December 23, 2010

Test Strip Recall Relion, Precision Xtra and other Abbott Strips

Aboott Laboratories has just issued a huge recall for blood testing strips which read low. The strips take too long to absorb the drop of blood.

The list of affected lots is given here:

Further information can be found here:

Here is their stated policy, though it would have been nice if they'd explained HOW to go about getting replacement strips:
Abbott Diabetes Care will replace affected strips at no charge with new product equal to the amount currently in the customer’s possession. Customers are advised to return all affected product currently in their possession. If customers have a partial package of product, Abbott Diabetes Care will provide a complete package of product as replacement.
They provide this customer care phone number:


The company seems to have gone out of its way to avoid explaining on the web site how to get your replacement strips. This makes me wonder if they will try to get customers to phone and then state on a recorded line that they have not suffered any injury from the defective strips before giving recall instructions as did the makers of the defective Aviva strips I purchased.

It also looks like you are out of luck if you have already used up these defective strips. If you have been seeing lower than expected numbers while using strips made by this company treat them with caution.


December 13, 2010

Also of interest: End of Year Research Roundup

As I read the medical news, I bookmark many articles that aren't significant enough to form the basis of a blog post or which reinforce points I've already documented with quality research on the main Blood Sugar 101 web site. Many of these are discarded as time goes by, but when I went through the past year's accumulation, I ran into a few that I thought you might find interesting.

What I'm going to do here is give you the links to a dozen of the most interesting articles and studies I've collected over the past year, which didn't make the cut for a whole blog post but are still worth reading.

1. 90,000 years ago so called paleo humans were already eating grains. The quasi-religious belief that early humans ate a grain and starch free diet has never been well supported by actual research. Though there were a very few human societies that were eating animal-only diets in the 19th century, they lived in extreme environments with extenuating circumstances that made a broader diet impossible. This study pushes back the evidence that "hunter gatherers" ate grains and starches another 80,000 years. There are plenty of good reasons to cut down on carbs, but the diets of people living hundreds of generations before us are not among them.

2. Coronary Artery Calicification (CAC) scores explain the dismal results in the Veteran's study. The Veteran's study, which found no improvement in cardiovascular death rates with tight control and a higher level of hypos, has been used to argue that it is dangerous to lower blood sugar to normal levels. This study re-analyzed the data and found that that the lower a person's CAC score was, the more effective tight control was in preventing them from having heart attacks. It makes sense that if you wait until your arteries have mostly turned into rock, blood sugar control alone won't be be enough to save you.

3. Diabetic nerve damage in the bone marrow may be what causes diabetic retinopathy. This study suggests a fascinating new mechanism to explain how diabetic blood sugars damage organs. The bone marrow sends out stem cells to repair organs, but when the nerves in the bone marrow are damaged by blood sugar-caused neuropathy the feedback loop controlling this process breaks down. This may lead to tissue overgrowth elsewhere in the body as stem cells go where they aren't needed.

4. Bis-phenol A levels in human correlates to heart disease. This study looks at NHANES data, a lot of it, and finds the connection to be strong. Bis-phenol A is strongly associated with the risk of obesity in humans, too.

5. Bis-phenol A is found in high concentrations on retail receipts and most dollar bills. Other significant sources are canned food (which you eat any time you eat in a restaurant) because cans are lined with this plastic, too.

6. The most common Type 2 Diabetes gene TCF7L2 appears to lower the beta cell's sensitivity to normally secreted incretin hormones. This probably explains why incretin hormone drugs like Byetta work very well for some people, not at all for others.

7. The earlier metformin is started, the better off people with diabetes are. Taking metformin within 3 months of diagnosis doubled the length of time it was an effective method of controlling blood sugar. This data was gathered from a group of people eating high carb diets and maintaining blood sugar levels high enough to damage and kill their beta cells. (They had A1cs near 7%). Metformin taken with a lowered carb intake that normalizes blood sugar will stay effective even longer.

8. A disturbing round-up of neglected study data shows that statins not only are not effective for women but may increase cardiovascular risk in women. The author of this review points out that the FDA approves statins for women based on data from male-only studies and have not reviewed subsequent studies suggesting they raise cardiovascular risk for some women.

9. High maternal DDE blood levels lead to obesity in their babies after birth. DDE is another hormone-mimic organic chemical found in our environment. This is yet another explanation for the terrifying rise in childhood obesity and diabetes that has nothing to do with "lifestyle choices" unless you consider breathing and drinking polluted water "choices."

10. Metformin (in a mouse study) appears to block formation of the Tau protein associated with Alzheimers disease and several other forms of dementia. Though mouse studies are often misleading, because "diabetic" mice have a completely different genetic profile than humans with Type 2 diabetes and because mice are adapted to completely different diets than humans, we do know that people with Type 2 diabetes are less likely to get classical Alzheimer's disease than is the population at large. So it may be possible that their use of metformin may play a role. If you have a family history of classic Alzheimers (the kind characterized by amyloid deposits in the brain on autopsy) or Pick's disease, this may be another reason to take metformin. Unfortunately, people with diabetes get more vascular dementia than the population at large.

11. Hypothyroidism artificially raises A1c because of its effect on the blood cell, not necessarily because blood sugar is higher. This may explain why some people report their blood sugar improves after starting thyroid replacement therapy. If you are hypothyroid, this finding suggests you should trust your meter over your A1c.

12. More large-scale evidence that antidepressants are a significant factor causing Type 2 diabetes. The DPPT study found that over 10 years steady antidepressant use more than doubled the risk of developing diabetes except among those taking metformin.


December 10, 2010

Huge Metastudy: "Non Diabetic" Blood Sugars Cause "Diabetic" Retionopathy

I have already documented on my main web site data proving that blood sugar levels considerably lower than those labeled "diabetic" produce changes in the retina leading to blindness.

Now this finding has been confirmed and quantified in a meta study that looked at records of "44,623 participants aged 20 to 79 years with gradable retinal photographs" which examined the correlations between signs of retinopathy and the subjects' fasting, 2 hour glucose tolerance test, and A1c results.

Glycemic Thresholds for Diabetes-Specific Retinopathy: Implications for Diagnostic Criteria for Diabetes:The DETECT-2 Collaboration Writing group. Stephen Colagiuri et al. Diabetes Care Published online before print October 26, 2010, doi: 10.2337/dc10-1206

The conclusion of the study was this:
A narrow threshold range for diabetes-specific retinopathy was identified for FPG and HbA1c but not for 2-h PG. The combined analyses suggest that the current diabetes diagnostic level for FPG could be lowered to 6.5 mmol/L [117 mg/dl] and that an HbA1c of 6.5% is a suitable alternative diagnostic criterion.
The metastudy found that "glycemic thresholds for diabetes-specific retinopathy were observed over the range 6.4-6.8 mmol/L [115 - 122 mg/dl] for F[asting]P[lasma]G[lucose] 9.8-10.6 mmol/L [176.4 - 191 mg/dl] for 2-h PG, and 6.3-6.7% for HbA1c.

From this we can safely conclude that "diabetic" retinopathy is indeed occurring at levels significantly below those established by the American Diabetes Association as defining diabetes.

Based on this, you should consider yourself at risk for retinal damage if you have fasting blood sugar over 115 mg/dl (6.4 mmol/L) , a 2 hour glucose tolerance test reading over 176 mg/dl [9.8 mmol/L) or an A1c over 6.3%.

However, you need to assess this information in light of the fact that retinopathy is a relatively late diabetic complication. Diabetic neuropathy--the nerve damage that leads to impotence, amputation, and autonomic dysfunction which raises blood pressure etc.--starts to become more common when 2 hour glucose tolerance test values go over 140 mg/dl, though there does not appear to be a direct correlation with A1c or fasting plasma glucose at the lower end of the range.

Heart disease incidence correlates with post-meal readings over 155 mg/dl and rises in a straight line from 4.7% A1cs becoming quite significant over 6%.

The good news is that though these values correlate with significant retinopathy in populations who follow traditional medical advice, keeping your blood sugar values under these thresholds after diagnosis using the strategy you will read HERE will keep you from developing it if you don't already have it, and even if you do, long term will give you a much better outcome.

You can read more about Diabetic Retinopathy HERE.

NOTE: In case you wonder why the ADA diagnostic criteria are so much higher than the levels at which diabetic retinopathy occurs, the answer is that the ADA set their diagnostic criteria years ago using on data from a few small non-European populations (Pima Native Americans and Pacific Islanders) whose diabetes is related to different genetic profiles and follows a different pattern from those common in European populations.

They did this on purpose out of a misguided desire to avoid diagnosing people with diabetes for as long as possible and have fought hard in the intervening decades to keep these flawed diagnostic criteria even though they have all been found woefully inadequate by a ton of research.

The whole sad history of how the ADA has worked for decades to ensure that you will have developed diabetic complications long before you are diagnosed with diabetes can be read HERE.

