Today's New York Times reports on the study of regulation of clinical trials by the F.D. A. conducted by the inspector general of the Department of Health and Human Services, Daniel R. Levinson. His report said that federal health officials did not know how many clinical trials were being conducted, audited fewer than 1 percent of the testing sites and, on the rare occasions when inspectors did appear, generally showed up long after the tests had been completed.
Report Assails F.D.A. Oversight of Clinical Trials
The article goes on to cite examples of clinical trails being run by marginal criminal characters, like a psychiatrist about whom they write,"Last November, the Oklahoma Board of Medical Licensure and Supervision suspended Dr. Linden’s license for three months because he had sex with two patients and gave them genital herpes infections." [This is NOT the first New York Times report of drug companies doing business with doctors who have been disciplined for serious ethical violations .]
The most telling statement in the report is this one:
" 'In many ways, rats and mice get greater protection as research subjects in the United States than do humans,” said Arthur L. Caplan, chairman of the department of medical ethics at the University of Pennsylvania.
"Animal research centers have to register with the federal government, keep track of subject numbers, have unannounced spot inspections and address problems speedily or risk closing, none of which is true in human research, Mr. Caplan said."
Many so-called "clinical trials" are run by questionable clinical trial mills, after the drug has been approved for use. They have with one goal, and one goal only: to make it possible for the sponsoring drug company to expand the uses for its drug.
These trials are likely to be poorly supervised and often throw out any data that doesn't prove the result they set out to get. When doctors participate in these trials--which many do--they are paid hundreds of dollars--sometimes thousands--per participant. This is NEVER disclosed to the patients they enroll who may be given the impression that the doctor is prescribing the drug or device under study because it will improve their health--though often there is no evidence for this at all.
Trials run as part of drug company marketing efforts and conducted by by for profit clinical trial mills earn huge amounts of money for these clinical trail mills. Since it is very difficult to recover damages no matter how badly the participant is hurt, thanks to the legal disclaimers participants sign, there is no motivation to protect the people taking the drugs.
Why does this matter to you, a person with diabetes? Because people with diabetes are a huge market for expensive, dangerous new drugs, so you are very likely to run into a doctor who wants you to sign up for such a trial.
You'll also notice a lot of Google Ads displayed on Diabetes-related sites are trying to recruit you to participate in clinical studies. There is rarely any identifying information when you click through as to WHO is conducting the study. Unless the trial clearly identifies who is running the trial, and it is a major, well respected, well known medical organization like Joslin Medical Center or Rockefellar University, with a track record in diabetes or obesity research, you'd be well advised to ignore it.
Finally, be aware that drug companies often sponsor "clinical trials" of drugs already on the market where the purpose of the "study" is only to sign up hundreds of thousands of new patients to take their expensive new drug, with the idea being that once they are on it for a couple months, they will stay on it forever. Often these kinds of trials never result in any publication of any result, because no true study is being done. This kind of study is also common with medical devices. It's a technique companies use to lure you away from their competitors.
Before you participate in any clinical trial, get answers to the following questions in writing.
1. What are the known dangers of the drug, including all side effects? All drugs have serious side effects and if you are told, NONE it either means you are being lied to or the drug is so little understood that the purpose of the trial is to find out what dangerous side effects it causes.
2. What restitution will the testing company make if you suffer a serious side effect or see your health deteriorate as a result of taking the drug under study? Prepare to hear some major weasel wording here.
3. If your doctor "invites" you into a study for a new drug or device, ask the doctor how much they are being paid, per patient, to recruit people into the study? This is not an insult to your doctor. Doctors ARE paid for recruiting subjects. They should disclose this to the people they are profiting on. Ask the doctor what hard evidence he or she has seen that this drug will be good for you. Don't trust your doctor to know about side effects. Recent research shows that most doctors are unfamiliar with even the most dangerous side effects of commonly prescribed drugs. Google the drug using its generic name until you find out what is known about it. Then bring what you find to your doctor's attention.
