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Diabetes Update: Home A1C Testing

Number 64; November 1, 2003

By David Mendosa

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

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

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

My most recent contributions are:

  • Home A1C Testing
    When I think about how much time, effort, and blood when into writing my major article this month, I sometimes wish that I could have been paid for it. It was more than six months ago that I started to review meters and test kits that will check your A1c levels at home. In that time I accumulated several computer files and a stack of paper several inches think. The blood came from the 19 A1c tests that I have had so far this year.

    Honestly, however, few magazines and Web sites are interested in articles this long and this complex. Most editors nowadays would gag at a 2,300 word article like this one. The more I got into the subject the less clear the answers became.

    I have been an editor myself and could have chopped it down to a standard 600 words. Perhaps that would get more people to read it. But would the oversimplification that such butchery would require be fair to my readers?

    I think not. And I hope you agree.

Book Reviews:

    500 Low-Carb Recipes

    Dana Carpender’s Magnum Opus

  • 500 Low-Carb Recipes
    Low-carb cooking has gone beyond fad to becoming the wave of the future. Nothing attests to that more than the number of these cookbooks now available. I remember a few year’s ago when Fran McCullough’s The Low-Carb Cookbook New York: Hyperion, 1997, 384 pp., $22.95) was one of the first ones that was any good. Now, lists about 40.

    By far the best of these came to me by accident. I subscribe to Dana Carpenter’s biweekly online newsletter “Lowcarbezine!” You can subscribe through her Hold the Toast website.

    I asked Dana Carpender to send me her new cookbook, 15-Minute Low-Carb Recipes, but it hasn’t been published yet. Fortunately, her publicist send me 500 Low-Carb Recipes instead. Fair Winds Press in Gloucester, Massachusetts, published this 496-page trade paperback last November for $19.95.

    I have studied several of the low-carb cookbooks and have found something good in each of them. Never before, however, has any cookbook excited me like 500 Low-Carb Recipes.

    By no means do I follow a low-carb diet. It is closer to low glycemic than anything. But Dana’s book certainly makes it easier for anyone to cut back on the carbs.

    I found Dana’s section on hot vegetable dishes one of the most interesting. The first recipe I used was one of three that she has for brussels sprouts. I had been looking for years for a good-tasting recipe for brussels sprouts, because this cruciferous vegetable is so good for you, and never found a recipe that produced palatable results. Until now. The great success of this recipe makes this whole cookbook a winner.

    In honor of my heritage I next cooked up a pot of Dana’s Portuguese soup (without potatoes). It did my ancestors’ country proud! On the agenda are two more soups, cream of cauliflower, and peanut soup.

    Compared with Fran’s book, 500 Low-Carb Recipes appears a generation less traditional and more modern. The recipes are simpler and have fewer ingredients. This is one extraordinarily practical cookbook with recipes that are quite easy to prepare.

    This is Dana’a second book. Her first, How I Gave Up My Low-Fat Diet and Lost 40 Pounds…and How You Can Too!, came out in 1999. 15-Minute Low-Carb Recipes is at the printer’s. I will review it here as soon as I get a copy.

News You Can Use:

  • Arturo’s List
    The biggest and usually most interesting mailing list about diabetes moved in September. Formerly at, the list is now one of the many hosted by Yahoo Groups. You can subscribe by sending an email to [email protected] or you can browse to and join from there. There are so many messages on this list that unless you are an active participant in the dialogue, you need to make sure that you subscribe in digest form. This way you will receive just two or three emails per day, but these messages consist of all the day’s messages.

    One of the reasons why this list is so good is that its owner is Dr. Arturo Rolla, an endocrinologist who teaches at Harvard and often participates on the list. Another big reason is the two moderators, who make sure that the participants stay on topic.

    Now, on Yahoo Groups the list is even better. If you subscribe in digest mode, each digest starts with a summary that consists of the number of the message, the subject, and the author. This makes it even easier to see if you want to read the entire message or not.

Research News:

  • TUGging at GLUT 4
    You might think that since nine out of 10 people with diabetes have type 2 that we would know a lot more about it than type 1. In fact, we are just beginning to understand how insulin update works with people who don’t have diabetes.

    Insulin resistance, which all type 2’s have, is much more complicated than beta cell failure, the cause of type 1. That’s not to say we understand the cause or causes, but beta cell or pancreas transplants can make the recipients into members of that small enviable class of people known as “former diabetics.”Once immunosuppressive drugs are no longer required, they could even be said to be cured.

    Now, scientist at Whitehead Institute for Biomedical Research in Cambridge, Massachusetts, say in the October 16 issue of Nature that they have found a protein that plays an essential role in regulating a cell’s ability to absorb glucose, the key to insulin resistance. The researchers discovered the protein following a five-year search for molecules that control a glucose transporter named GLUT4, according to the lead author, Jonathan S. Bogan, who is now an assistant professor in the Section of Endocrinology and Metabolism, Yale University School of Medicine.

    They named this crucial protein “TUG.” In one sense “the name is just cutesy,” Dr. Bogan writes me. It stands for a Tether that contains a UBX domain for GLUT4. UBX is itself an acronym as is GLUT4.

