The ongoing revelations about e coli in supermarket salad vegetables, Bisphenol-A in can linings and melamine in powdered milk point out to us the problems with relying on huge, anonymous multinational corporations for our food supply.
Intentional adulteration is a much bigger problem in packaged foods than any of us have realized--the melamine story is getting buried in the media thanks to the market meltdown, but every day it seems that a new brand name product is being found to contain melamine.
But even without adulteration, it turns out that many GRAS (generally regarded as safe) chemicals commonly added to packaged food, like sorbic acid, acetic acid, food colors and many others, turn out to be petroleum byproducts, many of them produced in bulk in Chinese refineries, and this, too, should be raising red flags in all of our minds as it is not likely any of these ingredients are being tested for adulteration.*
So what's a concerned omnivore to do?
One thing we can all do is eliminate from our diet the industrially prepared foods most likely to contain dangerous and adulterated additives and replace them with home cooked foods.
The other thing we can do is rely more on locally grown foods rather than those imported from parts of the world where slave labor tends crops in conditions that are not tolerated in more developed parts of the world.
If you have been thinking of eliminating questionable packaged foods and eating more locally grown produce but are not sure exactly how to go about it or don't have the energy to begin, a wonderful new book, Nutrition for Blokes may give you the encouragement you need.
Author Quentin Grady is well known to readers of alt.support.diabetes for his incisive reporting on the little known health benefits of common vegetables and on the issues surrounding the different kinds of oils found in our food.
Now he has written a book that contains a quirky, personal and highly entertaining series of essays that intermix stories about his forays into his local farmer's market in New Zealand with observations about the little known health benefits of the foods he finds there which illuminate the many fascinating physiological functions of the micronutrients found in fresh vegetables, fruits, meats and fish.
Quentin's title tells us that there is something else going on in this book: his target reader is, by definition a "bloke." Bloke is a term used exclusively in those territories that were once part of the British Empire. It refers to what we in the U.S. would call a "regular guy" or perhaps, a "manly man." Blokes care about sports. They don't like to fiddle around in the kitchen. And they sure as hell are not going to sit still while someone lectures them about healthy eating.
Which is why Quentin's book is such a delight. Because somehow Quentin has figured out how to get blokes to care about the food they are putting into their bodies without lecturing or asking them to change their fundamental nature.
I gave a copy of this book to my own personal bloke, whose daily diet tends to be rich in impulse items and who, though he works hard at keeping his eyeballs from rolling upward when I launch into a tirade on some dietary outrage, could hardly be described as a health nut.
He read it, laughed at quite a few of the stories Quentin tells in its pages, and then astonished me by heading to Stop & Shop and coming home with a bag full of colorful peppers, avocados, fancy oil extracts, walnuts and fish.
For the next couple weeks we ate better than ever before, as I was served colorful salads prepared by my "bloke" at almost every meal. Obviously, Quentin was onto something!
Many of us alt.support.diabetes regulars bought our copies of this book last year when someone was kind enough to arrange for the shipment of a few boxes from New Zealand. Now Quentin is selling his book directly to the public from a web site set up on my Phlaunt.com web marketing site. This allows him to take payment via PayPal which is extremely helpful as it handles the international currency conversion and enables purchasers to buy with a credit card or check.
Though I provided the sales web site that Quentin is using, I want to make it clear I have no financial interest of any kind in the sales of Quentin's book. I am letting you know about it solely because I love this book and would like more people to know about it.
Quentin is one of us--a person with diabetes--and he is also a fan of the "test test test" strategy that alt.support.diabetes has popularized. So while his book is not written specifically for people with diabetes, it does take into account the issues important to people with diabetes.
You can find out more about Quentin's book on his web site here:
http://www.phlaunt.com/quentin
And re the origin of your food, if you are in the U.S. you should be happy to know that new regulations will go effect tomorrow, October 1, 2008, that will give you more information about the country of origin of some of the food you eat.
AP: More foods getting labeled as U.S. or foreign-grown
Note that the country of origin labeling breaks down as soon as you get into packaged foods. This is yet another reason to "shop the edges" in your supermarket where you can buy products like fruit, vegetables, cheeses, dairy, nuts, meat and fish that have been minimally processed rather than the more questionable foods that have been canned, bottled, or frozen.
---------------
* You can learn about the way petrochemicals become food additives in the book, Twinkie Deconstructed by Steve Ettlinger, though sadly, he does not bring to his subject the kind of critical thinking that such a topic demands.
Tuesday, September 30, 2008
Monday, September 29, 2008
Here's a Version of the "Control Your Blood Sugar" Flyer available in mmol/L
Several people have asked me for a version of the flyer explaining how to control blood sugar that would use the mmol/L blood sugar measurement that is used throughout most of the world.
You can now download a copy of the flyer with the mmol/L measurements here:
http://bloodsugar101.com/flyer-mmol.pdf
Sorry for my having given into an attack of U.S.-centric thinking!
