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Diabetes Update: When to Test

November 1, 2005

By David Mendosa


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Ember at 7 Months
Ember at 7 Months

My most recent articles are:

  • The first issue of new magazine called Type 2 Life includes two articles that I wrote. Novartis Pharmaceuticals, which markets Starlix (nateglinide), publishes it “to deliver objective, lifestyle-oriented information to people who have type 2 diabetes.” I guess that’s why they asked me to write for it. Novartis reps are providing the magazine to doctors so they can put it in their waiting rooms.

    1. My article on “When to Test and Why” points out the evidence for the current shift to testing after meals, rather than before breakfast, at least for people whose diabetes is well controlled. This shift is good for Novartis and its Starlix, because that drug can help control mealtime highs. The URL is
      http://mendosa.com/when_to_test.htm

    2. My other article in the first issue of Type 2 Life is about what is perhaps the most important treatment for diabetes — and probably the one most honored in the breach — exercise. Writing this article certainly was good for me, because I now exercise more. I hope that you will too. As I took a long, slow walk this morning (because of newly diagnosed arthritis in a knee), I remembered the maxim that I coined for the article:
      It’s the Deed
      Not the Speed
      That summarizes the article, but there is a lot more here for anyone with diabetes. The URL is
      http://mendosa.com/exercise_type_2.htm

  • Evaluating Meters

    For my article about two organizations that evaluate meters please read my current “Meter News” column in the October issue of Diabetes Health magazine or read it on my website at http://www.mendosa.com/evaluating_meters.htm

Updates:

  • Dawn Phenomenon
    In previous issues of this newsletter we have discussed several strategies for controlling the dawn phenomenon. Now, Ann Munroe, a scientific and medical editor in Warriewood, New South Wales, Australia, writes about something that works for her:
    I have known about my type 2 for about 6 months and follow Dr Bernstein’s philosophy as much as possible, with good results except for a persistent and unpredictable dawn phenomenon. I was still trying the green apple before bed (with variable results) when I stumbled upon Hi-Maize. Taking about one-third of a cup a day seems to have knocked the dawn problem on the head very effectively. It doesn’t seem to affect my blood sugar too much, either.

    I live in Australia, and here it is available as a type of cornstarch for cooking or as a powder that you can put in drinks. There is a reference that explains the mechanism of how this works (it is called Novalose 260 in the research article). Anyway, it seems far superior to anything else I have tried, and I highly recommend it. I have only so far used the cooking type of Hi-Maize, and I make a sort of sweet pancake with it using a Da Vinci syrup, or a savoury one with mushrooms, cheese, etc. It hasn’t yet let me down in 10 days of trying it.

    I think Hi-Maize was originally invented here in Australia by the CSIRO (Commwealth Scientific and Industrial Research Organization), but I am not sure. The brand I got is called Select, but it is also made by Goodman Fielder here for addition to bread, etc. I’ll be watching with interest to see how everyone else goes with it!

    A few days ago I wrote the Hi-Maize website asking about U.S. availability, but they haven’t answered.

Product News:

  • Barley Cereal
    I just had a bowl of great barley cereal. It was really easy to make, tastes great, and is certainly healthy.

    I usually had McCann’s Irish Oatmeal for breakfast, as I have written on my website at My Favorite Low Carb and Low GI Foods. I serve both the barley cereal and the oatmeal with soymilk, stevia or sucralose, sliced almonds, and cinnamon.

    You probably know that barley is the lowest glycemic grain, even lower GI than oatmeal (porridge). Barley porridge has a GI of about 50.

    Currently it is only available on the Whole Control website, but the company hopes to get distribution in Vitamin Cottage, Wild Oats, and Albertson’s in the near future. Whole Control is in Denver, and its toll-free phone is 1 (888) 946-5326.

    Whole Control’s managing partner is Frank Harritt, who was diagnosed in 1987 with type 2 diabetes. Frank brings more than 20 years of successful marketing and sales experience on leading national brands.

    Its barley cereal is $3.95 for a one pound bag or $8.95 for a 2.5 pound bag, which comes to about $.25 per serving — not a bad deal for all the great health benefits.

    Whole Control golden barley cereal is nearly the perfect cereal for people with diabetes. Like oatmeal, it helps control blood glucose, blood pressure, and cholesterol — but with a much lower glycemic index. It tastes great, and I highly recommend it. In fact, I now have a bowl nearly every day!

Book and Magazine Reviews:

    Mind-Body Diabetes Revolution

    The Worst Pills for You

  • Worst Pills, Best Pills

    Most Americans take a lot of pills, some prescribed by their doctors and perhaps just as many that we buy over the counter. Those of us with type 2 diabetes probably even take more than most people.

