August 12, 2016 · 2:00 AM

Introducing Tresiba (insulin degludec): a New Long-Acting Basal Insulin

Tresiba joins other long-acting insulins like insulin glargine (Lantus), insulin detemir (Levemir), and good ol’ NPH insulin. It was approved by the U.S. Food and Drug Administration this year; it’s been used in other countries for longer. Insulin degludec will have different names depending on the country.

Who Is It For?

  • Adults with type 1 and 2 diabetes
  • Not for diabetic ketoacidosis
  • We have no good data on use in children (under 18), pregnant women, and nursing mothers

How Long Does It Work?

It will last for at least 30 hours in most users. After that, effectiveness starts to taper off but some effect may be seen as long as 42 hours after the injection.

What Is Its Role In Treating Diabetes?

Insulin degludec is a basal insulin, meaning that it runs in the background continuously. It’s not designed to reduce blood sugar that rises after a meal. If your pancreas still makes insulin, release of that insulin may reduce after-meal glucose levels adequately. Otherwise, after-meal glucose elevations are addressed with bolus insulin injections. Bolus-type insulins are the rapid-acting ones like Humalog and Novolog.

Most NPH insulin users, and some insulin glargine (Lantus) users, need the injection twice daily. Because of its long duration of action, Triseba users should never need more than one injection daily. I don’t have much experience with Levemir because the hospital where I work doesn’t stock it.

Triseba users should take it at about the same time daily. If you miss that time by up to five or six hours either way, it probably won’t matter.

What’s the Dose?

For type 2 diabetics who have never used insulin, the starting dose is typically 10 units/day.

For type 1’s switching from other insulins, the usual starting dose is one-third to one-half of the total daily insulin dose, plus rapid-acting bolus insulin around meal times for the remainder.

Change the dose no more often than every three or four days.

How Much Does It Cost?

I don’t know. Likely more than some of the other basal insulins.

Steve Parker, M.D.

PS: Click here for full prescribing information.

PPS: If words like glargine, degludec, and detemir turn your stomach, you’ll appreciate my book.

You'll not find "degludec" in here

You’ll not find “degludec” in here

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August 9, 2016 · 11:48 AM

Physical Activity = Improved Blood Sugar

If you’ve let your exercise program slip, Kelley Pounds, RN, CDE, may motivate you to get back on the wagon. She writes:

“I often get folks asking me what they can do to lower their blood sugar when they are already very low in carbs. The first question I now ask is “what are you doing for exercise?” What I am finding is that most people are not exercising and have no desire to exercise. Believe me, I understand.”

“I’m going to admit, a couple months ago, I NEVER imagined exercise could be enjoyable. I pretty much hated it. And I had ALL the excuses, even valid ones, to NOT do it…I’m too tired, I don’t have time, I don’t like to exercise, I’m too weak, everything hurts, you name it, I had made every excuse for myself to avoid it.”

Source: Physical Activity = Improved Blood Sugar – Low Carb RN (CDE)

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August 9, 2016 · 6:05 AM

Another Low-Carb High-Fat Success Story In Type 1 Diabetes

From DietDoctor:

“Tyler was diagnosed with type 1 diabetes at age 19. During the next decade he gained a lot of weight following the official dietary guidelines, needed more and more medications, and got all kinds of health issues. Something felt wrong.

Recently someone recommended him to check out the Diet Doctor website, and he decided to try LCHF and intermittent fasting.”

RTWT. Source: “I Only Wish I Had Known What I Know Now 10 Years Ago” – Diet Doctor

Here’s another LCHF program:

LCHF Mediterranean diet

LCHF Mediterranean diet

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August 8, 2016 · 2:37 AM

Ivor Cummins Found a New Low-Carb Diet Convert: Priyanka Wali, M.D.

Dr. Wali is an internist in San Francisco. In her medical practice, she saw first-hand how standard “diabetic diets” weren’t helping her patients and many others who have carbohydrate intolerance. Welcome to the club, Dr. Wali!

PS: She’s also a good stand-up comedian.

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August 8, 2016 · 12:02 AM

Kelley Pounds Says Low-Carb Purists Are Not Helping the Cause

Kelley makes a lot of good points. Click here for them.

She starts:

“There are some people who may NEED to be strict with low carb because they have a disease which requires it, those for whom excess carbs can cause an imminent, maybe even life threatening, problem, (such as those with an absolute insulin deficiency.) That’s not who I’m about talking about. Also, being strict with YOURSELF is not the problem. I am strict with myself. The problem is when you impose your standards on others.

The majority of us don’t have imminent, life threatening conditions. Often we are using low carb to address a chronic problem. We chose low carb to lose weight, control our blood sugar without any medication, or just because it is a healthy way to eat and makes us feel great!

Yet some folks have become so rigid that they cannot accept anything but perfection from themselves (which is their choice) OR ANYONE ELSE (which is the problem), especially people they know nothing about on social media. Some of these folks LOVE to comment and are quick to set others straight about what they should or shouldn’t be doing, about what low carb IS and what it ISN’T.”

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August 7, 2016 · 5:00 PM

Was William Banting’s Diet LCHF? (Low-Carb, High-Fat)

"Those numbers are so small!"

“Those numbers are so small!”

I’ve been reading about Banting’s diet for at least six years. Thanks to Tim Noakes in South Africa, it’s seeing a mini-surge in popularity. William Banting published his Letter on Corpulence in 1863. Eating like him to lose weight is sometimes referred to as “Banting.” It’s one form of a low-carb diet and considered a precursor to the Atkins diet.