4. Google the testing company on Google Scholar to see whether studies done by this clinical trial company ever turn into research papers and if they do, what the quality of the publications is that publishes them. Some supposed medical journals are marginal publications that verge on being Vanity Press offerings where anyone can publish if they pay enough. If you don't see the studies performed by the testing organization reported in top medical journals like New England Journal of Medicine, and Journal of the American Medical Association, be wary. The "clinical trial" may have one purpose only--drug marketing, and these are the kinds of trials where you are the most likely to be hurt.
5.If the drug or device involved is already on the market, research it carefully and be aware that the study may well be only an attempt to convert you from using a cheaper alternative. If the trial involves a psychiatric drug, like an antidepressant, be twice as careful. Many of these drugs are claimed to be non-addictive, but people who have tried to stop taking them report this is far from the case. Once you have been "habituated" to a powerful psychiatric drug [the euphemism now used in place of "addicted" though it means the same thing in practice], you may experience severe withdrawal symptoms if you go off it.
September 28, 2007
September 26, 2007
EASD: Why the OGTT Fails to Predict Heart Attack and Why this Harms People
Diabetes in Control reported today on a study presented at EASD by Dr Esther van 't Riet which found that in normal people the A1c is predictive of non-fatal heart attack, but, both fasting bg and the 2 hour OGTT [Oral Glucose Tolerance Test] results are not.
http://www.diabetesincontrol.com/results.php?storyarticle=5146
Before you conclude that this study "proves" that post-meal spikes are not what cause heart attacks, it is worth considering how the OGTT works and why it does NOT mimic the way your body responds to high carb meals.
The OGTT involves sucking down 70-75 grams of pure glucose and then testing blood sugar at various intervals to see what happens. It is a convention of medical research to use the OGTT value to diagnose "Impaired glucose tolerance" when the 2 hour result is over 140 mg/dl (7.7 mmol/L) and to diagnose diabetes when the 2 hour result is over 200 mg/dl (11.1 mmol/L).
However, glucose is the one form of sugar that does not require any digestion. It goes directly into the bloodstream within 15 minutes, unlike starch or sucrose which must be broken down in the stomach and may take up to an hour to reach the blood.
So the 75 grams of glucose you swill during an OGTT hit the blood in 15 minutes. In most people with the kinds of blood sugar control likely to result in a 5.5% A1c (the level Dr. Riet's study showed to correlate with heart attack)this initial very high blood sugar spike provokes reactive hypoglyecmia.
So what typically happens is that the person with marginal blood sugar control--the 5.5% A1c that marks a higher risk of heart attack--will get a very high blood sugar reading at 1 hour only to have the blood sugar plummet in the second hour. it is quite possible to have a normal or even a low blood sugar two hours after taking an OGTT where the one hour value was over 200 mg/dl (11.1 mmol/L). But this study only looked at that second hour response in diagnosing "impaired glucose tolerance."
However, look what happens when these same people with the 5.5% A1cs and "normal" two hour OGTT values eat the same number of grams of carbohydrate that are used in the OGTT in the form of real food.
That hamburger bun and order of fries with the 75 grams of carbohydrate digest more slowly, thanks to the carbohydrate they contain being combined with fat and protein. So if you have an A1c of 5.5% and test your blood sugar after eating 75 grams of carb in real food you are more likely to see something like 180 mg/dl (10 mmol/L) at one hour after eating and 160 (8.9 mmol/L) at two hours. By 3 hours your blood sugar may have dropped to 120 mg/dl, but until it does you have spend a couple hours with blood sugar levels that are known to be high enough to damage the organs!
It is a shame that almost no medical authorities test people for meal tolerance rather than using pure glucose syrup for the OGTT. The meal tolerance test, where a meal containing real food with a known carb count is served and blood sugar measured at one and two hours, would give doctors a much better idea of what is happening in the patient's body day in and day out. It would also be very likely to show a very tight correlation between exposure to elevated blood sugars after meals and increased incidence of heart attack.
