High Uric Acid Linked to Both Gout and Diabetes

Since this is coming from the Mayo Clinic, I think we need to take notice. I have never thought about this since I have never been bothered by gout, but it is something that many people have problems with and once the symptoms go away, most people forget about it until the next time then have gout.

Dr. Eric Matteson, MD, MPH, head of rheumatology at the Mayo Clinic in Rochester, Mn states, "Many people are walking around with uncontrolled uric acid levels and we used to not worry about it -- if they're not having symptoms, who cares?" This still is a problem for many doctors and patients and needs to improve. People need to be tested for uric acid levels under the following situations, people undergoing chemotherapy or radiation treatment, help diagnose the cause of recurrent kidney stones, and when you have gout or are otherwise at risk for kidney stone formation.

New studies are indicating that people with high uric acid levels in the blood are at a 20 percent increased risk for developing diabetes. What also needs to be of concern is the 40% increased risk of developing kidney disease. This tells me that if you already have diabetes and have had gout, you need to be tested regularly to help prevent kidney disease.

Although not mentioned in the studies, Matteson says, "Now we're finding that elevated uric acid, by itself, even if you have no gout, is associated with higher rates of heart attack, metabolic syndrome, diabetes, even death due to cardiovascular disease." He also states that gout is under treated disease and advises getting uric acid levels under control, through diet or medication. He also urges people to maintain a healthy weight and that obesity is a major risk factor for all of these conditions.

Read the press release here.

U.S. Surgeon Urges - Update Family Medical History

The holidays are here and it is time to update family history when you have seldom seen family members around. Corner you favorite uncle or aunt and asks some hard questions about the family medical history. Read my blog from about a year ago on obtaining family history.

This year the U.S. Surgeon General declares Thanksgiving as the eighth annual “Family Health History Day”. I say it may take the entire holiday season, but family medical history is important. Earlier generations were often very silent about serious health problems and early deaths. This could be important in your medical history and you need to get relatives alone to ask them about specific health questions.

Get as much information as you can and record this if possible on the spot. By carrying a voice-activated recorder in my shirt pocket, I did get a lot of valuable information one year, but the family found out I had family medical history and will not talk to me since. But, added with the information I had in my own research, I have more medical history than much of the family is aware. This has proved valuable and helps me understand why I developed type 2 diabetes.

Heart disease is not part of my health history, but cancer is and many types of cancer including colon cancer. This has proved very valuable and I have been able to prevent this so far.

So if you are short of family health history, use the holidays and family gatherings to increase your medical history knowledge. Read this article about a Dutch study and the U.S. Surgeon's notice and gather your medical history.  But don't stop there, keep on digging when you see or hear from family members.

For my US readers have a great Thanksgiving and everyone else, have a great day.

What is in a Title That Has People Upset?

This is a most interesting article and presents a very real problem for title conscious people. Some doctors do seem the have their noses out of joint a little too much, but some are very understanding and tolerant. The discussion centers on the fact that many nurses and dietitians now are getting their PhD's and are being called doctor in the workplace. The question really becomes a problem in distinguishing nurse practitioners and physician assistants with PhDs from licensed MDs.

Of the participants involved in the discussion, a solid majority had a strong negative reaction. Most of it revolved around the amount of education and medical residency MDs are required to have and not the nurse practitioners or physician assistants to say nothing about the registered dietitians that have earned their PhDs.

Some of physicians were very specific in their denouncing of people with PhDs being called doctor in the medical setting. Calling them liars and saying that they were deceiving people were just a few of the examples used. A few were even more senile calling nurse’s enemies.

Now I want to emphasize the more positive side of the discussion. A few said they had no problems with them being recognized for their education. One stated, "I personally don't have any qualms about calling someone else with a doctorate doctor. So it's OK if the nurse doctorates are called doctor. It's only a word."

Others felt that adopting the British system was an answer. That means using the word Mr. or Ms. And using this for people with medical licenses. I liked this suggestion and for patients hearing this, it would be more comforting. An emergency room doctor offered another solution: "Let's stop introducing ourselves as Dr. So-and-So. Instead of 'Hello, Mr. Smith. I'm Dr. Jones,' we could say, 'Hello, Mr. Smith. I'm Chris Jones and I'm the ER doctor/physician.' The bottom line: Emphasize our role and not our title."

One general practitioner blasted the title itself: "I don't like the pretentious prefix doctor at all...Use of such prefixes encourages patients to put the physician on a pedestal, and the physicians, of course, love it since they then don't have to say too much and [it] keeps their patients awed."

Most participants disagreed and wanted to preserve the title. As a patient, I prefer the attitude of the last two comments above. Physicians that want us to put them on a pedestal do not deserve this from patients. They must earn this through their actions and treatment of their patients as humans. A title for sake of the title does not deserve respect from patients until they earn it and education alone is not proof that they deserve a title. Even people with PhDs must earn their title by their actions and the way they treat people they serve. Yes, I said serve, because they do serve us as patients. They teach, advise, and are supposed to work with us to help us manage our chronic illness.

