Category: Diabetes 101

No Higher Risk for Type 2 Diabetes In Natural Menopause versus Ovarian Removal Menopause: Whether menopause comes naturally as a female ages or is brought on at an earlier age due to a hysterectomy that involves ovary removal, there is no increase in the diagnosis of type 2 diabetes, and the risk for type 2 diabetes does not increase.

This is the finding of a recent menopausal study that specifically targeted women who had natural menopause and also included women who had had their ovaries removed.  In all other studies, the natural menopausal women and the ovarian-removed menopausal women were combined together in a group rather than being separated.   This study is unique in that it separated the natural versus ovarian removal menopause for analysis and study.

This conclusion came as a result of a study carried out by the University of Michigan Health System.  The lead author of the study, Catherine Kim., M.D., M.P.H., an Associate Professor of Internal Medicine and Obstetrics and Gynecology, stated, “In our study, menopause had no additional effect or risk for diabetes.”  Dr. Kim added, “Menopause is one of many small steps in aging and it doesn’t mean women’s health will be worse after going through this transition.”

It was previously thought that postmenopausal women were at higher risks for type 2 diabetes because of a relatively high level of testosterone, the male hormone, which is considered a risk factor for type 2 diabetes.  This study concluded that was not the case.

This study also gave new information on the effect of diet and exercise and hormone replacement therapy on the overall health of menopausal women.

The participants of the study were enrolled in the Diabetes Prevention Program, which was a clinical trial of adults with glucose intolerance.  Glucose intolerance is the body’s struggle to convert glucose, or blood sugar, into energy.  Glucose intolerance at times leads to type 2 diabetes.  There are many factors that contribute to the diagnosis of type 2 diabetes, and these include age, weight, physical activity and family history.

When someone is diagnosed with glucose intolerance, the Diabetes Prevention Program study showed that lifestyle intervention and the addition of Metformin, a drug commonly used in the treatment of type 2 diabetes, as a preventive measure can delay or stop the progression to a diagnosis of type 2 diabetes in women who have gone through menopause.  Lifestyle changes would consist of losing 7 percent of a person’s body weight and exercising at least 150 minutes per week.  The study found that more research is needed on the role that hormone replacement therapy plays in the risk for type 2 diabetes.

The results of this study will appear in the magazine Menopause.  Funding for the research was provided by the National Institute of Diabetes and Digestive and Kidney Diseases, and the National Institute on Aging, the Centers for Disease Control and Prevention, and the American Diabetes Association.

V-Go Disposable Insulin Device for Type 2 Diabetes: In most instances type 2 diabetes can be controlled through diet and exercise, plus oral medication when needed. There are times, though, when these three critical ingredients aren’t enough to control the patient’s blood sugar levels. When that occurs, the patient is advised to add injectible insulin in their regimen to control their diabetes. The V-Go has been available since March 2011 in the United States, as it was given approval by the Food and Drug Administration in December 2010.

The V-Go has been described as a disposable insulin source, and there are two different medications that have been approved for use with the device – Humalog and NovoLog.

The device is described as small, 2-1/4” by 1-1/3” inch by 0.5”, and would weigh approximately 1 ounce when filled with insulin. The patient would apply a new V-Go to the skin daily for one 24-hour period. The V-Go would be inserted into the skin; the device would be worn next to the body underneath one’s clothing, so it would not be visible to the naked eye. The device is not electronic and has no moving parts. It will deliver 30 to 40 units of insulin over a 24-hour period. The device is designed for the continuous subcutaneous (under the skin) release of insulin. The V-Go provides a pre-set basal rate of insulin, plus an added dosing at mealtime, which would alleviate the need for multiple daily insulin injections. “The device was engineered to simplify basal-bolus insulin therapy for the millions of people suffering from type 2 diabetes.”

The device was recently approved for use in the United Kingdom for those suffering from type 2 diabetes. It received the CE Mark approval for sale in the European Economic Area.