You can now download a copy of the flyer with the mmol/L measurements here:
http://bloodsugar101.com/flyer-mmol.pdf
Sorry for my having given into an attack of U.S.-centric thinking!
Saturday, September 27, 2008
Whey Protein Powder Contaminated?
The FDA announced it had started testing some imports of Chinese dairy products coming into U.S. ports after the news hit about the way that milk products in China had been contaminated with melamine.
But we all know that the FDA has been gutted by the Bush administration and does not begin to have the resources needed to test the avalanche of foods coming in from China. Not only that, but even when the FDA samples foods coming into our ports, the paperwork is so sloppy that if a food is tested and rejected, the shipper need only take it to a second port. There is often no paper trail showing it has failed inspection elsewhere.
And that doesn't even get into the issue of how the FDA only tests a tiny sample of shipments.
Why should this scare you? Because we don't know the extent to which Chinese dairy products filled with melamine, a toxic plastic, have permeated out own food supply.
All we know is this: large food manufacturers who are buying millions of pounds of powdered milk, casein and whey to put into everything from bread, to cookies, to candy, to sauces on frozen vegetables are very likely to have been buying these products from the Chinese factories because the Chinese are able to offer much lower prices than competitors.
Now that we are learning WHY they are able to lower their prices--by replacing milk protein with plastic, for example--shopping the Dollar Store for our food supply is not looking like such a good idea. But until two weeks ago, what large manufacturer was thinking like that?
This latest scandal has special relevance to people with diabetes. Many of us are already walking around with kidneys that have been damaged by years of exposure to high blood sugars. We have been assured that the tiny amounts of melamine that may have found their way into our packaged food products are only toxic to babies, not adults, but the truth is that melamine may very well be toxic for anyone with microalbumuria whose kidneys are already damaged.
The other issue relevant to people with diabetes who eat low carb diets is that a lot of us use whey protein powders as a base for baked goods since we try to avoid baking with grains. Given that whey powder is one of the products that the FDA has said it has been inspecting, and given that we have no idea where the makers of these whey protein powders have gotten that whey powder, it is not outside of the range of probability that some of this whey protein powder might be contaminated.
With that in mind, it might be a good idea to eliminate whey protein powder from our diets for a while, until the melamine that may very well have slipped into this country before the scandal erupted has finished making its way through the system.
Yes, this might seem overcautious, but with every day's news reports adding additional products and countries to the list of those found to contain Chinese milk products contaminated with melamine, it might just be prudent.
If you are a fan of so called "nutrition" bars, you might want to give them a miss if they list whey or casein on their labels for the same reason.
Manufacturers are clamoring to reassure the public that their products don't contain these suspect substances, but that is to be expected. They may not contain them now. What they may have contained three months ago when the product on your shelf was manufactured may be another story.
And sadly, there is no requirment to list the country of origin for the ingredients of any food sold in the U.S., only where they were packaged. Since the Chinese sell raw materials to other companies that package them in the U.S. and slap their own labels on them, you cannot trust any label information to keep you safe.
But we all know that the FDA has been gutted by the Bush administration and does not begin to have the resources needed to test the avalanche of foods coming in from China. Not only that, but even when the FDA samples foods coming into our ports, the paperwork is so sloppy that if a food is tested and rejected, the shipper need only take it to a second port. There is often no paper trail showing it has failed inspection elsewhere.
And that doesn't even get into the issue of how the FDA only tests a tiny sample of shipments.
Why should this scare you? Because we don't know the extent to which Chinese dairy products filled with melamine, a toxic plastic, have permeated out own food supply.
All we know is this: large food manufacturers who are buying millions of pounds of powdered milk, casein and whey to put into everything from bread, to cookies, to candy, to sauces on frozen vegetables are very likely to have been buying these products from the Chinese factories because the Chinese are able to offer much lower prices than competitors.
Now that we are learning WHY they are able to lower their prices--by replacing milk protein with plastic, for example--shopping the Dollar Store for our food supply is not looking like such a good idea. But until two weeks ago, what large manufacturer was thinking like that?
This latest scandal has special relevance to people with diabetes. Many of us are already walking around with kidneys that have been damaged by years of exposure to high blood sugars. We have been assured that the tiny amounts of melamine that may have found their way into our packaged food products are only toxic to babies, not adults, but the truth is that melamine may very well be toxic for anyone with microalbumuria whose kidneys are already damaged.
The other issue relevant to people with diabetes who eat low carb diets is that a lot of us use whey protein powders as a base for baked goods since we try to avoid baking with grains. Given that whey powder is one of the products that the FDA has said it has been inspecting, and given that we have no idea where the makers of these whey protein powders have gotten that whey powder, it is not outside of the range of probability that some of this whey protein powder might be contaminated.
With that in mind, it might be a good idea to eliminate whey protein powder from our diets for a while, until the melamine that may very well have slipped into this country before the scandal erupted has finished making its way through the system.
