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Stopping Diabetes Before it Starts
i n s i d e t h i s i s s u e …
Diabetes Prevention Program Results Reported Early
Paradigm release post-
Have your fruit-
cake and eat it too
Kids with Diabetes:
Care at school is critical
issues guidelines for fly-
cian seeks causes and
diabetes, even in patients threeyears after they stopped taking
American Heart Association Expresses
it. Therefore it seems likely thatpioglitazone (Actos) and rosigli-
Concern Over Atkins Diet
p o i n t s o f i n t e r e s t
tazone (Avandia)—which arerelated to troglitazone—may
• Therapies to prevent type 2
Nutrition is an area of many theories and relatively little research.
Recently, many people have turned to high-protein diets, but
unfortunately, no data exist on their long-term benefits and risks.
The American Heart Association (AHA) and the American
• Advances in diabetes man-
Diabetes Association (ADA) have been evaluating the available
agement and pumps
The AHA findings lead to a strong recommendation against
• Handling stress
high-protein weight-loss programs such as the Atkins Diet, Protein
Power, The Zone and Sugar Busters. Their report cites a lack of
• Cholesterol-lowering drugs
credible scientific evidence of long-term weight loss and the possi-
bility of increased risk for those with diabetes and heart disease.
Stress and Diabetes
What’s New with Pumps?
In the weeks since the terrorists’ stress, diabetics should monitor
by Medtronic. The release ofthe new Minimed Paradigm
I’ve demonstrated it to find it to be too
that’s compatible with all pumps. It’s
called the Ultraflex Soft. It’s inserted
from the site like the Silhouette and the
• Participate in enjoyable activities.
neous tissue like the SofSet. I look for-
Sarah Calistro is a student at UCLA
and daughter of center patient Frank
For more information on stress, relaxation and diabetes,
visit these Web sites:
“Stress” (American Diabetes Association)www.diabetes.org
and click on the menu’s “Healthy Living” link
“Manage Stress” (Life Clinic)www.lifeclinic.com/focus/stress
“Diabetes, Depression & Stress”
(Carol E. Watkins, MD: Northern County Psychiatric Associates)www.ncpamd.com/dmdepression.htm
A Holiday Treat: Sugar Guidelines
For decades, people with sources (fruit, milk, vegetables, • Remember to keep the
Should I Worry About my Cholesterol-lowering Drug?
build healthy membranes for all the cells that makeup the body. It is only harmful when too much is
The withdrawal of the cholesterol-lowering drug
present in the blood. In many people, blood lipids do
Baycol has spawned much publicity recently. This
drug was withdrawn from the market because of
But in people with diabetes—especially type-2 dia-
deaths caused by severe inflammation of muscles,
betes—cholesterol and other potentially harmful blood
which in turn can lead to kidney failure. Patients who
lipids such as triglycerides are commonly more concen-
were on Baycol should have been contacted to dis-
trated. In diabetes, lowering these raised levels has been
continue this treatment and had an alternative pre-
shown to be especially beneficial in preventing heart
scribed for them. Those who are still using Baycol
attacks, strokes and other blood vessel problems.
should stop using it and contact their prescribing
Therefore, for those with diabetes, the benefits of
taking statins far outweigh the potential rare side
Baycol is a class of drug often called “statins”
effect of muscle inflammation. These drugs have been
because the drugs’ chemical names end in -statin.
a major advance in preventing the increased rates of
Other drugs in this class and widely in use include
heart disease and strokes that are present in people
Lescol, Lipitor, Mevacor, Zocor and Pravachol.
These drugs have a very powerful effect on lower-
ing the level of the harmful kinds of cholesterol inthe blood. Most people tolerate them well, with only
AHA Questions Diets’ Results
minor side effects. Severe inflammation of all bodymuscles, resulting in severe muscle pain, is a rare side
effect, and is most common shortly after starting the
Such diets may be particularly risky for patients with
drug. It’s extremely unusual in people taking only one
diabetes since they can speed kidney disease progres-
of the above kind of lipid-lowering drugs, but slightly
sion. They also may increase risk for gout, osteo-
more likely to occur in people who also take Lopid, a
porosis and cancer. The ADA has similar concerns
different kind of lipid-lowering drug. If you have
and will soon come out with its own statement.
started on a cholesterol-lowering drug and have mus-
Neither report denies that high-protein dieters lose
cle pains, you should stop the medicine and immedi-
weight at first; the concern is over the long term.
Many patients feel better eating a diet lower in carbo-
Why lower lipids? Cholesterol is an important
hydrates. However, this underscores the importance of
chemical that is carried around the blood and used to
working with a dietitian who can regulate the whole
make some hormones (cortisol, for example) and help
diet and help develop healthy eating habits.
