Encouraging Statistics

Sometimes the continual flow of bad advice given to people with diabetes can seem overwhelming. All of us have know the neighbor whose doctor put her on the low fat diet that made her give up on diets or the friend on insulin who has been told to test once a week, fasting.

We all run into dozens of people who have no idea that they could go a long way to normalize their blood sugars simply by cutting back on carbs, to say nothing of the doctors who warn us that low carb diets are "dangerous" but are eager to send patients for the weight loss surgery that kills a significant number within weeks of surgery and a lot more over a decade. Too often our attempts to share what we've learned--the techniques that give us near-normal numbers--fall on deaf ears. So I'm glad to have some good news to report.

This morning, when I spent some time delving deeper into the statistics that Google Analytics provides for the Blood Sugar 101 site, I saw real evidence that this site is reaching its audience and making a difference.

Over the past two years there have been almost two million visitors to the site, and over 507,000 of these visitors have read more than a single page. In fact, those who read more than one page spent an average of 9 minutes on the site. And because the site's traffic has quadrupled over the past two years, every day this month 3,000 - 4,000 visitors came to the site, of whom more than 1,000 read several pages. If site traffic stays at this level--and there's no reason it shouldn't as it has been increasing every year since inception, that would mean 365,000 people will have read multiple pages on this site this year alone.

Over this two year period, almost a million of these visitors read the "What is a Normal Blood Sugar" page. Of those 392,000 read the How to Lower Your Blood Sugar" page.

If only one in ten tried the technique reported there, that would be a stadium full of people who would have learned a vital lesson about how to control their blood sugar.

Given the speed with which traffic is growing on the site, it isn't beyond the bounds of probability that within a few years, millions of people will have learned a simple and very effective way to lower their blood sugar that is cheap, effective, and most importantly, safe.

What's even more impressive to me is that this traffic growth has happened entirely through a combination of word of mouth referrals and the site's high rank of Google searches which it maintains because of the density and usefulness of its content. For most of this period I haven't had a lot of time to devote to the site, except to update it with the most important new findings that readers need to know. So it's good to know that the fruit of previous years of labor is finding an audience--especially since when I began posting this research on the site I didn't expect it to reach anyone but a few hundred visitors to the old diabetes newsgroups and wondered at times if it was right to "waste" so much time on what often felt like a quixotic quest.

It wasn't a waste of time and I couldn't be happier. Now I look forward to the day when people will greet with incredulity the idea that there was one a time when people with diabetes didn't know that they could lower their blood sugar by cutting back on starch and sugar and assumed that complications were inevitable because that's what their doctors told them--the same doctors who told them their 7.2% A1cs were "great control."

If there's any moral here it's this. It doesn't take millions of dollars and corporate sponsorship to build a web site that can change people's lives. I'm thankful that the site is having an impact, and looking forward to seeing the next ten million visitors!

 

Research Round Up

Here are some more items I've collected over the past few months that don't justify a separate post but are still of interest. Click on the link to see the study.

1. Users of DPP-4 Inhibitors (i.e. Januvia and Onglyza) report far more infections than metformin users, especially respiratory infections which were twelve times more likely. This is not surprising, DPP-4 plays a significant role in the immune system and turning it off modifies how the immune system works.
2. Alpha cells secrete glutamate that damages beta cells. There have been several intriguing studies recently that suggest that an imbalance between the alpha cells that secrete glucagon, the hormone that raises blood sugar, and the insulin-secreting beta cells may play a part in causing diabetes. Keep an eye on this topic for further developments.
3. WHI finds NO relationship between blood Vitamin D levels and the later development of Type 2 diabetes in older women over a 7.3 year period. More cold water thrown on the latest fad cure-all. There may be reasons to normalize vitamin D levels, but I have been able to find zero evidence that preventing or improving diabetes is among them.
4. Whole fat dairy consumption lowers insulin resistance, raises HDL and correlates with "a substantially lower incidence of diabetes." The researchers who discovered this, by analyzing data from the 3736 adults studied in the Cardiovascular Health Study, appear to have been so disturbed by the implications of their study that they gave it a title that will keep anyone from noticing what they found, which is that eating butter and cream will improve your cardiovascular health.
5. Yet another study finds that A1c is a much better predictor of heart attack than a diabetes diagnosis or other "many other established risk factors" [i.e. cholesterol. "Every 1% increment [over 5.4%] independently predicts a 19% higher odds of MI [myocardial infarction, i.e. heart attack] after accounting for other MI risk factors including diabetes."