Actos for type 2 diabetes to go Generic in 2012: Actos, a medication commonly used in the treatment of type 2 diabetes, will cost less in 2012 when its generic form will become available as Pioglitazone. The maker/seller of Actos is Merck, and Merck’s patent on Actos will expire in August 2012 which opens the door for a generic form of the medication. 2012 is the scheduled date, but this date can deviate due to arrival dates, litigation or regulatory issues. For now, though, the hope is that Actos will become available in generic form in August 2012.

With the high cost of any medication that is not available in generic form, the purses of American consumers have been hit hard over the past years with newer and better medications to treat their illnesses. Drug companies spend many years researching and developing a drug for human consumption with as few side effects as possible. These years of research and development are a costly endeavor. The only way for the companies to recoup their expenses in developing the medications is through the patents that they have over the medication for a specified number of years. Once the patent has expired, the generic form of the medication becomes available through a variety of pharmaceutical companies. These generic forms of medication cost a great deal less.

Other medications with their patents ending within the next 14 months are as follows:

October 2011 – Zyprexa (schizophrenia/bipolar)
November 2011 – Lipitor (high cholesterol)
March 2012 – Lexapro (depression)
March 2012 – Seroquel (schizophrenia/bipolar)
March 2012 – Avapro/Avalide (high blood pressure)
April 2012 – Provigil (narcolepsy)
May 2012 – Plavix (clot prevention)
July 2012 – Tricor (high triglycerides)
August 2012 – Singulair (asthma/allergies)
August 2012 – Actos (diabetes)
September 2012 – Diovan (high blood pressure)
September 2012 – Geodon (bipolar disorder)
November 2012 – Lidoderm (pain patch)
December 2012 – Atacand (heart failure)
March 2013 – Lovaza (high triglycerides)
August 2013 – Tremodar (brain tumors)

As the cost of medication has risen, many people have cut back on their expenses by not taking their prescribed medications or reducing their dosage. This leaves the patient vulnerable to a medical emergency from which they may not survive. With the reduction in cost of any medication the patient may be taking, the easier the financial hardship on the patient and the more likely the patient is to take their medication at the prescribed dosage.

Generic medications are the chemical equivalent of the original brand-name medication and work just as well for nearly all patients, and the cost of using a generic medication versus an original brand-name medication can be drastic. As an example, Protonix, a medication used for severe heartburn, went off patent recently. Protonix now costs on average $16.00 a month for a generic form of the medication whereas the original brand-name medication is around $170.00 per month. A huge difference.

With each original brand-name medication that goes off patent, that means bigger and better savings for the consumer.

Diabetes Cure: Adult Stem Cells or Embryonic Stem Cells: A cure for type 1 diabetes has long been thought to eventually come from the replacement of the beta cells within the pancreas that produce insulin, a hormone that is necessary for life. These beta cells are contained with the Islets of Langerhans in the pancreas, and their job is to make and release insulin and control the level of glucose in the blood. There has been much controversy surrounding the use of embryonic stem cells (cells that are derived from an early-stage embryo) from a moral and ethical point. In some instances, the mere mention of stem cells taken from an embryo can cause an uproar in regards to abortions.

Embryonic stem cells are easy to grow in the lab, but these embryonic stem cells are difficult to turn into pancreatic beta cells that produce the needed insulin.

Embryonic stem cells are pluripotent cells and can generate all cell types in the body, whereas adult stem cells are multipotent cells and can only produce a limited number of cell types.

Professor Shimon Efrat of the Tel Aviv University, Department of Human Molecular Genetics and Biochemistry at the Sackler Faculty of Medicine, has done a study with the adult pluripotent stem cells. These adult-derived stem cells could pave the way for new treatment in diabetes, states Professor Efrat. Professor Efrat added that, “these induced pluripotent stem cells represent an embryonic-life state. To some degree, he found, the cells retain a ‘memory’ of what they once were – when created from pancreatic beta cells, the cells responsible for the production of insulin, these pluripotent cells prove more efficient than their embryonic counterparts in creating insulin-producing cells.” Professor Efrat stated, “This discovery promises to advance the development of cell replacement therapy for diabetics, possibly leading to an effective alternative to organ transplants.” He further stated that, “When generated from human beta cells, pluripotent stem cells, these memory cells act as though they are receiving a prompt from their past life; the cells already have some understanding of their purpose, making them more efficient in generating beta cells.”