Three Choices for “Dosing” Insulin for Type 2

I have not seen a lot of discussion about this topic. Many bloggers talk about bolusing for covering carbohydrates and for high blood glucose readings, but this blog by Joslin Communications talks about three choices for “dosing” insulin. This is talking about people with type 2 diabetes. Yes, type 1 is mentioned, but mainly as a comparison for helping type 2's get past their fear of needles and insulin.

The article discusses three basic types of regimens for people that use a basal/bolus treatment. The first is known as a fixed dose. The fixed dose regimen is predicated on the assumption that people eat a consistent amount of carbohydrates on a regular basis. They say that this works well and is appropriate for people new to diabetes and their understanding is limited and want to approach change slowly.

While they do describe varying the amount of insulin with each meal, the disadvantage is the rigidity and not allowing for extra insulin if the pre-meal blood glucose is high. This also can create problems if you are not feeling good and are not as hungry, thereby limiting the food intake for that meal or skipping that meal. This is when people on fixed doses of insulin can experience hypoglycemia. This also does not allow food intake to vary greatly and people will end up with a pattern of blood glucose readings that vary widely.

Next, the blog talks about the sliding scale for insulin dosing. I had hopes that this was more informative, but basically it just requires more testing pre-meal and adjusting for insulin as a correction, but using a fixed dose for the meal that will be eaten. This can be especially dangerous if for any reason a meal is delayed or not eaten as hypoglycemia can be a very real problem if this happens.

A sliding scale requires more patient time investment to manage diabetes and maintain a higher level of management. This method is preferred over the fixed dose of insulin and does allow for better management of diabetes if they are committed to a structured meal plan.

Both the fixed dose and sliding scale are based on carbohydrate counting and requiring that the food consumed matches the insulin injected. This means that people can vary the type of foods somewhat, but the total carb count must be the same for each meal.

The third approach in called matching insulin to carbohydrate. This is the method I use and does require knowing two ratios and applying them correctly. It also takes a little time to discover what each ratio is for yourself. Here you will definitely become your own science experiment to determine and refine your insulin to carbohydrate ratio and the correction ratio.

Unless you are extremely knowledgeable and very lucky, this process will take some time. I remember adjusting and refining mine for almost a month and then having a CDE tell me I was not doing it right. Turns out, I was right even if she thought otherwise. I was very insulin resistant and as a result my ratio was very narrow both for the insulin to carbohydrate and correction ratios.

In addition, you need to know what your target blood glucose is when the insulin is done. In my case, I take Novolog and it lasts for about four hours. I know that if I test before my next meal and I am above my target, either I miscalculated my carbs or my insulin resistance has increased or decreased. In addition, other factors can influence the blood glucose readings, such as stress, illness, or other factors. You will soon learn what affects you and how your body chemistry reacts to different factors and before long, you will become very adept at adjusting your ratios.

To use this method requires more attention to detail and good math skills. Insulin to carb matching is worth the extra effort because it allows more flexibility in food choices and most importantly enables you to take a more active role in your care. 

Read the Joslin blog here.

No Double Standards for Natural Health Products

I am almost sure our Canadian neighbors have heard this before, but it is interesting that both the American Medical Association and Canadian Medical Association are constantly calling for regulation of natural health products. While I know this is part of the checks and balances for both countries, both medical communities have increased the rhetoric recently for some reason.

While it is true in these difficult times that more people are turning to natural products to avoid the cost of any medical office visits or expensive medications, it is a shame that the medical communities are trying harder to make alternative medicine even more expensive and unaffordable to many more.

While the Canadian press release is short, it does spell out some excellent points. I do not think all of theirs applies here, but this does not negate concerns on both sides of the border. The one issue that is common is the mantra that because the ingredients are natural, there is not reason to be concerned about taking the alternative medications. This is one falsehood or myth that needs busting and here is my agreement that the regulatory agencies in both countries have been looking the other way for far too long. Allowing this reasoning to continue will do more harm than good in the short- and long-term.

I have written several blogs about the dangers of some alternative medications and supplements that do damage and harm if mixed with some prescription medications. Why with the internet and even the many pharmacists that are aware of the problems, why do people still not check out the harm that can be caused by taking alternative medications with prescription medications? Again, the false information put forth by the natural health products industry sells the perception that because its products are "natural," they must also be safe because they are not required to be tested.

While I agree that testing of many of the alternative medications is not necessary, I am concerned that those that need testing because of known conflicts are being given a pass and not required to be labeled with the known facts of causing harmful or even deadly conflicts. This is where both medical groups in both countries have a valid case and need to pursue it with vigor.

Consumer protection is a valid concern and the one area that the natural health products industry is negligent, this is their weakness, and this needs to be closed and the responsible parties held financially responsible. This carelessness is a concern well founded and needs attention in both countries.

Read my blogs here, here, and here. Read the press release here.