February 9, 2013

This Is Inflammatory Junk Science

I must tip my hat to Dr. Bill Quick for his blog earlier today on Health Central. Please read his blog. I had thought something was wrong with this study, but I am still waiting for a reply from Prof Craig Currie of Cardiff University School of Medicine. Whether I receive a copy of the study now makes no difference, and Dr, Quick confirms what I had thought about the study.

Angry – yes, but I cannot be as polite as Dr. Quick. To me this study is just what the title says. For this to be reported by one of the top Universities in the United Kingdom is not saying much about the medical school.

Two other press releases can be read here and here, but Dr. Quick sums up the faults of the study very succinctly. Therefore I ask you to read his blog and I'll be quiet. The last link in the first sentence of this short paragraph is also a link in Dr. Quick's blog.

February 8, 2013

Useful Aids for People with Diabetes

This blog is not your typical blog, but I hope it will help many people. I decided to do this as I have aids here, there, and elsewhere and I was trying to pull them into one source to find them easier. Even I would be better served if I would bookmark some of them.

http://labtestsonline.org/ I have used this one for many blogs and like the information. I have used only a small portion of this site, the parts related to diabetes. This site has a lot to explore and does take some time to be comfortable using it, but at the same time does have a logical order. You do need to visit the site regularly as there is often new articles and some changes as material is updated for new information. I try to visit biweekly.

http://www.umm.edu/altmed/ This University of Maryland website is one of my goto sites for information on herbs and supplements. I also use the symptoms area for research.

http://lpi.oregonstate.edu/infocenter/ This Oregon State University website is another site that I value highly for information on vitamins and minerals and some other supplements.

http://www.nlm.nih.gov/medlineplus/ Medline is a great site for health topics, drugs and supplements, and videos and cool tools. This site has been useful for me when I am doing research. Take time to explore the site and see if it will be useful for you.

Take time to explore this site to determine if you wish to join. There is no fee, and I find the site very useful, especially for recipes that otherwise would have no nutritional information. I don't use the shopping list, but that is just me. I do have a scale that I can use which really helps when doing my own recipes for which I do not have written records.

http://www.healthcentral.com/diet-exercise/ideal-body-weight-3146-143.html This is the first site that I have found useful and that allows for different body types, small, medium, and large frame.

http://professional.diabetes.org/glucosecalculator.aspx This is a handy calculator for converting an A1c value into an estimated blood glucose reading or an estimated blood glucose reading to an A1c value. This can be done for mg/dl or mmol/L. So if you are a person that thinks your blood glucose readings are more accurate that the A1c, then use your average figure and compare this to the actual A1c. I have used this in some heated discussions to show people that their averages will seldom arrive at the A1c value.

http://www.globalrph.com/conv_si.htm#top This is a often used table of conversion values for converting from USA units to units used by the rest of the world and the reverse.

http://reference.medscape.com/drug-interactionchecker This is a drug interaction checker. I seldom use this, but do when WebMD does not list the drug or lists no drug interactions.

http://diabetes.niddk.nih.gov/dm/pubs/medicines_ez/index.aspx This is my goto source for all diabetes medications. The top is generally where I go when looking up oral medications or insulins. Down the page is other useful information. I urge people to bookmark this for future reference.

http://nhlbisupport.com/bmi/ This is just one of the Body mass index (BMI) calculators available on the internet. I do not like calculating this, but occasionally I have needed to.

http://www.caloriesperhour.com/index_burn.php This site has several calculators, BMI, Estimate your Basal (BMR) and Resting Metabolic Rates (RMR), and how many calories you burn in a day based on a general activity level. It also has an activity calculator.

http://dwjay.tripod.com/conversion.html I admit that I seldom use this calculator, but I have on occasion.

http://www.nal.usda.gov/fnic/foodcomp/Data/SR15/sr15.html This is an outdated nutritional database, but I mention it for historical value as some food nutrition calculators do use this even though it has been superseded by this USDA website http://www.ars.usda.gov/main/site_main.htm?modecode=12-35-45-00 For this site I have taken you to the home page so that you may see other possible features you may wish to explore.

http://www.soc-bdr.org/rds/authors/unit_tables_conversions_and_genetic_dictionaries/e5184/index_en.html This is another glucose conversion table for converting values from USA to the rest of the world and the reverse. (mg/dl to mmol/L)

http://en.mte.cz/conversion.php And another glucose converter.

http://www.ncbi.nlm.nih.gov/sites/entrez US National Library of Medicine National Institutes of Health – this is one site I use when I am looking for information and have some of it and I come here looking for possible full text versions. I don't always find what I am looking for, but occasionally I hit the jackpot.

http://www.glycemicindex.com/ I use this site for glycemic index (GI) calculator and glycemic load (GL) calculator. This is primarily for when I cannot find what I want in published tables.

