August 30, 2006

More Bad Science? "Treating Post Prandial Hyperglycemia Does Not Delay Progression of Early Type 2 Diabetes"

Diabetes in Control reports on yet another pooly designed study sure to set back diabetes treatment.

The study, STOP-NIDDM gave people Acarbose (Precose) to see if it would delay onset and progression of diabetes. Precose is a carb blocker which I took for several years, so I know quite a lot about it.

The simple version of their finding is that using Acarbose to lower post-prandial blood sugars in people with fasting blood sugars near 125 mg/dl did not keep those blood sugars from rising to 140 mg/dl though it slightly lowered A1c.

What the article DOESN'T point out is that Acarbose only effectively blocks the equivalent of about 10-15 grams of carbohdrate, but the subjects in this study were told to eat a "healthy low fat diet" so they were eating more like 100 grams per meal.

So while their post-prandials might have been lowered from wretched (220-275 mg/dl) merely nasty (180 - 225 mg/dl) they could not have come anywhere near the normal level that it takes to prevent organ damage, including destruction of beta cells!

In addition, by the time someone's fasting blood sugar is in the 120s, as these subjects' were, Precose no longer eliminate spikes, it merely pushes them back a few hours. So testing at 2 hours post-prandially will miss the fact that at 3 or 4 hours the blood sugars are spiking dangerously high.

So the real conclusion of this study is not that controlling PP blood sugar doesn't delay progression of Type 2, it is that any treatment that doesn't NORMALIZE post prandial blood sugars but allows them to go over 140 mg/dl several times a day is a death sentence to beta cells, nerves, kidneys, and retinas.

Sadly, that probably isn't the message that doctors will be getting from this. After all, why tell your patients to test after meals when "research shows" that lowering post meal blood sugars doesn't do anything for them.

Meanwhile, on a related note, it's 8 years since my diagnosis this week and my recent blood work shows completely normal kidneys. My random fasting blood sugar was 86 mg/dl. I have no neuropathy in my feet except for that caused by my crushed lumbar discs. My retinas are perfect. My blood pressure yesterday was 120/80 without any BP meds. Over this entire 8 years I've kept my blood sugar truly normal using whatever it takes, low carb diet, then metformin, and now pre-meal insulin, and it is definitely paying off for me.

August 25, 2006

ADA Nutritional Guidelines -- Keeping Diabetics Diabetic!

The American Diabetes Association is funded heavily by Big Pharma and companies that manufacture high carb junk food. Not so suprisingly, despite a decade of peer-reviewed research proving that a) post-prandial blood sugars are what injure and kill diabetics and b) carbohydrates in meals cause high post-prandial blood sugars, and c) Limiting fat intake has no effect on heart disease, the ADA just came out with new Nutritional Guidelines telling people with diabetes to shun low carbohydrate diets, eat lots of whole grains, and restrict saturated fat to 7% of diet (replacing fats, with carbs, since they also tell people with diabetes to avoid high protein diets.)

There is no way of justifying these recommendations with scientific evidence. Not a single study has shown anything but good outcomes for people with diabetes who restrict carbohydrates. Major research has also proven that low fat diets do not improve cardiovascular health. In addition, study after study shows that cholesterol profiles improve for people on such diets in a way that corresponds to lowered cardiovascular risk (i.e. lower triglycerides and higher HDL).

But people on low carb diabetes diets aren't going to be buying products from ADA main sponsors, Cadbury Schwepps and General Mills. They aren't going to be buying $80 a month prescriptions from Big Pharma either. Obviously the ADA knows who is paying their executives' lavish salaries, and it isn't us poor schnooks with diabetes.

