While very out of control diabetes can and does raise lipid levels, most type 1 diabetics have better cholesterol levels than nondiabetics. This sometimes surprises people who do studies on the topic.
For example, in this study, 44 overweight kids with type 1 diabetes were matched to similarly overweight kids without diabetes, who were the same age, etc. The diabetics had lower total cholesterol, higher HDL (the one you want) and lower LDL and VLDL.
The authors speculate that this is because, if diabetes is what's making you fat, it doesn't raise your cholesterol, vs. if a sedentary lifestyle is making you fat, it'll also raise your cholesterol. I don't know. Personally, I don't think that explains it. In any case, it's also interesting to note that overweight kids with type 1 diabetes have blood markers that suggest better health than nondiabetic overweight kids.
This study similarly surprised its authors, and is about the same thing.
While a number of studies have convincingly shown that diabetes can have bad affects on your ability to think, in a number of studies diabetic children acheive better grades and higher standardized test scores than their non-diabetic peers. This is especially apparent in math- it's good practice, I guess.
And, of course, diabetes is a risk factor for climbing Mt. Everest!
(since I wrote that piece, a young woman with type 1 diabetes has climbed on Everest as far as the base camp, and another group of four young people with type 1 diabetes are planning an Everest climb as part of an advertising campaign for a diabetes company).
Sunday, November 11, 2012
Saturday, November 10, 2012
FDA Votes For Degludec
The FDA recently approved the new insulin degludec, and the vote was 8 to 4. I thought the 4 who voted against made an excellent case for why it should not be approved, or at least not yet, and I strongly advise you to avoid using degludec, at least until larger studies show that what looks like an increase in heart attacks isn't. Because I think that at the least, there's evidence that there's not enough evidence to say it's safe.
The FDA votes against medications are usually on one of three grounds.
3. Possible human error would lead to problems. For instance, if U500 insulin was accidentally given instead of U100 insulin.
2. Not enough safety evidence, or trials were done poorly.
1. Medication's side effects are a really big deal compared to possible benefits.
In my opinion, a no vote because of #3 is something a consumer should be aware of but is not a reason to avoid a medication- after all, you know what user error you want to avoid. #2 is sometimes nitpicky, but if a medication doesn't hold big promise, then this is a reason to avoid it. #1 should really make you pay attention.
For degludec, members of the committee raised issues #1 and #2, because the studies were not well done and because the risk of heart attack was higher in the group using degludec vs glargine.
I started wondering what committe votes looked like for other insulins. Unfortunately, I didn't find them. So here's an FDA fact for you: in was founded in 1938, and prior to that, there was no review process required before the release of a drug in the United States or much of anywhere else.
The FDA votes against medications are usually on one of three grounds.
3. Possible human error would lead to problems. For instance, if U500 insulin was accidentally given instead of U100 insulin.
2. Not enough safety evidence, or trials were done poorly.
1. Medication's side effects are a really big deal compared to possible benefits.
In my opinion, a no vote because of #3 is something a consumer should be aware of but is not a reason to avoid a medication- after all, you know what user error you want to avoid. #2 is sometimes nitpicky, but if a medication doesn't hold big promise, then this is a reason to avoid it. #1 should really make you pay attention.
For degludec, members of the committee raised issues #1 and #2, because the studies were not well done and because the risk of heart attack was higher in the group using degludec vs glargine.
I started wondering what committe votes looked like for other insulins. Unfortunately, I didn't find them. So here's an FDA fact for you: in was founded in 1938, and prior to that, there was no review process required before the release of a drug in the United States or much of anywhere else.
Friday, November 09, 2012
Methods of Glycosolated HbA1c Detection
There are six different methods for measuring glycosolated HbA1c percentages. Two methods rely on electrical conduction- they use the fact that glycated HbA1c has less charge than non-glycated HbA1c.
There is an immunoassay method that uses antibodies to a part of the glycated HbA1c- when measuring this way, the test looks at antibody attacks, and it looks at total HbA1c levels, and does a calculation that way. Boronic acid reacts differently to glycosolated HbA1c and so that can be used too. Spectrometers can actually really and truly look and measure the glycosolation.
I am relying on one source more than I usually do for today's fact. That source is Unexpected Hemoglobin A1c Results, by Alina-Gabriela Sofronescu, Laurie M Williams, Dorinda M Andrews, and Yusheng Zhu.
There is an immunoassay method that uses antibodies to a part of the glycated HbA1c- when measuring this way, the test looks at antibody attacks, and it looks at total HbA1c levels, and does a calculation that way. Boronic acid reacts differently to glycosolated HbA1c and so that can be used too. Spectrometers can actually really and truly look and measure the glycosolation.