I would appreciate additions to this and would gather them for another blog. All help is greatly appreciated.

February 7, 2013

Nutrients – Manganese


Manganese is a trace mineral that is present in tiny amounts in the body. It is found mostly in bones, the liver, kidneys, and pancreas. Manganese helps the body form connective tissue, bones, blood clotting factors, and sex hormones. It also plays a role in fat and carbohydrate metabolism, calcium absorption, and blood sugar regulation. Manganese is also necessary for normal brain and nerve function.

Manganese is a component of the antioxidant enzyme superoxide dismutase (SOD), which helps fight free radicals. Free radicals occur naturally in the body but can damage cell membranes and DNA. They may play a role in aging, as well as the development of a number of health conditions, including heart disease and cancer. Antioxidants, such as SOD, can help neutralize free radicals and reduce or even help prevent some of the damage they cause.

Low levels of manganese in the body can contribute to infertility, bone malformation, weakness, and seizures. It is fairly easy to get enough manganese in your diet -- this nutrient is found in whole grains, nuts, and seeds -- but some experts estimate that as many as 37% of Americans do not get the recommended dietary intake (RDI) of manganese in their diet. The American diet tends to contain more refined grains than whole grains, and refined grains only provide half the amount of manganese as whole grains.

Deficiency Symptoms
1. Asthma – Low manganese levels are consistently associated with childhood asthma, while one study found a similar relationship between dietary manganese intake and asthma in adults.
2. Ineffective utilization of several key nutrients – Choline, thiamin, ascorbic acid, and biotin all require adequate manganese to be utilized by the body.
3. Low thyroxine (thyroid hormone T4) – Manganese is essential in the production of T4.
4. Osteoporosis and joint pain - Bone mineral density doesn’t just come down to calcium (or magnesium). Manganese also plays a small but important role in skeletal health. Consider the story of Bill Walton, basketball legend and the greatest hyperbolist in the history of Western Civilization, who was diagnosed with osteoporosis at the height of his career after a series of broken bones that would not heal. The cause? A macrobiotic diet that left his serum manganese levels entirely undetectable.
5. Low HDL – In women fed a manganese-deficient diet, HDL plummeted.

Trace mineral testing is usually performed on a blood sample. Sometimes a 24-hour urine collection is obtained. Special metal-free blood or acid-washed urine containers are used to minimize the potential for sample contamination by any outside sources of minerals.

Blood and urine reflect recent mineral intake. Rarely, hair may be collected or a biopsy may be performed to obtain a tissue sample to evaluate mineral deficiencies, excesses, and storage that have occurred over time.

Recommended Daily Allowance
The daily Adequate Intake (AI) for manganese is listed below. Supplements and dietary intake of manganese together should not exceed 10 milligrams per day because of the risk of nervous system side effects. You should only take manganese supplements under the supervision of your doctor; that is especially true for children.

Children and Infants
Infants 0 - 6 months: 0.003 mg
Infants 7 months - 1 year: 0.6 mg
Children 1 - 3 years: 1.2 mg
Children 4 - 8 years: 1.5 mg
Males 9 - 13 years: 1.9 mg
Males 14 - 18 years: 2.2 mg
Females 9 - 18 years: 1.6 mg
Males 19 years and older: 2.3 mg
Females 19 years and older: 1.8 mg
Pregnant women: 2 mg
Breastfeeding women: 2.6 mg

Pregnant women and nursing mothers should avoid intakes of manganese above the upper limit of the AI, unless under a doctor's supervision.

Diabetes is a possible problem associated with manganese. Some studies show that people with diabetes have low levels of manganese in their blood. Researchers don't know if having diabetes causes levels to drop, or whether low levels of manganese contribute to developing diabetes. It should be a priority that more studies are needed. One clinical study found that people with diabetes who had higher blood levels of manganese were more protected from LDL or "bad" cholesterol than those with lower levels of manganese.

