There's an interesting study that was reported on Science News today which illuminates the very poor way in which doctors communicate the results of medical testing to their patients.
Wide Variety Of Errors Found In Testing Process At Family Medicine Clinics.
What this study found was that "...medical testing errors led to lost time, lost money, delays in care, and pain and suffering for patients, with adverse consequences affecting minority patients far more often. ...The most common errors involved failure to report results to the clinician, accounting for one out of four (24.6%) reported mistakes. Test implementation (17.9%)[i.e. people not getting the test that was ordered] and administrative errors (17.6%) were the next most common. ...A quarter of the errors resulted in delays in care for patients, and 13 percent caused pain, suffering or a definite adverse clinical consequence. Eighteen percent resulted in harm."
This really leapt out at me because I've been hearing from a lot of people whose emails bring to life what these kinds of testing errors really mean for people with diabetes.
Typically the person who is experiencing what sound very much like diabetes symptoms will write, "The doctor gave me a blood test but I didn't hear anything back, so I figured it was okay."
As this study shows--and as I have experienced in my one case--not hearing from your doctor often does not mean that the test was fine. It means that the result never got to your doctor.
Today's doctors' overworked staff do not have the time to double check that a lab test that was ordered came through from the lab. As this study shows about one in four tests never get reported by the lab at all. And whether the report gets through or not has nothing to do with whether the results was normal or not.
So if you were tested for diabetes, and don't hear from your doctor, you need to demand that your doctor's office sends you a copy of the lab result. It is only when they go looking for your lab test that the staff will discover they don't have a copy.
But the problems with lab tests go beyond this. Even if the doctor says, "your test came back fine" you STILL need to demand a copy of the lab results. Why? Because of what this study calls "Administrative errors."
What this means is that when the test comes in to your doctor's office some LPN whose total medical training was a one year certification course at a Junior College looks at the lab sheet and unless something is flagged "abnormal" puts the test into your folder or adds it to the pile of unimportant stuff the doctor doesn't have to look at unless he has nothing else to do.
If you call to ask about the result of this test that was not flagged abnormal, the LPN "Nurse" will tell you it was "fine." But often with diabetes blood tests, the word "Fine" can hide a world of hurt.
Consider the fasting blood glucose test that comes in at 124 mg/dl. This is officially "not diabetes." The ADA defines a diabetic fasting blood sugar as being over 125 mg/dl. So there are, sad to say, LPNS and even doctors who will tell you that you don't have diabetes when you have a fasting blood sugar of 124 mg/dl.
Yes, I know it is crazy. But it happens, though any rational person can see right away that a blood sugar of 124 mg/dl is so close to 126 mg/dl as makes no real difference. Test two days earlier or later and you might very well have seen a fasting blood sugar of 127 mg/dl or more.
By the same token, a lot of family doctors still consider "pre-diabetes" to be a fad diagnosis and will not even mention to you that you have pre-diabetes when your fasting blood sugar is over 100 mg/dl.
This is a huge problem because a lot of research has made it crystal clear that the fasting blood sugar test remains near normal in many people with Type 2 diabetes, until several years after their post-meal blood sugar is going up over 200 mg/dl after every meal. And other research is finding that into a whole slew of diabetic complications from heart disease to nerve damage to early retinal changes leading to blindness begin to occur when these post-meal blood sugars are high, long before the fasting blood sugar is high enough to earn you a diabetes diagnosis.
If you are already diabetic and doctor does an A1c test to check on how your blood sugar is doing, you may also be told you are "fine" when your A1c is hovering around 7.0%. Again, that's because of the way labs report the A1c result.
My lab--at the county hospital--lists an A1c of 6.0 to 6.9% as "VERY GOOD". It lists the A1c of 7.0% to 7.9% as "GOOD." If your doctor mails you a postcard that says "your A1c test result was good" you really need to call up and ask them to mail you a copy of the actual test result, because if that "good" A1c turns out to have been 7.9% it is high enough that you have a thee and a half times higher risk of having a heart attack or stroke than you would have had if your A1c had been between 5.0% and 6.0%. That doesn't sound good to me at all.
In today's environment of PCP doctors who have so many patients they can't remember who you are or what treatment they prescribed for you the last time you visited, you can't assume that the doctor ever saw your lab result unless it was highly abnormal.
Even worse, if you change doctors, don't assume that your old lab results will be forwarded with your "medical records" to your new doctor. Often they are not. Labs often don't keep copies of your old tests for more than a year or two, either.