I am relying on one source more than I usually do for today's fact. That source is Unexpected Hemoglobin A1c Results, by Alina-Gabriela Sofronescu, Laurie M Williams, Dorinda M Andrews, and Yusheng Zhu.
If you are a diabetic who would like to be interviewed and profiled, let me know.
Thursday, November 08, 2012
Temperature Affects Insulin Absorption
The first thing I read on a diabetes forum that surprised me was somebody stressing out about when to give her kid a bath. Because that bath was drop her kid's blood sugar.
If you were to use this effect consciously, you'd probably want to take your baths right after meals or at whatever time you are most likely to go high.
Really? I went and asked my CDE. She said, if it's a hot bath. Above about 110 degrees Fahrenheit (43 Celcius). It will make the insulin get absorbed more quickly and fully. So I took a thermometer in the bath with and me and low and behold my favorite bath temperature is 109 degrees Fahrenheit.
I suspect the threshhold is an artificial thing- in real life, any amount of warming will both speed up and increase insulin absorption. But my CDE was trying to put a number on how hot it has to get before she expected it to make a noticeable and significant difference.
If you were to use this effect consciously, you'd probably want to take your baths right after meals or at whatever time you are most likely to go high.
Some researchers are hoping to make a site warmer to go with an insulin pump to speed up the insulin absorption. With their warmer, they found that Novolog action peaked 35 minutes earlier than without it.
This effect is not specific to insulin. All drugs injected subcutaneously will be absorbed faster in heat, because of the changes in how blood circulates- it circulates more and closer to the skin when you're warmer.
Also, if you are storing insulin under warm enough conditions, it will be less effective- heat makes the insulin get absorbed more by your body but if you decide to bring your insulin vial into the sauna with you, your insulin in the vial is going to be less effective, even as the insulin already injected (or about to be injected) is more effective.
Wednesday, November 07, 2012
How Hypodermic Needles are Made
This is a five minute video on hypodermic needles from the Discovery Channel. I sure hope these aren't insulin needles, 'cause they're big.
Tuesday, November 06, 2012
Size of Pancreata
When you were born, your entire pancreas, if it had been taken out and smushed, would probably have fit inside a vial of the size that insulin comes in (most insulin vials hold 10mL of insulin and another 2 or so mL of air, and a baby's pancreas is about 9 mL- can be bigger or smaller). Almost half of your pancreas was made up of fat, with the other half being busy with the business of making digestive enzymes and hormones like insulin and glucagon.
Assuming you didn't develop type 1 diabetes or pancreatitis, your pancreas kept growing. The business part of your pancreas reached its maximum size sometime in your teens, twenties, or thirties. Then it began to slowly, slowly, slowly, atrophy.
The fat part of your pancreas grew too. Depending on how heavy you were, your pancreas may have put on a lot of weight. Unlike you, it didn't lose it. Your pancreas got more fatty as you got older, as the rest of it atrophied, and the fat part didn't.
If you were a normal or type 2 diabetic adult, your pancreas probably reached a maximum volume between 40 mL and 120 mL. After that... well, the average pancreas shrinks by about 20 mL between the ages of 30 years and 80 years old. Type 2 diabetes does not affect the size of the pancreas, although being overweight will make both the business part and the fat part of the pancreas larger, and being obese will make the fat part of the pancreas a lot larger.
If you are a type 1 diabetic... those antibodies likely attacked more than just your beta cells. About half of type 1 diabetics show mild signs of having exocrine pancreatic disease in terms of blood work (few show more than mild signs). An even higher portion have shrunken pancreata on imaging studies. The average pancreas size of type 1 diabetics is consistently small in the studies published, but the average size in different studies varies from 8 mL ( the size of a newborn baby's pancreas) to about 50 mL (the lower end of the normal range).
Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2680737 (I have also read through the studies linked to in this article, but the article I am linking to is my main source).
Assuming you didn't develop type 1 diabetes or pancreatitis, your pancreas kept growing. The business part of your pancreas reached its maximum size sometime in your teens, twenties, or thirties. Then it began to slowly, slowly, slowly, atrophy.
The fat part of your pancreas grew too. Depending on how heavy you were, your pancreas may have put on a lot of weight. Unlike you, it didn't lose it. Your pancreas got more fatty as you got older, as the rest of it atrophied, and the fat part didn't.
If you were a normal or type 2 diabetic adult, your pancreas probably reached a maximum volume between 40 mL and 120 mL. After that... well, the average pancreas shrinks by about 20 mL between the ages of 30 years and 80 years old. Type 2 diabetes does not affect the size of the pancreas, although being overweight will make both the business part and the fat part of the pancreas larger, and being obese will make the fat part of the pancreas a lot larger.