Food Sources
The following are important sources of manganese. In descending order from richest, hazelnuts, pine nuts, pecans, walnuts, mac nuts, and almonds are all good sources of manganese. Bivalves from the sea and mussels are the best source, followed by oysters and clams. Raspberries and dark chocolate when eaten together can also be an excellent source. Other dietary sources of manganese include wheat germ and whole grains (including unrefined cereals, buckwheat, bulgur wheat, and oats), legumes, and pineapples.

Precautions Toxicity
Inhaled manganese
Manganese toxicity can result in multiple neurological problems and is a well-recognized health hazard for people who inhale manganese dust, such as welders and smelters. Unlike ingested manganese, inhaled manganese is transported directly to the brain before it can be metabolized in the liver. The symptoms of manganese toxicity generally appear slowly over a period of months to years. In its worst form, manganese toxicity can result in a permanent neurological disorder with symptoms similar to those of Parkinson's disease, including tremors, difficulty walking, and facial muscle spasms. This syndrome, often called manganism, is sometimes preceded by psychiatric symptoms, such as irritability, aggressiveness, and even hallucinations. Environmental or occupational inhalation of manganese can cause an inflammatory response in the lungs. Clinical symptoms of effects to the lung include cough, acute bronchitis, and decreased lung function.

Methylcyclopentadienyl manganese tricarbonyl (MMT)
MMT is a manganese-containing compound used in gasoline as an anti-knock additive. Although it has been used for this purpose in Canada for more than 20 years, uncertainty about adverse health effects from inhaled exhaust emissions kept the US environmental protection agency (EPA) from approving its use in unleaded gasoline. In 1995, a U.S. court decision made MMT available for widespread use in unleaded gasoline. A study in Montreal, where MMT had been used for more than ten years, found airborne manganese levels to be similar to those in areas where MMT was not used. A more recent Canadian study found higher concentrations of respirable manganese in an urban versus a rural area, but average concentrations in both areas were below the safe level set by the U.S. EPA.

Ingested manganese
Limited evidence suggests that high manganese intakes from drinking water may be associated with neurological symptoms similar to those of Parkinson's disease. Severe neurological symptoms were reported in 25 people who drank water contaminated with manganese. Manganese in drinking water may be more bioavailable than manganese in food. Additionally, studies that are more recent have shown that children exposed to high levels of manganese through drinking water experience cognitive and behavioral deficits. Manganese toxicity resulting from foods alone has not been reported in humans, even though certain vegetarian diets could provide up to 20 mg/day of manganese.

Possible Interactions
If you are currently being treated with any of the following medications, you should not use manganese supplements without first talking to your health care provider.
1. Haloperidol and other antipsychotics -- There has been at least one clinical report of an interaction between haloperidol and manganese that resulted in hallucinations and behavioral changes in a person with liver disease. In addition, some experts believe that medications for schizophrenia and other forms of psychosis may worsen side effects from manganese supplements. If you take antipsychotic medications, do not take manganese without first talking to your doctor.
2. Reserpine -- Reserpine, a medication used to treat high blood pressure, may lower manganese levels in the body.
3. Antacids -- Magnesium containing antacids may decrease the absorption of manganese if taken together. Take supplements containing manganese at least 1 hour before or 2 hours after taking antacids.
4. Laxatives -- Magnesium containing laxatives may decrease the absorption of manganese if taken together. Take supplements containing manganese at least 1 hour before or 2 hours after taking laxatives.
5. Tetracycline antibiotics -- These drugs may reduce the absorption of manganese if taken together. Take supplements containing manganese at least 1 hour before or 2 hours after taking these antibiotics. They include tetracycline, minocycline (Minocin), and demeclocycline (Declomycin).
6. Quinolone Antibiotics -- Manganese may inhibit the body's absorption of these medications.

February 6, 2013

Diabetes and Driving

Should the American Diabetes Association be setting driving license guidelines for people with diabetes? This is a topic for discussion as the ADA has done exactly this for 2012 and 2013. Check out the 2013 guidelines here.  In discussing this within our informal group, there are mixed feelings. A few feel that the ADA should not have made a statement about this. Most of us think it may be a good thing. Even those of us feeling good about this have mixed emotions at some point.