That's why it is a very good idea to get a copy of every lab test you ever have had done and keep it with your important personal records. Often the real meaning of a medical test does not become crystal clear for a few years, because it is part of a developing pattern. Without previous lab results it is hard for a doctor to know if a borderline finding is significant or not. And in today's world of sloppy medical care, those past lab results may no longer be available.
Your lab results are yours and you have a right to a copy of every lab result you or your insurance has every paid for. When you go in for a lab test, ask exactly what you have to do to get a copy of your test result. Sometimes you will have to fill in special forms. Other times you will have to fax a letter to some functionary. Whatever it takes do it. Get a copy of your labs and if they are blood tests, call on the very helpful people involved in the online diabetes community to help you understand what they mean.
You can find help understanding your test results by posting messages at Tudiabetes.com, Diabetesforums.com and diabetesdaily.com.
BOTTOM LINE: If you have a test, find out what the result was, learn what you can about what the test result numbers mean, and make sure your doctor spends the time to interpret the test appropriately. Especially if it is a blood test that relates to diabetes.
August 15, 2008
August 14, 2008
Why I LOVE Apidra
Apidra is the brand name of yet another fast acting insulin. Its generic name is "insulin glulisine" and that is the name you will see it referred to in medical research studies.
I had been doing quite well with Novolog, but was curious to try Apidra as I had heard it was even faster and more physiological in the way it acted than Novolog. So at my last endocrinologist appointment I asked the doctor about it and she offered me a free sample.
The sample came in the form of a cartridge which had to be inserted in the Opticlick pen. At first I did not think I was going to like it. The Opticlick pen is reusable and is more bulky than the disposable Novolog pens I was used to. It comes in a case that looks like an eyeglass case and barely fits in my purse.
The Opticlick pen also features some electronics that keep track of the dose and the instructions say that if you put it in the fridge that will ruin the pen. Since I have always kept my pens in the fridge to preserve the potency of the insulin and we were headed into summer--the time of year when I traditionally cook a pen or two just walking around with it in my purse on a hot day--I figured my Apidra trial would be short.
Was I wrong! The Apidra cartridge I opened on April 11 dispensed its last unit last week.
The extra long life was due to two factors. The first is that I was eating extremely low carb 2 of the past 4 months at the urging of my surgeon, and when I eat less than ten grams of carbs per meal I only need to use my Levemir.
The other reason was that the Opticlick pen only requires that you shoot one unit to prime the pen, rather than the two units you have to shoot to prime the Novolog pen. When your usual dose is two units, as mine is, having to waste two units every time you take a shot makes the insulin disappear pretty quickly. (My carb insulin ratio right now when I am also injecting Levemir is 1 unit to 20 grams of carbs.)
The last few units of Apidra I injected were just as powerful as the ones I shot the first day I tried it. When I opened a new cartridge I was able to keep using the identical dose to cover the same amount of carbs, which is proof that there was no gradual fade with the previous cartridge. And that was true despite the fact that the Opticlick pen has been sitting in an un-airconditioned kitchen cabinet for the past 4 months--when it hasn't been traveling to restaurants on hot summer days in my purse.
This stuff is ROBUST!
But that's only the beginning of why I love this insulin. The other reason is its activity curve. Now please note, various insulins may perform differently in different people's bodies, so my results might not be your results. But my experience with Apidra is that if I inject it right before my first bite it covers fast carbs perfectly.
What do I mean by perfectly? I mean that if I cover an ear of fresh picked sweet corn with 1 unit right before my first bite, at 1 hour I am at 104 mg/dl and I'm back in the 90s at 2 hours. Since at 2 hours it has just about stopped working, I do not see delayed hypos when I get those good numbers at one hour.
The only potential downside with this kind of activity curve is that if you are eating really slow carbs you may have to split your doses for the meal and inject a second dose at 1 or 2 hours after eating. Otherwise the insulin may peak before your food is digested. I have mainly seen this happen with a slice of pizza eaten with the whole crust and a enchiladas/bean dinner.
But it's a lot better to have to give yourself a booster shot at one hour than to reach that one hour with your blood sugar unacceptably high, or to have to wait for a half an hour after you inject before you can start eating.
I had been concerned because I'd read that if something happens to the Opticlick pen the only place you can get a new one is from the endocrinologist. They aren't sold at pharmacies. But so far this hasn't been a problem. My pen is still working well.