If you are a type 1 diabetic... those antibodies likely attacked more than just your beta cells. About half of type 1 diabetics show mild signs of having exocrine pancreatic disease in terms of blood work (few show more than mild signs). An even higher portion have shrunken pancreata on imaging studies. The average pancreas size of type 1 diabetics is consistently small in the studies published, but the average size in different studies varies from 8 mL ( the size of a newborn baby's pancreas) to about 50 mL (the lower end of the normal range).
Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2680737 (I have also read through the studies linked to in this article, but the article I am linking to is my main source).
Monday, November 05, 2012
According to data from the US National Health Survey, in 2009 there were roughly 3,234,000 diabetic Americans aged eighteen to forty four (about 3%); 9,886,000 diabetic Americans aged forty five to sixty four (about 15%), 4,107,000 diabetic Americans sixty five to seventy four (about 23%), and 3,263,000 diabetic Americans age seventy five or older (about 18%), for a total of 20,490,000 (twenty million, four hundred ninety thousand) diabetic American adults. Prediabetics and the undiagnosed were not included.
Sunday, November 04, 2012
Endocrinology
Endocrinology is, at least etymologically, the study of hormones.
Diabetes doctors are endocrinologists because diabetes was historically thought to be all about insulin (I say historically because I think if we knew then what we know now about type 2 diabetes we might not classify it that way).
But not all endocrinologists are about diabetes. The endocrine system in the body has a number of parts: the gonads (ovaries, testes, or things that seem like they would have become ovaries or testes), the islet cell portion of the pancreas, the adrenal glands, the thyroid, the four parathyroid glands, and the pituitary gland.
Most endocrinologists fall into one of three categories: reproductive endocrinologists, who deal primarily with issues of infertility; metabolic endocrinologists, who deal primarily with diabetes but also with thyroid disorders and occasional pituitary, adrenal, and parathyroid disorders; pediatric endocrinologists, who deal with endocrine issues in kids, mainly diabetes, growth hormone deficiencies, adrenal hyperplasias, and thyroid diseases. A rare few endocrinologists actually specialize in thyroid disorders or adrenal disorders, or even endocrine cancers.
Endocrinology, diabetes, and metabolism is a specialty that a doctor gets after being an internist.
Reproductive endocrinology/infertility is a specialty that a doctor gets after being an OB/GYN.
Pediatric endocrinology is a specialty a doctor gets after being a pediatrician.
Many diabetics get their diabetes treated primarily by an internist, geriatrician, or pediatrician, or by somebody who's not a doctors such as a diabetes educator, nutritionist, or nurse. Or, of course, by themselves.
Diabetes doctors are endocrinologists because diabetes was historically thought to be all about insulin (I say historically because I think if we knew then what we know now about type 2 diabetes we might not classify it that way).
But not all endocrinologists are about diabetes. The endocrine system in the body has a number of parts: the gonads (ovaries, testes, or things that seem like they would have become ovaries or testes), the islet cell portion of the pancreas, the adrenal glands, the thyroid, the four parathyroid glands, and the pituitary gland.
Most endocrinologists fall into one of three categories: reproductive endocrinologists, who deal primarily with issues of infertility; metabolic endocrinologists, who deal primarily with diabetes but also with thyroid disorders and occasional pituitary, adrenal, and parathyroid disorders; pediatric endocrinologists, who deal with endocrine issues in kids, mainly diabetes, growth hormone deficiencies, adrenal hyperplasias, and thyroid diseases. A rare few endocrinologists actually specialize in thyroid disorders or adrenal disorders, or even endocrine cancers.
Endocrinology, diabetes, and metabolism is a specialty that a doctor gets after being an internist.
Reproductive endocrinology/infertility is a specialty that a doctor gets after being an OB/GYN.
Pediatric endocrinology is a specialty a doctor gets after being a pediatrician.
Many diabetics get their diabetes treated primarily by an internist, geriatrician, or pediatrician, or by somebody who's not a doctors such as a diabetes educator, nutritionist, or nurse. Or, of course, by themselves.
Saturday, November 03, 2012
There are More than 100 Different Meters on the Market
Blood sugar meters were first developed so that emergency responders and ER personnel could figure who was passed from low blood sugar, and who was passed out for other reasons. Today, their use at home is recommended for most people with diabetes. There are hundreds of meters out there (about fifty available in the United States).
I have listed more than a hundred meters and this is not a complete list.
Accu Chek (Roche) makes more than fifteen meters, although it has really different selections in different countries.
