Wednesday, November 30, 2011
Tuesday, November 29, 2011
Most of my old blogs were lost during the hacking attack and other website changes. I plan to update and repeat some of the previous blogs .
We all use home glucose test to manage our diabetes . Home glucose testing has been one of the major improvements in the day to day management of diabetes. It is not perfect but it is still a fantastic improvement when I think about the old urine glucose test that we previously used to make treatment decisions.
Monday, November 28, 2011
Wednesday, November 23, 2011
"Risk of heart
failure increased with age and duration of diabetes. Other modifiable factors associated with increased risk of heart failure were smoking, high systolic blood pressure, and raised body-mass index. In a subgroup of 18281 patients (87%) with data for blood lipids, higher HDL cholesterol was associated with lower risk of heart failure, but there was no association with LDL cholesterol. "
The above picture of a graph does not show well . It genererally shows that higher A1c results are associated with increased risk.
The only risk factors that are not within our power to control is our age and the duration of our diabetes. The others boil down to our own personal choice .
Diabetes is a game of numbers, play hard and win the day .
Saturday, November 19, 2011
Thursday, November 17, 2011
For People Who Take Acarbose (Precose) or Miglitol (Glyset)
People who take either of these diabetes medications should know that only pure glucose, also called dextrose-available in tablet or gel form-will raise their blood glucose level during a low blood glucose episode. Other quick-fix foods and drinks won't raise the level quickly enough because acarbose and miglitol slow the digestion of other forms of carbohydrate
These two drugs Precose and Glyset inhibit intestinal and pancreatic enzymes that convert carbohydrates into glucose.These medications have not been popular because of side effects , flatulence, diarrhea and abdominal pain.
Acarbose is used to reduce after meal glucose increases and may help lower the risk of heart disease . I have attached comments from the 2011 American Heart Association scientific sessions below. The discussion was about the cardioprotective effect of diabetes medications .
The older, already FDA-approved drug acarbose may also be a viable option, as it could potentially target postprandial glycemia as a risk factor for CVD, Rury R. Holman, FRCP, of the Oxford Centre for Diabetes, Endocrinology & Metabolism in the United Kingdom, said.
Several trials have associated acarbose with reductions in postprandial glucose and subsequent decreases in CVD risk factors. The Study to Prevent Noninsulin-Dependent Diabetes Mellitus (STOP-NIDDM), for example, revealed a 49% RR reduction for development of CV events in patients with impaired glucose tolerance in a secondary analysis. Similarly, data from a study in Japan linked acarbose with improved postprandial flow-mediated dilation and, thus, improved endothelial function.
To further investigate this association, Holman and colleagues are conducting the Acarbose Cardiovascular Evaluation (ACE) study - a multicenter, double blind, randomized controlled trial designed to assess potential CV benefits of acarbose in 7,500 patients with preexisting CVD and IGT. The study will be at 50% recruitment by the end of 2011 and results are expected in 2017, he said.
"When acarbose first came to the market in the late 1990s, it was seen as a head-to-head HbA1c-lowering drug," Holman said. "If its only impact is on postprandial glucose, it can only ever modestly reduce HbA1c. The drug is really meant to be given in combination, so if it was to be a CV-protecting drug, maybe there is some way to easily roll it out in other doses
Diabetes care is about winning in a game of numbers . Play hard. Dr . Calder
Wednesday, November 16, 2011
Prompt Treatment for Hypoglycemia
When people think their blood glucose is too low, they should check the blood glucose level of a blood sample using a meter. If the level is below 70 mg/dL, one of these quick-fix foods should be consumed right away to raise blood glucose:
- 3 or 4 glucose tablets
- 1 serving of glucose gel-the amount equal to 15 grams of carbohydrate
- 1/2 cup, or 4 ounces, of any fruit juice
- 1/2 cup, or 4 ounces, of a regular-not diet-soft drink
- 1 cup, or 8 ounces, of milk
- 5 or 6 pieces of hard candy
- 1 tablespoon of sugar or honey
Recommended amounts may be less for small children. The child's doctor can advise about the right amount to give a child.
The next step is to recheck blood glucose in 15 minutes to make sure it is 70 mg/dL or above. If it's still too low, another serving of a quick-fix food should be eaten. These steps should be repeated until the blood glucose level is 70 mg/dL or above. If the next meal is an hour or more away, a snack should be eaten once the quick-fix foods have raised the blood glucose level to 70 mg/dL or above.
Tuesday, November 15, 2011
Portable commode chair adapter( picture #2 )
My wife is now about 7 years post bilateral below the knee amputations due to septic shock. Her problem is further complicated by having bilateral knee replacements for over 25 years. Seeding of her damaged joints with bacteria from dental procedures may have been the cause of the bacterial sepsis. I bring this up primarily as a reminder to anyone with joint replacements to take antibiotics before and after any dental procedure regardless of how long the replacement has been in place. My wife had her knee replacements over 20 years before she developed sepsis. I would also discuss the idea of taking the antibiotics for 8 to 10 days after any dental procedure if you have joint replacements . Antibiotic use in this situation is still controversial , so be prepared to argue your case.