January 26, 2010

Victoza: A New Competitor for Byetta

The FDA finally approved Novo Nordisk's long delayed GLP-1 analog, Liraglutide, which is marketed under the name, "Victoza."

This drug was developed in the same time frame as Byetta and is similar in concept. But it's side effect profile was more troubling, hence the delay. It's being released with a warning that it might produce thyroid cancers, though this supposedly is mostly a problem in rodents. Even so, the fact that the thyroid cancer issue can't be completely dismissed would make a reasonable person ask, "What does this drug offer that makes it worth taking on even a tiny bit more risk than is found with Byetta?"

You can read the full European prescribing information for Victoza here:

Victoza Prescribing Information.

As far as I can see the only possible benefit to taking Victoza over Byetta is that it requires a once a day shot, rather than the twice a day schedule of Byetta. That said, it appears to produce less blood sugar control than Byetta does--when Byetta works, which isn't always--and reading between the lines, it doesn't look to me as Victoza has as good an impact on weight as Byetta does.

When looking at statistics for both these drugs, keep in mind that other research has found that Byetta is a drug that is worthless for two thirds of of those who take it and magic for the other third. This means that the averages published in Prescribing Information documents aren't a good guide to its effect.

If out of ten people taking a drug, three people drop 30 lbs each and the other seven gain 3 pounds each, the average weight loss is 7 lbs, but that statistic fails to reflect reality in any meaningful way.

The same is true with blood sugar control, as some people respond dramatically to Byetta and others who take it actually see their blood sugar go up.

With this in mind, it's hard to compare Byetta to Victoza based on published statistics. The average A1c drop reported when patients take Victoza and Metformin is 1%, which is really no better than the drop achieved taking Metformin alone.

Most tellingly the Victoza prescribing information presents no statistic for the impact of Victoza on blood sugar when it is not being given in combination with another blood sugar lowering drug.

This suggests very strongly that on average the drug has no impact on A1c, but because it might have a stronger impact on a subset, as Byetta does, it can't be dismissed.

My take on this drug is this: There is little reason to take it. The longer duration means that if you get the serious gastrointestinal reaction that GLP-1 analogs can cause, it's going to take a lot longer to wash out of your body. If you aren't going to respond to Byetta, it isn't likely you'll respond to this drug either, as non-response suggests that fiddling with GLP-1 isn't going to help you. The impact is less than Byetta and the side effects more troubling, especially since it is a new drug and hasn't been prescribed to a large group of patients as Byetta has.

To me the most worrisome side effect is this. As the prescribing information reports,
The overall rates of thyroid adverse events in all intermediate and long-term trials are 33.5 [Victoza], 30.0 [Placebo] and 21.7 events per 1000 subject years of exposure for total liraglutide, placebo and total comparators; 5.4 [Victoza], 2.1 [Placebo] and 0.8 events, respectively concern serious thyroid adverse events. In liraglutide-treated patients, thyroid neoplasms, increased blood calcitonin and goiters are the most frequently thyroid adverse events and were reported in 0.5%, 1% and 0.8% of patients respectively.
Bottom Line: Stick with Byetta and keep an eye on longer-term research findings about this drug. There's no reason to take it that trumps the mediocre performance and possible thyroid risk.


January 24, 2010

Keeping it Simple

After years of tracking diabetes news, we old-timers can become jaded. We've seen hundreds of mouse "cures" that go nowhere, hundreds of poorly designed studies meant to promote some product or scientific-religious belief, and very few new ideas that are worth the time it takes to find them. When we turn to a blog like this, we want to read something new, and when we write a blog like this, we may think that if we don't have something exciting to report, we probably should shut up.

But when I look at my blog and web site stats to see what people are reading here, and when I reflect on the many emails I get from site visitors, it's crystal clear that what excites the majority of the visitors to my blog and the main Blood Sugar 101 web site is not the fascinating new tidbits I occasionally dig up--the ones that interest the devoted core of readers who are likely to post comments on the blog.