Yes, this might seem overcautious, but with every day's news reports adding additional products and countries to the list of those found to contain Chinese milk products contaminated with melamine, it might just be prudent.
If you are a fan of so called "nutrition" bars, you might want to give them a miss if they list whey or casein on their labels for the same reason.
Manufacturers are clamoring to reassure the public that their products don't contain these suspect substances, but that is to be expected. They may not contain them now. What they may have contained three months ago when the product on your shelf was manufactured may be another story.
And sadly, there is no requirment to list the country of origin for the ingredients of any food sold in the U.S., only where they were packaged. Since the Chinese sell raw materials to other companies that package them in the U.S. and slap their own labels on them, you cannot trust any label information to keep you safe.
Wednesday, September 24, 2008
How You Can Help!
A lot of people have asked me what they can do to help people with diabetes. Well, one thing we can all do is get the same information that has been so helpful to all of us online to people with diabetes who aren't online.
To further this goal, I've put together a flyer which adapts the information found on the Alt.Support.Diabetes "Newly Diagnosed" web page so that it will fit onto one page.
It's a PDF file. If you like it, print out some copies and leave them by the pile of magazines at your doctor's office. Post some on community bulletin boards. Give it to friends with diabetes. Put it anywhere you see other posters.
The technique described on the flyer is very simple but extremely effective. It's time more people knew about it.
You can download the flyer by clicking on this link:
flyer.pdf
For the version that uses mmol/L measurements download
flyer-mmol.pdf
Be sure to click on "save a copy" to store a copy of the flyer on your own computer.
If you have comments or ideas for improving the flyer, please post them in the comments or email me at jruhl9999-d1@yahoo.com. Let's make this flyer great and get it to the people in our communities who need this information!
To further this goal, I've put together a flyer which adapts the information found on the Alt.Support.Diabetes "Newly Diagnosed" web page so that it will fit onto one page.
It's a PDF file. If you like it, print out some copies and leave them by the pile of magazines at your doctor's office. Post some on community bulletin boards. Give it to friends with diabetes. Put it anywhere you see other posters.
The technique described on the flyer is very simple but extremely effective. It's time more people knew about it.
You can download the flyer by clicking on this link:
flyer.pdf
For the version that uses mmol/L measurements download
flyer-mmol.pdf
Be sure to click on "save a copy" to store a copy of the flyer on your own computer.
If you have comments or ideas for improving the flyer, please post them in the comments or email me at jruhl9999-d1@yahoo.com. Let's make this flyer great and get it to the people in our communities who need this information!
Tuesday, September 23, 2008
Congress passes new Americans with Disabilities Act that Protects People with Diabetes from Discrimination
Lost in the cacaphony of the market meltdown is one piece of good news for people with diabetes: a new law which was just passed almost unanimously by congress, and which Bush says he will sign, says that employers can no longer discriminate against workers because they have diabetes.
This means that your employer will not be able to fire you because you require reasonable accommodations to take care of your blood sugar. If you need to take an occasional break to make a correction to your insulin dose or get some glucose, your employer cannot fire you. This doesn't sound like much, but I have read quite a few postings on tudiabetes.com over the last year from young people with Type 1 diabetes who have been forced off jobs because their employers insisted that they gamble with their lives by not making accommodations for their need to keep on top of blood sugars.
The law does not mean that an employer has to hire you if you are not qualified.
Existing law already provides that an employer cannot grill you about your health at an interview unless it is directly related to your ability to do the job, for example, if you are going to be driving a public bus or flying an airplane and are taking insulin.
Most people with diabetes need no accommodation at all from employers, but we may discriminated against--along with most people over 45--by employers who fear that having us on the payroll will push up their already enormous health insurance costs.
And as older people know, just having a law on the books doesn't stop discrimination for any quality that is obvious from a quick glance. Employers continue to discriminate in hiring based on age, color, body size, national origin, and gender. Often they do it by hiring contractors rather than full time employees. They do this so that the contracting agency company they hire can screen out the kinds of people the main company doesn't want to be bothered with.
People with Type 2 who tend to be heavy may therefore still find themselves facing discrimination at hiring time. But at least if you get hired you can't be fired because you have come down with diabetes.
Here's a write up about the new law and why it is being passed:
http://www.latimes.com/business/careers/work/la-na-disability22-2008sep22,0,2819372.story
This means that your employer will not be able to fire you because you require reasonable accommodations to take care of your blood sugar. If you need to take an occasional break to make a correction to your insulin dose or get some glucose, your employer cannot fire you. This doesn't sound like much, but I have read quite a few postings on tudiabetes.com over the last year from young people with Type 1 diabetes who have been forced off jobs because their employers insisted that they gamble with their lives by not making accommodations for their need to keep on top of blood sugars.
The law does not mean that an employer has to hire you if you are not qualified.