    Many pills are wonderful. Some may even be live-saving.

    And others can cause big problems. Personally, I have tried five different statin drugs to help control my cholesterol, and every one of them gave me excruciating muscle pains. I also can’t take Bactrim, a widely prescribed antibacterial combination drug. When I broke out in a rash all over my body, my doctor said, “Sorry that I poisoned you.”

    Every drug has a therapeutic dose and a toxic dose. For some people, like my experience with the statins and Bactrim, the two doses are the same. A more general example is the mineral vanadium, which people often recommend for those of us with type 2 diabetes. Vanadium might be valuable, but its therapeutic and toxic doses are awfully close together.

    Maybe even more common are unforeseen drug interactions. Fortunately, several excellent websites can help identify potential interaction problems. One of my most recent reviews of these sites is in an issue of my Diabetes Update newsletter at http://www.mendosa.com/diabetes_update_77.htm.

    Dozens of drugs also affect our blood glucose levels. One of the questions I get asked the most often is about drugs that affect blood glucose levels. Some drugs can cause hypoglycemia and others cause hyperglycemia. Others have some effect, although less severe.

    Stephen Freed’s appendix in Dr. Richard K. Bernstein’s Diabetes Solution is what I used to turn to most often to answer that question. But even though I have written articles for print for more than half a century, I am now more of an Internet person. So I asked Stephen if I could host his list on mendosa.com. His reply was even better. Stephen now hosts the list on his Diabetes in Control.com site. It’s better that way because he can keep it up-to-date there. The list is a PDF at http://www.diabetesincontrol.com/issues/issue246/drugs.pdf.

    Maybe we have grown too sanguine about the benefits that drugs can offer us. If you are one of those people who unquestioningly takes what your doctor prescribes — or your friend recommends — Worst Pills, Best Pills is for you.

    The new 2005 edition is a huge 913-page paperback that lists for a reasonable $19.95 (ISBN 0-7434-9256-0). Public Citizen’s Health Research Group put this tome together. Famous consumer advocate Ralph Nader founded this organization.

    The book analyzes the 538 drugs we use the most. Of these 181 are on its “do not use” list.

    It labels some of these “do not use until seven years after release.” This makes a lot of cautious sense. While there are rare breakthrough drugs that are much better than anything we had before, new drugs as a group are the most dangerous because not all that many people have used them. Think Rezulin. The first diabetes drug in a new class, Rezulin killed at least 63 people with diabetes before the FDA yanked it off the market five years ago.

    There is a lot of good stuff in the book, like its recommendation to take psyllium for high cholesterol, which I started to take after reading the book. Still, I think that it goes too far in the “worst pills” category.

    In diabetes drugs, for example, it says not to use two first-generation sulfonylureas Dymelor and Diabinese (other sulfonylureas, are OK for “limited use”). Generic metformin and brand-name Glucophage are also OK “for limited use.” Do not use, the book says, Actos, Avandia, Starlix, or Prandin. Most of us with type 2 diabetes use one of these drugs. If that’s you, you might want to read Worst Pills, Best Pills. But don’t stop taking them without talking it over with your doctor.

    The book doesn’t mention two seldom used diabetes drugs, Precose and Glycet. And too new to be included are Symlin and Byetta, which some people do consider to be breakthrough drugs, but might well fall out according to the book’s seven-year rule. The only diabetes drug the book doesn’t have any problem with is insulin. My website has a page about the different diabetes pills at mendosa.com/drugs.htm and the insulins at mendosa.com/insulin.htm.

    The current edition of Worst Pills, Best Pills is a revision of a book that Public Citizen has published since 1988. A totally new section this year covers the most common dietary and herbal supplements. What was amazing to me was that among these supplements the book says “do not use” to every single one.

    My conclusion: The book is extreme, but if you consider it judiciously, it can be a good balance to pharmaceutical propaganda.

  • AARP on Diabetes
    I’ve finally made it to the big time — the largest circulation magazine in the world. AARP The Magazine has an article about diabetes in its November-December issue. More than 23 million people subscribe to it — more than twice as many as to Reader’s Digest. I wish that I could say that I wrote the article. Instead Kelly Griffin interviewed me for it. She writes a fine article, and it is online at http://www.aarpmagazine.org/health/diabetes.html.

Web Resources:

  • Quacks
    People often write to ask about some new miracle solution to diabetes. I give them the usual warnings that anything that appears to be too good to be true probably is good for the salesman and especially to question anything that cures just about everything.