6. Higher saturated fat intake slows the progression of coronary artery disease in post-menopausal women. Carbohydrate intake speeds it up. In addition, "polyunsaturated fat intake was positively associated with progression when replacing other fats (P = 0.04) but not when replacing carbohydrate or protein. Monounsaturated and total fat intakes were not associated with progression."

7. Cortisone injections relieve pain of tendon problems in the short term but make them worse and more likely to recur long term. Tendon problems like frozen shoulder are a common diabetic complication. The evidence suggests that the best way to treat them is to leave them alone. They usually get better on their own in a few months. If they don't, my experience has been that acupuncture may help after the acute inflammation phase is over.
8. If you don't wash your hands before testing your blood sugar wiping away the first drop of blood and using the second drop will be more accurate--but don't squeeze Shockingly, the journal "Diabetes Care" actually published a study this month that is useful to people with diabetes.
9. Supplementation with Myo-Inositol may be very helpful in reducing insulin resistance and other characteristics of metabolic syndrome in post-menopausal women Don't go crazy with supplementation, based on this one study, since such studies are often paid for and skewed by companies selling the supplement, but keep alert to see if this finding is confirmed elsewhere.

Research Gives Fascinating insight into What Is Happening in Neuropathy

I just encountered a study that might explain the pattern in which neuropathy develops and gives us insight into how long it will take to reverse it.

Although the neuropathy investigated here was caused by HIV, the pattern in which it develops is the same as that of diabetic neuropathy--feet first, followed by hands after the neuropathy reaches the knee level. More importantly, the mechanism the researchers discovered is fundamental physiology and should apply to all neuropathies.

Here's a detailed discussion of the study from Science Daily. I urge you to read it:

Science Daily: Feet First? Old Mitochondria Might Be Responsible for Neuropathy in the Extremities

WHAT DOES THIS MEAN FOR PEOPLE WITH DIABETES?

If this finding holds up, its value it two-fold. First of all, it suggests that neuropathy may come from damage to the mitochondria that burn energy to supply the nerves, not just, as hitherto believed, the tiny capillaries that supply the nerve tissue.

There are other cross connections between mitochondrial dysfunction and diabetes, though this isn't an area that gets much attention in the health press. This Google Search will show you a sampling of studies that link the two:

GOOGLE Search "Diabetes and Mitochondrial dysfunction"

What's new and interesting about this new study is the discovery that mitochondria are born at one end of the nerve nearest the spine and migrate toward other end, and that, because the feet nerves have the longest journey, their mitochondria take the longest time to make the trip and hence the oldest and the most prone to manifest damage.

The study suggests it takes two to three years for the mitochondria in the feet to migrate to their destination. What we can take from is is the following: If you have developed neuropathy in your feet due to exposing your nerves to high blood sugar levels, once you take steps to stop diabetic neuropathy from happening--by lowering your blood sugar to normal levels--you should expect it to take at least three years for your new and improved mitochondria--the ones that haven't already been damaged--to make the long trip down the nerve cell to your toes.

This is why dietary studies that only last a year are useless for showing the real impact on health that is achieved by a diet that lowers blood sugar to normal levels. But if you know it will take three years after you have brought the damage to a halt to restore your nerves, you should have the patience to stick to it.

The benefits are incalculable. Especially when you remember that nerve damage from high blood sugars doesn't just affect your toes. It affects other long nerves, like the vagus nerve that controls everything from heart beat to your digestive tract.

The best technique for lowering your blood sugar to the level that will avoid nerve damage (keeping blood sugars under 140 mg/dl at almost all times) is described here:


How to Lower Your Blood Sugar

Try it. It works.

You should start seeing some improvements in your neuropathy fairly quickly after normalizing blood sugar, but the findings described above should remind you that it will take quite a while to fully correct previous damage.

As the nerves heal you may experience some pain, tingling, or itching in your extremities as the nerves start working again. This is normal and happens when any damaged nerve starts to heal, especially ones that previously were numb. The pain is a short term effect and should be replaced in a few months by normal function.

 

No Virginia Lowering Blood Sugar Does NOT Kill People with Type 2

Yet another PR release misrepresenting the latest findings of the ACCORD study is polluting the health news this week, and as a result tens of thousands of people with Type 2 diabetes will be given bad advice by their family doctors that will cause them to suffer unnecessary complications.

