A Colorado Lake

This newsletter keeps you up-to-date with new articles, Web pages, and books that I have written about diabetes.

• I list and link most of these on my at Diabetes Directory and in the site’s menu.

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

My recent contributions are:

• Keynote Address
  The day after the election I had the pleasure of delivering the keynote address to Institute for the Future’s Health Horizons Program in Menlo Park, California. I attended the entire conference and got a lot out of it, not least the inspiration to buy (and actually use!) a treadmill and weights. You can read my article on my site at Keynote Address.

• Incorrect Diabetes Terms
  While the conference that I spoke at last month was great, some speakers threw around incorrect diabetes terms, like calling us “diabetics.” Nobody referred to any of us as “noncompliant,” another terms that many of us take exception to. For my directory of what I see as these incorrect terms, please read Incorrect Diabetes Terms. I am sure that you can think of even more such terms than I list. If so, please write me at [email protected].

• Precision Comes Before Accuracy
  It doesn’t do much good if your meter is accurate but not precise. Precision is the ability of a measurement to be consistently reproduced. If you can’t consistently reproduce your blood glucose tests, your meter can’t possibly be correct, except once in a while. Random acts of accuracy are worse than useless. This article originally appeared in the November 2004 issue of Diabetes Health and is now also online at Precision Comes Before Accuracy.

Update:

• Drug Interactions
  At the conference I went to last month that I mentioned above several speakers stressed the importance of knowing about potential drug interactions. So I thought it would be appropriate to review the articles I wrote years ago on this subject.

  Several sites have good interaction tools. Probably the best free Web tools are at Drugstore.com and Drugs.com. The URL of the “Drug Interaction Checker” at Drugs.com is http://www.drugs.com/drug_interactions.html. Drugstore.com also calls its tool a “Drug Interaction Checker.” It is hard-to-find with a difficult URL, Link.

  There are several new sites that I haven’t used myself. The Express Scripts “Check Interactions” site is http://www.drugdigest.org/DD/Interaction/ChooseDrugs/1,4109,,00.html.

  Another one is Discovery Health’s “Drug Interaction Checker.” The URL of this tool is http://health.discovery.com/encyclopedias/checker/checker.jsp.

  If several readers try and compare some of these sites, I may include a further update in a subsequent issue. I would appreciate your comments on the ease-of-use and completeness of these site, if you care to write me at [email protected].

Research Notes:

• Preprandial Versus Postprandial Testing
  Just within the past few years we have had a much greater emphasis on blood glucose testing after meals. I emphasized the importance of this “postprandial” testing in a September 2000 article on Starlix in Diabetes Wellness Letter and more fully in a more recent article on testing guidelines on the American Diabetes Association’s website.

  Most experts recommend that you do your postprandial testing two hours after the first bite of the meal. Some, however, would like us to test after one hour. I previously recommended testing after two hours, as I explained in my testing guidelines article referred to above. But a recent study, “The postprandial glucose profile in the diabetic pregnancy” in the August 2004 issue of the American Journal of Obstetrics and Gynecology by doctors in the department of obstetrics and gynecology at the Rabin Medical Center of Tel Aviv University shows that at least for pregnant women who have diabetes, “the time interval for postprandial glucose peak in diabetic pregnancies is approximately 90 minutes after meals throughout the day and is not affected by the level of glycemic control.” This could be a good reason for all of us to change to testing an hour and one-half instead of two hours after the beginning of a meal. That is what I have done.

  But what is a good level? The experts disagree. The ADA says your goal should be below 180 mg/dl. The American College of Endocrinology says that it should be no more than 140 mg/dl. And some endocrinologists set the goal at 120 mg/dl.

  Of course, many people routinely do a fasting blood test every morning. In addition, we have the opportunity to test before and after each meal, before and after exercise, and when going to bed. Which of these are the most important times to test?

  Dr. Richard J. Schrot addresses this question in the October 2004 issue of Clinical Diabetes. His research on “Targeting Plasma Glucose: Preprandial Versus Postprandial” concludes that targeting fasting plasma glucose is more beneficial when your A1C level is very high, like about 10, while targeting postprandial glucose is more effective when you have a lower A1C, say about 7. Personally, I am now testing 90 minutes after each meal.

  You can read the entire article online at http://clinical.diabetesjournals.org/cgi/content/full/22/4/169

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