Instead, the researchers here, who clearly have NEVER MEASURED THEIR OWN BLOOD SUGARS and do not understand that a "normal" two hour results on an OGTT may not indicate normal blood sugar response to meals day in and day out, look at that 2 hour OGTT results and conclude that, since the OGTT results don't correlate with heart attack incidence, blood sugar is not causing heart attack. Instead they hypothesize that the A1c is only "a marker" and elevated blood sugars is NOT the cause of heart disease.
This is tragic. Because lowering blood sugar after meals is probably the single most powerful tool available to us to avoid heart disease!
But sadly, the researchers in this case conclude that doctors should not attempt to lower A1c but should just keep treating cardiac risk factors with expensive drugs.
I am sure you will hear doctors citing this study as a reason to avoid testing after meals or reducing blood sugar spikes since "clearly" the study shows that spikes don't correlate with heart disease.
But those of us who do control our blood sugar and avoid post-meal blood sugar spikes know that controlling spikes so that they don't go over 140 mg/dl (7.7 mmol/L) lowers blood pressure, lowers triglycerides and LDL and raises HDL without the need for expensive drugs. Which suggests that elevated post-meal blood sugars are what raise the risk factors and that normalizing blood sugar could prevent heart disease.
Sadly, bad science in the form of over-reliance on the OGTT will keep most people from ever learning this.
http://www.diabetesincontrol.com/results.php?storyarticle=5146
Before you conclude that this study "proves" that post-meal spikes are not what cause heart attacks, it is worth considering how the OGTT works and why it does NOT mimic the way your body responds to high carb meals.
The OGTT involves sucking down 70-75 grams of pure glucose and then testing blood sugar at various intervals to see what happens. It is a convention of medical research to use the OGTT value to diagnose "Impaired glucose tolerance" when the 2 hour result is over 140 mg/dl (7.7 mmol/L) and to diagnose diabetes when the 2 hour result is over 200 mg/dl (11.1 mmol/L).
However, glucose is the one form of sugar that does not require any digestion. It goes directly into the bloodstream within 15 minutes, unlike starch or sucrose which must be broken down in the stomach and may take up to an hour to reach the blood.
So the 75 grams of glucose you swill during an OGTT hit the blood in 15 minutes. In most people with the kinds of blood sugar control likely to result in a 5.5% A1c (the level Dr. Riet's study showed to correlate with heart attack)this initial very high blood sugar spike provokes reactive hypoglyecmia.
So what typically happens is that the person with marginal blood sugar control--the 5.5% A1c that marks a higher risk of heart attack--will get a very high blood sugar reading at 1 hour only to have the blood sugar plummet in the second hour. it is quite possible to have a normal or even a low blood sugar two hours after taking an OGTT where the one hour value was over 200 mg/dl (11.1 mmol/L). But this study only looked at that second hour response in diagnosing "impaired glucose tolerance."
However, look what happens when these same people with the 5.5% A1cs and "normal" two hour OGTT values eat the same number of grams of carbohydrate that are used in the OGTT in the form of real food.
That hamburger bun and order of fries with the 75 grams of carbohydrate digest more slowly, thanks to the carbohydrate they contain being combined with fat and protein. So if you have an A1c of 5.5% and test your blood sugar after eating 75 grams of carb in real food you are more likely to see something like 180 mg/dl (10 mmol/L) at one hour after eating and 160 (8.9 mmol/L) at two hours. By 3 hours your blood sugar may have dropped to 120 mg/dl, but until it does you have spend a couple hours with blood sugar levels that are known to be high enough to damage the organs!