What I really love about the pen is that it has an LCD display that retains the number of units you have injected. So if you are scatterbrained like I am, and inject without giving the dose quite as much attention as you should have, you can look at the pen and for a few minutes it still displays what dose you injected. That's very helpful.
It turns out that the company that makes Apidra (which is the same company that makes Lantus)is going to be selling Apidra in the Solostar disposable pen. They already have switched to selling Apidra in Solostar pens in Europe. That will make Apidra more competitive with Novolog and Humalog which both come in disposable pens. No one can tell me when this will actually happen, but supposedly it is scheduled for sometime in 2008.
I have tried the Solostar pen as my doctor gave me a Lantus Solostar sample last fall when they came out. It is pretty much identical to the Novolog pens and does not track the dose used. Unfortunately, the Solostar requires you to use 2 units to prime the pen, unlike the Opticlick which only uses one. This means the pens will not be lasting anywhere near as long for me. When I am not low carbing my Novolog pens usually last six weeks to two months--if I don't cook them first, a big IF.
I'm told a lot of pump users use Apidra, which given how stable and fast acting it is makes a lot of sense. But if you inject fast acting insulin and are still seeing highs at one hour, you might want to ask your doctor about trying this newer insulin and seeing how it works for you.
If you do test it, start with a low dose and expect it to work faster than the insulins you are used to.
I had been doing quite well with Novolog, but was curious to try Apidra as I had heard it was even faster and more physiological in the way it acted than Novolog. So at my last endocrinologist appointment I asked the doctor about it and she offered me a free sample.
The sample came in the form of a cartridge which had to be inserted in the Opticlick pen. At first I did not think I was going to like it. The Opticlick pen is reusable and is more bulky than the disposable Novolog pens I was used to. It comes in a case that looks like an eyeglass case and barely fits in my purse.
The Opticlick pen also features some electronics that keep track of the dose and the instructions say that if you put it in the fridge that will ruin the pen. Since I have always kept my pens in the fridge to preserve the potency of the insulin and we were headed into summer--the time of year when I traditionally cook a pen or two just walking around with it in my purse on a hot day--I figured my Apidra trial would be short.
Was I wrong! The Apidra cartridge I opened on April 11 dispensed its last unit last week.
The extra long life was due to two factors. The first is that I was eating extremely low carb 2 of the past 4 months at the urging of my surgeon, and when I eat less than ten grams of carbs per meal I only need to use my Levemir.
The other reason was that the Opticlick pen only requires that you shoot one unit to prime the pen, rather than the two units you have to shoot to prime the Novolog pen. When your usual dose is two units, as mine is, having to waste two units every time you take a shot makes the insulin disappear pretty quickly. (My carb insulin ratio right now when I am also injecting Levemir is 1 unit to 20 grams of carbs.)
The last few units of Apidra I injected were just as powerful as the ones I shot the first day I tried it. When I opened a new cartridge I was able to keep using the identical dose to cover the same amount of carbs, which is proof that there was no gradual fade with the previous cartridge. And that was true despite the fact that the Opticlick pen has been sitting in an un-airconditioned kitchen cabinet for the past 4 months--when it hasn't been traveling to restaurants on hot summer days in my purse.
This stuff is ROBUST!
But that's only the beginning of why I love this insulin. The other reason is its activity curve. Now please note, various insulins may perform differently in different people's bodies, so my results might not be your results. But my experience with Apidra is that if I inject it right before my first bite it covers fast carbs perfectly.
What do I mean by perfectly? I mean that if I cover an ear of fresh picked sweet corn with 1 unit right before my first bite, at 1 hour I am at 104 mg/dl and I'm back in the 90s at 2 hours. Since at 2 hours it has just about stopped working, I do not see delayed hypos when I get those good numbers at one hour.
The only potential downside with this kind of activity curve is that if you are eating really slow carbs you may have to split your doses for the meal and inject a second dose at 1 or 2 hours after eating. Otherwise the insulin may peak before your food is digested. I have mainly seen this happen with a slice of pizza eaten with the whole crust and a enchiladas/bean dinner.
But it's a lot better to have to give yourself a booster shot at one hour than to reach that one hour with your blood sugar unacceptably high, or to have to wait for a half an hour after you inject before you can start eating.
I had been concerned because I'd read that if something happens to the Opticlick pen the only place you can get a new one is from the endocrinologist. They aren't sold at pharmacies. But so far this hasn't been a problem. My pen is still working well.
