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FOOD FOR THOUGHT

We invite blurbs and tidbit articles for inclusion in this column. Materials received may be edited and used as space permits. Products and services included in this column are for information only; their inclusion does not imply endorsement by the Diabetes Action Network of the NFB.

New Urgency to Kidney Test

For decades, doctors who suspect their patients have kidney damage have tested for albuminuria (protein in urine), a reliable indicator of such damage. These tests have improved in sensitivity and predictive power (allowing quicker intervention to save kidneys and preserve health), and the current microalbuminuria test is far more effective than its ancestors -- though not enough diabetics are receiving it.

Nephropathy, kidney failure caused by diabetes, is not uncommon, and can lead to End Stage Renal Disease (ESRD), a serious complication forcing the patient into dialysis or kidney transplantation to preserve life. The quicker nephropathy is detected, the better the chances of avoiding ESRD.

Now there's another reason to get tested. Data presented at the International Society of Nephrology's symposium in New York, in June 2004 (co-sponsored by the National Kidney Foundation) show a solid link between measurable albuminuria and impending cardiovascular disease. "Microalbuminuria is a marker for existing inflammatory vascular disease ..." said one presenter.

As with kidney disease, and diabetes itself, so with cardiovascular disease: it is far better to discover the condition quickly, and take corrective action, than to wait until big, spectacular "events" make the diagnosis obvious. "High-risk patients, such as those with metabolic syndrome, diabetes, renal insufficiency, or hypertension, should be screened for microalbuminuria," said one of the researchers at the symposium.

What does this mean? If a simple urinalysis can predict a heart attack a long way off, isn't it a good idea? Talk to your doctor about the microalbuminuria test and what it means for your health.

Kidney/Pancreas Transplants

by Ed Bryant

Have you had a kidney or pancreas transplant? If you've received either, alone or as part of a kidney-pancreas set, I'd like to hear from you. How long have you had it? How has it affected your life? Contact me, Editor Ed Bryant, with your comments at: VOICE OF THE DIABETIC, 1412 I-70 Drive SW, Suite C, Columbia, MO 65203; telephone: (573) 875-8911; email: [email protected]

Diabetes Fact

It appears diagnosed diabetics make up 6 percent of the American population -- however they account for 15 percent of the annual health care cost. As "baby boomers" age, and as their children sit in front of TV and computer screens munching junk food, these figures are expected to rise.

Exercise or Viagra?

A significant proportion of diabetic men over age 50 suffer from erectile dysfunction (ED). Many of these men treat their ED with Viagra or its new equivalents, Levitra and Cialis. Researchers in Cologne, Germany, recently performed an interesting experiment.

Half the men in the study, all men with ED and mild to moderate circulatory problems, followed a targeted exercise program. The other half took Viagra. Three months later, 74 percent of the men on Viagra reported better erections, but the figure was 80 percent for the exercisers.

The researchers, who presented their findings at the European Association of Urology, say their data support the hypothesis that physical conditioning may help prevent or relieve ED, when such is caused by circulatory insufficiency.

The findings do not suggest any link between exercise and ED caused by neuropathy, but some researchers suggest that as circulatory damage co-occurring with generalized peripheral neuropathy may be the most common cause of "diabetogenic" erectile dysfunction, exercise may be a worthwhile option to consider.

Continuous Glucose Monitor

Medtronic Minimed is about to offer the Guardian, an FDA-approved continuous glucose monitor worn like an insulin pump. The device's sensor hooks to the abdomen with a catheter, and reports to a pager-sized receiver. The device has programmable alarms for "too low," and "too high." By no means "noninvasive," the Guardian must be calibrated by a conventional fingerstick test at least once every 12 hours.
The Guardian isn't on the shelf yet (as of press date), but will be offered at a "promotional price" of $999. Medtronic states "no release date yet." For more information, telephone: 1-800-646-4633, or visit www.protect-my-child.com or www.minimed.com

New Talking Meter

Roche Diagnostics is working on a replacement for the Accu-Chek Voicemate at this time, VOICE OF THE DIABETIC has learned. High-level sources at Roche confirm the work is underway, and that the meter may be unveiled sometime in 2005. Further details unavailable at this time; stay tuned.

 

A Different Kind of Insulin Pump

Starbridge Systems, of Swansea, Wales, is developing an insulin patch that contains a micro-pump. Described as looking like "a cross between a credit card and a first aid plaster" (Band-Aid, to speakers of American), the patch will contain a tiny pump, meant to be cheaper and easier to use than current pager-sized insulin pumps. Insulin infusion will be continuous, and controllable by the patient. The pump will be disposable.

The British National Endowment for Science, Technology, and the Arts has just awarded the company £140,000 to develop a prototype, "hopefully by the end of the year." Stay tuned.

Blood Pressure News

The American Diabetes Association (ADA) has lowered its "trigger point" recommendations for high blood pressure in individuals with diabetes. The new guidelines (as reported in Diabetes in Control Newsletter for March 30, 2004) are "no higher than 130/80." A number of recent major studies, including the United Kingdom Prospective Diabetes Study (UKPDS), have demonstrated improved outcomes, including reduced risk of stroke, when diabetics are given lower blood pressure targets, and then appropriate blood pressure medications are prescribed to achieve them.

As one class of blood pressure meds, the "ACE Inhibitors," are also effective against established diabetes complications like nephropathy and retinopathy, this is timely information. Talk to your doctor.

Can I Eat That?

