November 21, 2015

Diabetes Not Receiving the Attention It Deserves

During the month of June, more than 16,000 news articles mentioned cancer, while over 7,000 mentioned HIV/AIDS. Yet, diabetes was only mentioned in about 5,000. The discussion is strikingly disproportionate to the number of affected patients and potentially affected patients. The other problem about many of the articles is they do not make the distinction about the difference between the types and make education a priority.

Even Congress has been strangely silent about diabetes. I have been corresponding with my two senators and the representative, but none have expressed any anticipation of diabetes being on the agenda for 2015. I am very surprised at their willingness to discuss issues in an open manner.

It appears that Senator Reid (D - Utah) is forcing many issues and preventing others from even being discussed. The House of Representatives now has a change in leadership and it is presently unknown what will be the priorities.

I agree that diabetes is a topic receiving little conversation or even coverage in the news media. Having type 2 diabetes, I can understand that many others with type 2 do not want to talk about it in public and often with others with type 2 diabetes. There are two issues, stigma and severity, that help create the secrecy many type 2 people desire to maintain.

Stigma often stems from the belief that people bring type 2 diabetes onto themselves, a self-inflicted disease resulting from poor dietary choices and not enough activity. Meanwhile, there is a perception that type 2 diabetes is quite manageable for patients, simply a “touch of sugar” that requires taking a few pills each day, eating more vegetables, and exercising.

It is easy to say that for misunderstandings, we must start with education. As with other diseases, such as mental illness, a lack of information causes misunderstanding and judgment. Type 1 and type 2 diabetes are often grouped under the same umbrella, and misconceptions are common, such as the idea that type 1 and type 2 diabetes only result from unhealthy eating habits. Type 1 diabetes is an autoimmune disease, where the body attacks and kills the cells that make insulin. Type 2 diabetes is more complex: genetics, ethnicity, weight, age, environment, and lifestyle factors all play important roles in risk.

Even when patients seek treatment and confront their diagnosis, they are faced with a culture of shame and blame, and the misinformed response of, “It’s your fault.” It is also true that many doctors use this response on type 2 patients.

In addition to the stigma, the burden that this disease places on individuals in terms of health and cost is often forgotten. There are the countless severe complications, including stroke, blindness, kidney disease and heart disease that make diabetes a contributing factor in many other cases of death. The difference in expense is equally dramatic. Diabetes costs totaled $176 billion in 2012 and over 200 billion in 2014.

November 20, 2015

Bariatric Surgery Often Leads to Suicide

Surprise, this information has made many medical papers and they all refer to this Los Angeles Times article. This is another case of bariatric surgeons not giving their patients all the information they need to make informed decisions. They are so interested in the money they make that many push patients to make bad decisions. Vital information is not given to the patient and good questions patients do ask are often brushed aside.

Now I can't put all the blame on the surgeons although they shoulder most of it for not recognizing this group. I am referring to those that are so determined to lose weight that even good sense goes out the window and they often lie to the surgeons to make sure they get the surgery. They are often so vain that they will do anything to rid themselves of a few pounds. Most may have type 2 diabetes, but a few do not.

According to the study, in the three years after they go under the knife, patients who have bariatric surgery to aid in weight loss are more likely than they were before the operation to attempt suicide or end up in the hospital after doing harm to themselves.

A Canadian study that tracked 8,815 bariatric surgery patients found that in their three post-surgical years, 1.3% of those patients landed in the hospital following a self-harm emergency, which included intentional drug overdoses or suicide attempts by other means. However, that rate of self-injurious behavior represented a 54% increase over that seen in the same patient population during the three years before these patients had surgery.

Among those most likely to experience self-harm events following surgery were low-income patients and those living in rural areas. The research highlights a little-recognized challenge patients face in the wake of surgery that replumbs the stomach but also drives far-reaching changes beyond the digestive system.

The authors of the current study suggest that changes in patients' ability to metabolize alcohol in the wake of bariatric surgery might be implicated in some patients' worsening mental health. Certain bariatric surgery procedures that bypass parts of the stomach, patients who drink alcohol often find their tolerance low and become inebriated quickly. Such changes, wrote the study's authors, may affect some patients' risk-taking behavior and ability to suppress self-destructive impulses while under the influence.

Following surgery that limits stomach capacity, in the current study, 68% of the 168 self-harm emergencies noted were attributed primarily to medication overdoses. The study's authors also urged further research into the possibility that altered brain chemistry wrought by the surgical replumbing of the digestive tract might contribute to depression or suicidal behavior.

Most surgeons don't think of this and most ignore questions about this. The research also underscores the need for bariatric surgery practices, a specialty seeing rapid growth, to tend to the mental health of their obese patients not just before surgery, but for several years beyond. Most of the bariatric patients' psychological crises occurred in the second and third years after surgery, a period when there's little interaction between patients and the practices that provided their bariatric services.