    “UBX is similar to domains known to be involved in the regulated degradation of specific proteins,” Dr. Bogan continued. “These domains are called ‘UBiquitin,’ because they are present ubiquitously—in all cells and at all times in humans and other animals, plants, yeast, etc.” That explains the UB of UBX, but what of the X?

    “As far as I can tell, it was just another letter to use since UBA, UBL, UBD were all taken,” Dr. Bogan replied in his third email. “The X may also signify that this particular family was something of an unknown. The UBX family is more distantly related to ubiquitin than are other ubiquitin-like domains.”

    GLUT4 as an acronym is easier. It simply means the fourth GLUcose Transporter that scientists have discovered.

    TUG is one heck of an acronym encompassing as it does other acronyms. It does make sense, though, because the “protein we identified keeps glucose transporters inside the cell by tugging at them and preventing them from moving to the cell surface (in the absence of insulin).”

    Scientists working in the laboratory of Dr. Harvey Lodish, a co-author of the present research, in 1985 discovered the first glucose transporter. Scientists have subsequently discovered several others, including GLUT4. While most of these glucose transporters are at the cell surface, GLUT4 is usually deep inside the cell. It only moves to the surface when insulin sends a signal and is the only transporter that responds exclusively to the presence of insulin.

    Dr. Bogan had a collection of about 2.4 million different proteins. How to find the needle in the haystack that controlled GLUT4?

    He used tags to find TUG. Engineering GLUT4 proteins so they contained fluorescent tags, Dr. Bogan found that one protein, TUG, had a significant effect on GLUT4, acting as a tether that binds GLUT4 inside the cell. When insulin reaches the cell surface, it signals TUG to release GLUT4, which then moves to the cell surface to allow glucose absorption. These study results suggest that excess tethering may somehow contribute to insulin resistance.

    Dr. Lodish suggests that discovering this key component of the GLUT4 pathway is a significant clue for possibly identifying a diabetes drug target. “Insulin shots just overwhelm the cell and hopefully make it respond to insulin,” he says. "But so far, there aren’t any drugs that act directly on this pathway. Now we can begin to speculate, for example, that a drug which blocks TUG might enhance a cell’s ability to absorb glucose. It’s an hypothesis, but an easy one to test."

    The abstract, by Bogan JS, et. al, “Functional cloning of TUG as a regulator of GLUT4 glucose transporter trafficking,” Nature. 2003 Oct 16;425(6959):727-33, is online at

The First Peanut Butter Machine

The First Peanut Butter Machine

  • Peanut Butter Correction
    Dr. John Harvey Kellogg did receive the first patent for making peanut butter after all. In the January 2003 issue of this newsletter I cited his biography, which stated “Making no attempt to secure patents which would let him control the production of either peanut butter or any of his nut butters, he announced that they were products that ‘the world ought to have; let everybody that wants it have it, and make the best use of it.’”

    That is incorrect. Correspondent Ian Taggert wrote me this month saying that he had found the patents in a search for a school project. Dr. Kellogg filed two patents on November 4, 1895. One was for the “Process of Preparing Nutmeal” and the other was for a “Food Compound” that mixed peanut butter with the starch of wheat, barley, oats, or corn.

    The first of these is more relevant. The U.S. Patent Office granted patent #580,787 on April 13, 1897. It’s not easy to find on the agency’s site, because only images—not full text—are available for those years.

    It is, however, on the Patent Office site. And the patent does include the line that I said did not pass my “smell test” that “√ñI obtain√ña pasty adhesive substance that is for convenience of distinction termed ‘nut-butter.’ ”

    Admittedly, this is quite a stretch for Diabetes Update. I got interested in the history of peanut butter, however, when I reported in December 2002 that a Harvard study found that women who eat at least five ounces of peanuts and peanut butter a week reduced their risk of developing type 2 diabetes by 21 percent.


  • Do You Read Traditional Chinese?
    You can continue to read my Web site in American English, but now it is also becoming available in Traditional Chinese. Several of my articles have been translated into other languages, including Italian, Russian, and Czech, but this is the first time anyone has started to translate my entire diabetes site. I authorized “humble bee” to translate it all. He tells me that he comes from Taiwan, and Traditional Chinese is his mother tongue. The URL is

  • Insulin Delivery Survey
    Please click on the link in the line above. Your answers to this survey will help an innovative manufacturer of products for people with diabetes decide whether and how to proceed with an insulin delivery product.

    This survey is entirely anonymous—neither your identity, nor the identity of the survey sponsor, is accessible. As thanks for completing the survey, the manufacturer will donate $1 to the American Diabetes Association for each of the first 2,000 surveys submitted.

  • Attention MiniMed Users
    It has come to my attention that Medtronic Diabetes is no longer supplying test strips through the mail other than BD Logic strips. However, Tim Cady, the owner of Advanced Diabetes Supply, a full-line diabetes testing company, tells me that his company can provide a wide range of strips by mail order. I am myself a current customer of that company and can vouch for them. You can contact them at 1-800-730-9887 or [email protected].

  • 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 is free and will never include advertising. Nor will I ever sell, rent, or trade your e-mail address to anyone.


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

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