Kids’ Care at School Critical to Good Health
Program has been verysuccessful in raising
improved blood glucose control decreases the risk
and the school or day care provider. It delineates
of diabetes complications later. To achieve control,
responsibilities assumed by parents or guardians,
a child must monitor blood glucose frequently, fol-
school personnel and the student. It also should
low a meal plan and take medications. Children
also specify instructions for the following:
usually take insulin through injections or a pump.
• Blood glucose monitoring, including the fre-
Physical activity and nutrition also affect blood
quency and circumstances requiring testing.
• Insulin administration (if necessary), including
For appropriate care of the student with dia-
doses and injection times prescribed for specific
betes, school and day care staff must understand
blood glucose values and the storage of insulin.
diabetes and be trained in its management—as well
• Meals and snacks, including food content,
as in treatment of diabetes emergencies.
Yet studies have shown that most school person-
• Symptoms and treatment of low blood glucose,
nel don’t adequately understand diabetes, and that
including the administration of glucagons if rec-
parents of children with diabetes lack confidence in
ommended by the student’s treating physician.
their teacher’s ability to manage diabetes effectively.
Consequently, diabetes education must be tar-
• Symptoms and treatment of high blood glucose.
geted toward daycare providers, teachers and others
• Ketone testing and appropriate actions to take
including administrators, coaches, school nurses,
for abnormal ketone levels, if required by the
health aides, bus drivers and secretaries.
additional funds tosupport the center’s
Thyroid Hormone Replacement Therapy - Tricks of the Trade
patients with thyroid disease. Many of these
patients suffer from a form of hypothyroidism,
• Androgen therapy in women (breast cancer
or low thyroid hormone blood levels, and I
often must prescribe thyroid hormone replace-
Once a stable dose of thyroid replacement has
been reached, as indicated by normal thyroid
blood tests, the patient may continue the same
• Medications including sulcrafate, antacids,
dose for years. But patients should keep a few
iron, cholesterol-lowering drugs, seizure drugs
things in mind to ensure they’re achieving maxi-
Patients should let their doctor know of any
A variety of conditions, such as advancing age
medication changes made by other health care
or the administration of androgen therapy for
professionals. Thyroid hormone replacement
breast cancer, can reduce dosage requirements.
therapy should be taken at the same time each
Other conditions—and many medications—may
day, usually on an empty stomach without any
require an increase in the thyroid hormone dose.
other medications, if possible. It’s best to avoid
These are some common conditions that can
taking multivitamins or antacids around the
alter thyroid hormone replacement requirements:
same time, as well. Following these suggestionscan help patients assure the best therapy possible.
Diabetes.an Aspirin a Day
Apatient came into my office percent in the untreated group,
to-four-fold increase in risk fordying from heart disease. A majorrisk contributor: increased produc-
FAA Changes Rules for Traveling with Diabetes Supplies
that causes vessels to constrict andcauses platelets—the cells that are
The newest rules regarding people who fly with diabetes are listed
below. Check the ADA website (www.diabetes.org) for the most up-to-
• Passengers may board with syringes or insulin delivery systems only if
they can produce a vial of insulin with a pharmaceutical pre-printed label
that clearly identifies the medication as prescribed for that individual.
• Lancets can be carried if capped and are brought on with a glucose
benefit patients after a heart attack.
meter that has the manufacturer’s name embossed on the meter.
• Prescriptions and letters of medical necessity will not be accepted.
heart disease, those who started onaspirin experienced 44 percent less
• These rules apply within the 50 United States only. These are mini-
mum standards—carriers may have specific regulations.
• For further information, contact the ADA at 703-549-1500 Ext. 2108
or the Civil Aviation Security Division of the FAA at 202-267-9863.
Some ponies seem to get grossly overweight on nothing but fresh air and new thinking suggests that a condition called Equine Metabolic Syndrome may be responsible Anyone who has owned a native pony will be familiar with its ability to create fat out of thin air, and with thedifficulties in management this causes. Now at last, as a result of work done at the University of Missouri, acondit
Timothy M. Uyeki,* Yu-Hoi Chong,† Jacqueline M. Katz,* Wilina Lim,† Yuk-Yin Ho,† Sophia S. Wang,* Thomas H.F. Tsang,* Winnie Wan-Yee Au,† Shuk-Chi Chan,† Thomas Rowe,* Jean Hu-Primmer,* Jensa C. Bell,* William W. Thompson,* Carolyn Buxton Bridges,* Nancy J. Cox,* Kwok-Hang Mak,† and Keiji Fukuda* In April 1999, isolation of avian influenza A (H9N2) viruses from humans wa