    Nobody is better at exposing these quacks and scams than my friend, endocrinologist Bill Quick M.D. We have worked together for more than a decade, but I leave it to him to concentrate on exposing these frauds, because I don’t enjoy the hate mail and even more because my insurance won’t cover libel suits, which while unjustified still have to be defended by attorneys. Twice now I have had to hire attorneys because of something that I wrote, and both times I was lucky enough to arrange pro bono defenses and avoid lawsuits, but I don’t want to take any chances.

    Anyway, Bill has several important web pages about quacks. See especially Diabetes Quackery and Too Good to Be True.

    Also see Ten Ways to Avoid Being Quacked by Stephen Barrett, M.D., the aptly named “Quackwatch Doctor.”

  • The Diabetesdoc
    Endocrinologist Bill Quick M.D. has called himself “Bill the diabetesdoc” for some time now. He deserves that label, because no other endocrinologist has given more to the diabetes world through his Diabetes Monitor website and his blog.

    Now, unfortunately he has even more reason to call himself the diabetesdoc. He not only writes about diabetes — he has it too. It’s probably LADA, Latent Autoimmune Diabetes in Adults, a form of type 1. I don’t think that he caught it from writing about diabetes.

    Only a few other endocrinologists are active on the Internet, but none of them have diabetes. The three who come to mind are Arturo Rollo in Boston, who runs diabetes mailing lists including Diabetes World, Alan Rubin in San Francisco, who is the the first endo to have a podcast, and Reddy Biggs in Amarillo, who often posts on the misc.health.diabetes newsgroup.

    Except for Bill, none of these endos have diabetes. The only ones who do that Bill, his wife Steph (a diabetes nurse educator), and I can think of are Richard K. Bernstein in Mamaroneck, New York; Steve Edelman in San Diego; Lois Jovanovich in Santa Barbara; Irl B. Hirsch in Seattle; Wayne Moore in Kansas City, Missouri; Dick Guthrie in Wichita, Kansas; Ron James in Columbia, Missouri; and Stephen W. Ponder in Corpus Christi.

Announcements:

  • This Newsletter
    Diabetes Update 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.

  • HTML Format
    I send out Diabetes Update e-mail in HTML format, which all Web browsers and most modern e-mail programs can display. HTML has live links to all the sites named in the text so that with a simple click of a mouse you can connect to the site you have just been reading about.

  • My Guarantee
    This newsletter:
    1. Is and will remain free.
    2. Nor will I ever sell, rent, or trade your e-mail address to anyone.
    3. I will link sources of information.
    4. I will disclose any conflict of interest.
    5. If and when I learn of any errors of fact, I will correct them.

Archives:

I now send out Diabetes Update once a month. Previous issues are online:

  1. Diabetes Update Number 1: Diabetes Genes of December 10, 2000
  2. Diabetes Update Number 2: DiabetesWATCH of December 18, 2000
  3. Diabetes Update Number 3: Starlix of January 3, 2001
  4. Diabetes Update Number 4: Native Seeds/SEARCH, Tepary Beans of January 17, 2001
  5. Diabetes Update Number 5: Insulin Makes You Fat of January 31, 2001
  6. Diabetes Update Number 6: Available and Unavailable Carbohydrates of February 15, 2001
  7. Diabetes Update Number 7: Dates of March 1, 2001
  8. Diabetes Update Number 8: Quackwatch of March 15, 2001
  9. Diabetes Update Number 9: The Cost of Insulin of March 30, 2001
  10. Diabetes Update Number 10: Sof-Tact Meter of April 2, 2001
  11. Diabetes Update Number 11: iControlDiabetes of April 16, 2001
  12. Diabetes Update Number 12: Cinnamon, Tagatose of May 2, 2001
  13. Diabetes Update Number 13: Glycemic Index of May 15, 2001
  14. Diabetes Update Number 14: Eat Your Carrots! of May 31, 2001
  15. Diabetes Update Number 15: Glycemic Load of June 21, 2001
  16. Diabetes Update Number 16: Homocysteine of July 2, 2001
  17. Diabetes Update Number 17: Chana Dal Tips of July 15, 2001
  18. Diabetes Update Number 18: Lag Time in AlternativeLand of August 2, 2001
  19. Diabetes Update Number 19: Fiber of August 15, 2001
  20. Diabetes Update Number 20: How Diabetes Works of August 30, 2001
  21. Diabetes Update Number 21: Insulin Resistance of September 14, 2001
  22. Diabetes Update Number 22: Trans Fats, Honey, CU of October 1, 2001
  23. Diabetes Update Number 23: Pedometer Power of October 15, 2001
  24. Diabetes Update Number 24: Is Glycerin a Carbohydrate? of October 31, 2001
  25. Diabetes Update Number 25: Kill the Meter to Save It of November 15, 2001
  26. Diabetes Update Number 26: Protein, Fat, and the GI of December 1, 2001
  27. Diabetes Update Number 27: Insulin Index of December 14, 2001
  28. Diabetes Update Number 28: Fructose of January 4, 2002
  29. Diabetes Update Number 29: Aspirin of January 14, 2002
  30. Diabetes Update Number 30: Stevia of January 31, 2002
  31. Diabetes Update Number 31: Gretchen Becker’s Book of February 19, 2002
  32. Diabetes Update Number 32: The UKPDS of March 4, 2002
  33. Diabetes Update Number 33: Financial Aid of March 18, 2002
  34. Diabetes Update Number 34: Pre-Diabetes of April 1, 2002
  35. Diabetes Update Number 35: More Glycemic Indexes of April 15, 2002
  36. Diabetes Update Number 36: Gila Monsters of April 30, 2002
  37. Diabetes Update Number 37: Is INGAP a Cure? of May 15, 2002
  38. Diabetes Update Number 38: Native American Diabetes of June 3, 2002
  39. Diabetes Update Number 39: FDA Diabetes of June 19, 2002
  40. Diabetes Update Number 40: Diabetes Support Groups of July 1, 2002
  41. Diabetes Update Number 41: New GI and GL Table of July 15, 2002
  42. Diabetes Update Number 42: Diabetes Sight of August 1, 2002
  43. Diabetes Update Number 43: DrugDigest of August 18, 2002
  44. Diabetes Update Number 44: Hanuman Garden of September 3, 2002
  45. Diabetes Update Number 45: Guidelines of September 16, 2002
  46. Diabetes Update Number 46: Trans Fat of October 4, 2002
  47. Diabetes Update Number 47: Nutrition.Gov of October 16, 2002
  48. Diabetes Update Number 48: Our Hearts of October 31, 2002
  49. Diabetes Update Number 49: Our Kidneys of November 15, 2002
  50. Diabetes Update Number 50: A1C<7 of December 2, 2002
  51. Diabetes Update Number 51: Diabetes Searches with Google of December 16, 2002
  52. Diabetes Update Number 52: e-Patients of January 2, 2003
  53. Diabetes Update Number 53: Email News of January 16, 2003
  54. Diabetes Update Number 54: Third Generation Meters of January 31, 2003
  55. Diabetes Update Number 55: Hypoglycemic Supplies of February 14, 2003
  56. Diabetes Update Number 56: Food Police of March 1, 2003
  57. Diabetes Update Number 57: Vitamins of April 1, 2003
  58. Diabetes Update Number 58: Lancets of May 1, 2003
  59. Diabetes Update Number 59: Accurate Meters of June 1, 2003
  60. Diabetes Update Number 60: Chromium of July 1, 2003
  61. Diabetes Update Number 61: Traveling of August 1, 2003
  62. Diabetes Update Number 62: My Book of September 1, 2003
  63. Diabetes Update Number 63: Hot Tubs of October 1, 2003
  64. Diabetes Update Number 64: Home A1C Testing of November 1, 2003
  65. Diabetes Update Number 65: Detemir of December 1, 2003
  66. Diabetes Update Number 66: Erectile Dysfunction of January 1, 2004
  67. Diabetes Update Number 67: Acidic Foods of February 1, 2004
  68. Diabetes Update Number 68: Net Carbs of March 1, 2004
  69. Diabetes Update Number 69: Glycemic Index of April 1, 2004
  70. Diabetes Update Number 70: Dreamfields Pasta of May 1, 2004
  71. Diabetes Update Number 71: Cholesterol of June 1, 2004
  72. Diabetes Update Number 72: Meter News of July 1, 2004
  73. Diabetes Update Number 73: Pill Splitting of August 1, 2004
  74. Diabetes Update Number 74: GlucoMON of September 1, 2004
  75. Diabetes Update Number 75: Coding of October 1, 2004
  76. Diabetes Update Number 76: Sleep Apnea of November 1, 2004
  77. Diabetes Update Number 77: Keynote Address of December 1, 2004
  78. Diabetes Update Number 78: Mangosteen of January 1, 2005
  79. Diabetes Update Number 79: Noninvasive Dream of February 1, 2005
  80. Diabetes Update Number 80: Pelikan Sun of March 1, 2005
  81. Diabetes Update Number 81: Medtronic Monitors of April 1, 2005
  82. Diabetes Update Number 82: ExtendBars of May 1, 2005
  83. Diabetes Update Number 83: GlycoMark of June 1, 2005
  84. Diabetes Update Number 84: My British Book of July 1, 2005
  85. Diabetes Update Number 85: Disintegrating of August 1, 2005
  86. Diabetes Update Number 86: Meter Research of September 1, 2005
  87. Diabetes Update Number 87: Evaluating Meters of October 1, 2005
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