It is a shame that almost no medical authorities test people for meal tolerance rather than using pure glucose syrup for the OGTT. The meal tolerance test, where a meal containing real food with a known carb count is served and blood sugar measured at one and two hours, would give doctors a much better idea of what is happening in the patient's body day in and day out. It would also be very likely to show a very tight correlation between exposure to elevated blood sugars after meals and increased incidence of heart attack.
Instead, the researchers here, who clearly have NEVER MEASURED THEIR OWN BLOOD SUGARS and do not understand that a "normal" two hour results on an OGTT may not indicate normal blood sugar response to meals day in and day out, look at that 2 hour OGTT results and conclude that, since the OGTT results don't correlate with heart attack incidence, blood sugar is not causing heart attack. Instead they hypothesize that the A1c is only "a marker" and elevated blood sugars is NOT the cause of heart disease.
This is tragic. Because lowering blood sugar after meals is probably the single most powerful tool available to us to avoid heart disease!
But sadly, the researchers in this case conclude that doctors should not attempt to lower A1c but should just keep treating cardiac risk factors with expensive drugs.
I am sure you will hear doctors citing this study as a reason to avoid testing after meals or reducing blood sugar spikes since "clearly" the study shows that spikes don't correlate with heart disease.
But those of us who do control our blood sugar and avoid post-meal blood sugar spikes know that controlling spikes so that they don't go over 140 mg/dl (7.7 mmol/L) lowers blood pressure, lowers triglycerides and LDL and raises HDL without the need for expensive drugs. Which suggests that elevated post-meal blood sugars are what raise the risk factors and that normalizing blood sugar could prevent heart disease.
Sadly, bad science in the form of over-reliance on the OGTT will keep most people from ever learning this.
September 25, 2007
EASD: Imbecile Insulin Dosing Schedules Not Much Help for Type 2s
The "DUH" of the Week goes to the geniuses at EASD who reported studies showing that giving "insulin" to a person with Type 2 diabetes and extremely high blood sugars doesn't do much when that "insulin" is ONLY a basal insulin prescribed at the wrong dosage.
Imbecile mistake #1: Prescribing only a basal insulin which has no impact on post-meal blood sugars. What part of "Very high blood sugar spikes after meals damage the body" don't these people get?
Imbecile mistake #2: Giving patients only enough insulin to lower their fasting blood sugar to a level that is still way too high. I have spoken with many Type 2s whose doctors tell them they are doing great if their fasting blood sugar "on insulin" is around 120 mg/dl (6.7 mmol/L). Since this means that every time they eat a few grams of carbs they go over 140 mg/dl (7.8 mmol/L)--the level at which organ damage occurs--and stay there for hours you can see why this is a futile treatment plan.
When you add to the mix that these people are still being told to eat a low fat/very high carb diet, so that they are eating 50-100 grams of carbs at each meal pushing them into the 200s or higher, you can see why their "insulin" regimen is near worthless. Even sadder, these patients with the 120 mg/dl fasting blood sugars are the "good ones" in these doctors' practices. Many type 2s "on insulin" are still getting fasting blood sugars well over 150 mg/dl!
But sadly, this kind of rotten medical treatment is Standard Operating Procedure. Most people with Type 2 are treated by their busy family doctors and most family doctors treating people with diabetics ONLY prescribe basal insulins. And when they do, they almost always prescribe insulin in the generic doses that, out of fear of hypo, are set high enough to guaranteed that the fasting blood sugar level is high enough to damage the organs.
What is so sad here is that the only reason that these people aren't put on "insulin" regimens that give them normal or near normal blood sugars is that their doctors are too busy to bother with the interaction involved and it doesn't occur to them to send Type 2s to the same "Diabetes Educators" that they prescribe for Type 1s. A correctly prescribed basal/bolus regimen-- with insulin for both the fasting and the post-meal state, carefully titrated to match the carb input at mealtimes--can normalize blood sugars.
So because of medical ignorance hundreds of thousands of people are condemned, unnecessarily, to blindness, amputation, kidney failure, and heart attack death.