What attracts and generates responses from those visitors is the simple stuff that is so obvious to us old-timers we find it boring--the stuff that, sadly, 98% of all people with Diabetes world wide don't yet know.

Based on my mail and stats, here's the information that amazes people about the blog and site:

1. Normal blood sugars are much lower than the targets doctors tell patients to shoot for.

2. Diabetic blood sugars can be improved dramatically and even, for some people normalized, by cutting back on the carbs we eat.

3. Some diabetes drugs are safer and more effective than others but doctor often do not understand how to use diabetes drugs appropriately. With both metformin and insulin they often prescribes doses that are too low to do any good. By the same token, most if not all supplements sold as being "good for diabetics" are a complete waste of money.

4. Testing after meals is the best way to find out what foods are a good diabetes diet for you. Each person's diabetes is different, and without testing your favorite meals you won't know what foods are raising your blood sugar to levels that damage your body.

5. The so-called glycemic index doesn't work for most people with diabetes. Grains, whole or not, raise blood sugar dramatically.

6. Many people with Type 2 diabetes can drop their blood sugars surprisingly quickly without having to lose a single pound just by cutting down on carbs. Conversely, contrary to what doctors tell us, people with diabetes can lose a lot of weight and not see underlying blood sugar control improve. This is because most people with Type 2 have defects in insulin secretion that will not go away no matter what they weigh.

7. If you are thin and over 30 and diagnosed with "Type 2 Diabetes" and don't respond to pills there is good a chance you have either a slow form of autoimmune diabetes or, far more rarely, one of the genetic syndromes lumped together under the label "MODY." If so, you need to see a competent endocrinologist who is aware of these newer diagnoses. Unfortunately, not all practicing endocrinologists keep up-to-date.

There's nothing dramatically new here. It's all things I'd learned by 2003 after reading the diabetes newsgroup every day for a year. The new research that has trickled in since then has added very little that is new. Mostly it has confirmed that it's safe to cut carbs, a bad idea to eat low fat diets, and that there are more people with oddball forms of diabetes in the population than used to be thought.

So it strikes me that we in the blogosphere need to keep in mind, that yes, it's fascinating to read about obscure research that points to this or that possibly useful micro-finding. It's good there are bloggers out there tracking it, and I'm going to keep scanning the journals myself.

But when we are writing for a Googling world audience, it's far more important to keep the focus on the simple, boring facts about how blood sugar works that most people with diabetes still don't know. That knowledge is what can keep people from going blind, losing kidneys, or ended up with amputations.

I love my highly knowledgeable fans who read every post and keep up with the research cites. But I love even more the people who write to me that they've had diabetes for five years, but only brought their A1c down from 9% to 5.6% this past month after trying out the technique they found HERE. Even more, I love the people who write me two years later that they're still using that technique and still getting A1cs in the 5% range.

That's what matters. So if you've become bored with hearing about the "same old, same old" stuff, remind yourself it's not old stuff to the majority of people diagnosed with Type 2 diabetes whose average A1c is up near 9% and whose doctors have little to suggest even when their fasting blood sugar is up near 200 mg/dl.


January 21, 2010

Study: A1c Now Test is Crap and So Are Many Doctor Office A1c Tests

A study published in the January issue of the journal, Clinical Chemistry put eight brands of A1c test kits, including the A1c Now test sold in pharmacies and online, through rigorous testing. The other kits were the ones marketed to doctors for use in their offices.

You can read an abstract of this study here:

Six of Eight Hemoglobin A1c Point-of-Care Instruments Do Not Meet the General Accepted Analytical Performance Criteria. Erna Lenters-Westra1, and Robbert J. Slingerland. Clinical Chemistry 56: 44-52, 2010. First published November 19, 2009; 10.1373/clinchem.2009.130641

The study concluded only two of the eight kits produced clinically valid results. What is most telling, though, is that the study reports: Because of disappointing EP-10 results, 2 of the 8 manufacturers decided not to continue the evaluation. Their test kits were removed from the study after they completed only one of three CLSI protocols that were planned. CLSI stands for "Clinical and Lab Standards Institute."