Existing law already provides that an employer cannot grill you about your health at an interview unless it is directly related to your ability to do the job, for example, if you are going to be driving a public bus or flying an airplane and are taking insulin.
Most people with diabetes need no accommodation at all from employers, but we may discriminated against--along with most people over 45--by employers who fear that having us on the payroll will push up their already enormous health insurance costs.
And as older people know, just having a law on the books doesn't stop discrimination for any quality that is obvious from a quick glance. Employers continue to discriminate in hiring based on age, color, body size, national origin, and gender. Often they do it by hiring contractors rather than full time employees. They do this so that the contracting agency company they hire can screen out the kinds of people the main company doesn't want to be bothered with.
People with Type 2 who tend to be heavy may therefore still find themselves facing discrimination at hiring time. But at least if you get hired you can't be fired because you have come down with diabetes.
Here's a write up about the new law and why it is being passed:
http://www.latimes.com/business/careers/work/la-na-disability22-2008sep22,0,2819372.story
Monday, September 22, 2008
What does that C-peptide test result mean?
PLEASE READ THIS ARTICLE CAREFULLY BEFORE COMMENTING OR EMAILING ME QUESTIONS ABOUT YOUR C-PEPTIDE TEST! The point of this article is that the C-peptide test tells you only if you are making some amount of insulin, but not how much. It cannot be used to diagnose ANYTHING unless it is very close to 0. People keep emailing me asking me questions that could be answered by reading this post in full.
Now back to the post:
======
One of the common questions I get from readers of my web site is what the result of a C-peptide test might mean and whether it can identify the kind of diabetes they have.
Unfortunately, in many cases, the answer is, that it cannot.
C-peptide is a chain of proteins that is spun off in the process by which the beta cell makes insulin. During this process, a precursor molecule, proinsulin is split into insulin and C-peptide. So for every molecule of insulin your beta cells produce, they also produce a molecule of C-peptide.
C-peptide is removed from the bloodstream by your kidneys while insulin is removed by the liver. This makes a difference in how long these peptides stay in the bloodstream. It takes half an hour until C-peptide is removed, while insulin is gone in five minutes. This means that there should be five times as much C-peptide in your blood at any given time as there is insulin and the longer activity period should smooth out the effects of testing at any one particular moment.
However, if there is something wrong with your kidneys they may not remove C-peptide in a normal manner and the result of a C-peptide test may be misleading.
If a person is injecting insulin, measuring C-peptide is the only way doctors can determine whether they are also making insulin on their own since lab tests do not distinguish between injected insulin and homemade.
Some doctors prefer to measure C-peptide even in people not injecting insulin because of its longer life in the bloodstream which means you won't see as much fluctuation from moment to moment in C-peptide levels as you may find with insulin levels.
The main thing a C-peptide test tells you is whether or not your body is making C-peptide. This sounds like a "duh" kind of statement. But in fact, that really is all that the test tells us. This can be useful in itself--if there is no C-peptide in a blood sample, your beta cells are not making any insulin. A very low C-peptide result is the definitive way to diagnose severe Type 1 diabetes--though many people with Type 1 will continue to have a low level of C-peptide in their blood for years after diagnosis as good control started soon after at Type 1 diagnosis appears to keep a small number of their beta cells alive.
To derive more meaning for the results of a C-peptide test the lab must know whether it was taken fasting or not fasting and what the blood glucose level was at the moment it was taken. In theory, a high fasting blood sugar with a high C-peptide value should point to Type 2 diabetes primarily caused by insulin resistance. That is because the high C-peptide value would suggest a lot of insulin was being produced but insulin resistance was keeping it from lowering blood sugar. In contrast, a C-peptide value that was normal or below normal taken at the same time as a high fasting glucose would suggest a form of Type 2 where failing beta cells rather than insulin resistance was the primary thing raising blood sugar.
In theory, testing C-peptide very few years should also give you some idea of whether or not your beta cells are slowly failing.
Unfortunately, it is here that things start breaking down. The problem is that there is no standardization in the way that labs measure C-peptide or in the reference ranges they provide. A recent study that sent 40 different samples out to 15 laboratories found nine different techniques being used. The study found that "Within- and between-run CVs [coefficient of variation (CV) equals the standard deviation divided by the mean (expressed as a percent).It is used to measure consistency across a range of results] ranged from <2% to >10% and from <2% to >18%,respectively."
In short, if you sent the same sample to a different lab, you could get a very different result. This study concluded this inconsistency was greatest, "...especially at higher C-peptide concentrations. Within-laboratory imprecision also varied, with some methods giving much more consistent results than others."
It is usually suggested that because of the different test protocols and reference ranges in use, you use the same lab to compare C-peptide values, when trying to determine if your C-peptide levels are dropping. But the results of the study above suggest that "within laboratory imprecision" is significant enough to make this a questionable strategy, too.
