September 28, 2006

New Heart Attack Page on "What They Don't Tell You"

I've put together a page that links to the major studies that show that a) total cholesterol is not a good predictor for heart attack risk and only triglycerides and HDL seem to predict anything at all b) A1c predicts heart attack risk perfectly, and that risk rises significantly as soon as blood sugars are over true normal: an a1c of 4.6%

A1c Predicts Heart Attack

September 26, 2006

Magical Thinking Wastes Money and Damages Health

No, fellow people with diabetes. There isn't a magic pill you can buy (at great expense) that will fix your blood sugar and let you eat the way you can now only eat in your dreams.

But that doesn't keep the bottom-feeders of the supplement industry from rolling out an endless series of products designed to separate you from your money by activating precisely that dream.

I get a lot of mail from people asking me if this or that miracle pill will help their diabetes. The pills contain vitamins, minerals, and spices like cinnamon or fenugreek. Their cost to you is at least 100 times more than it would cost to assemble the ingredients on your own.

Their effect on the blood sugar is minimal. But supplement sellers know that people who have spent $50 for a bottle of hope will do their best to convince themselves that they see an improvement, even if there isn't any to see. Who wants to admit they got taken?

Every time the word finally gets around the diet/diabetes community that supplement A is worthless--which happens to every supplement in time--the supplement makers roll out supplement B which, based on a single study done in Bozoland on 6 subjects demonstrated an amazing ability to drop blood sugar by astounding amounts! Or supplement C which is made from a lichen long eaten by natives of Northern Lappland that eliminates hunger and causes the pounds to drop off you without dieting!

These pitches rely on a couple factors. People want to believe something magic can solve their problems without work, and having been raised to take pills to fix things since childhood, they are open to the idea that magic might reside in pills.

Furthermore, people find it easier to believe that something found in a distant land full of picturesque primitive peoples will have just such magical powers. They also like to believe that something "natural" though completely uninspected or regulated is healthier than a pharmaceutical product, a belief that should be laid to rest by the current spinach fiasco but probably won't. Finally, these supplement sellers appeal to paranoia. They , i.e. the Go'mint, doctors etc are keeping this secret because they don't want you to know about it!

It's a very effective package, and it earns the sleazebags who promote this crap billions but it doesn't do anything for our health.

Metformin is just as "natural" as most of the supplements being touted. It's a molecule found in an herb, refined and purified and, most importantly, tested in large populations so we know what it does.

More importantly, when you buy a metformin pill, you get exactly what you pay for. When you buy a supplement you get whatever the supplement seller decides to put into the pill, knowing there is no regulation or oversight in that business, thanks to
Orrin Hatch, whose campaigns are funded by one of the largest--and most deceptive-- maker of supplements in the U.S..

If you want to know just how sleazy the supplement makers are and how closely tied to the Republican Party machine, read Scorin' with Orrin

Taking its message to heart will save you a LOT of money and possibly your health!

September 20, 2006

Diabetes is NOT for Dummies

Thinking over the immense amount of study and work it takes to keep my blood sugar near the normal range, it's been striking me lately that what causes complications and death for most diabetics isn't just their blood sugar, it's their scientific illiteracy.

Diabetes is complicated, and the only people I've met who are able to get their blood sugars to truly normal numbers are those who are willing to read, study, test, and refine their treatment based on their testing results. Not so surprisingly, most of these are people with engineering or science backgrounds.

But people diagnosed with diabetes, no matter how intelligent, who can't read a graph, can't understand the statistics (or lack thereof) in a medical study, can't do computations in their heads, and don't know a thing about the physiology underlying their disordered blood sugars are in big trouble.