What I really love about the pen is that it has an LCD display that retains the number of units you have injected. So if you are scatterbrained like I am, and inject without giving the dose quite as much attention as you should have, you can look at the pen and for a few minutes it still displays what dose you injected. That's very helpful.
It turns out that the company that makes Apidra (which is the same company that makes Lantus)is going to be selling Apidra in the Solostar disposable pen. They already have switched to selling Apidra in Solostar pens in Europe. That will make Apidra more competitive with Novolog and Humalog which both come in disposable pens. No one can tell me when this will actually happen, but supposedly it is scheduled for sometime in 2008.
I have tried the Solostar pen as my doctor gave me a Lantus Solostar sample last fall when they came out. It is pretty much identical to the Novolog pens and does not track the dose used. Unfortunately, the Solostar requires you to use 2 units to prime the pen, unlike the Opticlick which only uses one. This means the pens will not be lasting anywhere near as long for me. When I am not low carbing my Novolog pens usually last six weeks to two months--if I don't cook them first, a big IF.
I'm told a lot of pump users use Apidra, which given how stable and fast acting it is makes a lot of sense. But if you inject fast acting insulin and are still seeing highs at one hour, you might want to ask your doctor about trying this newer insulin and seeing how it works for you.
If you do test it, start with a low dose and expect it to work faster than the insulins you are used to.
August 11, 2008
Strange Readings? Check Your Meter Battery
They say a man with two watches never knows what time it is. If you have two meters you may sometimes feel the same way about your blood sugar readings.
This past weekend I was seeing some really odd readings with my usual Ultra 2 meter--I was low carbing and using my usual dose Levemir but my fasting blood sugar was much higher than what I expected to see--113 mg/dl rather than low 90s or 80s.
Then I remembered something: when I had been out on a long walk the previous day and tested my blood sugar with the Ultra I keep in my purse, it had been 80 mg/d, but when I tested at home a few hours later without eating anything, it was back into the low 100s.
Finally I got the bright idea of testing my blood sugar simultaneously on both meters, and yes. The Ultra 2 was reading 113 and the purse Ultra read 90. In the past when I have tested the same draw on both meters they have matched within 3 mg/dl.
I did a control solution test (though I have NEVER yet had a control solution test identify a faulty meter, even when the meter has been found to test 50 mg/dl higher than a lab reading.) The control solution test showed the one meter reading considerably lower than the other when tested with the test solution, but both meter readings were within the ridiculously wide range supplied by the meter manufacturer.
Then I remembered that I had read somewhere that a battery is only good for about 1000 readings. Since I test about 5 times a day, that is not even a year's worth of tests. So before I went out to get a new meter and then had to wait months for the rebates involved, I figured it would be worth investing $2.49 in a new battery to see if it made any difference.
I installed the new battery and tested again. This time my two meters matched within 1 mg/dl. And they matched at the low reading, not that baffling high reading.
Problem solved.
But once again I was disgusted at this latest proof of how poorly designed these meters are. The weak battery had caused my meter to read 24% higher than it should have read, but there was no "low battery" message on my meter though the manual tells me there should be one when the battery is running low. I had definitely run more than 1,000 tests on this meter, but obviously the meter will continue to provide test results--erroneous test results--long after that number of readings has been exceeded.
Even worse, had I not had a second meter with a newer battery, I would not have discovered this problem and I might have ended up using too much insulin as I tried to get my fasting blood sugar down from the "high" of 113 to the normal middle 80s range I shoot for. Since my 113 really was 90, lowering my fasting blood sugar by another 20 mg/dl would have put me at risk of hypoing.
From past experience, I know that calling the meter company to complain would have only resulted in the phone-clone demanding that I do a control solution test and when the value fell within the 35 mg/dl wide range given on the vial of strips, they would have told me there was no problem.
But if there is a 35 mg/dl difference between what your meter says your fasting blood sugar is, and what it really is, there IS a serious problem. Not to mention the 7 expensive expensive strips I wasted on debugging this latest problem.
In a world where every other piece of electronic technology drops in price every three months, and where one out of every U.S. four adults over age 50 has diabetes and is hence a customer for the blood sugar meter companies, there is no excuse for the combination of poor performance and rising prices we continue to experience with these meters.
The meter is the single most powerful tool we have at our disposal to help us for achieve normal blood sugars. Isn't it time to demand that they work properly and that the companies charge a fair price for the strips?
This past weekend I was seeing some really odd readings with my usual Ultra 2 meter--I was low carbing and using my usual dose Levemir but my fasting blood sugar was much higher than what I expected to see--113 mg/dl rather than low 90s or 80s.