There are 3 million Americans with type 1 diabetes. For a cure to type 1 diabetes (a condition difficult to control on a day-to-day basis and that many times results in subsequent severe complications) some people have opted from an organ transplant to replace those insulin-producing cells. Like with any organ transplant, it is a difficult road to maneuver – a long wait list and a shortage of organ donors. This process can take many years. Professor Efrat noted, “The ratio of donors to potential recipients is about one to 1,000. A better option is sorely needed, and stem cells present a viable hope for the future.”

Professor Efrat did his study with a Ph.D. student, Holgen Russ, and in collaboration with Professor Nissim Benvenisty and Ori Bar-Nur from the Hebrew University, and the results were recently published in the journal Cell Stem Cell. “This discovery that was made by Professor Efrat and his fellow researchers was licensed to a start-up company that promotes the research and development of technology of innovative treatments for diabetes.”

Is Tight Blood Sugar Controls Best for Type 2 Diabetes: Should persons with type 2 diabetes keep their blood sugar levels under strict control, resulting in their A1C levels being the same as a person who does not have type 2 diabetes?

There are known benefits to keeping the blood sugar levels under tight control, but there is also a down side known as “insulin reactions” (hypoglycemia).

A true answer to the benefit of extremely tight control is still unknown.

This is the result of a report that was published by the German Institute for Quality and Efficiency in Health Care (IQWIG) that was recently issued. This compilation report was issued at the request of the Federal Joint Committee (G-BA). IQWIG was requested to prepare the report in a rapid form, meaning no preliminary reports were published. The study involved IQWIG using a randomized controlled trial comparing two treatment strategies in patients with type 2 diabetes. The “test” group measures’ goals were to lower blood sugar levels to near normal levels. In the “control” group measures’ goals there was no attempt to keep blood sugar levels at normal levels. With these two criteria in mind, the goal was to assess the benefit or harm of the interventions for “mortality (all-cause mortality), late complications of diabetes (heart attacks, strokes, damage to the kidneys or eyes, etc.), as well as quality of life.”

IQWIG included seven studies. In those seven studies, 28,000 had participated. Four studies had already been conducted between the 1960s and the 1990s, and the remaining three were after the year 2000. The ethnic origin was specific, Japan, and in some of the studies medications were used that are no longer in use. Rosiglitazone was listed as one such drug.

IQWIG analyzed these studies and their conclusion was that there were no differences between the two groups of “relevant aspects of treatment.” There was no identifiable “advantage or disadvantages found neither for all cause mortality nor for fatal heart attacks, (fatal and non-fatal) strokes, end-stage renal disease (and its pre-stages), amputations, or pre-stages of blindness. Insufficient data were available for the outcomes of quality of life and blindness.”

There were indications that patients with type 2 diabetes did benefit from extremely normal blood sugar levels in the “non-fatal heart attack” area, and it was in this area only. As well, those with the extremely normal blood sugar levels had indications of severe insulin reactions (hypoglycemia) as well as other serious events.

Jurgen Windeler, Director of IQWIG, commented on the current report: “It is quite astonishing: individual interventions, particularly drugs, have in part been well investigated in studies; however, we know relatively little about the advantages and disadvantages of treatment strategies. If doctors are faced with the question as to what they can specifically offer to their diabetes patients, whether they should lower blood glucose levels as much as possible, and in which patients this is a promising (or less promising) approach, they still do not receive satisfactory answers.”

In conclusion, the “few studies available do not allow reliable conclusions.”

Diagnosing Diabetes and Pre-Diabetes at the Dentist: One in four people in the United States have type 2 diabetes or are pre-diabetic. They do not know it.