Why? Because each person's diabetes works differently and needs a different combination of treatments. My diet won't control your diabetes, and my lunch time insulin won't cover your lunch. But if you're scientifically illiterate, and rely on the people who understand this stuff--like your doctor--you're guaranteed to get a generic one-size-fits-most treatment that will not prevent complications, because your doctor and other experts you consult don't have the time to figure out exactly how your diabetes works and what you need to do to control it. So they give you a regimen that has been carefully crafted with one end in view--to keep you from getting hypos, at the cost of ensuring that you'll have "hypers" that destroy your body.

I used to wonder why the typical Type 2 on insulin has an a1c of at least 7% and usually more like 8% or higher, when insulin allows for complete control of blood sugars. But now that I'm using insulin, I can see that for someone who isn't good at math and who isn't able to memorize carbohydrate counts, and for someone who can't estimate a food portion size correctly and isn't willing to read up extensively on the subject, the only safe way to use insulin probably IS to use far less than is needed, because the combination of ignorance and insulin is eventually going to lead to a very severe hypo.

Just watching people without diabetes attempt to do a low carb diet shows me what we are up against. You know them--the people who eat that big bowl of pasta and tell you how they can't understand why their low carb diet isn't working. Or the ones who eat "low carb" bars which have 20 grams of carbohydrate per serving and wonder why their blood sugar isn't getting better. Combine that kind of dietary ignorance with an insulin regimen which matches carbs to insulin units, and you can see why tight control leads so many people to the ER.

It isn't that there's anything wrong with tight control. It is that you can't do tight control unless you know how many grams of carb you are eating, and how far one unit will lower your blood sugar, how long the insulin lasts, when it peaks, and what happens if you take a drug that raises or lowers insulin resistance while using insulin. That requires a lot of knowledge and understanding, and sadly, people who can't handle their own taxes probably aren't going to be able to figure this stuff out.

But people who can't do their own taxes are willing to pay an accountant to straighten them out, because they understand what will happen if their inability to work with figures gets them in trouble with the IRS.

Unfortunately, there is no corresponding understanding among people with diabetes who are scientifically illiterate that they need help to keep their diabetes from killing or maiming them. They trust their doctor, without understanding that their doctor can't fix them up in the 15 minutes every three months they are allotted (if they are lucky!) any more than that their accountant could do their small business taxes in 15 minutes.

I'm not sure there is a simple solution for this one. The medical establishment would prosecute anyone who attempted to help people with their diabetes for pay who wasn't a qualified doctor, nurse or pharamcist, but those people who have that qualification don't have the time or inclination to give people with diabetes the help they really need. And if they do, the cost of their time makes their help unaffordable to most.

September 19, 2006

Should Pre-diabetics take Avandia?

A study published in the Lancet this week generated lots of buzz. The Canadian researchers running the study claimed Avandia dramatically reduced the progression from pre-diabetes to diabetes.

Does this mean YOU should rush out to get a prescription for this very expensive drug?

Not at all. Avandia is a drug whose side effects should make it a drug of last resort for anyone with pre-diabetes. In fact, its side effects, which are becoming more troubling with each passing year, seem to have made doctors lose their enthusiasm for Avandia for their patients with Type 2 diabetes, and many seem to be replacing it with the latest hot new drug, Byetta. This is probably the reason that Avandia's manufacturer is sponsoring studies like this whose aim is to get it prescribed off-label to a huge pool of new customers.

What's wrong with Avandia?

Three things:

1. It reduces insulin resistance by making your body to grow new fat cells into which it pushes glucose. People taking this drug get fatter! This is the last thing you need to do if you are already dealing with a condition that is worsened by obesity.

2. Avandia causes people to swell up with water and in some people this swelling causes major permanent damage. In fact, the researchers running the Canadian Avandia study mentioned that the people in that study who were taking Avandia developed more cases of congestive heart failure than matched controls who are not taking the drug.

Congestive heart failure is what happens when your heart muscle weakens and cannot pump blood properly. It often causes death anywhere from 1 to 5 years after diagnosis. The number of people with pre-diabetes who developed congestive heart failure in the study was small, but it was significantly MORE than the number in the control group. In fact, given the statistics published with the study, your chances of getting congestive heart failure from taking the drug were far greater than your chance of hitting a win of $1000 in a state lottery.