The fact is, insulin, prescribed right, ALWAYS lowers blood sugar and with some work and education it will produce blood sugars low enough to avoid all the serious diabetic complications. But "insulin prescribed right" means this:
1. Covering the fasting state with a basal insulin titrated to avoid hypos at 3 AM and provide a fasting blood sugar under 100 mg/dl. This may mean using 2 shots of different sizes since none of the basal insulins really lasts exactly 24 hours. One larger shot in the morning, one small at night works well for many people.
2. Covering meals with a faster insulin--Novolog, Humalog, Apidra or R (humulin/novalin), using a carefully computed "insulin/carb" ratio that matchs the dose of meal-time insulin to the estimated amount of carbohydrate in the meal. Ideally, the amount of carb in the meal should be kept low enough that mistakes in guestimating the carb count won't end up causing severe hypos. For many of us this means keeping carbs between 20 - 50 grams per meal.
Getting the correct dose figured out for both basal and bolus insulin involves starting with a low dose and very carefully working up until it's right. This takes time and, for most people, requires the help of a person trained in adjusting insulin doses--a Diabetes Educator.
But the hard work and initial effort involved in learning how to match your insulin dose to the carbohydrate in your meals will pay people with Type 2 diabetes back with decades of improved quality of life.
If you are currently "on insulin" and seeing fasting blood sugars around 120 mg/dl (6.7 mmol/L) and post-meal blood sugars routinely over 160 mg/dl (8.9 mmol/L) 2 or even 3 hours after each meal ask your doctor to send you to see a competent diabetes educator so you can work out an insulin regimen that works. If he or she won't, find a new doctor.
And if you are a person with Type 2--whether or not you are on insulin--who is still eating 100 grams of carbohydrates a meal and wondering why your blood sugar keeps getting worse, check out the web page below and try the strategy described there for two weeks. It may keep you from ever needing insulin!
Jennifer's Advice to Newbies. Don't let the name put you off, this advice has helped people who have had diabetes for decades, too.
Imbecile mistake #1: Prescribing only a basal insulin which has no impact on post-meal blood sugars. What part of "Very high blood sugar spikes after meals damage the body" don't these people get?
Imbecile mistake #2: Giving patients only enough insulin to lower their fasting blood sugar to a level that is still way too high. I have spoken with many Type 2s whose doctors tell them they are doing great if their fasting blood sugar "on insulin" is around 120 mg/dl (6.7 mmol/L). Since this means that every time they eat a few grams of carbs they go over 140 mg/dl (7.8 mmol/L)--the level at which organ damage occurs--and stay there for hours you can see why this is a futile treatment plan.
When you add to the mix that these people are still being told to eat a low fat/very high carb diet, so that they are eating 50-100 grams of carbs at each meal pushing them into the 200s or higher, you can see why their "insulin" regimen is near worthless. Even sadder, these patients with the 120 mg/dl fasting blood sugars are the "good ones" in these doctors' practices. Many type 2s "on insulin" are still getting fasting blood sugars well over 150 mg/dl!
But sadly, this kind of rotten medical treatment is Standard Operating Procedure. Most people with Type 2 are treated by their busy family doctors and most family doctors treating people with diabetics ONLY prescribe basal insulins. And when they do, they almost always prescribe insulin in the generic doses that, out of fear of hypo, are set high enough to guaranteed that the fasting blood sugar level is high enough to damage the organs.
What is so sad here is that the only reason that these people aren't put on "insulin" regimens that give them normal or near normal blood sugars is that their doctors are too busy to bother with the interaction involved and it doesn't occur to them to send Type 2s to the same "Diabetes Educators" that they prescribe for Type 1s. A correctly prescribed basal/bolus regimen-- with insulin for both the fasting and the post-meal state, carefully titrated to match the carb input at mealtimes--can normalize blood sugars.