Since four of the six kits that remained in the study ended up with unacceptable results, but must have had good enough results after the first protocol to encourage their manufacturers to keep them in the study, one can only conclude that the kits removed from the study did abysmally.

Which meters were withdrawn from the study after they did very poorly at the first level of testing? A1c Now and Quo-test.

Of the six remaining kits that completed all three laboratory test protocols,
Only the Afinion and the DCA Vantage met the acceptance criteria of having a total CV <3% in the clinically relevant range.
The CV is the "Coeeficient of variation." It is the statistic that represents the ratio of the standard deviation to the mean. It's a measure of how widely scattered data is. The larger it is, the more wide the range is that a set of data falls in. If a test kit produced a higher CV it tells you that using it repeatedly on the same sample produced an unacceptably broad range of results.

Even the kits that met the goals of the study had problems as the study concludes,
The EP-9 results and the calculations of the NGSP certification showed significant differences in analytical performance between different reagent lot numbers for all Hb A1c POC [point of care] instruments.
In other words, there was significant variation from batch to batch.

What does this mean for you?

1. Don't waste your money on a home A1c test. The accuracy is abysmal. This is actually disclosed in the package but in a way that confuses people. The packages says the results will fall within .5% of the actual lab result, but people don't realize this means that a 6.5% reading from this test could mean you'd get a reading of 6.0% or one of 7.0% at the lab. This is a significant difference. I used the A1c Now home kit twice several years ago and it was off by .5% both times.

An article about this published in the newsletter for endocrinologists that tipped me off to this added that lab results nowadays are usually very accurate.

2. If your doctor wants to test your A1c in the office and tells you it will give you an immediate result, demand to know which kit was used and if it is not the Afinion or the DCA Vantage, refuse the office test. It will be highly inaccurate, though you will be charged for it as if it were a lab test. Opt for a lab test instead. If your doctor gets snarky, direct him to the Clinical Chemistry article and suggest he use a meter that will give accurate results.

This is important because doctors often use nothing but the A1c to diagnose and gauge the progress of their patients. With the large variations from the true value you may get with an inaccurate test kit, you may think you are doing well when you are not, or vice versa.

3. If you are diagnosed with diabetes for the first time after being given an in office A1c test, be aware that this test is being administered for convenience. It is not a particularly accurate way of measuring your blood sugar. Get a blood sugar meter and test your blood sugar both first thing in the morning and one hour after each meal. If you see numbers over 200 mg/dl (11 mmol/L) at any time, you can be confident you are in fact diabetic. If you see only numbers between 140 mg/dl (7.7 mmol/L) and 199 mg/dl (11 mmol/L) after eating, you technically have "pre-diabetes", but your post-meal numbers are high enough to damage your heart, retinas, and nerves as this is the range where solid research demonstrates that "diabetic" complications begin to occur.

You can learn more here about Research Connecting Blood Sugar Levels With Complications.

You can learn how to lower your blood sugar levels to the safe range here: How To Get Your Blood Sugar Under Control

One final thought. You probably don't want to know what careful testing would find out about the CV of the obscenely expensive blood sugar test strips we rely on. The fact that we patients put up with $1.20 a piece strips that can vary by as much as 40 mg/dl(plus or minus) from the true reading at a reading in the mid 200s and by 20 mg/dl plus or minus at normal ranges is criminal.


January 13, 2010

Reckless Recommendation for WLS By Those Who Profit From it--And the ADA

During the holiday season another disturbing diabetes news story was released to the medical press without attracting much notice. That probably didn't bother those who planted it because their target audience isn't you, it's your family doctor.

The group releasing the news is an organization of surgeons who perform weight loss surgery (WLS) What they're promoting is the idea that WLS is a cure for diabetes. They did this by holding a convention filled with surgeons who earn a great deal of money every time they perform this particular surgery and representatives of the American Diabetes Association, a group that has never failed to endorse any product or service that has the potential to earn high profits for those who prey on people with diabetes. This convention released an impressive-sounding "Consensus Statement" designed to make busy family doctors think that world health authorities and experts have carefully analyzed bushels of research and concluded that WLS is a wonderful new cure for diabetes.

