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 www.mendosa.com/diabetes.htm 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:

• Erectile Dysfunction
  Before Viagra burst on the scene eight years ago, they called it impotence. Now it is merely erectile dysfunction, since it is a function that can usually be restored. If one drug doesn’t do it, a couple of others probably will.

  Levitra has been available for several months. Cialis came on the market last month. All of these drugs are quite similar in the way they work. The biggest difference is when they work.

  Whether it is impotence or erectile dysfunction, it is one of the biggest complications of diabetes. We haven’t talked about it much — until now. You can read my new article on erectile dysfunction at http://www.mendosa.com/erectile_dysfunction.htm.

• The Hunt for the Hormone Responsible for Diabetes
  Since 60 percent of all Americans are overweight and just 6 percent have diabetes, it’s clear that obesity doesn’t cause diabetes. Yet there is a close, not well-understood relationship.

  We now understand it better. Scientists at the Eleanor Roosevelt Institute in Denver found that diabetes in obese mice requires the melanocyte-stimulating hormone, which is made by the proopiomelanocortin (POMC) gene that is found in both mice and humans. Mice without the MSH hormone were obese, but did not develop diabetes.

  There’s more. These mice didn’t induce any glucagon. The absence of glucagon looks like hypersensitivity to insulin, leading earlier researchers to think that type 2 diabetes is caused by insulin resistance instead.

  It’s a complicated story that is hard to follow in their printed article. But researcher Miles Brennan explained the research in an interview with me. You can read my article about it at
  http://www.mendosa.com/hormones_obesity_diabetes.htm.

• Buyer’s Guide for Pedometers
  If walking is the best exercise for people with diabetes, a pedometer is the best gadget to encourage you to get going and measure your miles. The problem is that there are hundreds of different pedometers on the market, each with different functions and capabilities. The place to start your search for the one that is right for you is my new article in Diabetes Wellness News, which is also available online at
  http://www.mendosa.com/pedometers_buy.htm.

Update:

• Exenatide Trials
  The drug based on gila monster venom is crawling closer to market. The second of three Phase 3 trials of exenatide (synthetic exendin-4) produced dramatic results — lower A1C levels coupled with weight loss. Amylin Pharmaceuticals Inc. and Eli Lilly and Company plan on asking the U.S. Food and Drug Administration for approval in about six months.

  That’s part of the good news. The bad news is that the drug requires two shots per day. Ouch!

  The other good news is Exenatide LAR (Long Acting Release) might allow once-a-week to once-a-month administration. That version of the drug is in Phase 2 trials.

  Amylin’s website has more at http://www.amylin.com/Pipeline/index.cfm.

Book Review:

Dana’s Latest but Not Greatest

• 15-Minute Low-Carb Recipes
  As a beginning cook, there is nothing I would like more than a cookbook that will tell me how I can prepare a delicious meal with little effort. I call myself a beginning cook, because I now do my share of cooking at home. My inspiration was Dana Carpender’s outstanding 500 Low-Carb Recipes, which I reviewed here two months ago.

  I follow a low-GI rather than a low-carb diet, but certainly have nothing against low-carb recipes. Low-carb is what these two books have in common. The idea of getting in and out of the kitchen quickly makes Dana’s new book especially exciting to me.

  That’s why I was disappointed when the book arrived and I began to study it. The recipes are certainly quick and clearly low-carb. That’s not something that I would fault. They just do not excite me.

  I’m mostly in to cooking vegetable soups and stews these days, and these one-dish meals might seem to be perfect candidates for a cookbook such as this, but there are no stews and only a few thin soups offered here. I guess what I really like is the complex taste of slow-simmering stews, which are impossible in the 15-minute time limit.

  The bigger problem is that since I work at home I can be in and out of the kitchen all day, unlike most people who have to drive miles to get to their office. For those people this book will be a lot more valuable. Indeed, the book’s reviews on Amazon.com are uniformly positive. So if you, unlike me, are busy and committed to eating low-carb, this is another cookbook that you probably should check out.

  Dana Carpender’s 15-Minute Low-Carb Recipes, published in October 2003 by Fair Winds Press in Gloucester, Massachusetts, for $17.95, is a 253-page trade paperback.

Research News:

• Poorer Control
  Researchers report that only 35.8 percent of U.S. adults with type 2 diabetes have an A1C level below 7.0 percent. Along with the American Diabetes Association, they call that being in control, although a growing number of people would say that the level would have to be below 6.5 percent or even below 6.0 percent.

  The analysis is based on the initial release of the National Health and Nutrition Examination Survey (NHANES) 1999 to 2000. Compared to the earlier NHANES III for 1988 to 1994, our control is getting worse. In the earlier survey 44.5 percent of us were in control by their standard.

  Strangely, this decline parallels more aggressive therapy. People relying on diet alone declined from 27.4 to 20.2 percent. Use of oral medication went up from 45.4 to 52.5 percent, and the number of those of us on both orals and insulin shot up from 3.1 to 11.0 percent. Those on insulin only dropped from 24.2 to 16.4 percent. That means total insulin users were practically unchanged from 27.3 to 27.4 percent.

  The numbers for insulin and oral use are a substantial change from previously available data reported in Chapter 25, “Therapy for Diabetes” by Brian J. Fertig, MD; David A. Simmons, MD; and Donald B. Martin, MD in Diabetes in America, Second Edition, online at http://diabetes.niddk.nih.gov/dm/pubs/america/pdf/chapter25.pdf. They report in Table 25.2, based on the 1989 National Health Interview Survey, that of U.S. adults with NIDDM (now called type 2 diabetes) 18 years and older 39.4 percent used insulin and 52.0 percent used orals.

  The big question is why our control is getting worse. Could it have something to do with the larger portion sizes of the meals we eat? That’s a cultural reality and whether we like it or now, we are a part of that larger culture.

  The research is “Glycemic Control From 1988 to 2000 Among U.S. Adults Diagnosed With Type 2 Diabetes: A preliminary report” by Carol E. Koro et al. in the January 2004 issue of Diabetes Care, pp. 17-20. The abstract is online at http://care.diabetesjournals.org/cgi/content/abstract/27/1/17?etoc

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