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Diabetes Drugs

Diabetes Diet

Losing Weight the Easy Way

With all the attention this week being given to the FDA’s review concerning heart problems connected with Avandia, one of the major diabetes drugs, you may have missed the bad news for what could have been the first new prescription drug for obesity in more than a decade. Another FDA advisory panel voted against Qnexa, which Vivus Inc. developed.

In year-long clinical trials people who took the highest dose of Qnexa averaged a 10.6 percent weight loss. Those taking a placebo lost 1.7 percent of their body weight.

Unfortunately for Vivus and for people who want to lose weight, the side effects of Qnexa outweighed its benefits in the minds of most of the FDA’s panel members. These weren’t niggling concerns. They include the possibility that people taking Qnexa would be depressed and think suicidal thoughts, have their memory and concentration impaired, be at greater risk of kidneys stones, and could suffer from heart problems.

If the FDA still approves Qnexa in spite of the panel’s recommendation against it, this could be the easy way for the great majority of people with diabetes to lose the 10 percent of our weight that our doctors have told us that we need to do. Almost everyone who has type 2 diabetes is overweight. Our government’s statistics show that 85 percent of all American adults with diabetes are overweight.

If an effective weight loss drug is no longer an option for us, we could be left with our own resources. Still, I know that drugs we already have to control our blood glucose can also help some of us with type 2 diabetes to lose weight. I lost a lot of weight by taking Byetta, and friends of mine are achieving weight loss success with Victoza.

But since all drugs carry with them the risk of side effects, which is the FDA’s biggest concern, many of us would like to be taking as few drugs as possible. We can’t do it with with willpower alone, as Gina Kolata emphasizes in her book Rethinking Thin.

In 2007 I decided to do without drugs entirely and yet I lost even more weight. The strategy that I adopted was the only proven way, a very low-carb diet, very much like the one that Dr. Richard K. Bernstein has himself followed for years and has taught successfully to thousands of his patients with diabetes. By following the recommendations in his
book, Dr. Bernstein’s Diabetes Solution, I was able to bring my weight down from 170, when I started low-carbing in December 2007 to 151 last October.

But this year has been murder for my weight. In all my traveling since February I lost control. While I had no problem staying on a very low-carb diet, I ate too much fat and protein when eating out and wasn’t able to reliably check my weight on a daily basis so that I could immediate take corrective action. Consequently, my weight crept up as
high as 169 a few months ago.

Only by carefully watching what I eat and weighing myself every morning have I been able to start bringing it back down to where I am more healthy, feel better, and my clothes fit. Today my weight is down to 162, but I still have a way to go to reach my ultimate weight goal of 155.

I know that I’ll do it. I also know that we still don’t have any easy way to lose weight and to keep it off.

This article is based on an earlier version of my article published by HealthCentral.

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Diabetes Medication

Byetta Vindicated

Yesterday Medco Health Solutions presented a study at the Scientific Sessions of the American Diabetes Association. The study found that, contrary to warnings from the Food and Drug Administration, neither Byetta or Januvia increase the risk of acute pancreatitis.

Byetta and Januvia are two of the most important medications for type 2 diabetes, since they reduce blood glucose without increasing weight, which all the other diabetes drugs (except metformin, Victoza, and Symlin) do. In fact, Byetta is proven to reduce weight, and that’s why I wrote a book about it, Losing Weight with Your Diabetes Medication.

Due to reported cases of acute pancreatitis, several years ago the FDA added warnings to the labels for Byetta and Januvia.

However, Medco’s study indicates that patients taking either of these medications were no more likely to develop acute pancreatitis than patients taking other drugs to control diabetes. The study indicates there is an increased risk of acute pancreatitis for people with diabetes. But that it is not associated with the particular diabetic medication the patients are using.

“While cases of acute pancreatitis have been reported in patients using Byetta and Januvia, diabetic patients who are not taking these drugs also have been reported to have an increased risk for pancreatitis,” says Merri Pendergrass, MD, PhD, national practice leader of the Medco Therapeutic Resource Center for Diabetes, who conducted the study. “The major question has been are these medications causing the pancreatitis or are they innocent bystanders? Our findings are reassuring in that they did not reveal any increased risk of acute pancreatitis with Byetta and Januvia.”

Medco released even more good news for people taking Byetta. Another one of its studies presented at the ADA’s Scientific Sessions found that, despite FDA warnings, Byetta is not associated with an increased risk of acute renal failure in people with type 2 diabetes. This Medco analysis indicated that while there is an increased risk of acute renal failure in people with diabetes, the diabetes drug they are taking does not appear to impact that risk.

Medco Health Solutions Inc. conducted the study in association with the Medco Research Institute and the University of Texas Southwestern Medical School. Medco Health Solutions is a major pharmacy, ranking 35th on the Fortune 500. The study analyzed Medco’s pharmacy and medical claims data for more than 786,000 adult patients between January 2007 and June 2009.

They divided the people with diabetes into three groups based on whether they were taking Byetta, Januvia, or other diabetes drugs. A group of people without diabetes served as the control.

While the risk for acute pancreatitis was essentially the same among the three groups of people with diabetes, the average risk for all the diabetes groups was higher than that for the control group. Medco used comparable methodology and study parameters in the two studies.

The lack of increased risk of renal failure was news to me. But I’ve known for years that Byetta doesn’t pose an additional risk of pancreatitis, and I wrote about it here in October 2007. Now it’s time for the FDA to catch up.