Sugar is a carbohydrate. Your body needs a steady supply of carbohydrates, to maintain energy and life. What it doesn't need is an overdose. Your body needs quality protein, the equivalent of about three ounces of meat per day. It doesn't need an oversupply. And, your body needs a steady, small, supply of fats. Too much, and too little, are equally dangerous.

Twenty five hundred years ago, Greek physician Hippocrates of Kos taught that balance, moderation in diet and lifestyle, coupled with regular healthy exercise, was the best way to deter disease and ensure longevity. For diabetics, his advice is still current.

Free Internet Resource

Hundreds and thousands of doctors, hospitals, merchandisers, and NGOs (not to mention the U.S. Government) have Web sites dealing with diabetes. Their information ranges from excellent to awful. One of the most thorough, accurate, and comprehensive diabetes sites we've seen (www.mendosa.com) is also the work of a private citizen. If you have access to the Internet, and have a question about diabetes, go take a look.

The question I had was about computer programs to help diabetes management. With some of these, you key in your blood sugar test data by hand, and the computer will keep track of how you are doing. Other programs allow you to download directly from your glucose monitor. Some use Windows platforms; others are written for the Mac. Some are independent products; others are offered by specific monitor manufacturers. Some are "graphical," others allow reliable access to screen readers for the blind such as Jaws or Window-Eyes. Some are purchasable; some downloadable "shareware;" others are available free. The mendosa.com Web site had 48 pages of information about what must have been several hundred such programs, current and obsolete.

Skimming other sections of the site (he has many), it appears such information overkill is the rule; Lord knows how many thousands of pages he has on that site -- but they're all useful. Pay him a visit -- and learn something.

Islet Cell News

Islet cell transplantation, to replace nonfunctional pancreatic Beta cells and restore insulin function, probably represents an eventual cure for type 1 diabetes. However, there have been two big problems to overcome.

Most published research has focused on surmounting rejection, autoimmune attack against the new, transplanted islet cells. There's progress here. But, there's another issue: Where do we get enough islet cells to transplant?
It apparently takes up to three (human) cadavers to produce enough viable islets for one transplant, and xenotransplantation (use of animal islets, most often from the pig) still has a lot of unanswered questions, as does the use of human stem cells. Where else can we turn?

Researchers at University of Florida College of Medicine have given us another option. Working with laboratory rats, they successfully persuaded bone marrow cells to produce "clusters," structures resembling islet cells -- and these new structures produced insulin, and several other hormones normally provided by the pancreatic Islets of Langerhans.

Are they new islet cells? The researchers aren't sure, but they note the clusters, transplanted into diabetic mice, lowered their blood glucose from 550mg/dl to about 200mg/dl, and kept it stable there for three months.

Given time, this technique could become a useful tool in the treatment of human diabetes.

Another Reason for Good Face-to-Face Diabetes Education

The health Web site www.diabetesincontrol.com reports an estimated 90 million Americans "lack sufficient reading and math skills to understand basic health information and navigate the U.S. healthcare system."

More than most, diabetes is a patient-managed condition. To thrive, a diabetic MUST have access to quality health information, and it MUST be delivered in a manner he/she can understand. Thus the tendency of too many educated, privileged medical professionals to deliver their information in obscurantist highbrow verbiage makes things worse. It can cost lives.

Many Americans can't read. Others can't read well, or at a level sufficient to keep up with their doctors. Diabetes affects all of us, regardless of our literacy level -- and the answer is obvious -- plain, simple, clear instruction, in print and face to face. It is our obligation to explain diabetes care in ways our readers, listeners, and clients can understand.

Accessible Magazines

The Smithsonian Institution, America's national museum, publishes a number of magazines about history and technology (such as SMITHSONIAN, and AIR AND SPACE). Blind and visually impaired subscribers can now receive these magazines on audiocassette as well as standard print, for the normal subscription fee. For information on the Smithsonian's Accessibility Program, telephone: 1-888-783-0001.

Reversing Neonatal Diabetes

Children diagnosed with type 1, insulin dependent diabetes, at or before six months of age, can sometimes have their diabetes reversed, if they are given sulfonylureas, medications normally prescribed for non-insulin dependent, type 2, diabetes. It sounds unlikely, but it seems the sulfonylureas, given in time, to children who have a genetic defect, to the K-ATP potassium channel, may restore their insulin secretions. The doctors point out the time window for this therapy is short, and not all type 1 diabetes is caused by this particular defect -- but this could be very good news for many young children and their parents. Sources: BBC Online, and Diabetes In Control, Issue #206, May 5, 2004.

New Numbers for Pre-Diabetes

In past issues, we've discussed how the old classification for people with an elevated, but not quite "diabetic," blood glucose, Impaired Glucose Tolerance (IGT), is now to be called "Pre-Diabetes." This change is because about half the people with this condition go on to type 2, and because some of the high sugars will do damage even before the sugars reach the "diabetic" range. The idea is to diagnose quickly and take action ASAP.

As the "cut" or trip-wire for a diagnosis of diabetes has been revised downward (from 140mg/dl to 126mg/dl), more people have been diagnosed, many who'd not have been "diabetic" under the old standards. IGT has been revised downward as well, to a fasting plasma glucose higher than 110mg/dl.

The newest statistics suggest 18 million diabetics in the U.S., and perhaps 41 million individuals with IGT, double the old predictions. More people are diabetic -- but we're also doing a better job of finding them.