Here's the list of Corporate Sponsors of the ADA. Notice how many make drugs and junk food:

* ARAMARK Corporation [from their web site: "An international company specializing in food services for stadiums, arenas, campuses, businesses, and schools." Tater tots and nacho providers]
* Aventis Pharmaceuticals
* Bally Total Fitness Corporation
!!!!!* Blue Moon Licensing, LLC (Blue Moon Pizza)
!!!!! * Cadbury Schweppes -- America's Beverage [Chocolate, cookies etc]
* Colgate Palmolive Company
* Day-Timers, Inc.
!!!!! * General Mills, Inc. [cereal, cookies, snack foods]
* Gold's Gym International, Inc.
* Johnson Publishing Company, EBONY
!!!!! * Jones Soda Company
* MBNA America Bank, NA
* McNeil Nutritionals [The Splenda company]
* Merisant U.S., Inc. [The Aspartame company]
* Performance Bicycles, Inc.
* Rite Aid Corporation
* Solo Licensing LLC
!!!!* Specialty Brands of America [maple syrup, candy, etc]

List from This Page on the ADA Site

Don't give The ADA a cent of your money until they stop killing people with diabetes by telling them to eat food that raises their blood sugar. If you want to contribute towards diabetes cures, The Juvenile Diabetes Research Foundation (JDRF) uses its money far more wisely.

August 23, 2006

High Post Meal Blood Sugars Destroy Nerves -- Before Diagnosis

A new study adds to the mounting evidence that high post-meal blood sugars damage nerves long before people get diagnosed with diabetes.
Research conducted at Kings College, London found that people who went on to be diagnosed with diabetes had a much higher frequency of Carpal Tunnel Syndrome as early as 10 years before diagnosis. Carpal Tunnel is a nerve disorder.

The reason for this, not discussed in the article, is that the diagnostic test most frequently used to diagnose diabetes, the fasting plasma glucose test (FPG), misses abnormal blood sugars in a huge number of people, particularly women, in whom the early stages of diabetes are characterized by very high post-meal values and near normal fasting values.

Ten years of very high post-meal values will eventually destroy the beta cells, resulting in an official diabetes diagnosis. But by the time that happens, the ten years of exposure to high blood sugars have had time to ruin the nerves, blood vessels, retina, kidneys and other useful bits of equipment that we need to stay alive.

While Carpal Tunnel is a painful annoyance, what also goes unnoticed while high blood sugars run rampant after every meal is subtle destruction of the autonomic nervous system. The autonomic nerves, most notably the Vagus Nerve, control things like heartbeat, blood pressure, and the emptying of the stomach. Not only that, recent research by Dr. Kevin J. Tracy has shown that the Vagus nerve also regulates the immune system. His research shows that when the vagus nerve is not operating properly inflammation may go into overdrive.

It is possibly because the high post-meal blood sugars slowly destroy the vagus nerve which is so important for regulating heart beat and blood pressure, that for every 1% rise in the A1c the risk of cardiovascular "incident"--heart attack or stroke goes up almost two and a half times. It is also probably the reason why people with mildly elevated blood sugars may be prone to other inflammatory conditions.

If you have reason to believe you are at risk of diabets, but your doctor diagnoses diabetes using only a fasting glucose test and does not investigate what your blood sugars are doing after meals or administer a Glucose Tolerance Test, it is time to find a new doctor. Waiting until your fasting blood sugars are bad enough to render a diagnosis of diabetes means waiting until your nerves are already half dead!

If you can't get a doctor to test your post-meal numbers, you can find instructions on how to do this yourself at home with an inexpensive drug store blood sugar meter at HERE

August 17, 2006

Bad Science: ADA: "Type 2 BG Testing Doesn't Work"

Just when you thought the ADA was finally starting to get some faint foggy idea of how to improve the lives of people with Type 2 diabetes, they put
this
on their web site.

Here's the punchline:
"For patients with type 2 diabetes, control of blood sugar (glycemic control) does not appear to be improved if they self-monitor their blood glucose levels, according to researchers at the University of Western Australia, Fremantle."

As usual, the ADA page does not give any details about the study, in line with their usual belief that one of the complications of diabetes is extreme stupidity. This, apparently, is what keeps them from putting any explanations that could not be understood by a third grader into any of the materials they publish for diabetics.

But before you throw out your blood sugar meter, here's what the study actually proved: People who were told to only test their fasting blood sugars a couple times a week and whose only advice about how to control with diet was to eat a low fat diet full of healthy "whole grains" got no benefit from blood sugar testing.