Seeing your dentist every six months, as recommended, might one day help in an earlier diagnosis for those with undiagnosed diabetes or even pre-diabetes. Having missing teeth and deep periodontal pockets might lead to an early diagnosis of diabetes, which could lead to the prevention of some of the serious side effects of diabetes, such as stroke, heart disease, kidney and eye complications. Through early diagnosis, lifestyle changes could be implemented that could alter the course of the disease, and possibly prevent the diagnosis of diabetes at a later date if one is told that they are headed down the diabetic road.

A study was undertaken by researchers at the Columbia University College of Dental Medicine, and the results were published in the Journal of Dental Research. This study involved approximately 600 patients who visited a dental facility in Northern Manhattan. The participants were 30 years old or older (if Hispanic or non-white) and 40 years old or older (if non-Hispanic and white). None of these participants had ever been diagnosed with type 2 diabetes or pre-diabetes prior to the study. There were 530 patients with at least one risk factor reported by the patient – high cholesterol, high blood pressure (hypertension), obesity, simply overweight or a family history of diabetes. Five hundred and thirty patients received a periodontal exam and an A1C test. These patients were required to return for a fasting blood glucose test, the true test for a diagnosis of diabetes or pre-diabetes.

The test results were effective in identifying the patients who were walking around with diabetes without their knowledge and also effective in identifying those who were considered pre-diabetic.

“Periodontal disease is an early complication of diabetes,” stated Dr. Ira Lamster, Dean of the College of Dental Medicine, and senior author on the research paper results. Dr. Evanthia Lalla is an associate professor at the College of Dental Medicine and was a lead author on the paper. The study was supported by a research grant from Colgate Palmolive, and the authors of the study report no potential financial or other conflicts.

Early diagnosis is the key when it comes to diabetes. The earlier a person learns of their condition, the earlier they can make the necessary changes in their life to prevent a diagnosis of diabetes or receive treatment when they do receive a diagnosis of diabetes.

People tend to see the dentist because they want to keep their teeth, and they want to have a nice, white smile. A dentist’s office would be another place where a serious health condition, such as diabetes, could be caught in its earliest stages. No steps are in place at this time to begin this sort of testing for diabetes or pre-diabetes in a dental environment, but it would be another step in the right direction for the early diagnosis of diabetes.

Nuts Over Carbs for Diabetes: A recent study shows that when those dealing with type 2 diabetes switched out some of their regular carbohydrates for a half cup of mixed nuts each day, the participants’ blood sugar levels and LDL cholesterol levels dipped slightly over three months. This is no reason to eat nuts all day long, but it’s a good enough reason to think about throwing in some nuts in place of the carbs each day.

The study was led by David J.A. Jenkins, M.D., of St. Michael’s Hospital in Toronto, Canada. He “randomly assigned subjects to one of three treatments (daily supplements) for three months: mixed nuts (75 g/day; 40 patients), half portion of nuts (38 patients), or muffins (39 patients).”

The study had 117 patients coping with type 2 diabetes, and the study showed that the group that ate two ounces of nuts daily instead of carbs improved both glycemic control and serum lipids. The results of the study were published in the Diabetes Care.

We all know that nuts are high in calories, and we also know that they contain fats that are good for us. Nuts contain unsaturated fats, monounsaturated and polyunsaturated, the so-called healthy fats. These fats are believed to lower the LDL cholesterol levels, which is the bad cholesterol that clogs the arteries. Nuts also contain fiber, vitamin E, omega-3 fatty acids, plant sterols, and L-argine.

The nuts used in this study were unsalted almonds, pecans, hazelnuts, pistachios, walnuts, cashews, macadamias and peanuts. There were three groups in the study: Muffin group, full-nut group and half-nut group. The muffin group ate a “healthy” muffin, so called because the muffin was made of whole wheat products, sweetened with apple concentrate, and had no sugar added. This combination of ingredients had similar protein content to the nuts used in the study because of the egg white and skim milk powder that was contained in the muffin.

The patients in the full-nut group had a decrease in their A1C levels (0.21 percent), but the muffin group showed no such decrease. The LDL levels in the full-nut group decreased significantly, whereas the muffin group showed no such decrease.