Then I remembered something: when I had been out on a long walk the previous day and tested my blood sugar with the Ultra I keep in my purse, it had been 80 mg/d, but when I tested at home a few hours later without eating anything, it was back into the low 100s.
Finally I got the bright idea of testing my blood sugar simultaneously on both meters, and yes. The Ultra 2 was reading 113 and the purse Ultra read 90. In the past when I have tested the same draw on both meters they have matched within 3 mg/dl.
I did a control solution test (though I have NEVER yet had a control solution test identify a faulty meter, even when the meter has been found to test 50 mg/dl higher than a lab reading.) The control solution test showed the one meter reading considerably lower than the other when tested with the test solution, but both meter readings were within the ridiculously wide range supplied by the meter manufacturer.
Then I remembered that I had read somewhere that a battery is only good for about 1000 readings. Since I test about 5 times a day, that is not even a year's worth of tests. So before I went out to get a new meter and then had to wait months for the rebates involved, I figured it would be worth investing $2.49 in a new battery to see if it made any difference.
I installed the new battery and tested again. This time my two meters matched within 1 mg/dl. And they matched at the low reading, not that baffling high reading.
Problem solved.
But once again I was disgusted at this latest proof of how poorly designed these meters are. The weak battery had caused my meter to read 24% higher than it should have read, but there was no "low battery" message on my meter though the manual tells me there should be one when the battery is running low. I had definitely run more than 1,000 tests on this meter, but obviously the meter will continue to provide test results--erroneous test results--long after that number of readings has been exceeded.
Even worse, had I not had a second meter with a newer battery, I would not have discovered this problem and I might have ended up using too much insulin as I tried to get my fasting blood sugar down from the "high" of 113 to the normal middle 80s range I shoot for. Since my 113 really was 90, lowering my fasting blood sugar by another 20 mg/dl would have put me at risk of hypoing.
From past experience, I know that calling the meter company to complain would have only resulted in the phone-clone demanding that I do a control solution test and when the value fell within the 35 mg/dl wide range given on the vial of strips, they would have told me there was no problem.
But if there is a 35 mg/dl difference between what your meter says your fasting blood sugar is, and what it really is, there IS a serious problem. Not to mention the 7 expensive expensive strips I wasted on debugging this latest problem.
In a world where every other piece of electronic technology drops in price every three months, and where one out of every U.S. four adults over age 50 has diabetes and is hence a customer for the blood sugar meter companies, there is no excuse for the combination of poor performance and rising prices we continue to experience with these meters.
The meter is the single most powerful tool we have at our disposal to help us for achieve normal blood sugars. Isn't it time to demand that they work properly and that the companies charge a fair price for the strips?
August 6, 2008
More Evidence That Weight Loss After 65 is Dangerous To Your Health
We already knew from analysis of NHANES data that after age 70 any weight loss, including weight loss from intentional dieting, correlates with a higher risk of death. This was true even when controlling for the presence of diseases that might have caused weight loss like cancer. You can review some of the research that established this in this earlier blog post: Overweight is Healthiest Weight.
Now an intriguing finding about the hormone adiponectin may hint at why this is. The study is described in this week's issue of Diabetes in Control. Read the summary here:
Adiponectin May Increase Risk of Heart Attack.
Diabetes in Control's article reports: "This study examined a sample of 1,386 participants of the population-based Cardiovascular Health Study from 1992 to 2001. Participants consisted of adults aged 65 to 100 years and were recruited from four field centers in the United States. Subjects underwent physical examinations and laboratory testing. Of these participants, 604 experienced a heart disease event. Those with the highest levels of adiponectin were most likely to suffer a heart attack."
The kicker is this: Weight loss causes adiponectin to rise.
The researchers from this study speculate that "higher adiponectin concentration may reflect underlying disease processes in the body, or even have direct harmful effects, which may be amplified in the elderly. Adiponectin has been shown to increase energy expenditure through direct actions in the central nervous system in mice, and if this effect were also present in humans, it could be significantly harmful in older adults by accelerating the loss of skeletal muscle, a condition called sarcopenia."
Given that repeated analysis of the huge volume of NHANES research found a similar increase in death with weight loss even when people's underlying health conditions were screened out, I doubt that underlying conditions are the explanation for the correlation here. Indeed, there may very well be a reason why our bodies start to pack on weight at middle age and that reason may be that the fat we pack on helps keep us alive.
