March 23, 2012

Statin Risks Outweighed by Statin Benefits?

Statin drugs are at a crossroads. Some are promoting statins very heavily, which includes Big Pharma. At the same time the Food and Drug Administration (FDA) is issuing warnings about statins. These warnings must be part of the written materials included with every prescription.

As more risks are deemed hazardous and more people are experiencing them, it is right that the FDA has taken their action. Now we have an article in WebMD that ups the anti and says “Statin Risks Outweighed by Statin Benefits.” This has to be weighed carefully. Even though the article clearly states the favoritism for statins, as you read the article, I was surprised by the toned down approach taken.

Statin drugs are used to block an enzyme the body needs to create cholesterol and this in turn lowers the amount of LDL cholesterol (the bad cholesterol) in the body. The article lists the following statin drugs: Altocor, Altoprev, Mevacor (lovastatin), Crestor (rosuvastatin), Lescol (fluvastatin), Lipitor (atorvastatin), Livalo (pitavastatin),
Pravachol (pravastatin), and Zocor (simvastatin). Then the person interviewed - Steven Nissen, MD, chair of cardiovascular medicine at the Cleveland Clinic stated, “Clinical trials show that all of these cholesterol-lowering drugs cut the risk of heart disease by 25% to 30%.”

Dr. Nissen does use some common sense, but is still in favor of statins. He states that if you have heart disease, or have a very high risk of heart disease with high cholesterol; statins are one of the best classes of drugs for treating this. He goes on to state, "When used thoughtfully and with good monitoring, they are safe and effective. We all need to watch our cholesterol levels. But statin treatment is not for everyone.”

His last statement is very good and needs to be considered on an individual basis. Nissen says. "Statins should be coupled with good diet and exercise. They are not a substitute for a healthy lifestyle."

The article continues with who should and should not take statin drugs. It covers the risks, many common side effects and the latest warnings from the FDA. Please read as this may answer some of your questions about statins. This will also give you information to have a more informed discussion with your doctor.

In addition, this video needs to be watched. This is a cardiologist from the New York School of Medicine presenting his views on the FDA warnings. Unless I totally misunderstood him, it is full speed ahead with acknowledgment that the warnings exist, but that statins are best for the patient.

March 22, 2012

Will CDEs Really Help PWDs With Depression?

With the exception of a few CDEs working for physicians that are concerned about their patients and make sure that their CDEs are knowledgeable about depression, apparently the American Association of Diabetes Educators is still mired in the past and could care less about the patients. All they seem concerned about is their certification standing and their paycheck. Sad, but true. Read this blog for more confirmation.

Many of us were hoping that with a new leader that is trying (according to her) to improve the profession, we might see some changes. But, apparently those in the trenches are not buying into the changes and we as patients are getting more of the same BS they have been dishing out for years.

After reading the above-mentioned blog, I called my relative that is a CDE in a large practice and asked her about the webinar. She said that one of their CDEs was to have monitored the webinar and she would have a talk with her and get back to me by Monday evening.

I have now had a return call from her. The only statement I am allowed to use is this - “thank goodness the practice we work for gives and sends us to good continuing education classes.” I ask if this applied to the webinar. No, was the answer. We talked about some other topics of interest like self-monitoring of blood glucose and she would only state that she liked some of my blogs on SMBG.

As long as I do not quote her or mention specifics, she will talk openly about many topics as long as they remain just between us. So do not ask for quotes has been good for me. When it comes to her honesty about most topics, she has very good for advice to me and does not spout the mantras of ADA or other professional groups. I have to respect her for this and staying as a relative I can consult.

Based on my own observations, I would conclude that Wil Dubois is probably very much on target with his analysis of the CDE webinar.

March 21, 2012

The Individual Symptoms of Hypoglycemia

Yes, symptoms of hypoglycemia are very individual. One individual may have one feeling and another person may have different sensations. Some of the more common symptoms include extreme hunger, nervousness (shakiness or tremors), excessive perspiration (sweating), rapid heartbeat (tachycardia), headache, fatigue, mood changes, blurred vision and difficulty concentration and completing mental tasks.

Some of the less common ones are a cold feeling, seizures, loss of consciousness and a few others. What the symptoms are telling you is that your brain is not receiving enough blood glucose (sugar), and it is signaling your body for more. Now be aware that these symptoms are not specific to hypoglycemia. There may other causes and the only way to be sure is to use your blood glucose meter and test. If the meter says you are below 70 mg/dl (3.9 mmol/L) then you need to be concerned about hypoglycemia and take corrective action.