It is known that nuts are good for you, but so is olive oil and avocadoes. This current study did not take into account the possible benefits of olive oil and avocadoes.

So you might want to think about tossing out the muffin for breakfast and replacing it with nuts. Also work in a good dose of cardio exercise for approximately 30 minutes per day and add a little light weights three or four times a week.

In some cases, type 2 diabetes can be controlled through diet and exercise, avoiding the use of oral medications, but always follow your doctor’s instructions, even before going heavy on the nuts. This study group was a group of participants who were already on medication for their type 2 diabetes and were considered to have good control over their blood sugar levels.

New Study On Aspirin and Diabetes: A baby aspirin a day can help prevent a heart attack, according to the experts. If you are in the throes of a heart attack, it is recommended that you take a chewable aspirin. We all know there are numerous cases where the use of over-the-counter aspirin can be helpful to the extent that it can save lives.

A goal of a recent study in Canada was to see whether taking aspirin could prevent a first or second heart attack or stroke in those with diabetes.

That newly released study has given results on the use of aspirin as a preventative measure for heart disease and the recurrence of episodes in patients with diabetes. The study was carried out at the University of Alberta, Canada, by researcher Scot Simpson, an Associate Professor in the Faculty of Pharmacy and Pharmaceutical Sciences.

Simpson concluded that diabetic patients who had already suffered a cardiac or stroke condition who were taking a “low” dose of aspirin daily had “very little benefit” in terms of preventing a second heart attack or a decreased risk of mortality. But, the patients taking “higher” doses of aspirin showed a significantly lower risk.

The researchers took the results from 21 different studies and zeroed in on diabetic patients who had already had a heart attack or stroke to see how aspirin could prevent a second episode. The results were that when taking 325 milligrams of aspirin per day there was a 23 percent lower risk of death.

Simpson stated that people with diabetes have an increased risk of cardiovascular disease, “adding there is evidence that suggest as much as 60 percent of deaths in diabetics is attributable to heart disease.” Simpson stated that “pharmacists could have an active role” in helping patients with their questions regarding aspirin.

Before making any changes in your medication, always check with your doctor first, especially when it comes to any over-the-counter medication. People with type 2 diabetes, in many cases, take several different medications. The addition of aspirin, without their doctor’s consent, might lead to unnecessary problems and hospitalizations.

Aspirin (acetylsalicylic acid) has been around for many, many years and is most commonly used as an analgesic to relieve minor aches and pains, to reduce fever and is an anti-inflammatory medication.

There are side effects from taking aspirin. These include, but are not limited to, stomach upset, bleeding in the stomach (ulcers), and tinnitus (ringing in the ears), especially at higher doses.

As well, aspirin is no longer recommended for use in children when they are suffering from a cold, the flu or chickenpox or other viral sicknesses because of the risk of Reye’s syndrome.

Take care to always check with your physician before adding aspirin to your medicine routine or increasing the dosage, if you are already taking aspirin. The side effects can be serious and life threatening. Your physician will know your medical history and will be able to advise you on whether or not you should add aspirin on a daily basis and whether or not you should increase the dosage.

Linagliptin (Tradjenta) Possible Approval for Use in Europe for Type 2 Treatment: Linagliptin (sold under the name Tradjenta) has been available in the United States for those with type 2 diabetes since May 2011, when the Food and Drug Administration gave their approval for its use at that time. Tradjenta is an oral medication and comes in 5 mg tablets.

Tradjenta has proven to be effective for those with type 2 diabetes who had difficulties tolerating metformin or those with kidney problems. Tradjenta is used along with diet and exercise to lower blood sugar levels.

Tradjenta is not approved for use in conjunction with insulin or for the use in children. Tradjenta can cause low blood sugar levels, resulting in insulin reactions.