December 6, 2010

Why You Neet to Get Copies of Your Lab Test Results

Every time you go to the lab to get tested, insist on getting a copy of the results for your own files. You (or your insurance) paid for these tests and they are legally yours, so the lab or your doctor must give you a copy if you ask.

Most doctors will only tell you about abnormal lab test results and if nothing was what they consider abnormal they may only give you either a dumbed out summary or a verbal reassurance that "everything was fine."

Just how misleading this can be is shown by stories of people whose fasting blood sugar was 124 mg/dl who were told they were "fine", when one more mg/dl would have been enough to diagnose diabetes.

I experienced something similar. I was told my calcium values were fine when the normal range went up to 10.3 mg/dl and my reading was 10.3. Subsequent research turned up the fact that the high end of the "normal" range for blood calcium is associated with a significantly raised risk for heart disease.

As it was likely my raised blood calcium was due to overdoing my Vitamin D supplementation (which is a growing problem given the hype about this latest cure-all supplement) I stopped the supplementation since my blood Vitamin D level was far above the level defined anywhere as deficient and in another few months the blood calcium level had dropped to the middle of the range which is much less likely to cause serious health problems.

Keeping copies of truly normal lab results can also be important, because over time you may see a trend upward that points to a developing problem. If your "normal fasting blood sugar" each year was 75, 80, 85, 90, 95, 97, and 99 mg/dl these values would all be normal, but point to significant deterioration in your fasting blood sugar control. You'd end up a lot better off if you cut back on your carb intake while still normal than if you waited until it reached 101 mg/dl and you were officially told you were "pre-diabetic."

When you keep the actual copies of your lab tests you will also be able to tell if the doctor has actually done the right tests to determine what is wrong with you. For example, if you come from a family where many relatives have diabetes and have been relying on your doctor's assurance that you don't, it would be helpful to know whether he based this assurance on the fasting glucose test, the A1c, or a random glucose test.

If you are experiencing tingling in your extremities, your doctor should order a Vitamin B-12 test as Vitamin B-12 deficiency can look exactly like diabetic neuropathy and if not treated can cause permanent nerve damage. If you are taking metformin which can in some people cause problems with Vitamin B12 absorption and suddenly develop neuropathy while maintaining normal blood sugars, it is very important to ensure this test has been done.

If your doctor tells you that your cholesterol is too high, it is important to see whether this was based on a total cholesterol number alone, or took into consideration the readings for HDL and Trigycerides which are far more predictive of trouble.

Over the years, diagnostic standards change. This is another reason old lab tests may provide you with useful information years later. When I first ran into problems with my blood sugar, the definition of diabetes was a fasting blood sugar of 140 mg/dl. The cutoff subsequently dropped to 125 mg/dl.

A person who had been assured they weren't diabetic in 1996 based on the old standard might get more insight into why they already had diabetic complications like neuropathy or protein in urine the very day they were diagnosed with diabetes in 2000 if old copies of their fasting blood sugar tests showed they had been in the 130s consistently over the previous decade.

Another reason you want to hold on to your lab test sheets is that for many tests the range that defines normal varies from lab to lab and is not standardized. Labs also use different units for reporting test results. One of the big problems with Vitamin D recommendations is that labs use two different units for reporting blood levels of Vitamin D and people often assume they are deficient because they are looking at recommendations that are given using a unit that is not the one that their lab uses. Only your lab sheet will tell you what unit your lab used.

Insulin and C-peptide analysis are not standardized and and the lab reference ranges are different from lab to lab. Even the same hospital may send your blood draw out to different vendors for analysis so that the reference range will vary from year to year though you go to the same hospital lab. The reference range is essential for interpreting the result and when a test is not standardized, as is the case with insulin and C-peptide you can't compare your readings with those of others who use other labs.

There is another reason why you need to get copies of your test results right after you go to the lab. As I learned the hard way, after a few years it may be impossible to retrieve older lab results from the lab or your doctor.

Hospital labs do not keep results online for more than a few years. They are continually changing their computer systems and each time they make a change they get rid of old data. I found one set of labs impossible to retrieve from a local hospital only 3 years after they were done.

Doctors will have your old labs in their records, but you will lose access to those if you move to a new doctor. Even when you ask your old doctor to forward your medical records to the new doctor, what actually happens is that the doctor is sent a summary sheet not the actual records, which are put in storage somewhere and can be difficult or impossible to access if you need them.

If your doctor retires or moves to a new practice there may also be a brief period during which you can get your records, after which they may become impossible to retrieve.

When you get your lab tests you will often see values flagged as high that your doctor has not mentioned. The most common of these is the BUN which is often elevated in people who are eating a low carb diet because the low carb diet induces a degree of dehydration that affects the test result but does not cause any health problems. If you see a value on your lab sheet that concerns you, ask your doctor about it. There are also sites on the internet that explain the various test results and what they mean.

If you are paying for your lab tests as too many of us are, keeping copies of old tests can help you avoid unnecessary tests. If a doctor routinely schedules certain tests which you have long had normal values for, feel free to ask what the point of the testing might be.

All too often, the point of the test is to allow the doctor to qualify for some benefit to himself from imbecilic insurance-company sponsored programs that judge the quality of medical care by how many patients are given total cholesterol tests or quarterly A1c tests (irrespective of the value the tests show.)

If there is no health problem you need to diagnose or medication change you might make based on the result, there is no reason to pay for expensive testing.

When you go to a lab ask the person who does the test what the procedure is at that lab for getting your results. Some labs will give you the results as soon as they are ready if you show a driver's license. Others require you to fill out a form and will mail them to you.

It is helpful to get the results before your doctor's appointment so that you can discuss any issue you find in them. However, if you don't get a copy before the appointment, you can always ask the doctor to have a copy made at the front desk and can take that copy home with you.


November 30, 2010

Holiday Food Strategies

A lot of those of you reading this have been doing very well with your diets over the past weeks, months or even years. You know what's at stake and you're willing to forgo tempting high-carb treats if that's what it takes to avoid blindness, amputation or kidney failure. You have found meals that work for you, things to eat at lunch at work, and treats that don't raise your blood sugar to the levels that will harm you.

Then the holidays come and it gets ugly. Suddenly there's food everywhere and all of it is bad for you. Making good choices four or five times a day is tough enough. Making them 21 times a day can overwhelm the best of us.

And even worse, the food you encounter at this time of year comes with a lifetime's worth of emotionally plangent associations. It hurts to say no to a slice of Aunt Mary's Pecan Pie--your favorite since you were four. It's even worse not to be able to eat the cake you have baked every year since you had your own kids using your grandma's recipe--passed on from her own grandmother. The parties at work are full of things you used to love eating. The parties your friends give are full of once-a-year treats, too.

Everyone else can eat them, promising themselves they'll go on a diet in January. Not you. You know too well that indulging in six weeks of unrestrained eating will undo the very hard work you've done over the past year and possibly derail the good habits you've worked so hard to develop.

But avoiding it all can end up sending you into a deep depression, or fill you with rage at those people around you who are so carelessly damaging their bodies. Because food is so tightly linked with other emotions it is tough for most of us to turn away from food without paying a psychic cost.

So what to do?

The answer will be different for each of us, as our life histories and physiologies will also differ. But to help you out I've listed some strategies that have worked for myself and other people with diabetes over the years. Perhaps some of them will help you get through this stressful time of year.

1. Schedule Indulgence. Some of us do best if we build "safety valves" into our dietary regimens. If you know you can eat whatever you want on certain days (or hours) you might find it easier to say "no" to the food temptations that assail you the rest of the time. One day of high blood sugars every two weeks won't kill you and if you know you will eat freely at your Aunt Mary's traditional Christmas banquet--it's easier to say "no" to the packaged cookies, stale donuts, and mix-made brownies that assail you at work.

2. Keep the Foods that Really Tempt You OUT of the House One of the most helpful rules of dieting is this: If it isn't there you can't eat it. I have learned through dire experience that if there's a box of peppermint bark anywhere in the house, I'm in trouble. I do give myself permission to buy a small bar of the stuff and enjoy it, but when it's gone, it's gone. Family members, who agree I'm much cuter with all my toes, are respectful of my limits and do not fill the fridge with things that will make my life hard. Fortunately, there are plenty of holiday foods that don't appeal to me that they like, which are the ones they do bring home.

3. Fill the Fridge with Low Carb Treats. You can make Low carb cheesecake, pumpkin bread, rum flavored chocolate truffles, fudge and a host of other foods which are legal and will give you something to eat when the need to eat holiday junk becomes overwhelming. Buy yourself a wheel of Brie (sold this time of year at Whole Foods at a very reasonable price.) Pate is another holiday treat food which can be indulged in freely as are fancy sausages and ham.

4. Set a Reasonable Diet Goal. If you're in weight loss mode, it may be a lot easier to set as your holiday goal to end up at the same weight on January 2 as you were on November 24 rather than to lose weight during the holiday period. Everyone diets in January, which makes it much easier to get back on track then.