It is worth noting, again, that despite all the demonization of obesity in the media, Dr. Nir Barzilai's research about people who lived to be 100 years old or older found that fully one third of them were obese in their 50s.
So what does this latest finding mean for you? My guess is that it means that the best time to work on your weight is long before you hit your 60s. From then on your focus should be on blood sugar control and that your dieting efforts should be directed to maintaining your current weight rather than losing weight.
Certainly the body helps us out on this one. It gets tougher and tougher to drop a pound with each passing year and just maintaining our weight may take more self-restraint than we expended dropping 30 lbs in our 30s.
Vanity fanned by a media culture that makes people believe that we all should have bodies like liposuctioned, breast-augmented 20-year-old actresses makes it very hard to accept the idea that a healthy older person is a plumper older person.
Perhaps the next radical step the Baby Boom generation will have to take is to publicly challenge the fat-phobic media culture and start demanding that health authorities tell the truth about the relationship of weight and health in older people. That truth is simple: LOSING WEIGHT KILLS OLDER FOLKS.
Ignore it at your peril.
Now an intriguing finding about the hormone adiponectin may hint at why this is. The study is described in this week's issue of Diabetes in Control. Read the summary here:
Adiponectin May Increase Risk of Heart Attack.
Diabetes in Control's article reports: "This study examined a sample of 1,386 participants of the population-based Cardiovascular Health Study from 1992 to 2001. Participants consisted of adults aged 65 to 100 years and were recruited from four field centers in the United States. Subjects underwent physical examinations and laboratory testing. Of these participants, 604 experienced a heart disease event. Those with the highest levels of adiponectin were most likely to suffer a heart attack."
The kicker is this: Weight loss causes adiponectin to rise.
The researchers from this study speculate that "higher adiponectin concentration may reflect underlying disease processes in the body, or even have direct harmful effects, which may be amplified in the elderly. Adiponectin has been shown to increase energy expenditure through direct actions in the central nervous system in mice, and if this effect were also present in humans, it could be significantly harmful in older adults by accelerating the loss of skeletal muscle, a condition called sarcopenia."
Given that repeated analysis of the huge volume of NHANES research found a similar increase in death with weight loss even when people's underlying health conditions were screened out, I doubt that underlying conditions are the explanation for the correlation here. Indeed, there may very well be a reason why our bodies start to pack on weight at middle age and that reason may be that the fat we pack on helps keep us alive.
It is worth noting, again, that despite all the demonization of obesity in the media, Dr. Nir Barzilai's research about people who lived to be 100 years old or older found that fully one third of them were obese in their 50s.
So what does this latest finding mean for you? My guess is that it means that the best time to work on your weight is long before you hit your 60s. From then on your focus should be on blood sugar control and that your dieting efforts should be directed to maintaining your current weight rather than losing weight.
Certainly the body helps us out on this one. It gets tougher and tougher to drop a pound with each passing year and just maintaining our weight may take more self-restraint than we expended dropping 30 lbs in our 30s.
Vanity fanned by a media culture that makes people believe that we all should have bodies like liposuctioned, breast-augmented 20-year-old actresses makes it very hard to accept the idea that a healthy older person is a plumper older person.
Perhaps the next radical step the Baby Boom generation will have to take is to publicly challenge the fat-phobic media culture and start demanding that health authorities tell the truth about the relationship of weight and health in older people. That truth is simple: LOSING WEIGHT KILLS OLDER FOLKS.
Ignore it at your peril.
August 4, 2008
C-Peptide and Your Nerves
When a beta cell synthesizes insulin it creates a substance called "proinsulin" which splits into the actual insulin molecule and another substance--a chain of proteins called C-peptide. Details of this process are described in this Wikipedia article: http://en.wikipedia.org/wiki/Proinsulin
Most of us learn about C-peptide because testing its concentration in our blood is useful for determining if a person's beta cells are making insulin. This is especially true if a person is injecting insulin. That is because injected insulin only contains the actual insulin molecule not C-peptide. So the only way you get C-peptide in your blood is if your beta cells are making proinsulin, which then is presumed to turn into insulin.
For years C-peptide was considered to be inert, but it now turns out that C-peptide may play an important role in our body. There is some evidence that it is actively involved in the processes that fight oxidation in our blood vessels. This is important because damage to our blood vessels is what causes neuropathy. When tiny capillaries are damaged they do not supply blood to our nerves. Damage to blood vessels also leads to kidney damage.