Form your own opinion of what William Banting may have eaten by reading these:

In terms of macronutrient calories, here’s my rough back-of-the-envelope synthesis of Banting’s diet:

  • 20–25% carbohydrate
  • 25% protein
  • 20–25% fat
  • 25% alcohol
  • 1800–2000 total calories

For the 200 lb (91 kg) man that Banting was, 2000 calories would almost certainly have been a calorie-restricted diet. Leigh estimated he was eating at least 2800 cals/day at baseline before losing weight. I don’t doubt that.

In summary, Banting drank a lot of alcohol (even more than on the Ketogenic Mediterranean Diet), and ate fairly low-fat, moderately carb-restricted, and relatively high protein. In other words: low cal, low carb, low fat, high protein, high alcohol.

His weight loss, assuming it wasn’t a hoax, came from calorie restriction. Something about that combination of macronutrients apparently allowed him to stick with the program and maintain a 50-lb (23 kg) weight loss. Protein is particularly satiating. Your mileage may vary.

I’m concerned that 25% of calories from alcohol would displace more healthful micronutrients.

Steve Parker, M.D.

PS: Fun Fact: William Banting was a distant relative of Frederick Banting, the co-discoverer of insulin in 1921.

PPS: My diets are healthier than Banting’s, thanks to 150 years of nutrition science since then.

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August 7, 2016 · 5:13 AM

Is It Time to Freak-Out About Arsenic In Wine?

Is the arsenic in the irrigation water, pesticides, or introduced during processsing?

Is the arsenic in the irrigation water, pesticides, or introduced during processsing?

A class-action lawsuit in California claims that certain wines have dangerously high levels of arsenic that could cause cancer, cardiovascular disease, or diabetes. USA Today has one of the ubiquitous stories outlining the few details we know at this point.

Furthermore, chronic low-dose arsenic exposure can cause skin changes (e.g., scaly thick skin, darkening, lightening), peripheral neuropathy (numbness, pain, weakness, typically starting in the feet, then hands), peripheral vascular disease, and liver disease. The cancers linked to arsenic are mostly skin, bladder, lung, and liver. The increased cancer risk persists even after the end of exposure.

How Do You Know If You’ve Been Poisoned With Arsenic?

Comments here refer to chronic low-dose exposure; acute high dose poisoning is another can o’ worms.

First, see your doctor for a history and physical exam and let her know you’re worried about arsenic. If arsenic poisoning remains a possibility, lab testing is usually a 24-hour urine collection for arsenic, or spot urine for arsenic and creatinine. “Spot” in this context means a random single specimen, not a 24-hour collection. For the 48 to 72 hours before either of those tests, don’t eat fish, seaweed, or shellfish.

What about testing hair for arsenic? In general, it’s not accurate.

Bottom Line

At this point, if you or someone you love drinks wine, I suggest simply keeping an eye on this story as it develops. We need more facts. The whole thing could blow over, with nothing coming of it. One of the brands mentioned is Sutter Home, one of my favorites.

Remember a few years ago when we had the vapors over arsenic in rice?

Steve Parker, M.D.

PS: Wine is a time-honored component of the traditional Mediterranean diet, but see my books for alternatives to wine. You don’t have to drink wine to live long and prosper.

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August 3, 2016 · 3:01 PM

Over 10% of UK’s Drug Budget Goes for Diabetes Drugs

Here in the U.S., two of the top 10 prescribed drugs are diabetes drugs: Lantus and Januvia. That top 10 list is based on number of monthly prescriptions rather than revenue or cost.

Low Carb Diabetic has the details:

“The NHS in England spent £956.7m on drugs last year prescribed by GPs, nurses and pharmacists to treat and manage the condition. That sum represents 10.6% of the cost of all prescriptions issued by NHS primary care services in 2015-16.

The health service now spends more on medication for type 1 and type 2 diabetes than for any other ailment. The number of diabetics across the UK as a whole has recently risen to more than four million and has increased by 65% over the last 10 years.”

 

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August 1, 2016 · 11:13 PM

The Heavier Identical Twin Is Twice as Likely to Develop Type 2 Diabetes

The study was done in Sweden and involved 4,000 identical twin pairs. The lighter of the twin pairs had average body mass index of 23.9; the heavier twins averaged 25.9. Note that 25.9 is barely into the overweight range.

Type 2 diabetes definitely tends to “run in families.” If you have a genetic predisposition to it, then get overweight or obese, your risk increases even more.

From the abstract:

“In [identical] twin pairs, higher BMI was not associated with an increased risk of MI or death but was associated with the onset of diabetes. These results may suggest that lifestyle interventions to reduce obesity are more effective in decreasing the risk of diabetes than the risk of cardiovascular disease or death.”

Source: Risks of Myocardial Infarction, Death, and Diabetes in Identical Twin Pairs With Different Body Mass Indexes | JAMA Internal Medicine | JAMA Network

PS: Study results may or may not apply to non-Swedes.

PPS: Calculate your body mass index.

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August 1, 2016 · 10:39 PM

Pre-Mixed Insulins May Not Be Right For You

Kelly Pounds, RN, CDE, has a brief post on the problems of pre-mixed insulins. By pre-mixed, I mean something like Novolin 70/30, which is 70% intermediate-acting insulin and 30% regular insulin. Another common product is 75/25.

Click the link below for details.

“Mixed insulins can have their place.  For instance, they are ideal for those that can only afford one vial of insulin at a time.  Or for those with limited abilities in calculating and managing their insulin doses.  They may be ideal for those that are advanced in years or those with limited dexterity, limited understanding, or even vision problems (people that may mix up insulin vials if they have more than one.)  However, if you are not bound these types of circumstances, you may consider a different, more effective regimen.”

Source: Problems With Mixed Insulin Therapy – Low Carb RN (CDE)

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