In June 2011, Boehringer Ingelheim and Eli Lilly and Company, the makers of linagliptin, received a positive response from the European Medicines Agency’s (EMA) Medicinal Committee recommending that linagliptin in the 5 mg dose, film-coated tablets, be approved for use in Europe. “The Committee for Medicinal Products for Human Use (CHMP) has recommended the approval of linagliptin as a monotherapy in patients inadequately controlled by diet and exercise alone and for whom metformin is inappropriate due to intolerance, or contraindicated due to renal impairment.” They are also recommending that linagliptin might be used in combination with metformin and metformin plus sulfonylurea. Their research showed that when linagliptin was used in conjunction with metformin, it reduced the A1C levels by 0.6 to 0.7 percent when compared to the use of a placebo. The positive opinion for the use in Europe of linagliptin was based on a clinical trial program that involved approximately 4,000 adults with type 2 diabetes.

Professor Anthony Barnett, Clinical Director, Department of Diabetes and Endocrinology, University of Birmingham and Heart of England NHS, UK, was quoted as saying, “This will be an important step forward in the management of type 2 diabetes in Europe.” Furthermore, he stated, “Of note, linagliptin is primarily excreted via the bile and gut, meaning no dose adjustment is recommended in patients with kidney or liver impairment. Therefore, this will be the first DPP-4 inhibitor available at one dose for all adult patients with type 2 diabetes.”

Type 2 diabetes has increasingly been diagnosed around the world. Linagliptin will be a new treatment available in the UK for those suffering from type 2 diabetes and are having difficulties controlling their blood sugar levels.

Boehringer Ingelheim and Eli Lilly and Company are part of a worldwide alliance that was formed in January 2011. Enrique Conterno, President of Lilly Diabetes was quoted as saying, “We are extremely pleased by the CHMP positive recommendation for approval of linagliptin in Europe. Based on our comprehensive studies and the CHMP’s positive recommendation, we believe linagliptin can be an important new treatment option for adult patients with type 2 diabetes.”

Apple Peels, Diabetes and Muscle Wasting: You might not want to peel that apple before eating it, let alone put an apple peel down the garbage disposal or in the trash container under the sink.

Apple peels contains a good dose of ursolic acid. Ursolic acid is a natural compound found in apple peels called pentcyclic triterpenoid and helps to burn fat and build muscle. In a recent study in which mice were used, apple peel was shown to lower blood sugar levels, cholesterol and triglycerides. Ursolic acid is also known as malol, prunol, urson, 3-B-hydroxy-urs-12-en-28-oic acid.

This study was conducted by Dr. Chris Adams, an endocrinologist and senior author of the study for the University of Iowa. The study showed that the ursolic acid found in apple peels could be helpful with the wasting away of muscles that occurs in certain diseases, and also possibly help with metabolic disorders like diabetes. The study results were published in the June 2011 issue of Cell Metabolism.

From the information from his study, Dr. Adams stated, “We found that it actually promoted the growth of muscle, so the mice got bigger muscles and actually got stronger. We can measure mouse strength with a little machine called a grip strength meter.” He added, “It didn’t have any harmful effect on the kidneys or liver or anything like that which makes sense because it’s a natural compound that we actually eat.”

The mice that received the ursolic acid became leaner and had lower blood sugar levels, cholesterol and triglycerides. Further testing will be needed before it is determined that the same positive results will prove to be true for humans.

The muscle-building aspect of the ursolic acid would be beneficial in the treatment of the infirmed and elderly.

Also, it is not known whether the amount of ursolic acid that is consumed on a daily basis by humans would produce the same results.

Ursolic acid is found in apple peels, but it is also found in other plants, including bilberries, cranberries, hawthorn, prunes, elder flowers, lavender, oregano, thyme and peppermint. Ursolic acid has already been recognized as an inhibitor of various types of cancer cells.

Ursolic acid is currently used by the cosmetic industry in the manufacture of cosmetics in its topical form due to its anti-tumor (skin cancer) properties.

Type 1 and Type 2 diabetes diagnoses are growing in number each year. Every little piece of new information garnered that could help in the treatment of these conditions helps all those with these numerous conditions.

In the meantime, we might want to do what we are always told: Eat your fruits and veggies.