Thursday, November 29, 2007

Lessons for the Diabetes Community from the Cancer World

I just read a very disturbing book, The Secret History of the War on Cancer by Devra Davis. Suffice it to say that if you are easily scared, you should not read this book.

Dr. Davis is a distinguished epidemiologist. Her subject in this book is how the companies that profit from selling cancer causing products coopted the very organizations and government organs set up to "fight cancer." She describes how the American Cancer Society was taken over by people from the tobacco industry who used the mantra, "This needs further study" to keep the organization from letting the public know that as early as the 1930s scientists had proved very conclusively that cigarettes caused cancer, and that the more a person smoked the more likely they were to develop cancer.

The tobacco industry provided a great deal of funding for the American Cancer Society and one way it kept the public from learning how dangerous their products were was to fund research into other obscure causes of cancer, which was done to downplay the role their product was playing in the huge rise in lung cancer that followed the addiction of millions of soldiers to cigarettes in World War I.

An even more disturbing finding that Davis documents is the way that industries that produce cancerous chemicals have for decades paid researchers to research the cancer causing properties of their products and the chemicals used to make their products, but kept their results hidden from the wider scientific community. Companies have known for decades that workers in their plants were dying horrible deaths from exposure to chemicals used in their workplace, but kept this secret. In some industries, chemicals were used that caused 100% of all workers to get cancer after 25 years on the job. Nevertheless though scientists working for these companies knew this, the information was kept completely secret, because revealing it would reduce corporate profits. That people died because of the secrets they kept was just too bad.

What does this have to do with diabetes?

Well, the ADA has had the same role in the diabetes world that the ACS had in the cancer world. Funded largely by companies that make the high carb products that worsen blood sugar and the drug companies that profit mightily when people eat those products, the ADA has fought for decades against letting the public know that it is carbohydrates that raise blood sugar and that people with diabetes can control their diabetes by lowering their carbohydrate intake substantially.


Any time research proves that cutting out most carbohydrates from your diet--especially those supposedly "healthy whole grains"--improves the health of people with diabetes, the ADA says, "More studies are needed." Meanwhile they put their stamp of approval on high carb junk foods made by companies like Campbells "One gram of salt per serving" Soup.

The ADA has put millions of dollars into convincing people with diabetes that sugar is good for them. Not so coincidentally a top ADA sponsor is Cadbury Schweppes, the candy and soda maker. Check out the annotated list of ADA sponsors as of August 2006 . The company has removed the list of sponsors from the page linked on that entry, probably because it was so damning. But their sponsors continue to be companies that sell you food that makes you more diabetic or expensive drugs you will need if you eat that kind of food.

Like the American Cancer Society, the ADA raises huge amounts of money from the victim of the disease their policies have made more widespread. These donors do not realize that just as the ACS's leadership was full of chemical industry and cigarette company lobbyists, the ADA's leadership is not made up of people with diabetes or of doctors, but of laymen whose corporate connections are not made public, but who probably have long histories of connections with the drug and junk food companies.

Just as the ACS kept the public from knowing for 20 years that cigarettes caused cancer, the ADA has fought to keep you from knowing that it is carbohydrates that raise blood sugar and that a "healthy diet" for a person with diabetes is one that does not raise the blood sugar over normal limits.

Recently a news release went out to say that the ADA has decided to soften its long held hostile stance against recommending low carbohydrate diets for people with diabetes. Well, don't get your hopes up. The outcry against their dangerous and outdated dietary advice has gotten so loud they have to do some kind of spin control. But a "diabetes" organization that in 2007 still defines "tight control" as a blood sugar that drops to 180 mg/dl (10 mmol/L) at 2 hours after eating, and does not mention the word "carbohydrate" once on their Tight Diabetes Control web page is not about to tell anyone to stop eating the diet that is killing them. Not when the funds that pay the salaries of the mystery people who run the organization are paid by huge corporate junk food and drug makers.

The venality documented in Davis' book is terrifying. I had naively thought that the mess that is diabetes treatment was the result of our having a non-glamorous disease people think is caused by our own bad habits. Davis' book makes it clear that callous disregard for the public, deceptive advertising, and cooking the research to hide results that might cost some company money are standard operating procedure throughout the health establishment.

The end-of-life repentances of the cigarette and chemical executives who spent their lives misleading people about the safety of their products do not begin to atone for the hundreds of thousands of people they killed. Will the ADA executives and their self-serving sponsors who fund the organization to ensure that their products continue to find a market, ever come to grips with the way they have caused generations of Americans to go blind, lose their feet, and go on dialysis?