Labs may also not provide on a reference range for fasting C-peptide test results since most doctors order only fasting C-peptide tests. This can be a problem for those of us who have forms of diabetes where our beta cells are able to secrete basal insulin (the slow steady drip of insulin that keeps our blood sugar normal in the fasting state) but are unable to secrete insulin in response to the rising blood glucose that happens at meal time.
This pattern is characteristic of some forms of MODY diabetes, and explains why a person with MODY-1 or MODY-3 may have completely normal fasting C-peptide while experiencing extremely high blood sugars after meals. You can see an example of this in this MODY case history where the young patient whose genetic testing diagnoses MODY-1 has a normal C-peptide along with a 9.2% A1c.
With this in mind, here's what your C-peptide can tell you:
1. Very Low C-peptide test results.If your CC-peptide is significantly below the normal fasting range given by your lab no matter when your blood sugar was tested your beta cells are likely to be dead or dying. If you are young or very recently diagnosed with diabetes of any type, a very low C-peptide value is a good way of diagnosing Type 1 (autoimmune) rather than Type 2 diabetes.
But if you have had Type 2 for decades, and have not kept your blood sugars at normal levels, you may also have a very low C-peptide test value because over the years the very high blood sugars you have been exposed to may have killed off your insulin-producing beta cells.
Some insurers require a C-peptide test result below .5 nanograms/ml before they will cover the costs of an insulin pump.
2. High Fasting C-peptide Test Results. A high fasting C-peptide test value taken at the same time as a high fasting blood glucose test value suggests that you are insulin resistant though still making lots of insulin. (Unless you have kidney disease, in which case this test result may not reflect your actual insulin levels.)
If your fasting C-peptide level is high, it is very likely that you will be able to control your blood sugar by cutting way down on the amount of carbohydrate you eat.
It also means that you should first try strategies that lower insulin resistance before trying drugs that stimulate more insulin release, such as Amaryl, Glipizide, Januvia or Byetta.
If you have high fasting C-peptide levels, the drug Metformin, which increases insulin sensitivity, should be helpful in lowering your blood sugar. Exercise may also be very helpful as many people (though not all) find it temporarily reduces insulin resistance.
Weight loss may or may not help, depending on what is causing your insulin resistance. There are normal weight people who are very insulin resistant, but some people who are obese are able to reduce insulin resistance by losing weight--though of course, there is some circular logic here, since high levels of insulin resistance make weight loss very difficult!
3. Nonfasting C-peptide test results. If your non-fasting C-peptide test is not abnormally low (pointing to completely dead beta cells) there is no accurate way to interpret a non-fasting C-peptide test result. There are research studies where nonfasting C-peptide measurements are taken and studied, but given the nonstandarization of this test across labs and the fact that most labs do not give any lab reference range for nonfasting values, the meaning of a nonfasting C-peptide test that is normal or high (compared to a fasting reference range) is impossible to interpret.
If you have a normal C-peptide, very high post-meal blood sugars, normal or near normal weight, and a family history of thin people diagnosed with Type 2 diabetes or Type 1 diabetes that stayed relatively easy to control, you may have MODY but a C-peptide test will not be able to diagnose it.
Normal or High C-Peptide Test Results May Be Good News.
There is some recent research that suggests that C-peptide rather than being an inert byproduct of insulin synthesis is, in fact, important for preventing diabetic complications. This research is in its infancy. You can read about it in this earlier blog post.
If in fact it turns out that C-peptide is able to prevent complications, those of us who have secretory defects that respond to beta cell stimulation may have to reconsider whether or not to stimulate our beta cells with drugs like Byetta or sulfonylureas or whether to supplement with injected insulin that does not contain C-peptide.
I have been informed by correspondents diagnosed with MODY that they have been told by Dr. Hattersley who is one of the world's authorities on MODY, that he prefers to stimulate insulin secretion with gliclazide (Diamicron), a sulfonylurea drug that is unfortunately not available in the U.S., rather than use injected insulin because he believes it gives better long term results. If, in fact, C-peptide turns out to be beneficial, that might explain this finding. Unfortunately I have not been able to find any published research supporting the advantages of beta cell stimulation over insulin supplementation for people with MODY. The sulfonylurea drugs available in the U.S. often cause dramatic hunger and blood sugar swings that make them unpleasant to use and which lead to weight gain.
For people who do not have genetic secretory defects, the disadvantages of stimulating insulin secretion with drugs may be made clear by the most recent follow up to the UKPDS study, where people who used metformin to lower blood sugar had a far better long term outcome in terms of heart attack as those who used sufonylurea drugs. (Though all groups in this study had many more complications than necessary since they started out with A1cs of 7% or higher and allowed them to deteriorate over subsequent decades.) I'll be discussing this study in detail in a future blog post.
Now back to the post:
======
One of the common questions I get from readers of my web site is what the result of a C-peptide test might mean and whether it can identify the kind of diabetes they have.
Unfortunately, in many cases, the answer is, that it cannot.