5. Learn About the Physiological Reasons Why Food Can Get Out of Control When You Indulge. If you've been controlling by keeping your carbs low, you may be taken aback at the ravenous hunger that may emerge when you indulge in high carb treats. Too many people take this as a personal failing which turns self-hatred into yet another factor making them eat even more. I have put up a web page that explains why this happens and how to get the best of it when it does: When You Crash Off Your Diet

6. Give Your Self Some Motivating Alternative Rewards. Set yourself goals and if you achieve them, reward yourself with some non-food gift to yourself that you wouldn't otherwise indulge in. Make it something you really want. If your finances are strapped ask your family or best friends to help you with this. If you know you'll get that piece of jewelry you've longed for, or a weekend away, in January, if you achieve your diet goals, it may be easier to achieve them.

7. Forgive Yourself. If despite your best efforts things don't work out as you'd have liked, admit you're human and move on. People with diabetes have enough to contend with without adding self-hatred into the mix. Do the best you can and if it isn't enough, start over--not next week or next year, but right now. When you start over, analyze what it was that derailed you this time, so you can come up with an alternate strategy that will work better with your own, unique personality.

What have you found most helpful in getting through this season of non-stop food orgies?


November 23, 2010

Gift Ideas for People With Diabetes

It's that time again. I've blogged on this topic several times before. You'll find those posts here. I have updated the links where they needed to be updated:

Great Gifts for People with Diabetes (2009)

Holiday Gifts for People with Diabetes (2008)

The suggestions you'll find in these older posts are still useful. But here are some more.

1.Erythritol for baking There are several different brands of this sugar alcohol sweetener available online. It's expensive, but it is the one sugar alcohol that does not raise blood sugar and I've found that if you mix it up with a bit of Da Vinci Sugar free syrup it gives baked goods a very nice flavor.

2. Accu-Chek Multiclix Lancet Device Kit. This is a great gift for someone who does not use an Accuchek meter. The lancet comes free with the meters, so it's a waste of money for someone who does. The advantage of this lancet is that it is by far the most painless blood sugar testing device on the market. The lancets come in drums of six and since I only change to the next lancet every three months or so a box of the lancet drums will last many years.

3. Yoga, Swimming, or Other Fitness Classes at a local Gym or Y. These often cost extra above monthly membership prices, so if your giftee already belongs to a gym, they might appreciate your gift of some of these classes. Make sure you check which gym they attend. A three month membership in a gym that has a pool with lots of free swim time and hot tub is a wonderful "vacation at home" gift, especially in cold climates. (Oh how I wish there was a pool like that near me I could sign up for!)

4.Hypnosis Sessions to Help Achieve Dietary Goals. Some people find hypnotic suggestion very helpful in giving themselves a boost in their motivation. Dr. Bernstein recommends this technique in his book, and though I haven't used it for dieting, I have used it for other applications and have found it very useful. Look for someone who has been in practice for a while in your area and who can give you local references. A good hypnotist will ask the person exactly what suggestions they want to have implanted and create a CD of the session they can use at home. If you live in New England I highly recommend the services of Janet Masucci in Gill, MA.

5. Carb Counting and Nutritional Database Apps for Smartphones. Having nutritional information at your fingertips makes it a lot easier to track carb and calorie intake. This pays off for either weight loss or insulin dosing. Apps that give restaurant food counts can be very helpful. Look for nutritional sofware that makes clear portion size as counts without this vital information are useless.

6. Pulse Rate Monitor A very safe, healthy way for older people who are out of shape to improve fitness is to calculate the target pulse rate for low intensity workouts (there are sites online that will do this for you) and then to use a pulse rate monitor to stay in the "zone" where they are getting a good but safe workout doing simple exercises like brisk walking or biking. There are quite a few inexpensive monitors on the market nowadays which can be helpful for reassuring people that they are exercising enough to get benefits from it.

7. Help Paying for Meds and Testing Supplies. A shocking number of prescriptions go unfilled because people can't afford them, or because the copays are too high. People on Medicare may also have run out of coverage this time of year. Don't be shy about asking friends with diabetes if they'd like the gift of help in paying for essential medications.

That's a start. Please add your own suggestions in the comments section.

This is the time of year to make sure in advance that your friends and family know NOT to give you food gifts labelled "SUGAR FREE" or "DIABETIC.: These foods are invariably very high in carbs and the candies will often give you the runs. Just tell people that if they want to give you diabetes friendly food gifts they should stick to cheese, meat, nuts, dry wines, and dark chocolates (70% and higher).


November 18, 2010

Inhaled Cortisone Raises Risk of Diabetes By 34 Percent and Worsens Existing Cases

As someone who saw her marginal blood sugar control deteriorate dramatically and permanently after a single course of prednisone I know that cortisone can cause permanent damange to blood sugar control.

Years ago when I posted about this on the old board, several people sent me emails reporting that the same thing had happened to them. Prescription cortisones had either made them diabetic or, if they were diabetic but in good control, the cortisones had made their blood sugar control much harder, in some cases forcing them to use insulin.

My doctors have continued to tell me that the changes that cortisone makes in blood sugar are temporary. Now large study confirms that exposure to another form of cortisone, that found in the inhalers used to treat asthma and allergies, dramatically raises the risk of diabetes and worsens the blood sugar control of people who already have diabetes. The study is:

Inhaled corticosteroids linked to increases in diabetes incidence
Suissa S. Am J Med. 2010;doi:10.1016/j.amjmed.2010.06.019.

You can find an excellent summary of the study findings at Endocrinology Today here:

ET: Inhaled corticosteroids linked to increases in diabetes incidence

Here's the gist of the study as reported by Endocrinology Today:
The study cohort was composed of 388,584 patients, with 30,167 experiencing diabetes onset during a mean of 5.5 years of follow-up. Calculations put annual incidence rate at 14.2 per 1,000 patients.

Results also revealed that 2,099 patients progressed from oral hypoglycemic treatment to insulin, translating to an annual incidence rate of 14.2 per 1,000 patients for diabetes progression.

Data also linked inhaled corticosteroids with a 34% boost in the incidence of diabetes onset (RR=1.34; 95% CI, 1.29-1.39), although the greatest increase was seen among patients receiving the highest doses or the equivalent of at least 1,000 mcg of fluticasone daily.

Incidence of diabetes progression also rose with the current use of inhaled corticosteroids, with results indicating an RR of 1.64 (95% CI, 1.52-1.76). Again, the highest doses were associated with the greatest increase in incidence of diabetes progression (RR=1.54; 95% CI, 1.18-2.02).
These inhalers may be necessary for people with life-threatening asthma, and if you need one for that reason, you may just have to take the hit to your blood sugar.

But I know, from personal experience with family members, that doctors prescribe these powerful corticosteroid inhalers to people for mild allergies and bronchitis. In that case the risk involved is much higher than is justified by the relief the inhalers provide.

If you have a family history of diabetes, diabetes yourself, or know that you are insulin resistant, avoid these inhalers unless you need them to prevent severe asthma crises.

The same is true of all other forms of cortisone. Orthopedic surgeons will offer just about any one that comes into their office complaining of a sore joint a steroid injection, even in cases, like frozen shoulder, where the clinical evidence proves that these shots do nothing to speed up healing. My guess is that the surgeons do this because it makes the patient feel that they've done something to justify the whopping bill for the appointment.

Unfortunately, what these shots may also have done is damage your blood sugar control permanently. So think twice before you allow a large shot of any cortisone to be injected into your body.

Cortisone does not always cause permanent damage. The amount of the dose seems to be important, as the study above suggests. In most cases cortisone treatments will elevate blood sugar for a week or so and then the blood sugar will return to where it was before the treatment. The cortisone creams you apply to skin shouldn't raise your blood sugar at all, though over time if you over use them they will thin your skin.

Save cortisone treatments for the applications where they are appropriate--these are the conditions where it is necessary to turn off an out of control immune attack before it does serious damage. Cortisone helps in some difficult autoimmune conditions and can be lifesaving in others.

But for run of the mill pain and inflammation, like that from a stressed joint, torn tendon, or bad back, cortisone is overkill.

A huge review confirms that cortisone injections for tendon problems like frozen shoulder helps pain short term but yields worse outcomes middle and long term. In short, cortisone shots make it harder for tendon injuries to heal--while significantly raising the risk of diabetes (though the last wasn't explored in this particular study.)

Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials.
Brooke K Coombes et al. The Lancet , Volume 376, Issue 9754, Pages 1751 - 1767, 20 November 2010.doi:10.1016/S0140-6736(10)61160-9

If the problem is nerve pain, try a low dose of Tylenol.If the problem is inflammation use the lowest dose of a NSAID that works for you. Both these classes of drugs can be hard on your kidneys and liver if you take them too frequently so only take them when you really need to, and keep in mind the the less you use the better.

When my kids had fevers, I used to give them toddler sized doses of Tylenol until they were teens. They worked. The current trend is to package all these drugs in monster sized pills. Tylenol, which is effective in 325 mg pills, for example, is now sold mostly in 500 mg pills and caplets and in even larger sizes. Check the shelf for the small size pills, and start with a half tablet. Then work up to the dose that is effective. I often find half a Tylenol does the trick for my back pain.

