Category Archives: Uncategorized

How old is this device?

For folks taking insulin, Diabetes Daily has a good article by endocrinologist Dr Francine Kaufman. An excerpt:

Everyone with diabetes who takes insulin needs to have a sick day plan. This is something you develop with your healthcare professional to help you manage the high and low sugar levels that can be associated with an illness. The following advice applies to people with type 1 diabetes and people with type 2 diabetes who take insulin – the advice may be different if you have type 2 diabetes and do not take insulin.

Click to jump down to a section:

What happens when you are sick?

Track of your important numbers in a sick log

Glucose levels

Ketone levels

Temperature

Fluid intake

Urination

Vomiting, diarrhea, and dehydration

Insulin, amount and time

Medications

Key messages from Dr. Kaufman

When you get sick, you are at risk of becoming dehydrated from poor intake or from excessive loss of fluids due to nausea, vomiting, diarrhea, and fever (your body may lose more water when you have a high temperature). In addition, dehydration is common in diabetes because high glucose levels (above 180-200 mg/dL) cause sugar to enter your urine, dragging an excess amount of fluid with it. Illness also puts you at risk of developing ketones, which when coupled with high glucose levels can lead to diabetic ketoacidosis (DKA), a very serious condition. How do you know if you have ketones? Good question, click here!

The purpose of your sick day plan is to try to keep your glucose levels in a safe range – to avoid dehydration and to prevent ketones from rising to a dangerous level.

Source: Zoning in on Sick Day Management: Practical Tips, Strategies, and Advice – Diabetes Daily

Cardiovascular and renal systems simplified in one pic

The cited article below is by Milton Packer, who may have conflicts of interest since he has done work on behalf of drug companies. His article is a review of existing published literature showing beneficial effects of SGLT2 inhibitors on congestive heart failure, cardiovascular death, and kidney disease.

There is compelling evidence that sodium–glucose cotransporter 2 (SGLT2) inhibitors exert cardioprotective and renoprotective effects that are far greater than expected based on their effects on glycemia or glycosuria. In large-scale randomized controlled trials, SGLT2 inhibitors reduce the risk of hospitalizations for heart failure by ∼30% and often decrease the risk of cardiovascular death. This benefit is particularly striking in patients who have the most marked impairment of systolic function prior to treatment. In parallel, SGLT2 inhibitors also reduce the risk of end-stage renal events, including the occurrence of renal death and the need for dialysis or renal transplantation by ∼30%. This benefit is seen even when glomerular filtration rates are sufficiently low to abolish the glycosuric effect of these drugs.

Source: SGLT2 Inhibitors Produce Cardiorenal Benefits by Promoting Adaptive Cellular Reprogramming to Induce a State of Fasting Mimicry: A Paradigm Shift in Understanding Their Mechanism of Action | Diabetes Care

Steve Parker, M.D.

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Artist’s rendition of Coronavirus

I’ve been cross-posting about coronavirus and COVID-19 among my three blogs. In view of time limitations and efficiency, I’m going to be posting nearly all my coronavirus thoughts at Advanced Mediterranean Diet. Check it out if interested.

Thus far I haven’t treated a confirmed case of COVID-19 although I’m a full-time hospitalist in Scottsdale, AZ. I’ve been off-duty for four days but return to work soon. If the mainstream media is correct, I’m about to be overwhelmed by cases. So far, I’m overwhelmed by the damage this thing is doing to our economy, not to mention my 401k, which I just did.

Spicy times, indeed.

Steve Parker, M.D.

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How old is this device?

From Dr Muccioli at Diabetes Daily:

Why are people with diabetes more vulnerable to infections and complications of infections? It has been shown that people with diabetes are at a higher risk for infections and related complications, and, in particular, for various bacterial infections. Although the reasons for this are not completely elucidated yet and are likely multifactorial, research has shown that high blood glucose levels can directly and negatively impact the immune system and that  “…good control of blood sugar in diabetic patients is a desirable goal in the prevention of certain infections and to ensure maintenance of normal host defense mechanisms that determine resistance and response to infection.”As it relates to the COVID-19 outbreak, it follows that maintaining target blood glucose levels is an important preventative strategy for avoiding serious related complications, such as a secondary bacterial infection (i.e., pneumonia) and is likely an important determinant in the patient prognosis for anyone who becomes infected.

Source: Coronavirus & Diabetes: Your Questions Answered – Diabetes Daily

Read the whole thing.

A decade ago, some folks began to object to being called diabetics. Instead, they proposed “person with diabetes” or “people with diabetes.” Or simply PWD.

Given the major differences between type 1 and type 2 diabetes, I now propose PWT1D (person or people with type 1 diabetes) and PWT2D.

And so no one’s left out: PWLADA. Person with Latent Autoimmune Diabetes in Adulthood.

Whadda u think?