C-peptide is a chain of proteins that is spun off in the process by which the beta cell makes insulin. During this process, a precursor molecule, proinsulin is split into insulin and C-peptide. So for every molecule of insulin your beta cells produce, they also produce a molecule of C-peptide.
C-peptide is removed from the bloodstream by your kidneys while insulin is removed by the liver. This makes a difference in how long these peptides stay in the bloodstream. It takes half an hour until C-peptide is removed, while insulin is gone in five minutes. This means that there should be five times as much C-peptide in your blood at any given time as there is insulin and the longer activity period should smooth out the effects of testing at any one particular moment.
However, if there is something wrong with your kidneys they may not remove C-peptide in a normal manner and the result of a C-peptide test may be misleading.
If a person is injecting insulin, measuring C-peptide is the only way doctors can determine whether they are also making insulin on their own since lab tests do not distinguish between injected insulin and homemade.
Some doctors prefer to measure C-peptide even in people not injecting insulin because of its longer life in the bloodstream which means you won't see as much fluctuation from moment to moment in C-peptide levels as you may find with insulin levels.
The main thing a C-peptide test tells you is whether or not your body is making C-peptide. This sounds like a "duh" kind of statement. But in fact, that really is all that the test tells us. This can be useful in itself--if there is no C-peptide in a blood sample, your beta cells are not making any insulin. A very low C-peptide result is the definitive way to diagnose severe Type 1 diabetes--though many people with Type 1 will continue to have a low level of C-peptide in their blood for years after diagnosis as good control started soon after at Type 1 diagnosis appears to keep a small number of their beta cells alive.
To derive more meaning for the results of a C-peptide test the lab must know whether it was taken fasting or not fasting and what the blood glucose level was at the moment it was taken. In theory, a high fasting blood sugar with a high C-peptide value should point to Type 2 diabetes primarily caused by insulin resistance. That is because the high C-peptide value would suggest a lot of insulin was being produced but insulin resistance was keeping it from lowering blood sugar. In contrast, a C-peptide value that was normal or below normal taken at the same time as a high fasting glucose would suggest a form of Type 2 where failing beta cells rather than insulin resistance was the primary thing raising blood sugar.
In theory, testing C-peptide very few years should also give you some idea of whether or not your beta cells are slowly failing.
Unfortunately, it is here that things start breaking down. The problem is that there is no standardization in the way that labs measure C-peptide or in the reference ranges they provide. A recent study that sent 40 different samples out to 15 laboratories found nine different techniques being used. The study found that "Within- and between-run CVs [coefficient of variation (CV) equals the standard deviation divided by the mean (expressed as a percent).It is used to measure consistency across a range of results] ranged from <2% to >10% and from <2% to >18%,respectively."
In short, if you sent the same sample to a different lab, you could get a very different result. This study concluded this inconsistency was greatest, "...especially at higher C-peptide concentrations. Within-laboratory imprecision also varied, with some methods giving much more consistent results than others."
It is usually suggested that because of the different test protocols and reference ranges in use, you use the same lab to compare C-peptide values, when trying to determine if your C-peptide levels are dropping. But the results of the study above suggest that "within laboratory imprecision" is significant enough to make this a questionable strategy, too.
Labs may also not provide on a reference range for fasting C-peptide test results since most doctors order only fasting C-peptide tests. This can be a problem for those of us who have forms of diabetes where our beta cells are able to secrete basal insulin (the slow steady drip of insulin that keeps our blood sugar normal in the fasting state) but are unable to secrete insulin in response to the rising blood glucose that happens at meal time.
This pattern is characteristic of some forms of MODY diabetes, and explains why a person with MODY-1 or MODY-3 may have completely normal fasting C-peptide while experiencing extremely high blood sugars after meals. You can see an example of this in this MODY case history where the young patient whose genetic testing diagnoses MODY-1 has a normal C-peptide along with a 9.2% A1c.
With this in mind, here's what your C-peptide can tell you:
1. Very Low C-peptide test results.If your CC-peptide is significantly below the normal fasting range given by your lab no matter when your blood sugar was tested your beta cells are likely to be dead or dying. If you are young or very recently diagnosed with diabetes of any type, a very low C-peptide value is a good way of diagnosing Type 1 (autoimmune) rather than Type 2 diabetes.
But if you have had Type 2 for decades, and have not kept your blood sugars at normal levels, you may also have a very low C-peptide test value because over the years the very high blood sugars you have been exposed to may have killed off your insulin-producing beta cells.
Some insurers require a C-peptide test result below .5 nanograms/ml before they will cover the costs of an insulin pump.
2. High Fasting C-peptide Test Results. A high fasting C-peptide test value taken at the same time as a high fasting blood glucose test value suggests that you are insulin resistant though still making lots of insulin. (Unless you have kidney disease, in which case this test result may not reflect your actual insulin levels.)