Well, duh!

Fasting blood sugar is the hardest blood sugar to change. For people not on insulin, it can only be changed by modifying post-prandial blood sugars over a period of weeks. And, of course, before you can lower post prandial-blood sugar levels, you have to know what they are--by testing.

Then when you see blood sugar levels that are to high after a meal, you have to cut back on your carbohydrate intake until those post-prandial readings come down.

Unfortunately, Diabetes Australia still mandates that control via "Diet" for diabetics means cutting way back on FAT and eating "healthy grains".

So the poor victims here--I mean subjects--when they saw high fasting blood sugars, if they did anything at all, were likely to cut back even further on meat and cheese and pile their plates higher with pasta which, of course did not lower their fasting blood sugars. Not being as stupid as the researchers, when they couldn't change the test result, they didn't do much testing.

Does anyone still think this study showed that "blood sugar testing doesn't work?"

What wasn't explored at all by this study was what happens if you tell people to test AFTER MEALS and explain to them that if their blood sugar is too high, they can bring it down by eating less carbohydrates.

But as we all know, the ADA, which receives major funding from the big food and snack manufacturers, refuses to tell people with diabetes that they can change their blood sugars by cutting carbs. They still are resistant to the idea that people with diabetes deserve to know what their blood sugar is after meals and to be told--in terms any 3rd grader could understand--that starch and sugar are what raise it anc cutting back on them could keep them from needing hundreds of dollars a month of expensive drugs to counteract the impact of all those supposedly "healthy grains."

Bad advice and poorly thought-out research is nothing new from the ADA. But the real tragedy here is that this latest study gives insurers around the world the green light to stop paying for testing supplies for Type 2 diabetics, because "now we know, for Type 2s, blood sugar testing doesn't work."

Did ADA major-funder and carb supplier Cadbury Schwepps' stock just go up again on this news ? . .

August 9, 2006

STOP-NIDDM Research on HNF4-alpha and Type 2 Diabetes

A while back, I discussed the HNF4-a gene which is implicated both in one of the MODY forms of diabetes and in the Type 2 diabetes found among Ashkenazi Jews. I speculated that because researchers were only looking at people with Type 2 diabetes diagnosed with fasting glucose tests they were missing a lot of people with HNF4-a diabetes.

This is because, from what I can determine from the MODY research I've read, defects in this gene cause beta cells not to respond correctly to incoming glucose, pushing up post-prandial blood sugars. But because the problem first surfaces in post prandial blood sugars, in milder cases the fasting blood sugar may stay below the level used to diagnose diabetes for many years while very high blood sugars follow every meal--and destroy organs. Only when the PP control is completely gone does the fasting blood sugar start to rise.

Well, what do you know? An alert reader sent me notice of a newly published research paper which found that, in fact, women in the STOP-NIDDM trial who had a defective HNF4-a gene were almost twice as likely to become diabetic over the course of the study as those who lacked it.

The paper is "The Single nucleotide polymorphisms of the HNF4-a gene are associated with the conversion to type 2 diabetes mellitus: the STOP-NIDDM trial." Andrulionyte L, Laukkanen O, Chiasson JL, Laakso M.

These are researchers from the Department of Medicine, University of Kuopio, Kuopio, Finland, who earlier published an important study linking polymorphisms of this gene to Type 2 diabetes.

What does this mean for you? Just another bit of evidence that not all diabetes is necessarily caused by insulin resistance. The HNF4-a gene causes a secretory defect, rather than causing or increasing insulin resistance.

It also points out the importance of looking at your post-prandial blood sugars from time to time. Even if your doctor tells you that you are "fine" based on a fasting blood test, you need to make sure your blood sugars aren't going into the diabetic range years before your fasting blood sugars are high enough to diagnose you. By then, you'll have damaged your heart, your nerves, and possibly your eyes and kidneys.