Steve Parker, M.D.

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords.com.

Great exercise, but with risk of concussions, broken bones, and torn menisci

Obesity is a risk factor for type 2 diabetes in adults and also plays a significant role in the development of the disease at younger ages. Obesity is highly prevalent among US adolescents and young adults. Many adolescents and young adults with obesity already have blood sugar metabolism abnormalities, which is of great public health concern in view of the sharp increase in type 2 diabetes in adolescence.

From JAMA Network:

In the United States, about 1 of 5 adolescents and 1 of 4 young adults have prediabetes. The adjusted prevalence of prediabetes is higher in male individuals and in people with obesity. Adolescents and young adults with prediabetes also present an unfavorable cardiometabolic risk profile, putting them both at increased risk of type 2 diabetes and cardiovascular diseases.

Source: Prevalence of Prediabetes Among Adolescents and Young Adults in the United States, 2005-2016 | Adolescent Medicine | JAMA Pediatrics | JAMA Network

Steve Parker, M.D.

PS: Regular exercise and loss of excess fat weight are two great ways to prevent both prediabetes and type 2 diabetes. They also help with treatment.

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A masterpiece by Sunny Parker

I’m not generally a fan of U.S. federal government committee recommendations on what we should eat. They’ve led us astray before. For what it’s worth, the USDA and National Cancer Institute have put together a Healthy Eating Index. Salad-eaters score higher on the Index. I do believe the best salads are better than the crap most Americans eat.

From the Journal of the Academy of Nutrition and Dietetics:

Abstract

Background

Consuming salad is one strategy with the potential to harmonize diets more closely with national dietary guidance. However, it is not known whether nutrient intake and diet quality differ between people who consume vegetable-based salad and those who do not.

Objective

The objective of this study was to compare nutrient intake and diet quality between salad reporters and nonreporters.

Design

This study is a cross-sectional analysis of 1 day of dietary intake data collected via 24-hour recall.

Participants/setting

Adults 20 years and older (n=9,678) in What We Eat in America, National Health and Nutrition Examination Survey 2011-2014 were included. Respondents who ate salad on the intake day were considered salad reporters.

Main outcome measures

This study estimated nutrient intake from all foods and beverages (excluding supplements) and evaluated diet quality using the Healthy Eating Index (HEI) 2015.

Statistical analyses

Nutrient intake and HEI scores were compared between salad reporters and nonreporters using paired t tests with regression adjustment for confounding variables. Results were considered significant at P<0.001.

Results

On the intake day, 23% of adults consumed salad. Energy, protein, and carbohydrate intakes did not differ between salad reporters and nonreporters. Salad reporters had higher intakes than nonreporters of dietary fiber, total fat, unsaturated fatty acids, vitamins A, B-6, C, E, K, folate, choline, magnesium, potassium, and sodium (P<0.001). Total HEI 2015 scores were significantly higher for reporters (56 of a possible 100 points) than nonreporters (50 points) P<0.001. Reporters also had significantly higher scores for eight of 13 HEI components: total vegetables, greens and beans, whole fruits, total protein foods, seafood and plant proteins, fatty acids, refined grains, and added sugars (P<0.001).

Conclusions

Incorporating vegetable-based salad into one’s diet may be one effective way to increase nutrient intake and improve overall diet quality. Regardless of salad reporting status, HEI scores show that diets of US adults need improvement.

Source: Consuming Vegetable-Based Salad Is Associated with Higher Nutrient Intakes and Diet Quality among US Adults, What We Eat in America, National Health and Nutrition Examination Survey 2011-2014 – Journal of the Academy of Nutrition and Dietetics

Steve Parker, M.D.

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One way to break your fast

Eating within a 10-hour window shouldn’t be too hard. Breakfast at 7 AM, finish dinner by 5 PM. That’s  right, we don’t need to be eating every 3–4 hours. Do you think our ancestors have been eating three meals a day for the last 200,000 years? I don’t. The probably went 24–48 hrs without much food on a regular basis.

From LA Times:

In an early effort to explore the benefits of daily fasting in humans, researchers have found that people who are at high risk of developing diabetes improved their health in myriad ways when they ate all of their meals over a span of just over 10 hours, then fasted for the remainder of their 24-hour day.

Source: Variant of intermittent fasting improved health in new study – Los Angeles Times

Steve Parker, M.D.

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com

Salad and cheese

Jan over at Low Carb Diabetic has a great post on building a salad from the ground up.

“Salads make a nutritious and satisfying meal, whether it’s for lunch or dinner. The best part is that no two salads are exactly the same. There are limitless ways to make salad unique and flavourful. Get some tips for what to add to your next salad….”

Source: The Low Carb Diabetic: Super Salads – Some Tips for Building A Better Salad

Click for my nutritional assessment of various salad greens. Variety is also important.

Steve Parker, M.D.