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Diabetes Update: Native American Diabetes

Number 38; June 3, 2002

By David Mendosa

This newsletter keeps you up-to-date with new articles, columns, and Web pages that I have written. I list and link most of these on my Diabetes Directory at www.mendosa.com/diabetes.htm

From time to time Diabetes Update may also include links to other Web pages of special interest.

My most recent contribution is:

on June 3, 2002

  • Native American Diabetes
    Too often in my early work experience I didn't quite fit. When I worked in the Bureau for Africa of the U.S. Agency for International Development, my skin wasn't dark enough. Then when I shifted to the agency's Office of Population I would never have risen to the top because it was run by M.D.'s and I was just a M.A. When I sold bookkeeping services to small businesses, I hadn't yet had the experience of running my own. When I sold shoes to women, there was no way I could wear them. When I was an editor at Hispanic Business magazine, I wasn't Hispanic enough (being part Portuguese descent didn't count with the publisher).

    Now as I write about diabetes I know from my personal experience what it is. I feel doubly connected to the subject of my current column for the American Diabetes Association on Native American Diabetes. Not only do I have diabetes myself but I also learned recently that at least a small part of my ancestry is Native American. My fifth great-grandmother Mary Church was a Native American born in Rhode Island about 1725. That makes me 1/128 Indian. Considering where and when she was born, Grandma Mary Church was probably a member of the Narragansett tribe, which was a part of the Algonquin family.

    While this may not be enough Indian blood to brag about, I am frankly more excited about it that my relationship to the President. George W. Bush (Shrub) is my 10th cousin once removed.

    Being part Indian myself, I can walk the walk as well as talk the talk. Diabetes is a Native American epidemic. Some people though are doing something about it. See my column on the Web site of the American Diabetes Association. The URL is
    http://www.diabetes.org/main/community/info_news/web/default.jsp

Update:

    on May 16, 2002
  • Glucophage Dangers?
    With the scare stories in the popular press lately (based on a report in the Journal of the American Medical Association) it's no wonder that some of you who take Glucophage (metformin) to control your type 2 diabetes are concerned with its safety. Some of you have even written to ask me what alternative medications I would recommend. Here's my reply:

    Glucophage is the most widely prescribed diabetes drug. Literally millions of Americans, myself included, take it every day. So there must be good reasons why your doctor and mine prescribed it. One of the reasons is because it is the most effective drug in lowering blood glucose. Another is that it is the only diabetes drug that actually helps us to lose a little weight—and all of the others, including insulin, cause weight gain.

    Like any drug, Glucophage has serious side effects in some people. In rare cases, Glucophage may cause lactic acidosis (buildup of lactic acid in the blood), which is serious and can be fatal in half the cases. Read the full prescribing information at http://www.glucophagexr.com/glucophagexr/channels.jsp?BV_SessionID=@@@@2118230080.1022701210@@@@& BV_EngineID=ccccadcfdeedghecfkjcemndfnidflj.0&channelId=-1073750065&channelPage=/channels.jsp

    It says there, in the boxed warning about lactic acidosis, in part that:

    "The reported incidence of lactic acidosis in patients receiving metformin hydrochloride is very low (approximately 0.03 cases/1000 patient-years, with approximately 0.015 fatal cases/1000 patient-years). Reported cases have occurred primarily in diabetic patients with significant renal insufficiency, including both intrinsic renal disease and renal hypoperfusion, often in the setting of multiple concomitant medical/surgical problems and multiple concomitant medications. Patients with congestive heart failure requiring pharmacologic management, in particular those with unstable or acute congestive heart failure who are at risk of hypoperfusion and hypoxemia, are at increased risk of lactic acidosis."

    Like the boxed warning, the JAMA article was concerned with patients who have congestive heart failure or renal dysfunction. Apparently at a clinic in North Carolina diabetes patients were routinely prescribed Glucophage without checking for congestive heart failure or renal dysfunction. That was the problem the article addressed. You can read the JAMA article for yourself at http://jama.ama-assn.org/issues/v287n19/ffull/jlt0515-3.html.

    Regular monitoring of renal function is important in people who take Glucophage. You should discuss this with your doctor.

  • What is Low Glycemic?
    I thought I wrote about this here recently. But I can't find it, so here it is (again?). One of the most common questions I get is, "What is low glycemic?" I have resisted giving a specific answer, just generally recommending eating lower on the list. But the new GI Symbol Program Home Page, run by Glycemic Index Limited, a non-profit company, whose members are the University of Sydney, Diabetes Australia, and the Juvenile Diabetes Research Foundation, does have its limits. In terms of the symbol (which so far is available only in Australia), a high GI value is 70 or more (where glucose = 100), a medium GI value is 56 to 69 inclusive, and a low GI value is 55 or less. The URL is http://www.gisymbol.com.au/pages/index.asp.

Book Reviews:

    on June 2, 2002
    Zen and the Art of Diabetes Maintenance
  • Zen and the Art of Diabetes Maintenance
    For some of us older dudes the title of Charles Creekmore's new book, Zen and the Art of Diabetes Maintenance: A spiritual toolkit for a better life is the most interesting thing about it. It brings to mind Robert M. Pirsig's now classic 1974 novel Zen and the Art of Motorcycle Maintenance: An inquiry into values.

    Others may well think that Creekmore's unacknowledged rip-off of Pirsig's title shows his inability to do original thinking. Creekmore merely states that it is "meant as a whimsical, tongue-in-cheek title." He admits that he knows very little about Zen, Buddhism, or any other philosophy. He does know something about diabetes, learned after his diagnosis at about age 50. His interest in the book, he says, is to pass along "a thing or two about the spiritual side of managing diabetes."

    Unlike Pirsig's novel, Creekmore's book is non-fiction, a rambling, easy-to-read account of his life and apparently of anything that he can think of that he has heard about diabetes. While I learned more about him that I would like to know, I can't think of anything that I learned about the spiritual aspects of diabetes from the book.

    The American Diabetes Association just published Zen and the Art of Diabetes Management. It's a 231-page paperback listing for $15.95. It apparently had a different working title, because at least three booksellers call it How I Learned to Stop Worrying and Love Diabetes: A Complete Field Guide for Spiritual and Emotional Well Being. Had that title stuck Creekmore would not have been the first to rip off another classic, this one the 1964 movie "Dr. Strangelove, Or: How I Learned To Stop Worrying And Love The Bomb." Besides the bomb, others have learned to stop worrying and love Microsoft, HTTP, Y2K, the Internet, the Rocket, the Panopticon, the Monomyth, the A-Rod deal, The Strokes, the SMTP MTA, and myself, just to check a few titles of books, magazines, and articles.

    The actual title does seem a bit fresher, but it will never match the original. As I write today Amazon ranks Pirsig's novel 968. Creekmore's book stands at 72,497.

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