You can read about this convention and the Consensus Statement:

The Diabetes Surgery Summit Consensus Conference: Recommendations for the Evaluation and Use of Gastrointestinal Surgery to Treat Type 2 Diabetes Mellitus.
Rubino, Francesco. Annals of Surgery. 19 November 2009
doi: 10.1097/SLA.0b013e3181be34e7

You'll find a bit more detail here:

Diabetes In Control: World Summit on Bariatric Surgery Defines New Guidelines.

Soon you will be hearing from your family doctor that you could be "cured" of diabetes simply by undergoing a routine $20,000 operation. If you don't sign up, your diabetes is obviously your own fault. I have already heard from people who were given just that message by their doctors.

The most disturbing thing about the consensus statement is the horrifying suggestion, based on ZERO peer reviewed research--that WLS--obesity surgery--should be given to people with a BMI as low as 30, which is a much lower BMI than any used as a cutpoint in the recommendations of any experts in organizations who don't provide surgery. But this group of bariatric surgeons is obviously rubbing its hands in glee at the thought of the millions of new customers it's self-serving recommendation will bring in and their recommendations are very high on hype and almost entirely without grounding in hard science.

The position statement recommends weight loss surgery for women who are slightly overweight. For someone 5'3" the recommendation would kick in when they weigh only 170 lbs.

I happen to be 5'3" woman who once weighed that amount. I weigh 138 now, thanks entirely to cutting way down on the carbs in my diet and the addition of carefully chosen safe drugs to my daily regimen.

But the pitch these surgeons make is that WLS isn't just for weight loss. Oh, no. It "cures" diabetes. In fact, the science (what little there is, and there isn't much of good quality) shows WLSdoesn't do anything of the kind. What WLS does is lower A1c. It does that by severely limiting how much food you can eat and, more to the point, it makes people vomit violently when they eat a lot of carbohydrate so that it imposes a low carb diet on them, like it or not.

But before you get excited about the idea that WLS is a cure, it turns out, these surgeries don't even give people truly normal blood sugars. You can read about this in an earlier blog post HERE. The study cited in that post makes it clear that the dramatic claims that diabetes has been "cured" refer only to the blood sugars taken a month or two after surgery when people can barely eat. By five years later the average A1c is 6.58% and 17% of those who had the surgery see no improvement at all.

Almost twelve years after diagnosis my A1c is a lot better than the 6.58% that the loudest proponents of WLS claim as their 5 year surgery result. My highest A1c in the last 5 years was 6.0. My average is 5.7%. All from cutting back on carbs and finding the right, safe, drugs to control my blood sugar. No need for risky surgery.

Yes, my drugs do cost something: Metformin is a generic that is about $120 a year. My insulin cartridges cost $444. Total cost: $564. The cost of WLS runs about $20,000, assuming you don't have complications that will require more expensive surgery and hospitalization, as many people do. So the cost benefit to me of WLS would take 35 years to kick in--assuming WLS worked as well as meds and the low carb diet to prevent complications, which given how high the A1c is at five years in the patients whose surgeons are among the biggest boosters of WLS as a "Cure" for diabetes, is unlikely.

The tragedy is that it does NOT take dangerous surgery to achieve dramatic drops in blood sugar. You might have learned about this on the day you were diagnosed, had the ADA not put all its energy into terrifying doctors and the public about the "dangers" of the low carb diet and pushing a blood sugar boosting diet full of pasta, oatmeal, "healthy" whole grains, and high carb fruits like the banana.

Though a decade of research has come up with not a scintilla of evidence that that low carb diet does anything but improve blood sugar and cardiovascular markers and lower the incidence of diabetic complications, the ADA is now ready to recommend expensive life-threatening surgeries about which little is known though that little shows that the safety of WLS is far worse than the most extreme low carb diet.

In fact, there is very little high quality research about the long term effects of weight loss surgery. Most studies only involve a very few individuals followed for a short time, or, often in the case of diabetes "cures" of rodents. But what human research there is comes up with disturbing findings.

