, several excellent websites can help identify potential interaction problems. One of my most recent reviews of these sites is in an issue of my Diabetes Update newsletter at http://www.mendosa.com/diabetes_update_77.htm.

  Dozens of drugs also affect our blood glucose levels. One of the questions I get asked the most often is about drugs that affect blood glucose levels. Some drugs can cause hypoglycemia and others cause hyperglycemia. Others have some effect, although less severe.

  Stephen Freed’s appendix in Dr. Richard K. Bernstein’s Diabetes Solution is what I used to turn to most often to answer that question. But even though I have written articles for print for more than half a century, I am now more of an Internet person. So I asked Stephen if I could host his list on mendosa.com. His reply was even better. Stephen now hosts the list on his Diabetes in Control.com site. It’s better that way because he can keep it up-to-date there. The list is a PDF at http://www.diabetesincontrol.com/issues/issue246/drugs.pdf.

  Maybe we have grown too sanguine about the benefits that drugs can offer us. If you are one of those people who unquestioningly takes what your doctor prescribes — or your friend recommends — Worst Pills, Best Pills is for you.

  The new 2005 edition is a huge 913-page paperback that lists for a reasonable $19.95 (ISBN 0-7434-9256-0). Public Citizen’s Health Research Group put this tome together. Famous consumer advocate Ralph Nader founded this organization.

  The book analyzes the 538 drugs we use the most. Of these 181 are on its “do not use” list.

  It labels some of these “do not use until seven years after release.” This makes a lot of cautious sense. While there are rare breakthrough drugs that are much better than anything we had before, new drugs as a group are the most dangerous because not all that many people have used them. Think Rezulin. The first diabetes drug in a new class, Rezulin killed at least 63 people with diabetes before the FDA yanked it off the market five years ago.

  There is a lot of good stuff in the book, like its recommendation to take psyllium for high cholesterol, which I started to take after reading the book. Still, I think that it goes too far in the “worst pills” category.

  In diabetes drugs, for example, it says not to use two first-generation sulfonylureas Dymelor and Diabinese (other sulfonylureas, are OK for “limited use”). Generic metformin and brand-name Glucophage are also OK “for limited use.” Do not use, the book says, Actos, Avandia, Starlix, or Prandin. Most of us with type 2 diabetes use one of these drugs. If that’s you, you might want to read Worst Pills, Best Pills. But don’t stop taking them without talking it over with your doctor.

  The book doesn’t mention two seldom used diabetes drugs, Precose and Glycet. And too new to be included are Symlin and Byetta, which some people do consider to be breakthrough drugs, but might well fall out according to the book’s seven-year rule. The only diabetes drug the book doesn’t have any problem with is insulin. My website has a page about the different diabetes pills at mendosa.com/drugs.htm and the insulins at mendosa.com/insulin.htm.

  The current edition of Worst Pills, Best Pills is a revision of a book that Public Citizen has published since 1988. A totally new section this year covers the most common dietary and herbal supplements. What was amazing to me was that among these supplements the book says “do not use” to every single one.

  My conclusion: The book is extreme, but if you consider it judiciously, it can be a good balance to pharmaceutical propaganda.

• AARP on Diabetes
  I’ve finally made it to the big time — the largest circulation magazine in the world. AARP The Magazine has an article about diabetes in its November-December issue. More than 23 million people subscribe to it — more than twice as many as to Reader’s Digest. I wish that I could say that I wrote the article. Instead Kelly Griffin interviewed me for it. She writes a fine article, and it is online at http://www.aarpmagazine.org/health/diabetes.html.

• Quacks
  People often write to ask about some new miracle solution to diabetes. I give them the usual warnings that anything that appears to be too good to be true probably is good for the salesman and especially to question anything that cures just about everything.

  Nobody is better at exposing these quacks and scams than my friend, endocrinologist Bill Quick M.D. We have worked together for more than a decade, but I leave it to him to concentrate on exposing these frauds, because I don’t enjoy the hate mail and even more because my insurance won’t cover libel suits, which while unjustified still have to be defended by attorneys. Twice now I have had to hire attorneys because of something that I wrote, and both times I was lucky enough to arrange pro bono defenses and avoid lawsuits, but I don’t want to take any chances.

  Anyway, Bill has several important web pages about quacks. See especially Diabetes Quackery and Too Good to Be True.

  Also see Ten Ways to Avoid Being Quacked by Stephen Barrett, M.D., the aptly named “Quackwatch Doctor.”

• The Diabetesdoc
  Endocrinologist Bill Quick M.D. has called himself “Bill the diabetesdoc” for some time now. He deserves that label, because no other endocrinologist has given more to the diabetes world through his Diabetes Monitor website and his blog.

  Now, unfortunately he has even more reason to call himself the diabetesdoc. He not only writes about diabetes — he has it too. It’s probably LADA, Latent Autoimmune Diabetes in Adults, a form of type 1. I don’t think that he caught it from writing about diabetes.

  Only a few other endocrinologists are active on the Internet, but none of them have diabetes. The three who come to mind are Arturo Rollo in Boston, who runs diabetes mailing lists including Diabetes World, Alan Rubin in San Francisco, who is the the first endo to have a podcast, and Reddy Biggs in Amarillo, who often posts on the misc.health.diabetes newsgroup.

  Except for Bill, none of these endos have diabetes. The only ones who do that Bill, his wife Steph (a diabetes nurse educator), and I can think of are Richard K. Bernstein in Mamaroneck, New York; Steve Edelman in San Diego; Lois Jovanovich in Santa Barbara; Irl B. Hirsch in Seattle; Wayne Moore in Kansas City, Missouri; Dick Guthrie in Wichita, Kansas; Ron James in Columbia, Missouri; and Stephen W. Ponder in Corpus Christi.

Announcements:

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  Diabetes Update keeps you up-to-date with new articles, Web pages, and books that I have written about diabetes.

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