Since I have some experience as a trucking safety director, I was probably given the most attention. The fact that the Department of Transportation (DOT) has, in the last five years, allowed people with diabetes to have a commercial driver’s license (CDL), we have to think that this speaks volumes and this was without the ADA guidelines. When I retired, people with diabetes were not allowed to drive with a CDL. I was aware of a study being done by the DOT and some drivers being regularly tested and allowed to drive with diabetes, but only as part of the study. Now they are able to drive with diabetes, but must be evaluated every two years. Their diabetes doctors can stop this at anytime if the patient is not managing their diabetes.

Most people are able to drive a car with a regular driver’s license. Many states already have laws on the books about physicians reporting when it was felt people with diabetes were not responsible enough to drive or did not manage their diabetes in a responsible manner. Most all of us agree with the statement of writing group chair Daniel Lorber, MD, FACP, CDE, a member of the ADA Professional Practice Committee and director of endocrinology at New York Hospital of Queens in Flushing, when he says about the 2012 guidelines, “This country needs a far more consistent, fair and equitable means of determining driving risk when it comes to people with diabetes. The vast majority of people with diabetes have no problems driving safely whatsoever, and should not be held to restrictions that may interfere with their ability to work or live an otherwise normal life.”

Consistency is always good, if this is indeed the goal. I do wonder if anyone is actually looking at the laws of the different states and trying to propose legislation to bring laws into consistency. We do need this and if the ADA is working to make the following statement work and be consistent across the medical profession, this may be a small start. “The statement, therefore, highlights the need to identify those individuals, who are at high risk for unsafe driving, and to design and implement strategies to lower this risk.”

Our group also wonders if the doctors will be consistent in the way they report to the state about their assessment of the diabetes patients. Many people are concerned that some doctors will be more hard-nosed about this and try to have some patients lose their license. We are aware of some doctors that don't care and will not assess drivers with diabetes, while others that are being very hard-nosed about this and reporting almost 50 percent of their patients.

This is when patients are going to realize that these doctors have done nothing to educate them about diabetes and what to do to manage it more effectively. We have several members of our informal group that are very concerned. They have stated that if it was not for our group, they would have very little education. They have had their doctor ask them continuously about hypoglycemia and how often they have had it. Since only one of them has had one time with hypoglycemia, the doctor is claiming that they are not being honest and is becoming very belligerent about it. Yes, the three of them have had excellent A1c's. Two were 5.8% and the other 5.7%. The doctor says they all should be above 6.5% and nearer 7.0%. We have all urged them to consider finding a different doctor.

All three are between 56 years and 64 years of age and still working at jobs they love. One has finally found a different doctor and is much happier as the doctor has asked about hypoglycemia and after he explained, he is eating low carb, getting daily exercise, and has not had hypoglycemia or readings below 75 mg/dl. The doctor did download his meter and reviewed the log and said there was no indications of hypoglycemia. His latest A1c was 5.6% and the doctor just told him to continue what he is doing. They did discuss medications and the doctor asked if he wanted to go back to oral medications, but did not go farther when told no.

Most of our group feels that there are some people that are not paying enough attention to their blood glucose levels before driving. One of our group has a type 1 neighbor that has been taken to the hospital several times in the last year for extreme hypoglycemia and still drives. He does wonder if he will continue to have accidents like he has in the neighborhood and still be able to drive.

The section on driving with diabetes on the guidelines is rather lengthy, but has a lot of good information that patients need to understand to avoid problems and not put their driving privileges at risk.

February 5, 2013

We Now Have Guidelines for Diabetes in Youth

At least the American Academy of Pediatrics (AAP) has issued a set of guidelines to provide evidence-based recommendations on managing type 2 diabetes in children ages 10 to 18. The American Diabetes Association still does not know how to deal with children and adolescents unless they have type 1 diabetes. Type 2 does not seem to be on their list of objectives.

The guidelines are in a PDF file and can be downloaded and opened by Adobe Reader. Then they can be saved to another file. I think what Dr Bill Quick says is worth quoting. “A warning to those of you who might be interested in reading the guidelines: they are very lengthy and very wordy. So don’t expect to be able to hand a copy to your physician and have the doc scan it and comment upon it while you wait… But if your medical team sees kids with diabetes, and isn’t aware of these guidelines, it would be worthwhile to let them know these guidelines exist.”