So because of medical ignorance hundreds of thousands of people are condemned, unnecessarily, to blindness, amputation, kidney failure, and heart attack death.
The fact is, insulin, prescribed right, ALWAYS lowers blood sugar and with some work and education it will produce blood sugars low enough to avoid all the serious diabetic complications. But "insulin prescribed right" means this:
1. Covering the fasting state with a basal insulin titrated to avoid hypos at 3 AM and provide a fasting blood sugar under 100 mg/dl. This may mean using 2 shots of different sizes since none of the basal insulins really lasts exactly 24 hours. One larger shot in the morning, one small at night works well for many people.
2. Covering meals with a faster insulin--Novolog, Humalog, Apidra or R (humulin/novalin), using a carefully computed "insulin/carb" ratio that matchs the dose of meal-time insulin to the estimated amount of carbohydrate in the meal. Ideally, the amount of carb in the meal should be kept low enough that mistakes in guestimating the carb count won't end up causing severe hypos. For many of us this means keeping carbs between 20 - 50 grams per meal.
Getting the correct dose figured out for both basal and bolus insulin involves starting with a low dose and very carefully working up until it's right. This takes time and, for most people, requires the help of a person trained in adjusting insulin doses--a Diabetes Educator.
But the hard work and initial effort involved in learning how to match your insulin dose to the carbohydrate in your meals will pay people with Type 2 diabetes back with decades of improved quality of life.
If you are currently "on insulin" and seeing fasting blood sugars around 120 mg/dl (6.7 mmol/L) and post-meal blood sugars routinely over 160 mg/dl (8.9 mmol/L) 2 or even 3 hours after each meal ask your doctor to send you to see a competent diabetes educator so you can work out an insulin regimen that works. If he or she won't, find a new doctor.
And if you are a person with Type 2--whether or not you are on insulin--who is still eating 100 grams of carbohydrates a meal and wondering why your blood sugar keeps getting worse, check out the web page below and try the strategy described there for two weeks. It may keep you from ever needing insulin!
Jennifer's Advice to Newbies. Don't let the name put you off, this advice has helped people who have had diabetes for decades, too.
September 22, 2007
Extremely Bad Science: Depression & Type 2
Here's a study that is a "perfect storm" of bad science. Unfortunately, as you can see from the way the media report is titled, the findings are being presented by the media in a way that suggests people with Type 2 have mental problems, though, in fact, the study is so badly flawed as to be worthless.
Here's one version of the media coverage:
EASD: Studies Link Depression and Type 2 Diabetes
From the article: "Type 2 diabetes may be linked to mental health disorders, but age and gender may be contributing factors, according to two separate studies.
"Symptoms of depression or psychological stress were associated with increased risk of type 2 diabetes in men, but not in women, Swedish researchers reported."
Why is this bad science? Two reasons.
1. The symptoms of "depression" used to compute the amount of depression in the study subjects included "sleep difficulties, apathy, anxiety, depression, fatigue, and back or shoulder pain during the preceding 12 months." [emphasis mine]
Anyone who knew anything about diabetes would immediately note that "back and shoulder pain" can be caused by a lot of other things besides depression. Like, for example, the tendon and disc problems associated with abnormally high blood sugars.
It is now known that carpal tunnel syndrome develops about 10 years before people receive a diagnosis of diabetes and may indicate the presence of high post-meal blood sugars that are missed by the fasting plasma glucose test used for diagnosing diabetes.
It is also known that Frozen Shoulder is much more common among people with diabetes and it too is probably caused by high blood sugars which thicken tendons. I recently read in the book Sciatica solutions : diagnosis, treatment, and cure for spinal and piriformis problems by Dr. Loren Fishman that some specialists believe that vertebral disc problems may be caused by blood sugar abnormalities.
So my conclusion--and that of anyone familiar with diabetic tendon problems--would be that people who have diabetes or undiagnosed diabetes who also have back and shoulder pain probably have physiological back and shoulder problems caused by high blood sugars, NOT psychosomatic symptoms caused by depression. And diagnosing them as depressed based on this laundry list of vague symptoms is a mistake.
