A Good Time to be Diagnosed?

There's plenty to depress us in the diabetes news. The ADA continues to pander to the snack food and drug companies. Medical researchers who are funded almost entirely now by drug companies continue to publish research so poorly designed a freshman can see the flaws in the design and statistical analysis. But even so, when I compare the situation now to what it was when I was first diagnosed in 1998, there are a lot of reasons to be optimistic. Here--listed in no particular order--are a few of them.

1. Doctors are Finally Prescribing the Right Drugs. When I was diagnosed in 1998, the only drug available for people with Type 2 diabetes in the U.S. that wouldn't damage their health was insulin--which most doctors would not prescribe until the patient had already developed life-ruining complications like nerve pain and kidney damage. Now we have metformin, arguably the best drug ever invented for people with diabetes because it reduces insulin resistance, enables weight loss, and after many years of use in Europe appears to have a safety profile no other drug can beat. Just this past month the ADA's last-to-get-on-the-bandwagon" "Experts" recommended that doctors use metformin followed by insulin instead of the traditional sulf drugs (Amaryl, Glipizide, Gliclazide, etc) which probably burn out beta cells and have been shown to increase the incidence of heart attacks.

[NOTE: An alert reader tells me that Metformin was, in fact, available in the U.S. in 1998, but if it was, my doctors sure weren't aware of it. The first time any one suggested I use it was in 2001. In 1998 I knew one person who was on Avandia as part of a drug trial, but most people who were taking oral drugs that I knew were taking sulfonylurea drugs.]

2. New Classes of Drugs are Appearing Which Don't Make you Fat and Dead. In the bad old days doctors routine prescribed Sulfs and Avandia/Actos, both of which make you fatter and do bad things to your heart. Avandia/Actos also turn out to occasionally cause blindness--via retinal edema. But the new class of drugs which is just emerging cause weight loss and, so far, show no evidence that they worsen heart disease. Byetta, the first of these, is already on the market and Januvia is coming, along with several other versions. These incretin hormone mimic drugs don't work for everyone, but for those for whom they do work, they work very well.

3. Insulin Pills that Work are in Human Trials. A pill from an Israeli company, Oramed, is being tested in humans. It looks like it might actually do what no insulin today can do--enter the liver and allow the body to release insulin quickly in response to incoming food, rather than release at the very slow speed of injected and inhaled insulins. It has been tested in a small group of people, and it worked for them.

The limitation on this pill looks to be that it cannot deliver very high doses of insulin, but for people in the EARLY stages of Type 2 diabetes or those, like me who are not insulin resistant but don't produce enough insulin, they could be the "Magic Bullet" we've all been waiting for. An oral insulin spray is also in testing which might be helpful, too, though it probably shares with inhaled insulin the property of not being able to be administered in a carefully controlled dose.

More on the insulin pill is available here

4. Some doctors ARE getting it. The AACE (American Association of Clinical Endocrinologists), unlike the ADA's elderly and reactionary Expert Committee, continues to revise downward the blood sugar targets they suggest for their patients. An increasing numbers of endos and even some family doctors are urging their patients to cut way back on carbohydrates to achieve better control, too.

Not everyone in the medical community is ignoring the findings of the multi-million dollar WHI study that showed that low fat diets are worthless for preventing heart disease and not everyone ignores the many studies that show that carb restriction improves both blood sugar and cholesterol profiles for people with diabetes.

Which doctors are most likely to recommend low carb diets? Those who themselves have diabetes! And beyond them, those whose patients have shown them how well they work by bringing their A1cs down from 10 or 12% to the 5% range.