Weight loss surgery, it turns out, is dangerous. To know just how dangerous it is you have to remember that it is standard practice when evaluating the outcome of a surgery to report on the patient's status six weeks after the surgery. After that, most patients are "lost to follow up."

So when you read the statistics about deaths associated with WLS, the percentages given usually describe usually only those deaths that occurred during the first few weeks after the surgery. You do not hear about the complications--or deaths--that take place two, five and ten years after the surgery.

Here's a good example of a study that has been interpreted to show that WLS is safe: Mortality After Bariatric Surgery: Analysis of 13,871 Morbidly Obese Patients From a National Registry
Morino, Mario. Annals of Surgery. December 2007, Volume 246, Issue 6, pp 1002-1009. doi: 10.1097/SLA.0b013e31815c404e

Like most, it only only tracks deaths that occurred within the first 60 days. Even then, in this group of patients, .25% died people within two months. That's 25 for each 10,000 people who had the surgery. Drugs that can be shown to have killed that many people are taken off the market--viz Rezulin, Bextra, etc.

But if you accept that it was worth killing 25 people so that thousands can lose weight and have their diabetes "cured", you might want to look at another very similar study that expanded the time horizon. You can read about it in my previous blog post HERE

This study analyzed registry statistics collected in Pennsylvania and it too found modest death rate. "Only" .9% of patients died within 30 days, slightly less than one in a hundred, though for the families of that one in a hundred, the death was a horrible, unexpected tragedy.

But there were a lot more families left to mourn because the death toll rose dramatically as the group was followed longer. One year after surgery, 2.1% of the group had died. (Twenty-one out of every thousand.) By two years, 2.9% (Twenty-nine out of a thousand). Then things got worse. Three years after they had had the surgery, 3.7% were dead. By four years, 4.8% and by five years, 6.4%. That's slightly more than one out of every seventeen dead.

And yet the ADA's leaders, who have railed about the "dangers" of the low carb diet, stand by when these surgeons suggest that people whose weight is only slightly above normal should be subjecting themselves to a surgery this dangerous to attain an A1c (if they live) of 6.7.

The reason that the death rate increases as time goes by is that people who have had these surgeries are prone to develop problems as the years go by that often require more surgery. The stomach stretches and incisions burst. Bands get embedded in tissue or infected. Some people develop so much scarring in their intestinal tract they can no longer absorb nutrients and starve to death. Some develop profound anorexia, due to the destruction of part of the gut that secretes the hormones that regulate brain hormone centers and they literally starve themselves to death--often blaming themselves for what they think are psychologicla problems because no one explains to them that the brain hunger regulatory system depends on gut hormones.

Would a drug that killed 6.4% of those who took it over five years ever get approved? Of course not. But surgeries don't have to be approved. The FDA does not examine surgeries. No one does. Surgeons are free to do any surgery they can get paid for and the only limit on them is how likely they are to get sued by unhappy survivors of their victims.


If you are a person with diabetes with a BMI near 30, here is a list of safe alternatives to weight loss surgery.

1. Follow the technique described here: How to Get Your Blood Sugar Under Control. This simple, moderate approach works extremely well. I hear from people all over the world who have tried it and report that their A1cs have plummeted from as high as 13% down to the 5% range. Try it for two months before you let someone amputate portions of your stomach. This techniques will give most people much better results, over time, than the surgery.

2. Byetta. If you can't control your eating, Byetta may help a lot. One out of three people respond well to it, and when they do, they find that they can easily cut way back on their food and that their blood sugar improves greatly. I know two people who have lost over 100 lbs each on Byetta and several who have lost 30-50 lbs. All have seen better blood sugars. Best of all, if you don't do well on Byetta, all you have to do is stop taking it and any problems it has caused will reverse.

