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
Pump Update: Minimed
2 Paradigm release post-
Sugar: Have your fruit-
3 cake and eat it too
Kids with Diabetes:
4 Care at school is critical
Changing Rules: FAA
5 issues guidelines for fly-
Prevention: USC physi-
6 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 diabetes compared
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) and click on the menu’s “Healthy Living” link
“Manage Stress” (Life Clinic)
“Diabetes, Depression & Stress”
(Carol E. Watkins, MD: Northern County Psychiatric Associates)
A Holiday Treat: Sugar Guidelines
For decades, people with sources (fruit, milk, vegetables, • Remember to keep the Sugar Guidelines
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
Decreased Requirements:
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- Increased requirements:
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. 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 ( 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.


Equine metabolic (read-only)

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

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