2. The second problem here, a major one, is that we know that some of the powerful psychiatric drugs given--often very inappropriately--to people who complain of mild depression can cause diabetes. Zyprexa is only one of these, the best known, but the other drugs commonly used may also affect glucose metabolism.
However, the article states that these studies did NOT identify patients who had been treated for depression with these drugs that can destroy blood sugar control. Hence the association of "depression" with diabetes is worthless. Yes, inappropriate drug TREATMENT for depression may CAUSE diabetes, but this is not the conclusion being drawn here, that somehow, having Type 2 diabetes makes people more depressed.
How do people get media attention for such poorly conducted research? These studies wouldn't get an "A" at a well conducted high school science fair! But it still got international media attention and you can bet that a lot of doctors are going to only read the headline and conclude that depression and diabetes go together.
It DOES depress me to see yet another example of the lousy science that hurts people with diabetes, just as it depresses me to see the rotten treatment so many people with diabetes get.
My choice for replacement headline? "DUMB DOCTORS CAUSE DEPRESSION IN PEOPLE WITH TYPE 2 DIABETES."
Here's one version of the media coverage:
EASD: Studies Link Depression and Type 2 Diabetes
From the article: "Type 2 diabetes may be linked to mental health disorders, but age and gender may be contributing factors, according to two separate studies.
"Symptoms of depression or psychological stress were associated with increased risk of type 2 diabetes in men, but not in women, Swedish researchers reported."
Why is this bad science? Two reasons.
1. The symptoms of "depression" used to compute the amount of depression in the study subjects included "sleep difficulties, apathy, anxiety, depression, fatigue, and back or shoulder pain during the preceding 12 months." [emphasis mine]
Anyone who knew anything about diabetes would immediately note that "back and shoulder pain" can be caused by a lot of other things besides depression. Like, for example, the tendon and disc problems associated with abnormally high blood sugars.
It is now known that carpal tunnel syndrome develops about 10 years before people receive a diagnosis of diabetes and may indicate the presence of high post-meal blood sugars that are missed by the fasting plasma glucose test used for diagnosing diabetes.
It is also known that Frozen Shoulder is much more common among people with diabetes and it too is probably caused by high blood sugars which thicken tendons. I recently read in the book Sciatica solutions : diagnosis, treatment, and cure for spinal and piriformis problems by Dr. Loren Fishman that some specialists believe that vertebral disc problems may be caused by blood sugar abnormalities.
So my conclusion--and that of anyone familiar with diabetic tendon problems--would be that people who have diabetes or undiagnosed diabetes who also have back and shoulder pain probably have physiological back and shoulder problems caused by high blood sugars, NOT psychosomatic symptoms caused by depression. And diagnosing them as depressed based on this laundry list of vague symptoms is a mistake.
2. The second problem here, a major one, is that we know that some of the powerful psychiatric drugs given--often very inappropriately--to people who complain of mild depression can cause diabetes. Zyprexa is only one of these, the best known, but the other drugs commonly used may also affect glucose metabolism.
However, the article states that these studies did NOT identify patients who had been treated for depression with these drugs that can destroy blood sugar control. Hence the association of "depression" with diabetes is worthless. Yes, inappropriate drug TREATMENT for depression may CAUSE diabetes, but this is not the conclusion being drawn here, that somehow, having Type 2 diabetes makes people more depressed.
How do people get media attention for such poorly conducted research? These studies wouldn't get an "A" at a well conducted high school science fair! But it still got international media attention and you can bet that a lot of doctors are going to only read the headline and conclude that depression and diabetes go together.
It DOES depress me to see yet another example of the lousy science that hurts people with diabetes, just as it depresses me to see the rotten treatment so many people with diabetes get.