3. Insulin. If your blood sugars can't be controlled by cutting carbs, surgery probably won't fix it, because if your beta cells are dead, messing with your digestive tract won't do much. According to Dr. Ren, who is cited in the blog post linked above, about 17% of those who undergo gastric surgery for diabetes experience no improvement. And of course, that number excludes those who die of the surgery whose diabetes became tragically irrelevant. Insulin, prescribed by a doctor whose staff is willing to work with you to set the dose correctly, will normalize your blood sugar, especially if you cut way down on your carb intake so that the insulin doesn't have as much work to do.

None of thse is a "cure" but neither, according to the blood sugar statistics released by the most enthusiastic proponents of WLS, is the surgery.


January 7, 2010

News You Didn't See About New Dangers with Supplements and Drugs

More Bad New About Vitamin C

I already blogged about the evidence that Vitamin C supplementation may make us more insulin resistant and render exercise useless, but the bad news about vitamin supplementation just keeps pouring in.

Vitamin C supplementation, it turns out, is also associated with a higher rate of cataracts. This finding emerged in a long study of 24,593 women 49–83 years old from the Swedish Mammography Cohort who were followed from September 1997 to October 2005. Data about their supplement use was collected by questionnaire, and cataract extraction cases were identified by linkage to the cataract extraction registers in the geographical study area (where there is a public health system).

The study found that
Among women aged 65 years or more, vitamin C supplement use increased the risk of cataract by 38% (95% CI: 12%, 69%). Vitamin C use among hormone replacement therapy users compared with that among nonusers of supplements or of hormone replacement therapy was associated with a 56% increased risk of cataract (95% CI: 20%, 102%)
Vitamin C supplements and the risk of age-related cataract: a population-based prospective cohort study in women Susanne Rautiainen et al. Am J Clin Nutr (November 18, 2009). doi:10.3945/ajcn.2009.28528

Since cataracts are something that are already more prevalent in people with diabetes, this is another reason to limit your Vitamin C intake to what you get in lower carb fruits and vegetables.

Bad News About Niacin

Niacin is heavily promoted as a heart disease fighter but it turns out people with diabetes appear to have less ability to rid the body of niacin and that high levels may promotes insulin resistance.

You can read about this finding here:

Diabetes In Control: Nicotinamide Overload a Trigger for Type 2 Diabetes.

The study discussed in the Science Daily article is:

Nicotinamide overload may play a role in the development of type 2 diabetes. Shi-Sheng Zhou, et al. World J Gastroenterol 2009 December 7; 15(45): 5674-5684

The authors speculate that the commercial addition of B vitamins to foods like cereal and bread may be harmful. In addition, they note that niacin is eliminated from they body by sweating, which casts an interesting light on why exercise might be helpful to people with diabetes.

Lots of Bad News About Statins

Moving on, hidden in a press release describing a study published in the journal, Ophthalmology, a study conducted to learn whether statins might decrease Age Related Macular Degeneration (AMD) is the news that statins not only don't prevent Age Related Macular Degeneration, a major cause of blindness, but
Statin users were at slightly higher risk than non-users for developing advanced AMD,
The study is discussed here:

Science Daily: Can Heart Disease Treatments Combat Age-Related Macular Degeneration?

The answer to the question posted in the title of the Science Daily article, turns out to be a resounding "No!" But it takes awhile to figure that out. As is so distressingly common, you will read several paragraphs which make it sound as if low dose aspirin had a protective effect on AMD, only to run up to this phrase,
"Though not statistically significant, the WHS risk reduction is similar to the result of the only other large randomized trial on this question..."
Why do people who are supposed to be reputable scientists get away with making statements like this? Not statistically significant means, "Even after we played all the games we could with these statistics we had to admit our results could easily be attributed to chance."

When reporting the association between statin use and an increased risk of AMD the chief researcher struggles to ignore her finding:
Dr. Maguire said several factors may be masking a protective effect for statins, the most important being that most patients who take statins for CVD are also at high risk for AMD. Only a randomized controlled trial could reveal statins' impact on AMD in the wider population, but since so many elderly people take statins it could be difficult to recruit a control group
She then suggests that maybe a longer study would find the protective effect she couldn't find.