This is definitely not a statistical fluke, as it was already known that Avandia produced congestive heart failure in a significant number of people who were taking it for diabetes.

3. People taking Avandia develop macular edema at a rate higher than expected. Macular edema is the fancy name for the retinopathy which causes diabetic blindness. This side effect only emerged as an issue in the last year, though it was reported several years ago in newsletters intended for medical professionals. Since it has recently been reported that early "diabetic" retinopathy is surprisingly prevalent in people with pre-diabetes, any drug that can worsen it must be looked at with great caution.

These problems with Avandia and the research reporting them are all documented at my page, The Truth about Oral Diabetes Drugs. Just load the page and search for "Avandia".

If people with pre-diabetes had no other options, perhaps a drug with these problems would be worth trying. But people with pre-diabetes can achieve far better improvements in blood sugar just by cutting their carbohydrate intake down to where their blood sugar doesn't spike over 140 mg/dl (7.7 mmol/l) an hour after each meal. There are no side effects with this approach except, frequently, significant weight loss.

Reducing insulin resistance with a brisk 30 minute walk 3 times a week can also achieve similar effects for those whose insulin resistance is responsive to exercise.

Finally, even for those who can't modify their diets and can't exercise there is another, much cheaper, drug which has been shown in controlled studies to achieve at least as good results in slowing down diabetes: Metformin. Even better, Metformin not only doesn't have the dangerous side effects, it causes weight LOSS, rather than weight gain.

Why pay $85/month to grow new fat cells on your butt and gamble with your heart muscle and vision when you can get the same effects with a $20 dose of Metformin without the problems?

September 8, 2006

Why Do Strips Cost MORE When all Other Technology is Cheaper?

Ten years ago, I bought a cheap computer with a soon-to-be-outdated operating system for $1,900. Eight years later, I bought a much more fashionable computer for a mere $750.

So why is it that 100 blood sugar testing strips, which were $60 eight years ago now cost almost $100? Every other high tech item on the planet has dropped in price except these blood testing supplies we people with diabetes are dependent on.

Something stinks here!

There are technologies out there that can measure blood sugar without the need for any costly disposable. Several companies have gone into testing with meters that use noninvasive methods to measure blood sugar. Several seem to work quite well. But these are small upstart companies with limited funding and without the resources to bring new products to market.

Big Pharma, which is raking in the profits from the $100 a box strips, is most definitely not putting its efforts into developing this kind of technology.

The profit numbers for the test strip business are hard to find online, but a 2003 report available on the web estimated that profits from disposable blood sugar testing supplies would be near $6 billion dollars a year by 2005, with a 15% annual growth rate. View sales estimates here.

That's a LOT of money--and a lot of motivation for big Pharma to avoid investing in new technologies that would make noninvasive monitoring possible. A not terribly paranoid mind might find itself asking just how far these big companies might go to preserve that $6 billion dollars of profit. Do they buy up promising patents and sit on them? Do their lobbyists make sure that the small companies attempting to produce such devices encounter overwhelming amounts of regulatory intervention from their totally owned subsidiary, the FDA?

If the big companies had invested even a small amount of real money into developing new noninvasive testing technology, the chances are very good we'd have meters now that did burn money like a Hummer burns gas.

But with the money pouring into drug company coffers from the disposable strips, you can be sure that the only companies working on noninvasive meters will continue to be small, fringe companies with little funding, while the big guys will continue to assure the public that, "Noninvasive meters don't work"--while continuing to raise test strip prices.

Gives a whole new meaning to the concept of "Blood Suckers" doesn't it?

September 3, 2006

A Good Time to be Diagnosed?

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

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

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

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

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

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

More on the insulin pill is available here

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

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

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