There's a lifetime relationship between the total amount of Tylenol and NSAIDs you take and your risk of end stage kidney disease. So the less you take the better off you'll be, but there are times when you are in pain and they can be very helpful.

And if a doctor tries to prescribe any form of cortisone for you, do a bit of research on your own to find out if it really is appropriate. The saddest part about the prednisone that ruined my blood sugar control is that it was prescribed for something it had no chance of curing. The doctor gave it to me as is so often the case so he could say he'd done something rather than telling me the truth, which was that the condition I'd shown up with was one that would not respond to medical treatment.


November 14, 2010

Do Something that Actually Helps

I don't know about you, but I'm sick of diabetes awareness events that accomplish nothing.

Wearing ribbons, lighting candles, and thinking about your friends with diabetes is what we call "Slactivism." You feel like you've done something, but all you've done is make yourself feel good. Nothing changes.

So go on, light all the virtual candles you want, but when you are done, consider what the impact might have been if all that money and media power that went into promoting this slactivist event had been put to the task of telling the public the single fact that might give them a fighting chance against diabetes: that the starches and sugars they eat are what raise their blood sugar and that if they cut back hard on starch and sugar they could lower their blood sugar and avoid all the complications their doctors think are inevitable.

That a "healthy diet for diabetes" is a diet low in carbs is a simple idea that 80% of people with diabetes never hear about. Many doctors don't even know it. If they did, they wouldn't be handing their newly diagnosed diabetic patients ADA sanctioned brochures telling them to eat oatmeal, bananas, apples, potatoes and whole wheat toast. (And no I'm not exaggerating. My doctor gave me that brochure just 3 years ago.)

So celebrate World Diabetes Day by telling everyone you meet the truth about what people with Type 2 diabetes need to do to regain their health: test their blood sugar after meals and cut back on carbohydrates until they see normal blood sugars.

It's that simple. If 1/1000s of the resources put into promoting these slactivist festivals were put into distributing the How to Lower Your Blood Sugar flyer thousands of people might avoid nerve damage, impotence, retinal damage and kidney failure.

For people with diabetes every day is Diabetes Day. They need information not feel good media events. If you have that information, share it with a neighbor or relative who could use it. Maybe it will help, maybe not, but at least you tried.


November 6, 2010

Diabetes Hit Parade: The Top 10 Pages on This Blog

Every week I get statistics that tell me, among other things, what pages on this blog get the most visitors.

Since the traffic counts I get apply only to the previous month, the supremacy of these pages has nothing to do with cumulative traffic, but reflects the fact that the topics they discuss are the ones that people with diabetes commonly search on.

Because many of you reading this are here because you subscribed to this blog sometime over the past four and a half years it has been in existence or because you stumbled over it in a way that didn't bring you to one of the more popular pages, I though it might be useful to post a list of the ten pages that are currently the most popular. So here without more ado are [Cue drum roll]:


  1. Metformin vs. Metformin ER 11/30/2006
  2. When to Test Blood Sugar in Type 2 11/16/2007
  3. Can Type 2 Diabetes Be Reversed? 8/18/2009
  4. Beta Blockers Worsen Blood Sugar May Cause Diabetes 9/2/2008
  5. How to Reverse Fatty Liver 3/13/2009
  6. Onglyza: Just Like Januvia But with More Side Effects 8/3/2009
  7. Victoza: A New Competitor for Byetta 1/26/2010
  8. What Does That C-Peptide Test Mean? 9/22/2008
  9. Massive A1c Fail: It Does Not Accurately Diagnose Diabetes 10/18/2010
  10. Yet Another Problem with Januvia 9/12/2008
I'm happy to see that a couple posts from every year of the blog's history are represented here. These Top 10 posts also tell me that my visitors are most likely to find this blog when looking for information about drugs--especially new drugs--and blood sugar tests.

Do you have a favorite blog post you come back to or recommend to friend?


October 28, 2010

Red Yeast Rice: Another Dangerous Supplement

The public continues to buy the argument that "natural" products are safer and healthier than pharmaceuticals, despite ample proof that this is not true.

The main reason why is this: in the 1990s wealthy large companies paid for expensive PR campaigns that appealed to the public's paranoia, convincing many that the government was trying to take away their wonderful supplements. At the same time, the industry paid large amounts into the campaign coffers of "anti-regulation" senators and in return they got the law they wanted that prohibits the government from regulating supplements. (Details about how the industry destroyed the FDA's ability to regulate supplements can be found in this Harvard Law School publication HERE.)

As things stand now, manufacturers can sell pretty much anything they want to as long as they don't make health claims on the label and as long as their supplements don't cause enough death or disability to trigger an investigation.

What this means for you the consumer is this: supplement manufacturers can promote their wares as medicines as heavily as they want to, as long as they do not put the claim on the actual bottle they sell. They can put it on a web site. They can pay a PR person to plant articles in health magazines, and they can send brochures to self-appointed alternative medicine "practitioners." And, believe me, they do.

Supplement manufacturers often sell their extremely expensive products with the argument that the natural supplement is a better choice than a pharmaceutical drug. For example, they may tell you that soy isoflavones are better than pharmaceutical estrogen at menopause. Or that you can control your blood pressure by taking magnesium rather than blood pressure medication. As long as they don't put this false claim on the label, the FDA cannot step in. It's worthy of note that if a health claim is supported, it CAN be put on the label. But if that is the case the FDA would then be able to treat the supplement as a drug and test it to see if the bottle contains what it says it does.

In most cases, it doesn't. Which is why you will never see any health claim on supplement labels.

Every time anyone takes bottles of supplements to the lab they find that these bottles do NOT contain what they say they do. They may not contain any of the expensive herb or chemical you are paying for or they may contain an amount of that substance that is quite different from what they list on the label.

Sometimes the bottle you just paid $23.95 for contains little beyond some calcium carbonate pills. But though you are frequently not getting what you paid for, at other times the pills you buy may contain too much. And since some supplements are toxic in large doses this is a concern. Even within a single bottle, given the lax manufacturing practices in this unregulated industry, pill to pill the ingredients may vary.

And the problems with what's in that bottle go beyond fluctuating doses. The pills you buy may also contain poisons. These may occur in the form of heavy metals, industrial contaminants (solvents etc.), and the naturally occurring toxins that come from fungal or bacterial contamination.

A recent lab analysis of what was in the bottles of 12 brands of Red Yeast Rice, a supplement marketed for controlling cholesterol, makes it crystal clear why if you do find yourself needing medicinal treatment, you should avoid the use of unregulated supplements.

The study can be found here: Marked Variability of Monacolin Levels in Commercial Red Yeast Rice Products Ram Y. Gordon et al. Archives of Internal Medicine, 2010; 170 (19): 1722 DOI: 10.1001/archinternmed.2010.382

You can read a more detailed report about this study's findings here: Science Daily: Active ingredient levels vary among red yeast rice supplements.


People take Red Yeast Rice to lower cholesterol instead of statins, rightly fearing the problems that statins can cause. What the supplement industry does not make clear is that the reason Red Yeast Rice may lower cholesterol is that it contains a chemical, monacolin K, which is chemically identical to the chemical marketed as the pharmaceutical drug lovastatin.


The main difference between statin in the red yeast rice pill you buy and pharmaceutical lovastatin is that the amount of lovastatin you get in the "natural" supplement is completely unknown. In the study cited above, researchers found that the concentration of lovastatin in the 12 different branded bottles varied from 0.10 to 10.09 mg per capsule. That's a significant range!

Since the size of the dose of statin you take has a lot to do with both its effectiveness and with whether it will cause the severe side effects that statins cause (including brain damage leading to mild, irreversible dementia and muscle wasting) it is extremely unwise to take your statin in a form where you have no idea how much you are getting. This study clearly shows that when you buy your statin as a "natural supplement" you may be getting almost none, some, or too much. Why play Russian Roulette with your meds?


But that's not the only problem with Red Yeast Rice. The other problem is that because it is an unregulated "natural" product which is created by growing funguses on rice, it often contains other funguses--some of which produce poisons.

In the case of Red Yeast Rice the fungus-produced toxin that produced by the funguses that grow alongside of those that produce the statin is called citrinin. It is a toxin known to destroy the kidneys in animals.

The study cited above found "elevated levels" of citrinin in four out of twelve brands of Red Yeast Rice products it evaluated. (The phrasing suggests the researchers also may have found lower levels in other bottles.) Sadly, the researchers did not reveal to the public which brands contained this toxin. My guess is that they did this out of a fear of lawsuits brought by the companies who earn billions each year from selling you this toxic crap.

I would have to say that one of the most common questions I get in my email from readers of this blog and the Blood Sugar 101 web site is "What supplements do you recommend I take." Many of my correspondents will accompany this question with a long list of supplements they are already taking.
Sadly, many of them are taking red yeast rice in the erroneous belief that it is safer and healthier than the statins that doctors push on people with diabetes.