The surgeons in the United States were of the opinion that they screened their patients more carefully and had contact with their surgery patients longer than the study indicated. It could be interesting to have a study done on patients in the United States to see if the surgeons really know what they are talking about and actually do what they say.

November 19, 2015

New British A1c Values

I had an embarrassing surprise on a diabetes forum lately when I questioned an HbA1c value of 49. The person was from the United Kingdom and I admit that I was not familiar with the change in values. There may be a few other countries that have adopted this, but I have not encountered them as of yet. Australia apparently has converted to the new system.

The InDependent Diabetes Trust (IDDT) is the organization that developed the new system. This table is from their newsletter.

The relationship between the current HbA1c and the new measurements will be:
HbA1c (DCCT)
Current measurement (%)
HbA1c (IFCC)
Measurement from October 2011 (mmol/mol)
6 42
7 53
8 64
9 75
10 86
11 97
12 108
13 119

I need to thank Tom Ross for the information he had in his November 12, 2015 blog. His information starts at “More risk-assessment!” which is a ways down the blog. Tom does give us a converter link and this will help us convert to the new standards of HbA1c readings. I would urge you to read Tom's blog.

This means that those of us in the United States will now have another conversion to make to understand when seeing information from some other countries.

November 18, 2015

Ideas to Consider After Diabetes Diagnosis

Many different people have different thoughts about what to do when you are initially diagnosed with type 2 diabetes. I doubt my ideas have not been exposed before, but several in our group have asked me to blog about these ideas. It is surprising the different attitudes we have encountered in the last three years.

Yes, we all have seen anger or something similar. Some have seen shock and self-blame. All these are normal reactions as is denial and many go this route and many in our group have seen this. Tim and I have often questioned why we have seen severe depression when this is not one that we see that often. Yes, later we have all seen quite a bit of depression and mostly mild versions of depression.

A couple of people we know are still in the self-blame stage and have refused to consider anything else even with several of the group working with them and explaining how they are not to blame.

We are always happy when people we are working with accept their diabetes and want to take charge of their health. Much of what we suggest depends on how long it has been since diagnosis and recent A1c results. The longer it has been or the higher the A1cs, the more we work with them to help them learn the basics and find what works for them.

I can understand if you panic about the diagnosis, but try not to make drastic changes before you understand something about diabetes. Find what you can do to manage your diabetes, as often you need to take a step back and learn what you can about diabetes. You need to learn what measures should be taken to manage diabetes, and what will help you prevent the complications.

You will need to break down the complexity of diabetes into easy to understand terms and learn why it is important to get an obtainable HbA1c reading. It is even more important to learn how to do the daily testing and learn how the different foods you consume affect your blood glucose levels. Learn to test in pairs, before you eat and about 2 hours after to discover how the meal affected your blood glucose level.

Most newly-diagnosed people with type 2 diabetes are aware that what we eat and how active we are affects our blood glucose levels. Next, we need to learn how caffeine, stress, and amount of sleep affect our diabetes management. All of this should tell you how important the different logs or journals we maintain can help us with diabetes management. Keeping information about your blood glucose readings, what you ate, when you exercised, and how stressed you were that day can provide clues or trends. Use these to discover what affected your blood glucose readings.

The more you learn about what affects your blood glucose levels, the more accurately you can tailor your diabetes management plan to avoid continual trial and error.

Having support in managing your diabetes can be a great help. Several studies have shown that having some kind of support system, whether it is family, friends, a health coach, or a behavioral health counselor, can greatly improve an individual’s ability to manage their diabetes. If you feel like you could use a boost in support, ask your primary care provider about local support groups where you might find peers who may be able to relate to what you are going through because they have been through it.

November 17, 2015

HBOT Helps Foot Ulcer Survival

When I wrote that HBOT may not help foot ulcers on April 12, 2013, I was disappointed because I felt that the researchers had missed something or used the wrong pressures. I have now seen three people being treated by hyperbaric-oxygen therapy and all three have foot ulcers that healed with HBOT.

Results of the study were presented at the European Association for the Study of Diabetes (EASD) 2015 Meeting, by lead investigator Magnus Löndahl, MD, of Lund University, Sweden.

A total of 38 patients completed hyperbaric-oxygen treatment, 37 completed placebo treatment, and 19 did not complete treatment (both groups combined). At baseline, hyperbaric oxygen and air patients had had type 2 diabetes for 23 and 21 years, respectively, had a median age of 67 and 71 years, and had foot-ulcer duration of 11.4 and 10.3 months.

What surprises me is the length of foot ulcer duration. I know one of the three had a foot ulcer for 5 months and two others for less than 4 months. In addition, three of our support group have had foot ulcers for less that 4 months and were able to have their foot ulcers healed with medications. This is one reason to see a podiatrist on a quarterly basis, as they examine your feet for foot ulcers, ingrown toe nails and other foot problems. They will also examine your lower legs for problems and refer you to another doctor if necessary.