The files - “Guidelines full text” and “Technical report full text” for downloading can be found here at the end of this Medscape article. I have to be fair and list the other medical organizations that assisted the AAP in developing the guidelines. They were developed with support from the American Diabetes Association, the Pediatric Endocrine Society, the American Academy of Family Physicians, and the Academy of Nutrition and Dietetics (formerly the American Dietetic Association).

Coauthor Janet Silverstein, MD, professor of pediatrics at the University of Florida and chief of endocrinology at Shands Hospital, Gainesville, FL has made some statements to Medscape that are important to be considered. “First is a recommendation for insulin treatment in all patients who present with ketosis or extremely high blood sugar, in whom it may not be clear initially whether they have type 2 or type 1 diabetes. This is important because overweight or obese children are frequently misdiagnosed as having type 2 when in fact they are positive for antibodies associated with type 1.”

Her next statement is more important. “Once type 2 diabetes is confirmed, lifestyle modification along with metformin as first-line therapy is recommended. Metformin and insulin are the only 2 glucose-lowering medications currently approved in youth less than 18 years, but others are being studied.” I would urge everyone to read the Medscape article and consider downloading at least the Guidelines.

February 4, 2013

Insulin Is Not Punishment

Insulin isn’t punishment like your doctor would like you to believe. Yes, I've said it. There seems to be more than a few doctors that use insulin as a threat to chastise and intimidate people with type 2 diabetes. This is a tool they use to try to get patients on oral medication to adhere to their regimen and not need to go on insulin.

This is the reason I like our group where now 10 of 14 members are on insulin. All of us have type 2 diabetes and we don't feel like we have failed. We just like the lack of side effects and the ease of diabetes management. When I brought this article to the attention of the group, only one member expressed that his doctor had tried this on him and that was the last time he had seen that doctor. Most of the members have chosen to be on insulin after talking with the rest of us, seeing our A1c's, and how we feel on a daily basis.

This article is an interesting one on Insulin Nation. The type 2 person was picked out of a group of people that had taken the A1c test at a Taking Control of Your Diabetes (TCOYD) Conference in San Diego. Her A1c was 11.6%. This was her ticket to a 20-week “Extreme Diabetes Makeover” program led by TCOYD's founder Dr. Steve Edelman. Other members of the team included an exercise physiologist, a CDE, a nutritionist, and Dr. William Polonsky.

We put her on Byetta right after the conference,” Edelman says, “Because she was fighting weight problems and her glucose levels after eating were in the upper 200s, I increased her metformin dose to 1,500 mg at bedtime. Sometimes just shifting the dose to nighttime helps the morning blood sugar.” Stanton's glipizide dose was increased to the maximum, but even the new medications and dose increases were not helping her daily morning readings. This is when they added a long acting insulin at bedtime.

Stanton wasn’t afraid of the shots — both Byetta and insulin required daily injections — but she viewed her need for insulin as a personal failure. For years, her previous doctors had portrayed “going on insulin” as a last resort — the punishment for being a “bad diabetic.”” Where have I heard this before? Yes, this is what I said above was a tool the doctors like to use.

Dr. Polonsky, founder of the Behavioral Diabetes Institute, knew he had to change that feeling and explained that if you have diabetes long enough, you may well need insulin at some point. He also explained that insulin is not only for type 1 diabetes. With type 2 diabetes, the pancreas will eventually quit working when it can't produce enough insulin to help manage elevated blood glucose levels.

Increased exercise and modified diet are not the answer when a person with type 2 diabetes has consistently elevated blood glucose levels. Insulin is the medication that works to bring elevated blood glucose levels down and this is what makes exercise and diet changes work. This should indicate that people with type 2 diabetes need to consider insulin sooner rather than as a medication of last resort.

If you have a doctor that uses insulin as a threat, you have your health to think about and it might be wise to ask the doctor for insulin. If he goes back to using it as a threat or says you are admitting failure, then it is the time to find another doctor. Your diabetes health is not something you should think of as a failure and the sooner you consider insulin, the easier it will be to remain healthy.