Since so many people with diabetes already have early kidney damage at the time they receive their diabetes diagnosis, this is disturbing news. The last thing a person with diabetes needs is to be taking a supplement that contains a chemical known to poison the kidneys.


As things stand now, the FDA can act against a supplement only after doctors report damage to patients that is linked to their taking a specific supplement. But because doctors expect people with diabetes to develop kidney failure and may not even know their patients are taking these alternative medicine forms of statins, it is very unlikely that the damage that kidney-toxic red yeast rice may be wreaking will ever be noticed.

There are real problems with statins, but at least when you take a statin you bought at the pharmacy you can be sure that the capsule contains the dose you were told it did and that it is not contaminated with poisons.

The same is true of every other supplement you may buy. And given the amounts of money that corporations who profit from selling you dangerous crap are paying into the campaigns of candidates howling for more "deregulation" you can be sure it isn't going to change any time soon.

If you really want to protect your health, avoid all supplements. You have no way of knowing what is in any of them. Some companies claim that their supplements have been tested for purity. However, when I investigated these claims in the past, I learned that all this means is that one batch was taken to the lab, once. There is no assurance that what you buy will match the lab assay provided (and the small print that accompanies these claims of lab-proven purity is full of legal weasel-wording.)

Other potentially damaging supplements include kelp, all of which is contaminated with arsenic. When I contacted supplement companies about this I was told that finding arsenic in natural kelp it was "normal." None denied the claim that their products contained arsenic. Arsenic exposure has been implicated as a cause of diabetes. (Details HERE).

Fish oil may contain mercury. Vitamin D capsules appear to contain amounts of Vitamin D that do not correspond to the label Details HERE.

The supplement industry always responds to these kinds of reports by appealing to anti-government paranoia. "This is a plot by the FDA to take away your freedom" is the usual response.

Personally I would like to take away the freedom of a cynical multi-billion dollar industry to sell you whatever it feels like putting in a pill, slapping a label on the bottle that lies about its contents, and to ignore the fact it is charging you a fortune for toxins that can shorten your life and make what is left of it miserable.


October 25, 2010

Understanding Doctor Fails

Picture this: Your computer won't turn on, so you take it to the repair shop. The guy there tells you it's going to cost $60 for him to take a look at it. You leave the computer with him for two days. You pick it up, pay your $60, but when you plug it in at home you find it still doesn't work. The problem, it turns out, is that the repair shop you took it to was a car repair shop, not a computer repair shop.

This is a silly story, of course, because no one takes their computer to a garage to get it fixed. But sadly, something very similar exactly what happens to many of us when we take our malfunctioning diabetic bodies in to family doctors for repair. We assume they are experts in the diagnosis and treatment of blood sugar related medical problems when in fact, this is not true. Many doctors have been taught very little about how to diagnose diabetes and even less about how to keep it from ravaging the body.

To understand why, you have to understand how doctors are trained. In medical school they learn anatomy. They dissect bodies and learn the location, names, and perhaps the function of hundreds of organs and tissues. As far as diabetes goes, they learn the location of the pancreas and its anatomy, and may be shown the damage done to tissues by diabetes, though they will not be told that it is the high blood sugars people with diabetes live with that cause the damage, not some underlying disease.

After mastering anatomy, doctors are taught to recognize the symptoms of hundreds of common medical conditions, among which is Type 2 Diabetes. This is where they learn "diagnosis."


Doctors are taught that Type 2 Diabetes is a condition diagnosed by a fasting blood sugar test over 125 mg/dl. Unfortunately, many people, including most women, develop dangerously high post-meal blood sugars years before their fasting blood sugar is high enough to provide a diagnosis.

And to make it worse, since the diagnostic cutoff was arbitrarily set to 140 mg/dl until just thirteen years ago, many doctors practicing now who were trained before 1997 still secretly think diabetes isn't serious until fasting blood sugar reaches at least 140 mg/dl and because of this, won't treat diabetes aggressively for years after a patient is initially diagnosed until the fasting blood has deteriorated to where they consider it really diabetic. While they are waiting, high blood sugars are ravaging your organs.

A few doctors are taught to diagnose diabetes with a 2 hour oral glucose tolerance test and consider a 2 hour reading over 200 mg/dl proof of diabetes, but these same doctors often ignore 2-hour glucose tolerance test results when the one hour reading is over 200 mg/dl even though the official diagnostic criteria that define Type 2 Diabetes also state clearly that a person should be diagnosed as diabetic if they experience two or more random blood glucose readings over 200 mg/dl no matter when or how they were obtained.

On top of this, the growing reliance of family doctors on the A1c test they can do in thier office is causing even more doctors to fail to diagnose diabetes, as I discussed HERE.

All this explains why so many doctors fail to diagnose diabetes in a timely fashion and why so many people are walking around with diabetic blood sugars for years before they are finally diagnosed.


In medical school, doctors memorize the standard treatment recommendations for hundreds of different conditions. But since diabetes is just one of these many hundreds of conditions whose treatment they must memorize to pass their medical boards, they can give it perhaps a day of study, or perhaps only a few hours.

What they are taught is that people can avoid diabetes by eating "right" but doctors do not take courses in nutrition in medical school so they rarely know anything about how different foods affect the body or what diets actually lower blood sugar.

After doctors receive their degrees, they go through one year hospital internships followed by multi-year residencies, also usually in hospitals, where they work with more experienced doctors and treat the medical crises that bring people to hospitals.

During these years they will treat many people with Type 2 Diabetes--but only after decades of poor blood sugar management have caused these people to experience medical crises like heart attacks, amputations, kidney failure, or diabetic blindness that bring them to the ER.

Nowhere in his training with your doctor encounter healthy people with Type 2 Diabetes whose health is normal because they control their blood sugar and keep it at normal levels. He will not be taught that it is possible for people with Type 2 Diabetes to keep blood sugars normal and live normally healthy lives.

With this kind of training behind him, when your doctor sees a person with Type 2 who is not suffering from a major complication, he thinks they are doing very well no matter how bad their blood sugar might be. In fact, your blood sugar will have to be very bad indeed before your doctor takes any steps to improve it.

Most doctors do not prescribe any drugs to patients with Type 2 Diabetes until they have had an A1c over 8% for at least a year. This corresponds to an average blood sugar of 183 mg/dl, which is one high enough to wreak significant damage on organs. (Details about what sciences has learned about what blood sugar levels produce complications can be found HERE.)

After a patient has spent enough years with high blood sugars that they do start looking like they are headed for a severe medical crisis, doctors prescribe oral drugs--usually whatever the drug reps are pushing the hardest, even though there is a lot of evidence that prescribing insulin very soon after diagnosis--before damage has set in--results in far better outcomes years after diagnosis, even when patients only take insulin for a short while. (Details HERE.)


Once a doctor completes his residency and goes into private practice, 99% of his "education" about Type 2 Diabetes comes from people in the pay of drug companies--salespeople and other doctors who are taking huge "consulting fees" from a drug company to "educate" other doctors about how superior that company's drugs are supposed to be.

As a result,doctors are not informed about the serious side effects of these newer drugs until they have harmed so many people the FDA steps in. Even then, drug company flacks will provide a steady stream of reassurance about a dangerous drug until it is removed from the market (which usually takes 5-12 years after it starts injuring people.)

Doctors also learn little or nothing about non-drug treatments except for those that have been branded and are earning someone a lot of money. This is why when you learn about any diet from a doctor it usually has some other doctor's name (and financial empire) associated with it.

The rest of your doctor's medical knowledge comes from newsletters, heavily sponsored by drug companies. These distill a few gems of diabetes research into a headline and a one paragraph summary. These summaries cannot not explore the details of the research that can contradict the statement made in the headline that accompanies it. And when a highly promoted study funded by a drug company is debunked by academic researchers their studies often do not make it into the newsletters.

Since your doctor does not have the time to keep up with the thousands of studies concerning the hundreds of conditions he must come up with, he has no choice but to rely on these newsletters. Unfortunately, after reviewing them for almost a decade I have come to believe that 90% of what they tell doctors about appropriate treatment for their patients with diabetes is out and out false.

With this in mind, you can see why you so often come back from a visit to the doctor without anything more than a prescription for another expensive, side-effect laden oral drug. Your doctor does not have the time to learn all the ins and outs of diabetes. He does not have the time or interest required to read and analyze research or to hunt for better treatments for his patients. He does not begin to understand what is really raising your blood sugar or why you have so much trouble losing weight.

Until you have a medical crisis--a heart attack, amputation, or diagnosis of end stage renal disease--you doctor does not consider your case to be important, and in any event he believes that the drugs he can prescribe will only delay your ultimate and very unpleasant fate. So the faster you are out of his office so he can treat someone else whose condition is not their fault and who he might be able to help, the happier he will be.


In fact, it is possible for people with diabetes to achieve normal blood sugars, maintain them for years, and avoid developing new complications or seeing existing ones get worse. Details HERE. A very small sample of the success stories people send me can be read HERE.