Probably not. After all, unlike those cigarette industry folks who eventually got cancer from their own product, the ADA denizens don't have diabetes, they only profit from it.

Tuesday, November 20, 2007

Tagged

Khürt Williams from Honey Sweet tagged me with the meme going around with these rules:

1. Link to the person’s blog who tagged you.

2. Post these rules on your blog.

3. List seven random and/or weird facts about yourself.

4. Tag seven random people at the end of your post and include links to their blogs.

5. Let each person know that they have been tagged by posting a comment on their blog.
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Seven Random and or Weird facts about myself:

1. My great-grandfather was born in the 1820s.

2. My daughter has appeared in music videos by Green Day and Kelly Clarkson.

3. I lived for three years on a farm that had no indoor plumbing.

4. I have written two completed novels set in the early 19th century.

5. I was a professional musician in Nashville in the late 1970s.

6. I sent and received my first email in November of 1980.

7. I've been involved in online discussion groups since 1987.
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The folks I know online are pretty much tagged, so I'm going to risk whatever it is that happens if you don't pass on a meme and not pass this one on.

Saturday, November 17, 2007

Great Diabetes Gift!

I just got the diabetes bag I ordered only two days ago from Rickina at Stick Me Designs.

It is even nicer than I expected it to be. I can stuff every possible diabetes supply I can think of into this bag and still get it shut.

Here's a photo:



Needles, pen, pen needles, insulin vial, meter, lancet, strips, even my handy dandy needle snipper, all fit in. And with all this stuff in the bag, it still closed:



Rickina, who recently went through a diabetic pregnancy which made her realize the need for this kind of bag, makes these herself. I also sew, and I can tell you, her work is beautiful.

You could also put your glucose in one of the zippered compartments, or your house keys wallet and money, for that matter. It would also be perfect for putting in a larger handbag or for when you travel and want to be sure you have all your stuff with you as carry on.

Most of all what I love is how jaunty it is.

Way to go Rickina!

Friday, November 16, 2007

When to Test Blood Sugar in Type 2

One of the topics that comes up a lot in the email I get from visitors to my What They Don't Tell You About Diabetes web site is the question of when is the best time to test your blood sugar.

A lot of doctors still tell people with Type 2 to test first thing in the morning and before meals. That was what I was told at diagnosis in 1998. People who test using this schedule may tell you their blood sugar is usually 120 mg/dl, which sounds pretty good, except that since this is a fasting number it usually hides the information that the person's blood sugar maybe going to 250 mg/dl or higher after every meal.

Research has shown that for people with Type 2 diabetes--especially those who have been diagnosed recently and still retain some beta cell function--it is the high spikes after meals that contribute most heavily to raising the A1c and causing complications. If you only test your fasting blood sugar, you will not know anything about how high your blood sugar is spiking after meals, so you won't know which foods are toxic to you because they cause dangerous spikes.

If you are like most people with Type 2 your access to the very expensive blood sugar testing strips is limited. You may have to pay for strips yourself or your insurance may pay for a single box each month. That means that you need to use each strip as efficiently as possible. Here are some strategies that you can use to get the information out of your blood tests that will let you drop your A1c back into the healthy zone.

  1. Keep a written log that matches what you eat with the test result you get.
    Even though your meter may keep a list of your readings, these readings are meaningless unless you know what food you ate that resulted in each particular reading. If you write down what portion size of which food you ate and match it to the blood sugar you saw after eating it, you will accumulate the information you need to eliminate toxic foods and replace them with those that do not raise your blood sugars.


  2. Determine when your blood sugar reaches its highest point after eating.
    Your goal is to bring your blood sugar peaks below the level that we know cause complications. To do this, you need to learn when your blood sugar hits its highest level. Research studies show that the average person sees a blood sugar peak 75 minutes after eating carbohydrate.

    But you're not average, you're you. So the first thing you need to do is determine when your own blood sugar peak occurs. Start out by testing at 1 hour, 1.5 hours, 2 hours, and 3 hours. Do this for three meals. You should start seeing at which time the highest reading occurs. That's the time you should plan to test in the future.

    Don't test at 30 minutes after eating. Though many people see a high at this point, research has shown that brief peaks at 30 minutes after eating do not correlate with an increased incidence of complications. The one hour reading is the earliest that you should concern yourself about.

    If you eat pasta which digests very slowly you may see a peak much later than usual. You should test for peaks from pasta 4 or 5 hours after eating if you don't see them in the first 3 hours.