I try to stay objective, but sometimes the sheer amount of poorly summarized research that is even more poorly reported in the media makes me want to weep.

I have written at length about the ACCORD study, which is the study doctors cite when they tell patients, many controlling blood sugar with diet, that it is dangerous to lower their A1c below 7%. You can read those posts here:

ACCORD REDUX: It's the High Blood Sugars Stupid

ACCORD Redux: Low A1c Does Not Raise Risk of Death

When the Doc Says Lowering Your A1c is Dangerous

If your doctor tells you that lowering your A1c is dangerous, remind him or her of what the ACCORD study actually found, which was this: People who attempted to lower their A1c to 6.5% using a combination Avandia, insulin, and a high carb diet had a higher risk of death only when they did not actually achieve a lowered A1c..

The people who DID manage to lower their A1cs in the ACCORD "intensive control" group did fine.

Today's study is NOT news. It is an extension of the same poorly designed ACCORD study whose results were deconstructed and debunked--but not until a lot of family doctors got the message that they must stop their patients from lowering their A1cs below 7%--even if they did it with diet alone.

What this latest publication from the ACCORD group is, is a look at the longer term outcomes in the groups involved in the original study. You can read the very uninformative abstract here:

Long-Term Effects of Intensive Glucose Lowering on Cardiovascular Outcomes The ACCORD Study Group. N Engl J Med 2011; 364:818-828March 3, 2011

There is nothing in this study that contradicts the finding that the people in the "intensive control" group who did poorly did poorly because their A1cs dropped.

It is when you look at the news story as dumbed down for the TV audience that you see what a tragedy it is that the ACCORD study group continues to publish these studies without making it clear what they really show.

For example, when I scan Google News I see this headline: "New results from a large government-run trial confirm that very aggressive treatment to lower blood sugar is associated with an increased risk of death in people with type 2 at high risk for heart attack and stroke." And given that doctors have been brainwashed into believing that ALL people with Type 2 diabetes are at high risk for heart attack, this translates into "Don't lower your blood sugar!" or "Low A1cs Kill!"

I have people emailing me all the time now that their doctors have lectured them about how they are risking death when they lower their A1c to 5.8 using diet alone. This is idiotic.

The real headline to describe this latest ACCORD Study should be this:

STARTING INTENSIVE DIABETES TREATMENT 20 YEARS AFTER DIAGNOSIS WILL NOT REVERSE THE DAMAGE CAUSED BY THE HIGH BLOOD SUGARS OF THE PREVIOUS DECADES. LOWER A1CS IMMEDIATELY AFTER DIAGNOSIS TO SEE EXCELLENT RESULTS.

Or perhaps:

PEOPLE WHO CANNOT LOWER THEIR A1CS USING POORLY PRESCRIBED REGIMENS INVOLVING DANGEROUS TZD DRUGS AND INSULIN PRESCRIBED WITHOUT PROPER EDUCATION DO POORLY

But let's get one thing clear: Nothing in the ACCORD study suggests that lowering A1c is harmful when it is done by cutting back on carbohydrate intake, avoiding the cardiotoxic TZD drugs Avandia and Actos that were heavily used in ACCORD, and using insulin only after being given a good explanation about how it works that allows you to adjust and tailor your doses based on what you see with your meter.

If you are not using insulin in a way that is giving you frequent hypos and are achiveing A1cs in the 5% range you will not develop the neuropathy that damages the nerves that control your heart beat or the kidney disease that damages your blood pressure, or for that matter, blindness or amputation.

But I can rant on about this as much as I want. Mostly the world ignores it. You who are reading this now and are educated and can read the detailed analysis of the ACCORD studies you can find in the blog posts linked above. But most people with Type 2 diabetes trust their doctors and will do whatever those doctors tell them. Even though your average family doctor's knowledge of diabetes is often 20 years out of date and dangerously confused. And many of those doctors will tell them that they should NEVER lower their A1c below 7% because ACCORD proved it's "dangerous."

If you know someone with diabetes who isn't the kind of person who Googles things, explain to them what this study really proved--that "lowering A1c" is only dangerous when you do it with a poorly chosen drug cocktail and then don't manage to lower your A1c.

Remind them too, that ACCORD is only one, not very well designed study, and that there is a ton of other research that shows that lowering A1c to 6.5% or below does improve health, most notably the ADVANCE study, which was larger and longer than ACCORD.