Accu Chek Active (made in at least three models, and I think this is the same as the Sensor)
Accu Chek Advantage
Accu Chek Aviva/ Plus (same meter, different strips)
Accu Chek Aviva Compact
Accu Chek Combo
Accu Chek Compact Plus
Accu Chek Aviva Expert (this one will calculate insulin doses for you!)
Accu Chek Aviva Nano
Accu Chek Advantage
Accu Chek Go
Accu Chek Mobile
Accu Chek Performa
Accu Chek Performa Nano
Accu Chek Nano
Accu Chek Voicemate (for blind people)
Advocate meters sells four:
Redi-Code
Redi-Code DASH
Redi-Code Duo
Redi-Code Plus
Arkray makes seven fairly obscure meters:
Assure Platinum
Assure Pro
Assure 4
Glucocard 01(which talks)
Glucocard 01 Mini
Glucocard X
Glucocard Vital
The Bayer line has three basic meters with some variations:
Breeze 2
Bayer Contour
Bayer Contour Link
Bayer Contour Next EZ
Bayer Contour USB
Bayer Contour USB Next
it has also sold
Contour TS
and Bayer Didget, which connects with Nintendo systems
Agamatrix has four meters that it makes solo:
Jazz
Presto
Keynote
Keynote Pro
As well as two that it makes in partnership with Sanofi:
BGStar
iBGStar
Bionime advertises five meters, sold with and without the word "Rightest" in front:
GM100
GM210
GM300
GM550
GM700
But makes a handful more, such as
Pura
Biosense makes the Solo V2 (which not only speaks English and Spanish, but also Mandarin Chinese).
Beurer has a number of meters, which in makes in mg/dl and mmol/l versions. The ones with B measure blood pressure as well as blood sugar:
BGL 40
BGL 60
GL 32
GL 40
GL 44
Broadmaster Biotech makes three versions of the Glucose Shephard. I think one of them tests ketones. They applied for FDA approval (and from one I can tell from the FDA website, they got it) but they don't sell meters here.
Fifty50, the diabetes supply company, also makes its own meter, the Fifty50.
ForaCare sells fourteen blood sugar meters, four of which also test blood pressure:
G20
G30a
G31
G71a
G90
Premium V10
V12
V20
V22
V30a
D10
D15
D20
D30
GlucoCom sells the GlucoCom.
Infopia sells three monitors:
Element
Evolution
Eclipse
Life Scan is selling five meters:
One Touch Verio IQ
One Touch UltraSmart
One Touch Ultra Mini (in lots of colors)
One Touch Ultra 2
One Touch Ultra Link
but has also made
One Touch Select
One Touch Verio
One Touch Verio Pro
One Touch VITA
Abbott sells five meters:
Freestyle Freedom Lite
Freestye Lite
Freestyle InsuLinx
Precision Xtra
and for hospitals Precision Xtra Pro
Refreshingly enough, Microdot makes nothing but the microdot.
And MyGlucoHealth makes nothing but MyGlucoHealth (and accessories).
Nova Cares just sells two versions of practically the same thing:
Nova Max Plus
Nova Max Link
Nipro sells six that all sound like shoes to me:
True2Go
TrueResult
TrueTrack
TrueBalance
TrueRead
Sidekick
Oak Tree International sells thirteen meters, but only one is FDA approved (they mostly, from what I can tell, sell in Asia):
EMV2
EasyMax15
EasyMaxN
EasyMaxV
EasyMaxT1
EasyMax L
MasterDriver
EasyPlusT2
EasyPlus R2N
GlucoDock
Android APP
Omnis makes two
Embrace
Victory
OKBiotech makes four:
OKmeter Optima
OKmeter Match -this one gives a smiley face for a good reading :- )
OKmeter Link
OKmeter Direct
The Prodigy line has three:
Prodigy Autocode
Prodigy Pocket
Prodigy Voice
Simple Diagnostics sells:
CleverChoice Mini
CleverChoice Pro
CleverChoice Voice
CleverChoice Voice+
CleverChoice AutoCode
Telcare makes the :
Telcare (surprise!)
Walmart's Relion Line includes four meters:
Relion Confirm
Relion Micro
Relion Prime
Relion Ultima
I don't know who makes
Glucoleader Enhance
Glusensor i-Care
Value+
SmartCare
SmartCare Mini
I have listed more than a hundred meters and this is not a complete list.
Accu Chek (Roche) makes more than fifteen meters, although it has really different selections in different countries.
