This is the best time in history to have diabetes. Thanks to the advancement of science, supported by the profit motive and a degree of free market economics, we now have 10 classes of drugs to help us conquer the disease.
I recently finished a series of brief reviews on each drug class. Click on the Drugs for Diabetes page for links to all the reviews.
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Equal Justice Under Law
AAPS is the first national physician group to sue the federal government over the the Democrat’s new healthcare reform law, according to an article at MedPageToday. The challenge is based on violations of both the Fifth and Tenth Amendments to the U.S. Constitution, which the polititians had taken an oath to uphold.
The new law will interfere greatly with the patient-physician relationship, inserting polititians and bureaucrats into the middle. Patients will suffer.
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Meglitinides—also called glinides—increase the output of insulin by the pancreas beta cells into the bloodstream. In that respect they are similar to sulfonylurea drugs, so the two classes are sometimes lumped together as insulin secretagogues. If the pancreas produces no insulin at all—as in most cases of type 1 diabetes—these drugs won’t work.
Two meglitinides are available in the U.S.: repaglinide is sold as Prandin, and nateglinide is Starlix.
Meglitinides have about the same effectiveness as sulfonylureas, but are considerably more expensive. Repaglinide and nateglinide increase the pancreas’ output of insulin, working faster than sulfonylureas. They don’t last as long as sulfonylureas, which may help avoid hypoglycemia. Glinides work mostly to reduce sugar levels after meals.
We don’t know if these drugs affect death rates.
Uses
May be used alone or in combination with certain other diabetic drugs. Since they have the same mechanism of action, sulfonylureas and meglitinides would not normally be used together. In combination therapy, you want to use drug classes that work by different mechanisms.
Dosing
Starting dose for repaglinide is 0.5 mg by mouth before each meal. Maximum dose is 4 mg before each meal.
Nateglinide: 120 mg by mouth immediately before each meal.
Side Effects
Hypoglycemia is the most common and potentially serious adverse effect of the meglitinides, but may be less common than with sulfonylureas.
Weight gain is common.
Precautions . . .
Nateglinide: Use with great caution, if at all, in the setting of severe kidney disease and moderate to severe liver disease.
Repaglinide: Use cautiously in severe kidney and liver disease.
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Tom Naughton at his Fat Head blog has a hilarious interview with Ronald McDonald.
Steve Parker, M.D.
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This is the first day of Passover, a major Jewish holiday. My Lord and Savior, Jesus Christ, was a Jewish carpenter while he was walking the Earth. I figure he must have observed Hebrew traditions. In preparation for teaching my children about Passover, I reviewed it at Wikipedia. Here’s a brief summary:
Passover is the Jewish celebration of the Hebrews’ release from enslavement by Pharaoh in Egypt. Before release, the Lord brought ten plagues to Egypt. The tenth plague was the killing of the firstborn – all in the area: humans (including Pharaoh’s firstborn), even cattle.
The Hebrews were instructed to mark their doorposts with the blood of a spring lamb. The spirit of the Lord would pass over those homes, sparing the firstborn therein.
The Wikipedia article is a quick read full of interesting details on Passover customs.
Steve Parker, M.D.
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When you sell a man a book, you don’t sell him 12 ounces of paper and ink and glue—you sell him a whole new life.
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Mt. Fuji in Japan
Last November I started another self-experiment to see if vinegar consumption would lead to any weight loss in me. I quit after nine weeks instead of sticking it out for the entire 12-week trial. I just got tired of it and hadn’t seen any weight loss. And I ran out of apple cider vinegar.
Results? No change in weight.
A Japanese study had shown loss of 2.2-4.4 lb in Japanese overweight study subjects. Maybe it didn’t work for me because I wasn’t overweight. Or because I’m not Japanese. Or because I chose to do the experiment over the Christmas-New Years’ holiday, a notorious over-eating time of year.
Oh, well.