Once you understand what is at stake and what you can do to improve matters, your doctor can even become an ally in your search for health--as long as you understand his limitations and do not expect him to do the hard work involved in teaching you what you need to know to regain your health.

With all this in mind, I'd like to offer you these tips:


1. Don't expect your doctor to know very much about diabetes. Educate yourself by reading books. You can find a selection of useful diabetes books listed HERE. You can also learn a lot by interacting with others online with Diabetes who will share what they've learned with you. You can find some support groups listed HERE. Keep in mind that each of us is different and what works for one person may not work for another, but feel free to try out different approaches people who are in excellent control themselves suggest until you find the one that works for you. Just be sure when you take advice that the person giving it knows what good control means. You can learn what blood sugar levels are associated with complications HERE.

2. Get your doctor to prescribe a blood sugar meter and testing strips. Armed with this powerful tool, you can easily determine which foods are safe to eat and which foods raise your blood sugar to damaging levels after you eat them. The meter will give you a much better idea of what it is safe for you to eat than any doctor will. Only by testing the food you eat can you find out which foods allow you to keep your blood sugar from rising into the danger zone.

3. Do not take any drug your doctor prescribes without researching it. Doctors are woefully ignorant about side effects and may brush off reports of side effects that are signs of very dangerous conditions.

Because drug companies have shown themselves perfectly willing to lie about their drugs' real side effects and to mislead doctors about their effectiveness, you cannot trust that your doctor is aware of the real dangers of prescription drugs.

I have been keeping up with news about the commonly prescribed diabetes drugs for almost a decade and you can learn what research has found about all of them by following the links you'll find HERE. You can also search this blog using the Google search at the right, to find posts about various drugs. Updates to the main Blood Sugar 101 site are tracked on a separate blog HERE.

When prescribed a drug for some other symptom or a diabetic complication, the best way protect yourself against the dangers of drugs is to learn how to read the official, FDA required Prescribing Information published for each drug.

You can find these online. They often include terminology unfamiliar to non-medical people. Usually you can use Google to find a medical dictionary that will translate these terms. If you need help, stop by one of the many online diabetes discussion forums where you will be able to find people who can help you interpret what you read.

The prescribing information will tell you how effective the drug really is and what factors might make a specific drug dangerous--for example pre-existing conditions or interactions with other drugs you might also be taking. It will also warn of the side effects associated with the drug, though sadly it will not tell you which are temporary and go away when you stop the drug and which are permanent.

Drug companies mix trivial side effects with the ones that ruin lives and give no hint to doctors which are which. Doctors are so used to people reporting the trivial side effects that they often ignore the serious ones. If you suffer a known side effect from a drug--for example sinus headache from Januvia, or muscle aches from a statin drug--do not assume it is trivial. These kinds of side effects may often indicate a more severe problem that left untended can harm you. (Immune system problems with Januvia and muscle wasting from statins.)

4. If your family doctor can't help you with a serious problem insist on seeing a specialist. Specialists get more in-depth training with a narrower subset of conditions.

But that said, don't assume that a specialist is competent just because they claim to be. Sadly, many of us have learned that the world is full of incompetent specialists, including endocrinologists. Doctors often refer you to specialists with whom they network--usually doctors that practice out of the same hospital, and may be ignorant about which doctors in your region are really the most competent.

As a rule, specialists practicing at prestigious regional medical centers are more likely to be competent than those practicing out of small community hospitals that only handle routine cases.

The good news is that most people with Type 2 Diabetes can do extremely well with a combination of self-education, meter-testing their diet, and the use of safe drugs like Metformin and insulin which have survived the test of time. The less you trust that your doctor is the expert, and the more you use your doctor as a resource to prescribe you the tools you have learned about that that can help you safely regain your health the better off you will be.


October 19, 2010

Database Reveals Drug Company Payments to Doctors

Vital information is revealed on this web site: Dollars for Docs. On it you will find a database that reveals the payments 7 large drug companies made to doctors in return for having those doctors pose as experts while promoting the company's drugs to other doctors. This promotion often involved reciting scripts provided by the company.

These payment revelations were forced out of the companies, after they lost lawsuits that proved these companies had broken the law with how they marketed their drugs.

Needless to say, when a company is reeling in billions of dollars from the sale of a drug this kind of penalty and a fine that isn't even the size of one year's profits from the drug constitute nothing more than a slap in the wrist written off as part of the cost of doing business.

I urge you to read the whole web site, including this important article:

Docs on Pharma Payroll Have Blemished Records, Limited Credentials.

Then use the Search Box on the right of THIS PAGE to see if your doctors are being paid by Big Pharma to promote drugs to their peers.

Unfortunately, what this database does NOT do is reveal whether your doctor has been fed an expensive lunch by drug reps (a common technique to make them feel beholden), sent to resorts to receive "education" about an expensive new drug, or given the opportunity to participate in a "study" which involves signing up as many patients as possible to try the company's new drug in return for a hefty payment for each "study subject" recruited.

In case you wonder what kinds of misinformation drug companies pay doctors to tell their peers here are a few of the more common:

1. The makers of all new diabetes drugs invariably tell doctors that their drug will "rejuvenate beta cells."

This was the case with Avandia, Actos, Byetta, and Januvia. The claim was eventually disproven for Avandia and Actos, but not before these drugs had been on the market for ten year--ten years during which people paid obscenely high amounts for mediocre drugs with dangerous side effects that turn out to do nothing to restore beta cell function. Byetta has been on the market for about five years now and there is still no evidence that it rejuvenates beta cells in humans. Since it's effect on blood sugar wears off after a few years for most people, it's highly unlikely it has any such effect. The same is true of Januvia.

If beta cells are being "rejuvenated" you should see better blood sugar with each passing month that you take the drug.

2. The makers of new drugs pay doctors who pretend to be experts to "teach" family doctors that their brand new, untested drugs are better for patients than old, safe, tested drugs like metformin. As a result, many patients at diagnosis are put on dangerous new drugs that have little impact on their blood sugar but cost a fortune.

The inflated claims about the value of these new drugs make their drugs sound much more effective than they are and these "expert" doctors discourage family doctors from prescribing the insulin these patients really need.

No new oral drug on the market lowers insulin resistance or protects the heart the way that metformin does. No oral drug on the market lowers A1c more than 1% on average in populations whose average blood sugar is closer to 9% than 7%.

There's good evidence that newly diagnosed people with Type 2 diabetes do much better long term if put on insulin immediately after diagnosis. This can lower blood sugar dramatically and lower insulin resistance too. (Very high blood sugar worsens insulin resistance.)

3. Drug company shill doctors are given scripts which they use to convince other doctors that the side effects known to be associated with their drugs are not as serious as they sound, even when the side effect is death.

This isn't hearsay. Someone I know personally very well was working, running audiovisual equipment, at a convention, held inside a locked building guarded by armed guards, where a drug company whose drug had recently been found to kill significant numbers of people were educating their staff in the techniques and language to use to reassure doctors that the drug was still worth prescribing. One technique was to use euphemisms for words like "died" when describing studies.


October 18, 2010

Massive A1c Fail. It does not accurately diagnose diabetes.

The American Diabetes Association's Committee of [Misguided] Experts has recently recommended that the A1c test be used for screening patients to see if they have pre-diabetes and diabetes. They suggest defining an A1c of 6.0-6.4% as indicating "pre-diabetes" and one of greater than 6.5% as diagnosing "diabetes."

Like almost every suggestion these so-called experts have made since they started -meddling in diabetes diagnosis in 1978 this one will condemn millions of Americans to live with undiagnosed diabetes for years--years during which their daily exposure to damagingly high blood sugars will ensure they develop the diabetic complications--heart disease, nerve damage, and kidney failure that prove so profitable to drug companies.

And no, this isn't my opinion. This is the conclusion drawn by researchers who looked at what would happen had a large pool of people being screened for diabetes been screened with the A1c test instead of the Glucose Tolerance test that revealed that many of them had diabetes or pre-diabetes.

The study is reported here:

Screening for Diabetes and Pre-Diabetes With Proposed A1C-Based Diagnostic Criteria Darin E. Olsen et al. Diabetes Care October 2010 vol. 33 no. 10 2184-2189. doi: 10.2337/dc10-0433

This team examined the records of 4,706 Non-Hispanic white or black adults without known diabetes. These people were given both A1C tests and a 75-g Oral Glucose Tolerance Test (GTT) when they participated in either the prospective Screening for Impaired Glucose Tolerance study (n = 1,581), the National Health and Nutrition Examination Survey (NHANES) III (n = 2014), or NHANES 2005–2006 (n = 1,111).