A recently published study found one mechanism which may explain the effects of C-peptide on blood vessels. You can read the abstract HERE:
Human C-peptide antagonises high glucose-induced endothelial dysfunction through the nuclear factor-κB pathway .
How important this could be is suggested by a very small controlled study where for three months human C-peptide was injected in people with Type 1 diabetes who produce no C-peptide of their own. Improvements were seen in neuropathy and kidney function in the group who received the C-peptide.
Beneficial effects of C-peptide on incipient nephropathy and neuropathy in patients with Type 1 diabetes mellitus.
Another very similar study that lasted 6 months found a similar effect on nerves:
C-Peptide Replacement Therapy and Sensory Nerve Function in Type 1 Diabetic Neuropathy
It is important to understand that the process by which synthetic insulin is manufactured never produces C-peptide. There is a false belief floating around the internet that insulin manufacturers "throw out" the C-peptide. In fact, what they do is get genetically modified microbes to spit out copies of the final insulin molecule. Pro-insulin is never produced in the insulin manufacturing process. Pro-insulin was present in the old animal insulins but the process of purifying those animal insulins which was necessary to eliminate substances that caused serious allergic reactions in some people also eliminated the C-peptide, so you will not find C-peptide in any animal insulins sold today as they too contain only the actual insulin molecule.
The good news for those of us who are lacking C-peptide is that it appears that drug companies are working on producing synthetic C-peptide. If the initial, admittedly very small scale, research on the ability of C-peptide to prevent complications holds up, in a few years you might be able to inject synthetic C-peptide and lower your chances of developing microvascular complications.
But that said, it is very important to realize that there is just as much--if not more--research that suggests that you can also reverse and prevent microvascular complications by keeping your blood sugar within truly normal limits, and avoiding highs that go over 140 mg/dl for any significant amount of time. That level appears to be the level at which neuropathy first appears. You can read the research that shows this on this page:
Research Connecting Organ Damage with Blood Sugar Level.
One thing that makes me question whether C-peptide is a truly magical elixir is how many people with Type 2 who still produce insulin--often a lot of it--develop neuropathy and early kidney damage before they have blood sugars high enough to give them a diabetes diagnosis. Since these people are secreting proinsulin and often test with very high levels of C-peptide since they are primarily insulin resistant, not insulin deficient, one has to wonder how potent the effects of C-peptide really are. Clearly the presence of C-peptide in these people's blood streams does not prevent the microvascular complications.
Another question that rises in the minds of those of us who still can produce some insulin is whether we are suppressing our C-peptide secretion by injecting insulin and if we are, if this might make complications more rather than less likely.
The evidence, such as it is, suggests that injecting insulin early rather than late lowers the rate of microvascular complications--mostly because, as stated before, the benefits of lowering blood sugar to normal levels appear to outweigh any possibly helpful impact of C-peptide.
So if your own native--produced insulin is not able to keep your blood sugar in normal limits, any benefits you get from producing C-peptide are outweighed by the damage caused by the high blood sugars your inadequate insulin production creates. In any event, it appears that even when you inject insulin your body still produces some insulin. That is why doctors will give C-peptide tests to people with Type 2 who inject insulin and use the results to rule out Type 1 diabetes. Even when people with Type 2 diabetes are injecting large amounts of insulin, if some beta cells are still alive they will secrete detectable amounts of C-peptide.
Since there is clearly another big-selling diabetes product in the works here, if you start seeing a lot of studies promoting the value of C-peptide in the journals you should assume that some company is about to launch a blockbuster new, and of course expensive, synthetic C-peptide.
We won't know how effective it really is until we can see the results of some large trails with thousands rather than tens of subjects. My guess is that it will have some value, as does Symlin, another drug that replaces a hormone destroyed when the pancreas is the subject of immune attack. But is the case with Symlin, the value of an artificial C-peptide will be enormously enhanced if it is used in conjunction with a diet that cuts way, way down on the carbohydrates that raise blood sugar.
No magic bullet is going to prevent complications when your blood sugar is well over 200 mg/dl for hours at a time. And fortunately, we already know how to prevent that from happening. Cut back on the carbs!
Most of us learn about C-peptide because testing its concentration in our blood is useful for determining if a person's beta cells are making insulin. This is especially true if a person is injecting insulin. That is because injected insulin only contains the actual insulin molecule not C-peptide. So the only way you get C-peptide in your blood is if your beta cells are making proinsulin, which then is presumed to turn into insulin.