  3. Eliminate the Foods that Cause Unacceptable Spikes.
    You can test all you want, but if you don't use the test result to eliminate the foods that cause blood sugar spikes, you might as well not test at all. Testing is the most powerful tool you have as a person with diabetes to regain your health, but you must act on the information you get from your testing.

    If you see an unacceptable high blood sugar reading, the only way to bring it down is to cut back on the amount of carbohydrate in your meal. Carbohydrates are what raise blood sugar, and despite what you may read in books written by people who do not have diabetes, every gram of carbohydrate you eat will raise your blood sugar no matter whether it is supposedly "healthy", "low glycemic" or the label says it is magically treated to keep it from raising blood sugar.

    So if your blood sugar is too high after eating a meal, determine where the carbs came from that raised your blood sugar in that meal, and cut back on the carbohydrate food or eliminate it completely.


  4. Nutritional Software Can Help You Discover Where The Carbs Are
    I like LifeForm. Others use Fitday. Find a reliable source of nutritional information and look up the foods you eat to see where the carbs are coming from. Read the labels on the prepared foods you buy and be careful to note the portion sizes which are almost always much less than you eat. For example, have you ever gotten "2.5" servings out of a can of Campbell's soup? No. I didn't think so. But that's the portion size given on the label, so if you eat half the can, you're getting 20% more carbs than are listed on the label.


  5. Shoot for Healthy Blood Sugar Targets
    These are the targets that will give you an A1c in the 5% range no matter how high your A1c is now. If you don't believe me, check out THIS PAGE of reports from people who have used these targets to dramatically lower their A1cs.

    One hour after eating: under 140 mg/dl (7.8 mmol/l)

    Two hours after eating: under 120 mg/dl (6.7 mmol/l)

    If you can do better than this, go for it. Normal people rarely go over 120 mg/dl ever and are usually under 100 mg/dl at 2 hours after eating.


  6. Use Generic Meters and Strips if Access is Limited

  7. Wal-mart sells the Relion meter for $8.88 and the strips are less than half the price of the name brand strips. They work just as well. The drugstore brand meters made by TrueTrak are also much cheaper than the brand name strips, though the strips may lose their accuracy over time, once the vial is opened. Companies give away "free" meters only to get you using their overpriced strips. Don't pay full price for name brand strips. It isn't necessary. You can sometimes get good deals on strips on eBay but check the expiration date. Don't buy expired strips and don't buy strips by mail when it is hot as the heat can destroy them.

Tuesday, November 13, 2007

Study: Studies funded by Drug Makers Underestimate Problems

Today's New York Times drew my attention to this study:

Adverse Effects of Inhaled Corticosteroids in Funded and Nonfunded Studies

It looked at studies of inhaled drugs and found two phenomena that should surprise no one who follows the news about any new drug.

1. Studies paid for by the company making the drug found far fewer side effects than studies of the same drug paid for by organizations that had no financial stake in the drug. The drug maker's studies were much more likely to describe a drug as "safe" or "effective" than were other studies.

2. The reason for this lay in the way that the studies were designed which appeared to make it easier to hide the side effects.

What's crucial here is that the misleading studies funded by the drug makers included the clinical trials used to get approval for the drug.

This should remind you that all the studies done to get approval for a drug are paid for by the company who will profit (greatly!) from the drug's sale. But this system ensures that the studies will be cooked as far as possible.

What does this mean for you? Simply this: for chronic conditions it makes sense to avoid new drugs no matter how well hyped until they've been in the marketplace for enough time that their real side effects will become apparent.

And don't trust those company funded studies that "prove" that the drugs cause much-yearned for benefits like weight loss or beta cell regeneration. Almost always these benefits disappear when the drug is studied by someone who isn't going to profit from its sale.

Sunday, November 11, 2007

Debugging the Highs: Update

Well, I went through my debugging sequence as I described in a previous blog entry and the news is not good.

I am responding completely differently to R insulin than I was just three months ago, which is the the last time I was not taking Metformin.

My response to the R insulin was so different from what it was 90 days ago, that I went so far as to drive to a Wal-mart pharmacy in a different state and buy a new vial of R there, just to make sure that the two week old-vial I was using didn't have something wrong with it. The previous vial I'd bought at my usual pharmacy was the same lot as the insulin I'd bought a couple months before and I wondered if perhaps it had weakened.

To test the potency of the new insulin, I ate the identical meal for dinner using the same dose of the new insulin as I had eaten the night before with the dose from the older vial. I ended up with a blood sugar reading only 5 mg/dl different at one hour from what I'd seen the previous night. Unfortunately, that reading was 178. And that was with 4 units of insulin, which is a lot for me. This was using a 1/12 insulin/carb ratio which was what I would have used before when not taking Metformin.