If your fasting C-peptide level is high, it is very likely that you will be able to control your blood sugar by cutting way down on the amount of carbohydrate you eat.
It also means that you should first try strategies that lower insulin resistance before trying drugs that stimulate more insulin release, such as Amaryl, Glipizide, Januvia or Byetta.
If you have high fasting C-peptide levels, the drug Metformin, which increases insulin sensitivity, should be helpful in lowering your blood sugar. Exercise may also be very helpful as many people (though not all) find it temporarily reduces insulin resistance.
Weight loss may or may not help, depending on what is causing your insulin resistance. There are normal weight people who are very insulin resistant, but some people who are obese are able to reduce insulin resistance by losing weight--though of course, there is some circular logic here, since high levels of insulin resistance make weight loss very difficult!
3. Nonfasting C-peptide test results. If your non-fasting C-peptide test is not abnormally low (pointing to completely dead beta cells) there is no accurate way to interpret a non-fasting C-peptide test result. There are research studies where nonfasting C-peptide measurements are taken and studied, but given the nonstandarization of this test across labs and the fact that most labs do not give any lab reference range for nonfasting values, the meaning of a nonfasting C-peptide test that is normal or high (compared to a fasting reference range) is impossible to interpret.
If you have a normal C-peptide, very high post-meal blood sugars, normal or near normal weight, and a family history of thin people diagnosed with Type 2 diabetes or Type 1 diabetes that stayed relatively easy to control, you may have MODY but a C-peptide test will not be able to diagnose it.
Normal or High C-Peptide Test Results May Be Good News.
There is some recent research that suggests that C-peptide rather than being an inert byproduct of insulin synthesis is, in fact, important for preventing diabetic complications. This research is in its infancy. You can read about it in this earlier blog post.
If in fact it turns out that C-peptide is able to prevent complications, those of us who have secretory defects that respond to beta cell stimulation may have to reconsider whether or not to stimulate our beta cells with drugs like Byetta or sulfonylureas or whether to supplement with injected insulin that does not contain C-peptide.
I have been informed by correspondents diagnosed with MODY that they have been told by Dr. Hattersley who is one of the world's authorities on MODY, that he prefers to stimulate insulin secretion with gliclazide (Diamicron), a sulfonylurea drug that is unfortunately not available in the U.S., rather than use injected insulin because he believes it gives better long term results. If, in fact, C-peptide turns out to be beneficial, that might explain this finding. Unfortunately I have not been able to find any published research supporting the advantages of beta cell stimulation over insulin supplementation for people with MODY. The sulfonylurea drugs available in the U.S. often cause dramatic hunger and blood sugar swings that make them unpleasant to use and which lead to weight gain.
For people who do not have genetic secretory defects, the disadvantages of stimulating insulin secretion with drugs may be made clear by the most recent follow up to the UKPDS study, where people who used metformin to lower blood sugar had a far better long term outcome in terms of heart attack as those who used sufonylurea drugs. (Though all groups in this study had many more complications than necessary since they started out with A1cs of 7% or higher and allowed them to deteriorate over subsequent decades.) I'll be discussing this study in detail in a future blog post.
Wednesday, September 17, 2008
Sixy-Five Percent of Funds Raised by ADA Go to Fundraisers NOT ADA
The next time you are tempted to contribute to the American Diabetes Association, consider this: The LA Times reported this July that only 35.1% of the money donated to the American Diabetes Association in California actually went to the ADA. The rest went to the for-profit fundraisers it hired.
American Diabetes Association rated in the LA Times Charity Database HERE
Here's who got the money that was raised in the name of the ADA:
List of Fund Raisers that ADA Money Went to - LA Times Charity Database
I've run into those ADA fundraisers. Last year they phoned me every night for a month. Since they are keeping 65% of every dollar they raise, their enthusiasm is understandable.
What is NOT understandable is why the American Diabetes Association is willing to lend its name to such predatory fundraising practices. Well conducted health charities in California keep 80% or more of every dollar raised in their name. Here is a list of other health charities in California and how much of the funds raised in their names actually get to them:
Other Health Charities Listed in the LA Times Charity Fund Raising Database
Nationally the news about the ADA's efficiency is not much better. The Charity Navigator web site which rates charities nationwide gives the ADA two stars and presents
this page of information about how the ADA uses its money.
Note that the ADA gets the lowest possible rating, one star, for "Organizational Efficiency" or how it spends its money.
The ADA gets $213 million dollars a year of which $7,678,945 is spent on "administrative expenses." That translated into English means "Salaries for top ADA executives.".
The Charity Navigator site calculates the "fundraising efficiency" of an organization which is how much money it spends to raise a dollar. They report that the ADA spends $.26 to raise a buck. In contrast JDRF spends $.09.
And this doesn't even get into the issue of what it is that the ADA does with the money it spends on programs. As readers of this blog know very well, much of the ADA's spending goes to promote the agendas of the drug companies that feed it millions.