Nevertheless, the vinegar option would be reasonable for an overweight person to try.
PS: I blogged recently about how vinegar diminishes blood sugar elevations after meals that contain complex carbohydrates. So an overweight type 2 diabetic would be a perfect study subject.
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The Healthy Librarian at the Happy Healthy Long Life blog wrote about a small scientific study documenting an incredibly easy way to increase blood levels of vitamin D in people taking supplemental vitamin D:
Take the supplement with the largest meal of the day
Subjects of this research were taking vitamin D supplements—often a very high dose—for medical reasons, yet blood levels remained unacceptably low. Blood levels of vitamin D (25-hydroxyvitamin D) rose by 50% simply by taking the same dose with the largest daily meal.
Other people, including young healthy adults, may or may not respond the same way. Do you know?
As for me, I’ll be sure to take my vitamin D supplement with my largest meal.
Disclaimer: All matters regarding your health require supervision by a personal physician or other appropriate health professional familiar with your current health status. Always consult your personal physician before making any dietary, nutritional supplement, or exercise changes.
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Vinegar reduces blood sugar elevations after meals containing complex carbohydrates, according to the Department of Nutrition at Arizona State University.
Meals containing carbohydrates (and to a lesser extent, proteins) raise blood sugar after meals in people with or without diabetes. [I’ve written previously about the normal ranges of blood sugars.] Previous studies established that a single vinegar dose around mealtime lowers postprandial (after meal) blood sugar levels by up to 50%. Arizona investigators wanted to know the best dose and timing for reducing postprandial blood sugar elevations.
They ran multiple tests on about 40 adults who reported they were generally healthy except nine had type 2 diabetes (not taking insulin).
Findings
Mealtime vinegar ingestion reduced postprandial (two hours after meal) blood sugars by about 20% compared to placebo. The test meal was white bagel (variable amounts), 20 g of butter, and 200 g of juice.
The most effective dose of vinegar was 10 g (about two teaspoons or 10 ml) of 5% acetic acid vinegar (either Heinz apple cider vinegar or Star Fine Foods raspberry vinegar). This equates to two tablespoons of vinaigrette dressing (two parts oil/1 part vinegar) as might be used on a salad. The authors also say that “…two teaspoons of vinegar could be consumed palatably in hot tea with lemon at mealtime.”
Discussion
The study authors suggest that the blood-sugar-lowering effect of vinegar may be related to inhibition of digestive enzymes or to a slower rate of empyting by the stomach. Remember that most of digestion and absorption of nutrients occurs in the small intestine; the stomach first has to empty food into the small intestine. Vinegar seems to inhibit digestion of starch but not of simple (monosaccharide) sugars.
They also note another study that found vinegar slowed the rate of stomach emptying by almost 40% in type 1 diabetics with gastoparesis, potentially raising the risk of low blood sugar.
Take-Home Points
The development of cardiovascular disease, like heart attacks and strokes, seems to be tied especially to elevations of blood sugar after meals as compared to before-meal or fasting sugar levels. This may be related to formation of free radicals and inflammatory mediators. So reduction of postprandial blood sugar elevations by vinegar may be particularly helpful in preventing heart disease. It will be many years before we can prove this by a clinical study, if ever.
Diabetics, especially type 2’s without gastroparesis, may better tolerate grains, fruits, and legumes—in terms of lower blood sugar spikes—if they eat them in a meal that includes two teaspoons of vinegar.
Reference: Johnston, Carol, et al. Examination of the antiglycemic properties of vinegar in healthy adults. Annals of Nutrition and Metabolism, 56 (2010): 74-79.
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Several published treatment guidelines for high blood pressure (hypertension) recommend that type 2 diabetics aim for systolic blood pressure of 130–135 or less. The latest research indicates that a goal of 140 mmHg is adequate.
Details are available in the HeartWire issue of March 14, 2010.
PS: You won’t find mention of diastolic pressure in the HeartWire article.
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