This article is based on an earlier version of my article published by HealthCentral.

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Diabetes Medication

Short Needles

Sometimes it’s superior to be short. Especially if it’s a needle.

Now, the company that makes some of the highest quality needles and lancets has gone even further. Becton, Dickson and Company, which many of us know simply as BD, announced a few days ago that it has produced a pen needle that is even smaller and thinner than anything available before.

BD says that it BD Ultra-Fine Nano is the “world’s smallest pen needle” and is proven to be as effective as longer needles for anyone — big or small, thin or fat. These new needles promise to be less painful for any one of the 5 million Americans who inject insulin or GLP-1 to manage their diabetes.

Please catch the reference to GLP-1. This means that not only insulin users but also those of us who use Byetta or Victoza. These are the newest class of diabetes drugs that people with type 2 diabetes can use to reduce their A1C and their weight at the same time.

This shorter needle is just 4 mm long and has a thin 32 gauge. It provided equivalent glycemic control compared to 31 gauge needles that are 5 mm or 8 mm long and had “reduced pain, no difference in insulin leakage and was preferred by patients,” according to a study reported in Current Medical Research and Opinion. While five of the seven authors of this study work for BD, which raises a red flag, two of them are independent researchers. And one of them, Timothy Bailey, M.D., the director of the AMCR Institute in San Diego, I greatly respect and know personally.

Even though this needle is only 4 mm long, it reaches the subcutaneous tissue — the layer of fat that all of us have below our skin — that is the recommended site for injections of insulin and GLP-1s. And it’s not too long to mean a risk of injecting into muscle, where we can absorb insulin too fast, increasing the risk of hypos. So this new needle promises better glycemic control.

With this needle we don’t have to pinch-up the skin. And it fits all of the insulin pens and dosers sold here.

As I writer, I don’t like to admit that pictures can sometimes be superior to words. Even photos that I have taken myself, like this one. They seldom are, but this is an exception.

Here is one of those new needles mounted on a saline pen. You can see for yourself how short it really is.

A BD Ultra-Fine Nano Pen Needle on a Saline Pen

This article is based on an earlier version of my article published by HealthCentral.

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Diabetes Testing

Limiting Test Strips

Today people who have diabetes can be thankful that the United States doesn’t have a single-payer health care system. Based on two Canadian studies released today, most of us could face the prospect that our health insurance would soon cease to cover the cost of testing with blood glucose strips.

The studies both proposed that Canada could save money by cutting benefits to people with type 2 diabetes who are using drugs other than insulin. Last year 63 percent of people with diabetes in the province of Ontario who weren’t using insulin used on average 1.29 test strips per day. Although many of us would say that’s too little, one of the studies concluded that it’s too much.

The Canadian Medical Association Journal CMAJ on December 21 released these studies subject to revision. You can read the full-text of one study at “Blood glucose test strips: options to reduce usage.” The full-text of the other new study is at “Cost-effectiveness of self-monitoring of blood glucose in patients with type 2 diabetes mellitus managed without insulin.”

Each article recognizes that those of us who inject insulin have to test regularly to avoid hypos, if for no other reason. All type 1s and about one-fourth of type 2s inject insulin. Continue Reading

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Diabetes Medication

Good Drugs, Bad Drugs

We know that the only person who can tell us what to eat and exercise is ourself. But most of us need a third leg of diabetes control — one or more of the prescription drugs — and we usually leave that decision up to our doctor.

Often this is a big mistake. Many of our doctors are too set in their ways. The problem is simply that doctors too are human.

Older doctors have practiced most of their lives with a Hobson’s choice of one oral diabetes drug. In 1957 the first sulfonylureas became available by prescription in the United States. Not until about 40 years later did the Food and Drug Administration approve a second diabetes drug, metformin.

Until we could get metformin, we did have the opportunity to take insulin instead of a sulfonylurea. And we had a lot of different sulfonylureas to choose from, making it appear that our choice was greater that it really was. Brand names include Amaryl, Glucotrol XL, Diaßeta, Glynase, Micronase, as well as Dymelor, Diabinese, Orinase, and Tolinase. Combination drugs like Metaglip, Glucovance, Avandaryl, and Duetact also are part sulfonylurea. Continue Reading

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Diabetes Medication

The Big Ds: Diabetes, Depression, and the D Vitamin

Since alliteration helps us to remember connections, we’re lucky that diabetes, depression, and the D vitamin all start with the same letter. We aren’t lucky that diabetes and depression are so closely connected, as I wrote in my essay on “Diabetes and Depression” here a year ago. But we’re in luck that vitamin D might treat both conditions, killing two birds with one stone, as our less technologically powerful ancestors used to say.

“About 70 percent of the population of the United States has insufficient levels of vitamin D,” says Adrian Gombart, a principal investigator with the Linus Pauling Institute at Oregon State University. “This is a critical issue as we learn more about the many roles it may play in fighting infection, balancing your immune response, helping to address autoimmune problems, and even preventing heart disease.”

People with diabetes may have even lower levels of vitamin D, according to a review last year in The Diabetes Educator. People at risk of diabetes and the metabolic syndrome (or syndrome x) also have low vitamin D levels.

Recent research found that 19 percent of people with type 2 diabetes probably suffer from major depression and an additional two-thirds of us have at least some depressive symptoms. People with diabetes are twice as likely to be depressed as other people.
Continue Reading

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