For years C-peptide was considered to be inert, but it now turns out that C-peptide may play an important role in our body. There is some evidence that it is actively involved in the processes that fight oxidation in our blood vessels. This is important because damage to our blood vessels is what causes neuropathy. When tiny capillaries are damaged they do not supply blood to our nerves. Damage to blood vessels also leads to kidney damage.
A recently published study found one mechanism which may explain the effects of C-peptide on blood vessels. You can read the abstract HERE:
Human C-peptide antagonises high glucose-induced endothelial dysfunction through the nuclear factor-κB pathway .
How important this could be is suggested by a very small controlled study where for three months human C-peptide was injected in people with Type 1 diabetes who produce no C-peptide of their own. Improvements were seen in neuropathy and kidney function in the group who received the C-peptide.
Beneficial effects of C-peptide on incipient nephropathy and neuropathy in patients with Type 1 diabetes mellitus.
Another very similar study that lasted 6 months found a similar effect on nerves:
C-Peptide Replacement Therapy and Sensory Nerve Function in Type 1 Diabetic Neuropathy
It is important to understand that the process by which synthetic insulin is manufactured never produces C-peptide. There is a false belief floating around the internet that insulin manufacturers "throw out" the C-peptide. In fact, what they do is get genetically modified microbes to spit out copies of the final insulin molecule. Pro-insulin is never produced in the insulin manufacturing process. Pro-insulin was present in the old animal insulins but the process of purifying those animal insulins which was necessary to eliminate substances that caused serious allergic reactions in some people also eliminated the C-peptide, so you will not find C-peptide in any animal insulins sold today as they too contain only the actual insulin molecule.
The good news for those of us who are lacking C-peptide is that it appears that drug companies are working on producing synthetic C-peptide. If the initial, admittedly very small scale, research on the ability of C-peptide to prevent complications holds up, in a few years you might be able to inject synthetic C-peptide and lower your chances of developing microvascular complications.
But that said, it is very important to realize that there is just as much--if not more--research that suggests that you can also reverse and prevent microvascular complications by keeping your blood sugar within truly normal limits, and avoiding highs that go over 140 mg/dl for any significant amount of time. That level appears to be the level at which neuropathy first appears. You can read the research that shows this on this page:
Research Connecting Organ Damage with Blood Sugar Level.
One thing that makes me question whether C-peptide is a truly magical elixir is how many people with Type 2 who still produce insulin--often a lot of it--develop neuropathy and early kidney damage before they have blood sugars high enough to give them a diabetes diagnosis. Since these people are secreting proinsulin and often test with very high levels of C-peptide since they are primarily insulin resistant, not insulin deficient, one has to wonder how potent the effects of C-peptide really are. Clearly the presence of C-peptide in these people's blood streams does not prevent the microvascular complications.
Another question that rises in the minds of those of us who still can produce some insulin is whether we are suppressing our C-peptide secretion by injecting insulin and if we are, if this might make complications more rather than less likely.
The evidence, such as it is, suggests that injecting insulin early rather than late lowers the rate of microvascular complications--mostly because, as stated before, the benefits of lowering blood sugar to normal levels appear to outweigh any possibly helpful impact of C-peptide.
So if your own native--produced insulin is not able to keep your blood sugar in normal limits, any benefits you get from producing C-peptide are outweighed by the damage caused by the high blood sugars your inadequate insulin production creates. In any event, it appears that even when you inject insulin your body still produces some insulin. That is why doctors will give C-peptide tests to people with Type 2 who inject insulin and use the results to rule out Type 1 diabetes. Even when people with Type 2 diabetes are injecting large amounts of insulin, if some beta cells are still alive they will secrete detectable amounts of C-peptide.
Since there is clearly another big-selling diabetes product in the works here, if you start seeing a lot of studies promoting the value of C-peptide in the journals you should assume that some company is about to launch a blockbuster new, and of course expensive, synthetic C-peptide.
We won't know how effective it really is until we can see the results of some large trails with thousands rather than tens of subjects. My guess is that it will have some value, as does Symlin, another drug that replaces a hormone destroyed when the pancreas is the subject of immune attack. But is the case with Symlin, the value of an artificial C-peptide will be enormously enhanced if it is used in conjunction with a diet that cuts way, way down on the carbohydrates that raise blood sugar.
No magic bullet is going to prevent complications when your blood sugar is well over 200 mg/dl for hours at a time. And fortunately, we already know how to prevent that from happening. Cut back on the carbs!
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