People with type 2 diabetes do need to be concerned about hypoglycemia. I often see people complaining about having some of the symptoms shortly after they are diagnosed with diabetes. They are wondering why they have these feelings but their blood glucose readings are still in the 100's. This is generally because they have had a rapid drop from a higher reading that their body has been accustomed to and their brain is telling them it needs more glucose. This should still be of concern, tested for, and not ignored.

I can remember this shortly after I was diagnosed and I would test every half hour for several hours until I knew that I had not gone below 70 mg/dl. Many people with type 2 diabetes never experience true hypoglycemia, but this false hypoglycemia can still become serious if ignored. Those of us with type 2 on insulin even need to be more careful. A small percentage of people with type 2 diabetes can become hypoglycemia unaware. It is more of a concern for people with type 1 diabetes.

Hypoglycemia unaware is the term used to describe the complete lack of symptoms when blood glucose is going low. This does happen to some people with type 2, but not that frequently. Once it does happen, much care needs to be taken. A continuous glucose monitor should be necessary. If your insurance will not allow one, then take time to learn BGAT (blood glucose awareness training), it just may save your life. You will need to learn this on your own as the CDEs refuse to waste time on it. Too much to learn and it will not improve their paycheck.

If you are on oral medications, this web site should be one that you read. It discusses the oral medications and how they can affect your blood glucose and cause hypoglycemia.

March 20, 2012

Researchers Now Advising Against Red Meat

We really need to read carefully some of the studies about red meat that are being reported lately. Observational studies prove little, but these studies are getting press. Recently one of the studies was done by a doctor associated with the Harvard School of Public Health, Boston, MA, it is looks like 22 years of observational looking fits the agenda of the lead investigator.

Now I am not saying that this is not possible, and with all of the growth hormones and antibiotics fed to cattle, it may be that they are right. I do know that less meat is being certified as heart healthy, and the majority of this is grass fed beef.

This is getting a lot of attention in the news media and even in some of the medical journals. It is also being hyped in the medical press. There are even some bloggers hyping the study as being the last nail in the red meat coffin.  I do not believe them.  

At least Tom Naughton has shown the truth about the study and I urge you to read his blog here. Another blog worth reading is this one at Mark's Daily Apple. It is written by a guest blogger and worth the time to read.

For those wanting to read Gary Taubes, I urge you to read his blog about the red meat studies which he calls by other terms.

Since I am behind the times on this topic, reading what others more versed on this is only proper and I hope I have given you something worth your time.  Two other articles about the same study are here and here.

March 19, 2012

Are OTC Diabetes Drugs - a Good Idea?

What do you feel about medications for diabetes, cholesterol, high blood pressure, asthma and migraines becoming over-the-counter (OTC) medications? The current Food and Drug Administration (FDA) is seriously floating this idea. No decision has been made yet, but we need to be prepared should this become submitted for comments.

This came to light in an article by the Associated Press on March 7 and was reproduced in the Washington Post dot com, business section. Another article is here.

In the past, the FDA has approved this action for many drugs only if studies show that patients can safely take the drug after reading the package labeling. There are reasons the FDA is considering this, but I will let you read the reasons on the link above.

Quinn Phillips, writing for DiabetesSelf Management dot com presents other ideas to consider. Both emphasized that this could relieve the patient per doctor load and free up doctor time for patients needing to see the doctor. It is true that we now have the home use A1c test kits. We could use these to check our quarterly blood glucose levels. This self treating of diabetes is bound to create health problems and increase the number of deaths from over medication.

Patients left to their own initiatives have a bad habit of over medication because they think more has to be better. They do this now with supplements, so why would they not do this with medications they are able to get over-the-counter? Yes, many patients will properly use the medications. There will also be patients that will under-medicate themselves thinking they can always increase the dosage later.

Someone has proposed self-serve medical Kiosks where information would be entered in a computer to assist patients in calculating the medication and the dosage required. Others are proposing that pharmacists would be able to keep the medications behind the counter and after the initial doctor's prescription, they would be able to give out the medications upon the patient updating the data via computer. This would be the self-monitoring of blood glucose data entered by the patient.

All of this leaves open the possibility of fabricating data to obtain more medications or decreasing the amount of the medications. Even if the pharmacist could perform the A1c test, people would still be potentially able to skew the results.

Since this is not yet a fact of life, we need to be aware of the potential and how we would react to this happening. The FDA emphasized that consideration of any over-the-counter change is still in the initial stages. If you have thoughts on this topic, please leave a comment below.