But her whole comment reeks of the religious belief that statins must be good for people. In view of this, the last sentence is particularly disturbing as it tells us that despite the publication of study after study that fails to find benefits for most older people in taking statins, so many older people are now taking them that it is impossible to find a control group who do not.

This also means we will have a tough time linking any rise in "Age Related" blindness to these drugs if in fact statins are contributing to the rise.

And if that doesn't depress you enough, another study found that two different statins have a disturbing impact on several proteins associated with dementia.

Science Daily: Show Statins Show Dramatic Drug And Cell Dependent Effects In The Brain

Which discusses:

Differential effects of simvastatin and pravastatin on expression of Alzheimer's disease-related genes in human astrocytes and neuronal cells. Weijiang Dong et al. The Journal of Lipid Research, 2009; 50 (10): 2095 DOI: 10.1194/jlr.M900236-JLR200

You rarely hear about the finding that statins can cause dementia, sometimes irreversibly, because of the saturation marketing for these drugs that has doctors and patients alike completely brainwashed, but it is well documented. You can find the citations to that documentation HERE.

Antidepressants Don't Work Better Than Placebo for Most Of Those Who Get Them

Tragic news for those of you who are reading this blog because you became insulin resistant after taking an SSRI antidepressant is the convincing finding that for people with mild and moderate depression, these antidepressants are no more effective than a placebo--i.e. a sugar pill.

Before you protest that they helped you, I want to define "severe depression" which is the only kind of depression the studies find these drugs apparently can help. If you were able to get up in the morning, get out of bed, make it to work or school, no matter how sad you felt, you did not have severe depression. Severe depression is the kind that ends up causing people to need hospitalization. I've seen it and it's very different from the mild condition that is so common--and so profitable to the people who market SSRIs.

What this study demonstrates is that even though people might attribute feeling better to the drugs, there is no evidence the drugs did anything more than make them think they should feel better. So if the pills helped you, so would laying on of hands, a sprinkle of fairy dust, expensive guga-guga extract from far off Wabutuland, or anything else you believed would have magical powers.

When a large study shows something works no better than a placebo, it means that it is worthless. Unfortunately, these worthless SSRI drugs make people fat, increase their insulin resistance, and may be a factor contributing to the so-called "obesity epidemic." If you need a placebo, go with something harmless like acupuncture, or fairy dust. SSRIs have very bad side effects.

Antidepressant Drug Effects and Depression Severity Jay C. Fournier, et al. JAMA. 2010;303(1):47-53.

And along with that bad news we get the even worse news is that one out of eight people who go to a doctor for help with depression are now being prescribed one of the highly dangerous antipsychotic medications which are known, for a fact, to cause diabetes.

Science Daily: More U.S. Patients Receive Multiple Psychotropic Medications


National Trends in Psychotropic Medication Polypharmacy in Office-Based Psychiatry. Ramin Mojtabai; Mark Olfson. Arch Gen Psychiatry, 2010; 67 (1): 26-36

These drugs are meant for people who are hearing voices and are unable to function without them. For them, the choice of living with diabetes or schizophrenia may be an easy one. But the drug companies are marketing these powerful antipsychotics to family doctors who have no idea how to use them appropriately and they are producing a new generation of diabetics.

That's enough bad news for now. I'm going to have discuss the new marketing efforts being employed to convince doctors that weight loss surgery, despite its significant risk of death, is an appropriate cure for people with diabetes no matter what they weigh. But not yet.


January 4, 2010

The National Day of Repentance

It's that day again. The tree is down. The wrapping paper and party hats went out with the recycling. The supermarket has replaced the aisle full of candy canes with one of diet shakes because it's that time of year: Time to atone for all that self-indulgence. Time for the annual Super Bowl diet.

Why do I call it the Super Bowl diet? Because 98% of those who start dieting today will have given up their diets by the time they tune in to watch the annual Battle of the Behemoths. (For those of you in parts of the world deprived of the wonder that is the NFL, The Super Bowl takes place in early February.)