On a related note: A visitor stopped by to post a comment saying that as a person with Type 1 diabetes he was offended that I didn't "understand" that all type 2 diabetes is caused by insulin resistance. I just want to make my point here very clear. I do not question that many type 2s are insulin resistant. But it turns out that many are not. Indeed, there is increasing evidence that secretory defects are an equal cause of type 2 diabetes, and that insulin resistance is NOT necessarily the major cause in a significant amount of type 2.

The best explanation of this is in a wonderful paper
The Genetic Basis of Type 2 Diabetes Mellitus: Impaired Insulin Secretion versus Impaired Insulin Sensitivity by John Gerich.

I invite anyone who still thinks all Type 2 is caused by insulin resistance to read this article and bring themselves up-to-date on what the researchers are finding.

The reason that I focus on Type 2s who are not significantly insulin resistant is because, since I started writing about this on my web site and on the alt.support.diabetes newsgroup, I've heard from a surprising number of people diagnosed as Type 2, who, like me, are not overweight and who have found when they use insulin or sulf drugs that they are not insulin resistant. Since something like 20% of all type 2s are not overweight, I often wonder just how big the pool of Type 2s with secretory defects like that caused by HNF4a might be.

August 4, 2006

British Meters are Whole Blood Calibrated!

I first saw someone post that British blood sugar meters still read in whole blood calibration rather than the plasma equivalent calibration now used in the U.S. on Dr. Bernstein's discussion board which you'll find here .

I checked this out by posting a question on alt.support.diabetes.uk and sure enough, it turns out that it was true. The Roche meters (and strips) sold in the UK are whole blood calibrated, while those sold in the U.S. are plasma calibrated. That includes all the Accuchek meters.


Why does this matter? Because for the same blood sample, meters that read in whole blood calibration give readings 12% lower than those that read in plasma calibration. So a Brit who reads online that a healthy blood sugar target according to the AACE is under 140 mg/dl or 7.7 mmol/l and then gets a reading of 7.6 on his Accuchek meter is happy. He'd be a lot less happy if he realized that 7.6 on the Accuchek would be 8.5 on an American Accuchek, which is, of course, what the AACE is referring to.

Similarly, the 200 mg/dl or 11 mmol/l that is diagnostic for diabetes on a random check is also a plasma calibrated value. The same reading would be 9.9 mmol/l on a blood calibrated meter.

And, just to make it really confusing, while some web sites claim that the Ultra sold in the UK is plasma calibrated, like those in the U.S., Lifescan's UK site specifically says that the strips sold for their Ultra meters in the UK are whole blood calibrated.

Here's a government pamphlet explaining the situation (though it incorrectly identifies the difference as 11% when it has been reported elsewhere as 12%.
UK Pamphlet

Here's the Lifescan link with conflicting information: Lifescan UK Info

From what the Brits have posted when this discussion comes up, it appears that their medical professionals are NOT aware of this issue at all.

If you are in the UK and attempting to maintain healthy blood sugar levels, be sure to convert your readings to plasma readings by multiplying them by 1.12!

August 1, 2006

Quoted again . . . Almost right but not quite

I seem to have become the Poster Girl for "Thinking Twice about Exubera". A new article which is popping of in quite a few newspaper web sites quotes me, a lot more accurately, as explaining my concern that it would be tough to match Exubera to carb intake.

http://www.philly.com/mld/philly/news/15171769.htm

The only thing not quite right here is that I didn't say there were only 2 dose sizes.

Here's what I actually wrote to the journalist who wrote the article:

> But Exubera isn't sold in units, it is sold in mg, and the prescribing
> information tells doctors to calculate the dose based on the patient's
> weight. Their guideline says that someone my weight should be taking 3 mg
> of Exubera, which they state is equivalent to 8 units of insulin. I can hypo
> severely on 5 units of insulin! In fact, I'd have to eat 80 - 100 grams of
> carbohydrate at once to keep from hypoing, which is about twice what I ever
> eat. But I have friends who weigh less than I do who need five times as
> much insulin as I do. For them that dose will be too little to keep them
> from developing dangerous blood sugar spikes aftere eating.
>
> To make it even worse, 3 mg of Exubera does not have the same insulin unit
> equivlence to three 1 mg doses of Exubera.