Yesterday tried using a 1/8 insulin ratio, and it worked okay at lunch with 25 grams of carbs, though not great. But when I tried it at dinner with 40. I ended up at 157 at 1 hour and 126 at two.

That doesn't sound too bad, but there's a hitch: Eventually the insulin IS kicking in and I'm going low. After my meals yesterday I ended up in the low 80s feeling shivery--and after eating more fast acting carbs I was still in the 80s an hour later.

This sounds like what happens when a person has developed antibodies to insulin. The insulin is bound by the antibodies for a while making it less effective, then the antibodies release it and it kicks in later.

If that is my problem, the only thing I can do is wait it out and hope it goes away. Needless to say, I'm going to have to cut way back on carbs because I am going too high after meals, staying high and then getting lows, which make me feel like crap all day long.

If any of you have had anything like this occur, let me hear about it.

Thursday, November 8, 2007

Halle Berry: Poster Girl for MODY?

There's been a huge outcry online now that Halle Berry, previously a poster girl for Type 1 diabetes, has told the press that she has been able to wean herself off insulin.

A lot of people with Type 1 diabetes are very upset with this for the very understandable reason that it is impossible to go insulin if you have Type 1 diabetes unless you get an experimental pancreas or beta cell transplant--and even those are iffy. So there are a lot of people with Type 1 who are feeling betrayed and that is making for a lot of anger.

In fact, what happened to Berry has happened to quite a few people who have emailed me over the years since I put up my web page about monogenic diabetes (MODY).

None of them are TV or movie stars, so their experiences didn't hit the media. But all of them were diagnosed with Type 1 diabetes in their late teens or early 20s only to find out years later that they actually had a genetic form of diabetes that keeps beta cells from secreting--a form of diabetes where it is possible to reestablish beta cell secretion using sulfonylurea drugs like Amaryl or, more recently, Byetta instead of, or in combination with, insulin.

While some forms of MODY, like the one I appear to have, are mild enough to be misdiagnosed as Type 2 diabetes, as mine was, others can be quite severe and easily confused with Type 1 diabetes. Here's a case history of just such a case:

Identification of MODY: the implications for Holly
Journal of Diabetes Nursing, Jan, 2004 by Jo Dalton, Maggie Shepherd


The main things hinting that MODY might be at fault here were that insulin doses remained in the "honeymoon" range, years after diagnosis and that the patient did not develop DKA. Note also that the patient's father was diagnosed with "Type 2" later in life, but actually had a much milder form of the same genetic diabetes. The virulence with which these gene express is modified by many environmental factors science does not yet understand.

Many doctors still believe, incorrectly, that a person cannot develop MODY unless one parent has been diagnosed with diabetes. But even though neither of Ms. Berry's parents was diagnosed with MODY it does not rule out that she might have inherited the gene from one of them. In addition, as in the case of Holly's father, the gene may spontaneously mutate and appear in a person with no relatives with diabetes.

That there are "silent" carriers of these genes scattered through the population was only realized recently when scientists started testing family members of people diagnosed with MODY via gene tests. They discovered that there were other people in the families who were carrying MODY genes but whose blood sugar abnormalities had escaped diagnosis--probably because, like mine, the gene defect affected only post-meal blood sugar levels and were not detectable using a fasting plasma glucose test.

It is also worth noting that scientists who study genetic diabetes believe there are many more genes out there causing insulin secretory disorders than the six that have been so far identified. So it is possible that there are a lot more people diagnosed as Type 1 diabetics who have one of these not yet diagnosed genes.

However, it is also very important to note that whatever the cause of the defect, these MODY forms of diabetes are every bit as capable of wreaking havoc on eyes, nerves, and kidneys as is Type 1.

As far as Ms. Berry's situation goes, I hope that she isn't settling for the 7%-8% A1c that so many doctors consider good enough for someone with Type 2. As exciting as it might be to be able to give up insulin, trading shots for blood sugars high enough to cause blindness, amputation, and dialysis is not such a smart idea.

Ms Berry still has diabetes, it still has the potential to ruin her life, and she still needs support from the rest of the diabetes community in learning how best to get her blood sugars down into the normal range so she can avoid developing complications.

And we all need to realize that Ms. Berry's situation points out how misleading are the current diagnostic criteria which lump hundreds of different genetic and metabolic disorders into one of two bins--Type 1 and Type 2.