I like dieting this time of year because it is so easy. With so many people cutting back on their food there's a brief period when you are spared many of the temptations that social life provides. For a few weeks, people don't sneer if you suggest there must be somewhere healthier than the Cheesecake Factory for lunch. They don't bring donuts to departmental meetings. They don't invite you over for dinners filled with lovingly baked platters of things your metabolism can't handle.

But only for a few weeks. Then the rest of the world gets over their holiday-induced resolutions and life gets back to normal.

Except for us folk with diabetes. For whom food can NEVER get back to being normal.

As is always the case when I wander out into the wider world, over the past few weeks I ran into people who have other chronic diseases, and as always happens when I expand my circle of friends, I was reminded how lucky I am to have one of the few chronic diseases that does not doom me to slow, inexorable deterioration, and which unlike most chronic conditions, offers me the ability to control--by the dietary choices I make--how bad that disease is going to get.

My friends who have MS can eat whatever they want--which I would envy, except that they also wake up every morning wondering what function they might have lost overnight, and knowing that the only thing they can do is pray researchers will come up some treatment, some time, that will work.

There is no diet that will stop the progression of MS, or hereditary dementia, or COPD, or Lou Gehrig's disease or any of hundreds of other horrible conditions that prey upon our human bodies.

But diabetes is different. All I have to do to keep this disease process at bay is pass on the toast and home fries, the fudge and the muffins, and keep my carbohydrate consumption within the limits that insulin makes manageable.

Is it a pain to have to do this? Yes, but trust me, if you have to have a chronic condition, folks, diabetes is the one you want to have.

But as grateful as I am to have a condition I can influence with my dietary choices, I don't discount the effort it takes to do it, nor do I have anything but compassion for people who find it hard to exercise the control it takes to keep the complications at bay.

When you can't go off your diet come the Super Bowl, it is tough. There are hundreds of tips and tricks that most people with diabetes don't know about, because they don't know any other people with diabetes who are striving to avoid the complications. Doing it yourself is almost impossible, and it is not accidental that ALL the people I know who are in great shape a decade or more after their diabetes diagnoses are active online and discuss strategy and technique with others who are coping with the same challenges.

Online support can really help you get through all the days when you have to pass by all the food everyone else in the world can eat and you can't. It can help you on the days when you do everything right and still screw up.

I had that kind of day today myself. I'm on a new and oddball diet I'll describe in a future post. It allowed me to eat a nice lunch at a restaurant today. (I started it ten days ago). Unfortunately, my insulin cartridge seems to have died, perhaps thanks to having been carried around in my purse and getting exposed to too much cold. So though I covered my lunch with the amount of insulin that usually gives me normal blood sugars, I ended up at 216 mg/dl two hours after eating.

I felt like crap. I felt angry, because dammit I really do work at keeping my sugars under control and it sucks that it has to be so hard--especially as I have been eating very carefully for the last week. It wasn't like I'd eaten anything that awful at lunch either. I'd had a Chinese lunch with no egg roll, no chicken fingers, no wontons, no rice.

But that's how it is, and as that is the worst blood sugar I've had in a month, I'll be fine. Fortunately, I have my online friends who know what "216 at 2 hours" means and how crappy it feels. One of them might be able to tell me how to keep my insulin from going bad in the winter. This isn't the first time it's happened. I'm glad I've got those friends. If you are having trouble with your blood sugar control, finding a few of your own might really help.

You can find online diabetes support in many different web communities. They are all different, so you'll have to visit each one to see where you feel most at home. I've listed some of the communities you might want to check out on this page:

Finding Support Online

If you need help finding palatable foods to eat and other people who have managed to make a reduced carbohydrate diet work long term, check out the Low Carb Friends support board. Their recipe forum has lots of excellent recipes and ideas. There are quite a few people active on Low Carb Friends who can help you figure out what you can eat just about anywhere that won't raise your blood sugars. Some have diabetes, most don't, but all are committed to keeping the carbs under control.

If you know of other helpful online support environments for people with diabetes, let us know about them by posting in the comment section. Getting support this time, instead of trying to go it alone, may be what makes it possible to wake up next year at this time thinner, fitter, and with a much healthier A1c.

Let's all help each other make that happen!