The ADA has campaigned for a generation against telling people with diabetes that lowering carbohydrate intake can lower blood sugar. They have fought against lowering the recommended blood sugar targets for people with diabetes long after the American Association of Clinical Endocrinlogists lowered theirs.
The ADA continues to tell people with diabetes that it is a "myth" that people with diabetes should cut back on starch and sugar. They continue to promote high carbohydrate/low fat diets that make blood sugar control impossible and force people with Type 2 diabetes to rely on expensive, largely ineffective, dangerous oral drugs.
The ADA continues to tell people with Type 1 diabetes that it is dangerous to shoot for blood sugar targets lower than 180 mg/dl (10 mmol/L) two hours after eating.
And the ADA continues to be the authority that doctors turn to for guidance in how to treat their patients with diabetes--which is one reason why so many of them diagnose patients late, promote diets that raise blood sugar, and accept dangerously high A1cs as "good control."
The ADA is run by very well paid professional charity executives who do not have diabetes. These are people who have never tested their blood sugar after eating a high carb meal, people who have never suffered from neuropathy caused by poor medical advice, people who are not going to go blind from the advice they dish out. They have close ties to the drug companies who dominate their agendas. They have no interest in hearing from or catering to the needs to those of us who have diabetes even though they raise those hundreds of millions of dollars in our name every year.
It's time for this to stop. Let your friends and family know these facts about the ADA's shockingly bad rating as a charity so they aren't tempted to enrich for-profit fundraising companies in the mistaken belief that their money would be going to help cure your diabetes.
Every time I see an obituary in the newspaper where the bereaved family asks contributions in memory of their loved one be sent to the ADA I marvel at the con job the ADA has done on the American public.
Let's bring it to an end!
American Diabetes Association rated in the LA Times Charity Database HERE
Here's who got the money that was raised in the name of the ADA:
List of Fund Raisers that ADA Money Went to - LA Times Charity Database
I've run into those ADA fundraisers. Last year they phoned me every night for a month. Since they are keeping 65% of every dollar they raise, their enthusiasm is understandable.
What is NOT understandable is why the American Diabetes Association is willing to lend its name to such predatory fundraising practices. Well conducted health charities in California keep 80% or more of every dollar raised in their name. Here is a list of other health charities in California and how much of the funds raised in their names actually get to them:
Other Health Charities Listed in the LA Times Charity Fund Raising Database
Nationally the news about the ADA's efficiency is not much better. The Charity Navigator web site which rates charities nationwide gives the ADA two stars and presents
this page of information about how the ADA uses its money.
Note that the ADA gets the lowest possible rating, one star, for "Organizational Efficiency" or how it spends its money.
The ADA gets $213 million dollars a year of which $7,678,945 is spent on "administrative expenses." That translated into English means "Salaries for top ADA executives.".
The Charity Navigator site calculates the "fundraising efficiency" of an organization which is how much money it spends to raise a dollar. They report that the ADA spends $.26 to raise a buck. In contrast JDRF spends $.09.
And this doesn't even get into the issue of what it is that the ADA does with the money it spends on programs. As readers of this blog know very well, much of the ADA's spending goes to promote the agendas of the drug companies that feed it millions.
The ADA has campaigned for a generation against telling people with diabetes that lowering carbohydrate intake can lower blood sugar. They have fought against lowering the recommended blood sugar targets for people with diabetes long after the American Association of Clinical Endocrinlogists lowered theirs.
The ADA continues to tell people with diabetes that it is a "myth" that people with diabetes should cut back on starch and sugar. They continue to promote high carbohydrate/low fat diets that make blood sugar control impossible and force people with Type 2 diabetes to rely on expensive, largely ineffective, dangerous oral drugs.
The ADA continues to tell people with Type 1 diabetes that it is dangerous to shoot for blood sugar targets lower than 180 mg/dl (10 mmol/L) two hours after eating.
And the ADA continues to be the authority that doctors turn to for guidance in how to treat their patients with diabetes--which is one reason why so many of them diagnose patients late, promote diets that raise blood sugar, and accept dangerously high A1cs as "good control."
The ADA is run by very well paid professional charity executives who do not have diabetes. These are people who have never tested their blood sugar after eating a high carb meal, people who have never suffered from neuropathy caused by poor medical advice, people who are not going to go blind from the advice they dish out. They have close ties to the drug companies who dominate their agendas. They have no interest in hearing from or catering to the needs to those of us who have diabetes even though they raise those hundreds of millions of dollars in our name every year.
It's time for this to stop. Let your friends and family know these facts about the ADA's shockingly bad rating as a charity so they aren't tempted to enrich for-profit fundraising companies in the mistaken belief that their money would be going to help cure your diabetes.
Every time I see an obituary in the newspaper where the bereaved family asks contributions in memory of their loved one be sent to the ADA I marvel at the con job the ADA has done on the American public.
Let's bring it to an end!
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