When the researchers compared diagnoses made using the oral glucose tolerance test with those made using the ADA's new A1c criteria they found:
The proposed criteria missed 70% of individuals with diabetes, 71–84% with dysglycemia, and 82–94% with pre-diabetes.
And if that isn't bad enough, they also found that
There were also racial differences, with false-positive results being more common in black subjects and false-negative results being more common in white subjects.
Applying the NHANES 2005–2006 data, the researchers estimated that,
... approximately 5.9 million non-Hispanic U.S. adults with unrecognized diabetes and 43–52 million with pre-diabetes would be missed by screening with A1C.
Unfortunately, such is the clout of the American Diabetes Association and its Experts, that huge numbers of doctors around the U.S. have already switched to screening patients using the A1c test. One huge factor driving this change is because doctors can earn extra money by administering A1c tests to patients in their office.

As documented earlier, these in-office tests are extremely unreliable. Details HERE.

But this latest study adds to our misery by making it clear that even accurate lab A1c tests miss most cases of diabetes diagnosed by the GTT.

So millions of people who ask their doctor if they might be developing diabetes will be given an in-office A1c test (billed by the doctor at five times its actual cost) and then be reassured by their family doctors that they are "fine" when, in fact, they are walking around with blood sugar levels high enough to damage their heart, their arteries, their nerves, their retinas, and their kidneys.

If you rely on an A1c to diagnose diabetes you can be certain that by the time that A1c has risen high enough to earn a diagnosis, you will have serious, even irreversible damage that could have been avoided had you only been given timely warning that your blood sugar level after meals is high enough to damage your organs.

To learn what blood sugar levels have been proven to cause organ damage visit this page HERE.

To learn how to test your blood sugar at home to find out if you are running blood sugars high enough to damage your organs visit this page HERE.

If you learn you are running higher than normal blood sugars you can lower them using this very simple technique described HERE.

If you are black, you may, conversely, be told that they have diabetes based on an A1c test when you don't. A growing body of evidence suggests that the A1c test is a poor guide to blood sugar control in black people, probably because of differences in the genes that govern their red blood cells.

A false positive diabetes diagnosis isn't as damaging to your body as a false negative, because if a false positive usually leads to you taking steps to lower your blood sugar. This helps everyone as there's evidence that even people whose blood sugar is completely normal according to the Glucose Tolerance Test have a significantly higher risk of heart attack if their blood sugar does not return to its fasting level by the end of the test. (You can read details of that study HERE.)

But a false positive may make it prohibitively expensive for someone misdiagnosed this way to buy affordable health insurance in the US and that, too, can be harmful.

October 5, 2010

OT: Spot Jenny's New Novel and Enter a Contest to Win a Free Copy of Blood Sugar 101

As those of you who are friends of this blog know, after many years of writing novels for fun, I sold a three book series of historical romances to Avon a little over a year ago. The first of those books, Lord Lightning, is now on bookstore shelves around the U.S.A..

The photo below shows me admiring the first copy of book I ever spotted in a store. It was the Barnes & Noble bookstore in Holyoke, MA. As you can imagine this was an exciting moment.

I'm really curious about where else Lord Lightning might be showing up, so I'm calling on all my web friends to help me out and let me know if Lord Lightning made it to the shelves in your town. To encourage you to participate I've created a contest and will be offering offering prizes to randomly selected people who report their book spottings.

UPDATE: The contest is now over so links to it have been removed. The winners were drawn on November 1, 2010 and notified by email. Congratulations to Birdy who won the copy of Blood Sugar 101.

I really appreciated the photos people sent in. Seeing my book displayed in so many different places around the US and Canada was a thrill. Seeing it on people's Kindles and Nooks was great too.

My editor tells me the book is selling well which is great news in today's difficult economic environment. Thanks to everyone who bought a copy. I hope you enjoyed reading it!

READ EXCERPTS: You can find an brief excerpt on Amazon HERE

There's a longer excerpt posted on HarperCollins' web site HERE Click on the orange "Read Now" button to view it.


September 26, 2010

Surgical Site Infections Rise Dramatically when Blood Sugar is over 140 mg/dl

Though doctors call them "diabetic" complications, many studies conducted in cell cultures, animals, and humans, which you can read HERE, point to the conclusion that organ damage due to high blood sugars starts at levels that doctors label "prediabetic."

Now another study--one that looked at the factors causing post-operative infections has come up with the same finding.

The study is:

Postoperative Hyperglycemia and Surgical Site Infection in General Surgery Patients Ashar Ata et al. Arch Surg. 2010;145(9):858-864. doi:10.1001/archsurg.2010.179

You can read a good summary of this study, with more information than is found in the abstract here: Science Daily: Postoperative High Blood Sugar Appears to Be Associated With Surgical Site Infection

The researchers examined the records of 2090 patients. For 1561 of these patients, blood sugar measurments were recorded and 803 of these blood sugar measurements were taken within 12 hours of surgery.

The researchers found that in the group as a whole the following factors were predictive of surgical site infection (SSI):
increasing age, emergency status, American Society of Anesthesiologists physical status classes P3 to P5, operative time, more than 2 U of red blood cells transfused, preoperative glucose level higher than 180 mg/dL... diabetes mellitus, and postoperative hyperglycemia.
But here's where things get interesting. Because the researches found that,
After adjustment for postoperative glucose level, all these variables ceased to be significant predictors of SSI; only incremental postoperative glucose level remained significant.
And what was the postoperative glucose level at which bad things started to happen?

Readers of this blog, don't all answer at once, but you're right!

It was 140 mg/dl the very same blood sugar level we have long been telling people with diabetes should be the very highest they ever let their blood sugar reach if they can possibly avoid it.

In the type of surgery studied in which post operative infection was by far the most common--colorectal surgery, where 14.11% of patients suffered infections, the researchers found that those with blood sugars higher than 140 mg/dl were over three times more likely to suffer infection as those without.

Science Daily also quotes the full text article as saying,
In conclusion, we found postoperative hyperglycemia to be the most important risk factor for surgical site infection in general and colorectal cancer surgery patients, and serum glucose levels higher than 110 milligrams per deciliter were associated with increasingly higher rates of post-surgical infection.

What makes this study so important is this: If you go in for a major procedure it is almost 100% certain that, despite your protests, the anesthetist will hook you up to a glucose drip before surgery. This guarantees that no matter how perfectly you have been eating, your blood sugar will be at least 140 during your surgery--a number that surgeons, trained to believe that 200 mg/dl (11.1 mmol/L) is "Diabetic" will tell you was a "nice normal blood sugar" as mine did.

The only way to avoid this is to negotiate it with the surgeon before you commit to the surgery and get it in writing in a form that you can give to the hospital staff before the surgery.

No matter what you have been told orally, the staff in the hospital will listen only to the surgeon and pay attention to you only if they see written instructions that look like they could lead to a law suit.

Unfortunately, if my experience is anything to go by, getting such written instructions may be impossible, even with an otherwise excellent surgeon. Therefore, it would be a good idea to print out this study and keep it in your file of important medical papers so that you can take it with you when you have your preliminary meeting with the surgeon.

Once your surgery is done, you are not out of the woods. The food you will be given in the hospital will be the "diabetic menu." This may be called a "Carb-controlled diet" (It was at the hospital I stayed in) but this is misleading. It is, in fact, the same old dangerously high carb/ low fat diet that nutritionists still defend to the death--the death of the patients with diabetes who eat it.

For breakfast you'll be offered toast with jelly but no butter, cereal with skim milk, and sugary fruit, so that you face the choice of starving or raising your blood sugar well over that 140 mg/dl level. The rest of your meals will be thin slices of fat free mystery meat and starchy veg, with fruit--canned in corn syrup--for dessert.

Again your only defense here is signed orders from your doctor, which may be very hard to attain. That is because most doctors do NOT understand that the carbs you eat are what raise your blood sugar. They really don't.

And they remain convinced that blood sugars up to 200 mg/dl are not dangerous and that it is a mysterious disease called "diabetes" that harms people, not exposure to high blood sugars.

Doctors also believe, without question, that high fat diets cause heart attacks and that it is much healthier for you to eat that toast and jelly than a fresh egg.

So before you go into a hospital for elective surgery, if possible, get a letter, signed by your surgeon or another doctor who practices at the hospital where you are having your surgery ordering the nutrition staff to allow you to order at will from the regular menu and forbidding them to make you eat foods from the "diabetic" menu.

If it isn't possible, arrange for friends or family members to bring you the foods you need to eat to keep your blood sugars normal. Arrange to go home where you have control over your food supply as soon as it is possible.

If you are forced to go to a nursing home after surgery, make sure that your doctor orders the nursing home staff to allow you or a chosen family member who understands your dietary needs to control what you eat and, again, forbid the use of the "diabetic" diet. Otherwise, you will be forced to eat the high carb/low fat diet that will raise your blood sugar and make surgical infection more likely.


September 24, 2010

Avandia Finally Gone but Actos is Just as Dangerous

The FDA has for all practical purposes killed Avandia. Patients will have to be given a scary disclosure form to sign if it is prescribed and it can't be prescribed without the doctor filling in paperwork explaining why the patient couldn't be put on Actos.

The flaw here is that Actos is just as dangerous a drug. Here is a brief list of the problems with Actos. You can find the citations to the studies backing up each of these statements on this page: Actos and Avandia: Dangerous Diabetes Drugs.