Now at 6 years, 63.2% of patients who received at least 37 treatments (of 40 total) of hyperbaric oxygen survived compared with 40.5% of those who got placebo.”

Dr Giel Nijpels, from the Free University of Amsterdam, the Netherlands, the session moderator, commented on the potential clinical use of hyperbaric oxygen.”

"It seems to work, but we can speculate about the disadvantages, including the high cost. Also, I have some doubts about the way the data were analyzed — I'm unsure if this is fully accurate. The problem is that they attempted to blind the patients, and there was a huge dropout rate.

"Also, let's remember you find this type of treatment only in large academic centers — it isn't that easy to administer this form of therapy," he added.

Turning his attention to the possible reasons for the positive effect on chronic diabetic foot ulcer, Dr Löndahl said: "I have no definite explanation today. It might be a coincidence or associated with ulcer healing. It is unlikely to be due to improved macrovascular function, but we do have data that improved microvascular function might be associated with survival, not least due to improved autonomic neuropathy."

Despite the positive results, Dr Löndahl concluded that "we need more information and to further explore and verify findings before [this therapy is]…applied in clinical management of diabetic foot ulcer."

I feel that this type of treatment needs to be explored further, as the expense needs to be considered. HBOT does have its place in medicine, especially in diabetes and traumatic brain injury, and possibly other areas besides deep sea diving.

November 16, 2015

AACE Corporate Partners

It is interesting the number of corporate-partners the American Association of Clinical Endocrinologists has picked up in the last few years.
2015 = 3
2014 = 3
2013 = 2
2012 = 2
2011 = 3

They have this to say about their conflicts of interest. “The following Pharmaceutical and Medical Equipment manufacturers serve as members of the Corporate AACE Partnership. Their generous support and valuable input helps make possible the many educational programs and activities that AACE provides for its members, including this highly effective resource (AACE Online).”

CAP Member Directory

Abbott Diabetes Care
Member Since 2014

Member Since 1993

Aegerion Pharmaceuticals
Member Since 2015

Amgen Inc.
Member Since 2004

Apricus Biosciences, Inc.
Member Since 2015

Member Since 2002

Bayer Healthcare
Member Since 1995

Boehringer Ingelheim Pharmaceuticals, Inc.
Member Since 2009

Clarus Therapeutics, Inc.
Member Since 2014

Corcept Therapeutics
Member Since 2013

Dexcom, Inc.
Member Since 2010

Eisai Inc.
Member Since 2012

Eli Lilly & Company
Member Since 1993

Genentech, Inc.
Member Since 1999

Genzyme Corporation
Member Since 1998

Member Since 1996

Health Monitor Network
Member Since 2012

Interpace Diagnostics
Member Since 2015

J&J Diabetes Solutions Companies
Member Since 2014

Janssen Pharmaceuticals, Inc.
Member Since 2001

Lexicon Pharmaceuticals, Inc.
Member Since 2013

Medtronic Diabetes
Member Since 1995

Merck & Co., Inc.
Member Since 1997

Novo Nordisk, Inc.
Member Since 1993

Pfizer, Inc.
Member Since 1993

Member Since 2007

Roche Diabetes Care
Member Since 1997

Member Since 1994

Takeda Pharmaceuticals North America Inc.
Member Since 1999

Member Since 2011

Member Since 2011

Member Since 2011

November 15, 2015

Why Can't We Joke About Diabetes?

This is a difficult topic for many people. Maybe I have too thick of a skin, as most diabetic jokes seldom get any emotion from me. Even some of the caustic remarks said to me won't get a rise from me. I generally ignore the food police or I hand it right back.

Why is it that people with diabetes can't develop a thicker skin? Over on A Sweet Life, there have been two blogs (one has been pulled) about how thin-skinned people can be about diabetes.

The blog that has been pulled was complaining about a remark made by President Obama and the comments all felt that the remark was not that offensive and was innocent enough. But, the author had the blog deleted. I could see both sides and either side was correct depending on what you were looking for in the remark. The blog author was highly incensed by the remark.

The second blog, which is still posted is a great post and shows that we should be able to laugh at ourselves. I would encourage you to read the blog by Melissa Lee as it could be the answer you need.

Yes, some jokes are cruel and insensitive and out of place, but others can be a lot of fun and we need to laugh at these. Plus, we need to be able to laugh at ourselves even with diabetes. If we can't laugh at ourselves, then we are the worse for this.

I can understand those that are newly diagnosed, not finding many things humorous and there is a lot of education that needs to be done for people to understand the difference between the different types of diabetes. I am not talking about the people with diabetes, but the general public and some doctors.