My choice for replacement headline? "DUMB DOCTORS CAUSE DEPRESSION IN PEOPLE WITH TYPE 2 DIABETES."
September 21, 2007
Three Different Conversations
This past week I had some version of the following exchange with three different people. One works at the local diner. One is an executive at a well known political action organization. One is an excellent dentist. All occurred in the midst of a conversation about something else.
Me: I maintain a web site that summarizes what mainstream lab research tells us about controlling diabetes.
Other Person: Oh, really. My [mother/father, sister/brother, aunt/uncle, and grandparents -- chose 3] all died of diabetes. I really worry about it.
Me: Have you tested your blood sugar after eating?
OP: No. Why would I do that?
Me: To get an early indication of whether you are developing diabetes--so that you can cut back on the carbohydrates you eat and prevent it from getting much worse.
OP: Carbs? Why carbs. Aren't you supposed to eat a low fat diet? That's what they told my [mother/father, sister/brother, aunt/uncle, and grandparents -- choose 1.]
Me: Yes. Well that's sadly part of why they probably died of diabetes. It is carbs that raise blood sugar, not fat.
OP: Wow. I didn't know that. You ought to write something about this!
Me: I have!
===
The sad part here is that these people all see doctors. The doctors know that they are overweight and also know their family histories. But no doctor ever mentioned any of these ideas to them. Instead, they were simply told to "lose weight" and "to exercise" which they've tried in the past with little success, like 95% of all people over age 45. When they do try to lose weight, they eat a low fat diet full of healthy grains. Guess how much weight they lose. You got it. None.
None of these people had been tested for diabetes with anything but the fasting plasma glucose test. I suspect their FPGs are well over normal, too. But in this region at least, most family doctors won't tell a person they have a problem with their blood sugars until their fasting blood sugar reaches the 120 mg/dl range. And if they do tell them to diet, they still tell them to eat a Low Fat/HIGH carb diet.
Every one of these people could have been given the information that--without the need to lose midlife weight--could have given them normal blood sugars and an unrestricted future. None of them were. Sadly, all of them probably will develop diabetes, because who is going to pay attention to what some woman with a computer says?
Me: I maintain a web site that summarizes what mainstream lab research tells us about controlling diabetes.
Other Person: Oh, really. My [mother/father, sister/brother, aunt/uncle, and grandparents -- chose 3] all died of diabetes. I really worry about it.
Me: Have you tested your blood sugar after eating?
OP: No. Why would I do that?
Me: To get an early indication of whether you are developing diabetes--so that you can cut back on the carbohydrates you eat and prevent it from getting much worse.
OP: Carbs? Why carbs. Aren't you supposed to eat a low fat diet? That's what they told my [mother/father, sister/brother, aunt/uncle, and grandparents -- choose 1.]
Me: Yes. Well that's sadly part of why they probably died of diabetes. It is carbs that raise blood sugar, not fat.
OP: Wow. I didn't know that. You ought to write something about this!
Me: I have!
===
The sad part here is that these people all see doctors. The doctors know that they are overweight and also know their family histories. But no doctor ever mentioned any of these ideas to them. Instead, they were simply told to "lose weight" and "to exercise" which they've tried in the past with little success, like 95% of all people over age 45. When they do try to lose weight, they eat a low fat diet full of healthy grains. Guess how much weight they lose. You got it. None.
None of these people had been tested for diabetes with anything but the fasting plasma glucose test. I suspect their FPGs are well over normal, too. But in this region at least, most family doctors won't tell a person they have a problem with their blood sugars until their fasting blood sugar reaches the 120 mg/dl range. And if they do tell them to diet, they still tell them to eat a Low Fat/HIGH carb diet.
Every one of these people could have been given the information that--without the need to lose midlife weight--could have given them normal blood sugars and an unrestricted future. None of them were. Sadly, all of them probably will develop diabetes, because who is going to pay attention to what some woman with a computer says?
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