1. Actos can cause heart failure in young people who did not have any signs of heart failure before taking it. Heart failure is a weakening of the heart muscle that is almost always fatal after a number of years of increasing debility.

2. Actos taken over long periods of time damages the structure of the arm and leg bones in a way that causes fractures. By the time these fractures occur, it is too late to do anything about the damaged bones because how Actos works is that it turns the stem cells that should have turned into bone cells into fat cells which absorb glucose and turn it into body fat. That's a heckuva way to lower blood sugar, but that is what it does.

3. Actos makes people gain weight in the form of new fat cells that they are stuck with forever even if they stop the drug. (See #2 for why.)

4. Actos has been shown in studies to be less effective than the wimpiest high carb dietary changes (mostly calorie restriction) and mild exercise. Actos is far less effective than the adoption of a diet of 100 g a day of carbohydrate or less.

5. Actos causes macular edema--i.e. swelling in the most sensitive part of the retina which causes blindness.

6. Actos appears to raise the risk of bladder cancer. This occurs when the drug is taken for a longer period or at higher doses.

You risk all this in exchange for an average drop in A1c of .2% (at the 15 and 30mg doses) and .9% drop at the 45 mg dose at which bladder cancer becomes an issue. And those drops are in a population whose average A1c was 10% at the start of the study, meaning that after taking this dangerous drug for 6 months they still had A1cs in the 9% range we know will cause blindness, amputation, kidney failure and heart attack death. That finding is reported, somewhat deceptively here:

Official FDA Required Actos Prescribing Information

In contrast to this miserably poor improvement, hundreds of people who cut down on their carbs following the advice you will find HERE report dropping A1cs from 10% or more down to the 5%-6% range at which complications are very, very rare.


September 18, 2010

Why The New Drugs Cause Such Terrible Side Effects

Yet another piece of bad news showed up--without mainstream coverage--in the health news this week. A long term study of Actos discovered that there is a clear dose and time-related increase in bladder cancer among those who take it.

As MedPage Today reports:
An interim analysis of data from the study, which includes more than 193,000 patients with type 2 diabetes, revealed no statistically significant increase in bladder cancer among pioglitazone users compared with nonusers (hazard ratio 1.2, 95% CI 0.9 to 1.5), but "the risk of bladder cancer increased with increasing dose and duration of [pioglitazone] use, reaching statistical significance after 24 months of exposure.
Of concern to all of us should be the way that the company that makes the drug attempts to wave off this latest of many findings that show how their drug ruins lives. Takeda's spokesweasel claims, "the data did not reach statistical significance for the primary endpoint of increased risk of bladder cancer."

What this means is that even though the data shows a very strong relationship between bladder cancer and their drug when a larger dose is taken for 2 years, the relationship disappears when you add into your statistical pool all the people who took it for a shorter time period or at low doses.

If you can't see the problem with this argument, I worry about you.

Apparently the renegade doctors who earn huge salaries hyping drug company products have decided a drug is only dangerous if it kills large numbers of those who take it, not just a measurable number of those who take it at commonly prescribed dosage levels for several years.

But that's not what I'm blogging about here. What I'm blogging about is why so many of the new drugs have such terrible side effects and why we only learn about them ten to fifteen years after the drug is on the market.

The reason is this. Today's newer generation of drugs target specific genes and cell receptors. The TZD drugs, Actos and Avandia, target the PPAR-gamma transcription factor which regulates genes that affect how lipids are stored. No one questions that they do this, or that in a significant number of patients (but by no means all who take them) they lower blood sugar.

The problem is that PPAR-gamma regulates genes involved in a bunch of other processes in the body, too--processes that have nothing to do with blood sugar control.

PPAR-gamma, for example, transforms the bone stem cells that should turn into new bone into new fat cells. This is why after a decade on the drug many people start experiencing broken bones in their arms and legs (the areas where PPAR-gamma is most active) and why once bones begin to break there is no cure. A decade of rebuilding has been subverted and the weakened structure of the bone cannot be fixed.

And this points to the huge problem with the drug regulation process. There is no requirement--none, zilch--that a company applying for permission to market a new drug investigate what OTHER physiological processes are affected by the drugs's mechanism. All the drug company has to show is that it achieves what they are selling it to do. In the case of Actos and Avandia, that means causing a very modest drop in A1c--about .5%.

If course, if a drug undergoing the approval process does something that is severely damaging right away, the problem will show up during the approval testing. If lots of people's skin peels off, or lots of people have strokes, a drug won't usually get approved.

But most of the unintended consequences of the way new drugs work are more subtle and don't cause dramatic events during the first year or two that a person takes them. Many of these life-ruining side effects happen so slowly they don't show up for five to ten years--and then it takes a lot of work to link the side effect to the drug.

Many of these side effects are never linked. Doctors expect to see people with cancer in their practices and don't connect the cancers with a drug the person has taken for a decade. They expect to see heart attacks in people with diabetes and don't know that more people are having heart attacks than expected and that this is because of some drug they prescribed four years before.

It is only when the side effect is odd that anyone notices at all. If young people with no sign of heart disease suddenly develop heart failure as happens with both Avandia and Actos, a few doctors notice and report this to the FDA. (Many of course, don't.)

If people start breaking arms and legs--an odd pattern for osteoporosis--as happens with both Avandia and Actos, a few more doctors notice.

But the fact that a few doctors notice and report doesn't mean that other doctors hear about these side effects since they get all their "drug education" from drug company sales reps, those pretty young ladies who used to be college cheerleaders who show up at the office bringing such welcome take out lunches.

And the FDA will not pull a drug from the market when evidence of these more subtle side effects emerges either. It takes years to kill a dangerous drug--years during which the company that sells it continues to rake in its billions.

Cancer is a particularly troubling side effect of newer drugs, because the public believes, erroneously, that the drug approval process keeps cancer producing drugs off the market.

This turns out not to be true. Though drug testing eliminates drugs that cause cells to become cancerous in a test tube over a few weeks or which cause malignancies over the short life spans of rodents, it cannot identify drugs that change how the body fights cancers in ways that allow slow developing human cancers to gain traction.

That is why evidence a that a drug is raising the incidence of cancer rarely appears until a drug is almost at the end of its 14 year patent period. It has taken more than 12 years to notice the link between bladder cancer and Actos. It took nine years after its approval for anyone to notice the signal suggesting that Diovan raises cancer incidence by about 8%.

And that's why it won't be until another nine years or more that the public will learn that any drug that inhibits DPP-4 is turning off an immune system mechanism essential to fighting melanoma, prostate cancer, ovarian cancer and lung cancer. Details HERE.)

Even when the link between a drug and a serious, even fatal, side effect finally made clear by large population studies don't expect the drug to be taken off the market. There will be panels and hearings and FDA deliberations, but if the history of Avandia is anything to go by, the drug will still be selling at your local pharmacy five years after its clear what its real dangers are.

Because these secondary effects don't kill everyone who takes the drug, or 50% of them or even 10%, the drug company spokesweasels will argue, as the Takeda one does above that unless it is damaging everyone who takes it, it's still a good drug. They will also claim--though there is not a scintilla of evidence to support this claim, that the drug is saving many other lives which balance out the ones we know it is taking.

The only oral diabetes drug for which there is conclusive evidence that that it prevents deaths is Metformin, which has been on the market (in Europe) since the 1950s.

And not so incidentally, Metformin is the only oral diabetes drug that has not been linked conclusively with causing a fatal side effect. Though it was long thought that it might, rarely, cause lactic acidosis, that has been disproved. We now now that the incidence of lactic acidosis in those taking metformin is identical to its incidence among those not taking it.

But there is no evidence that the expensive newer diabetes drugs do anything but lower blood sugar very slightly--much less than dietary changes and exercise can do. There is no evidence any of these newer drugs are saving lives. And because when the drug companies go looking for this evidence, they keep finding the opposite--it was that kind of study that stopped the profits rolling in from Avandia--don't expect to see such studies funded in the future.

Is there any way to detect these life-ruining side effects before several million people have taken the drug?

A very good place to start would be to require that drug companies investigate the effect of a new drug on all the known expressions of the gene, transcription factor, protease or other physiological component it is known to impact. This information is widely available. There are databases online that link to all the research about every gene for example. A reasonable person should be able to read through these studies and determine which impacts might cause harm. Then those effects could be investigated as part of the approval process.

Doing this would have given us the answer we need about whether inhibiting DPP-4, a protease known to fight cancers, raises the incidence of the DPP-4 sensitive cancers--research that researchers say should be done, but that has not been done.

Drug companies will tell you this is too expensive and that such regulations would mean no more wonder drugs.

But when wonder drugs are clearly killing tens of thousands of people who would otherwise have lived, you have to ask yourself how wonderful they really are. We went to war over an attack that killed less than 3,000 people. But we let drug companies sell products that may be killing tens of thousands unnecessarily. Even though there is good evidence that the drug companies know their products are causing unnecessary deaths and hiding this evidence so they can continue to rake in their billions.

Isn't it time this changed?