Accu Chek Active (made in at least three models, and I think this is the same as the Sensor)
Accu Chek Advantage
Accu Chek Aviva/ Plus (same meter, different strips)
Accu Chek Aviva Compact
Accu Chek Combo
Accu Chek Compact Plus
Accu Chek Aviva Expert (this one will calculate insulin doses for you!)
Accu Chek Aviva Nano
Accu Chek Advantage
Accu Chek Go
Accu Chek Mobile
Accu Chek Performa
Accu Chek Performa Nano
Accu Chek Nano
Accu Chek Voicemate (for blind people)
Advocate meters sells four:
Redi-Code
Redi-Code DASH
Redi-Code Duo
Redi-Code Plus
Arkray makes seven fairly obscure meters:
Assure Platinum
Assure Pro
Assure 4
Glucocard 01(which talks)
Glucocard 01 Mini
Glucocard X
Glucocard Vital
The Bayer line has three basic meters with some variations:
Breeze 2
Bayer Contour
Bayer Contour Link
Bayer Contour Next EZ
Bayer Contour USB
Bayer Contour USB Next
it has also sold
Contour TS
and Bayer Didget, which connects with Nintendo systems
Agamatrix has four meters that it makes solo:
Jazz
Presto
Keynote
Keynote Pro
As well as two that it makes in partnership with Sanofi:
BGStar
iBGStar
Bionime advertises five meters, sold with and without the word "Rightest" in front:
GM100
GM210
GM300
GM550
GM700
But makes a handful more, such as
Pura
Biosense makes the Solo V2 (which not only speaks English and Spanish, but also Mandarin Chinese).
Beurer has a number of meters, which in makes in mg/dl and mmol/l versions. The ones with B measure blood pressure as well as blood sugar:
BGL 40
BGL 60
GL 32
GL 40
GL 44
Broadmaster Biotech makes three versions of the Glucose Shephard. I think one of them tests ketones. They applied for FDA approval (and from one I can tell from the FDA website, they got it) but they don't sell meters here.
Fifty50, the diabetes supply company, also makes its own meter, the Fifty50.
ForaCare sells fourteen blood sugar meters, four of which also test blood pressure:
G20
G30a
G31
G71a
G90
Premium V10
V12
V20
V22
V30a
D10
D15
D20
D30
GlucoCom sells the GlucoCom.
Infopia sells three monitors:
Element
Evolution
Eclipse
Life Scan is selling five meters:
One Touch Verio IQ
One Touch UltraSmart
One Touch Ultra Mini (in lots of colors)
One Touch Ultra 2
One Touch Ultra Link
but has also made
One Touch Select
One Touch Verio
One Touch Verio Pro
One Touch VITA
Abbott sells five meters:
Freestyle Freedom Lite
Freestye Lite
Freestyle InsuLinx
Precision Xtra
and for hospitals Precision Xtra Pro
Refreshingly enough, Microdot makes nothing but the microdot.
And MyGlucoHealth makes nothing but MyGlucoHealth (and accessories).
Nova Cares just sells two versions of practically the same thing:
Nova Max Plus
Nova Max Link
Nipro sells six that all sound like shoes to me:
True2Go
TrueResult
TrueTrack
TrueBalance
TrueRead
Sidekick
Oak Tree International sells thirteen meters, but only one is FDA approved (they mostly, from what I can tell, sell in Asia):
EMV2
EasyMax15
EasyMaxN
EasyMaxV
EasyMaxT1
EasyMax L
MasterDriver
EasyPlusT2
EasyPlus R2N
GlucoDock
Android APP
Omnis makes two
Embrace
Victory
OKBiotech makes four:
OKmeter Optima
OKmeter Match -this one gives a smiley face for a good reading :- )
OKmeter Link
OKmeter Direct
The Prodigy line has three:
Prodigy Autocode
Prodigy Pocket
Prodigy Voice
Simple Diagnostics sells:
CleverChoice Mini
CleverChoice Pro
CleverChoice Voice
CleverChoice Voice+
CleverChoice AutoCode
Telcare makes the :
Telcare (surprise!)
Walmart's Relion Line includes four meters:
Relion Confirm
Relion Micro
Relion Prime
Relion Ultima
I don't know who makes
Glucoleader Enhance
Glusensor i-Care
Value+
SmartCare
SmartCare Mini
Friday, November 02, 2012
The wrong 1 in a 1,000,000
According to the CDC, 1 per million people under age 20 died of diabetes in 2008-2009 (at least according to their death certificates). This is less than half the rate from forty years ago in the US, but it still represents roughly forty deaths from diabetes in children and teenagers nationwide, per year.
http://www.ncbi.nlm.nih.gov/pubmed/22925225
http://www.ncbi.nlm.nih.gov/pubmed/22925225
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