Rimonabant As you may recall, this is a new drug that will appear on the market sometime early next year, and which I have already mentioned in a previous newsletter. A new study has just been published about the metabolic effects of this drug on patients without diabetes but who are either overweight or obese, and have dyslipidemia. Dyslipidemia is a common condition in type 2 diabetes where the triglycerides are elevated, the good cholesterol (HDL) is low, and the bad cholesterol (LDL) is particularly lethal. Being overweight and having dyslipidemia puts an individual at a particularly high risk for heart attacks. The study included 1,033 people who had the above conditions. These were randomized into two groups who either received placebo (no-activity pill) or Rimonabat for 12 months, in addition to a low-calorie diet. Results showed that the Rimonabat group lost more weight (up to 18 lbs.), and sustained a more dramatic improvement of the dyslipidemia. Additionally, both glucose and insulin levels in the Rimonabant group showed some normalization. These are great results, however, not without significant side effects. Almost 40% of the patients did not complete the study because of adverse events such as depression, anxiety and nausea. As a reminder, let me say that this drug is a selective CBI-receptor blocker. Basically, it blocks the effects of marijuana, which as we know will cause weight gain. This drug will likely be a hit with the metabolic syndrome and diabetic populations next year.   BYETTA VS. LANTUS IN SUB-OPTIMALLY CONTROLLED TYPE 2 DIABETES Byetta is the new kid on the block. Some of you, who are not optimally controlled on pills may have been started by me on Byetta. This is the drug that was initially derived from the Gila monster’s saliva and has a role in stimulating pancreatic beta cells to make more insulin. It is taken as a twice-daily subcutaneous injection. Lantus, as probably most of you know, is the 24-hour insulin preparation that I like to prescribe to patients who were not optimally controlled on oral medications. The study included 551 patients who were randomized to either Byetta or Lantus, while continuing their oral medications. Both groups had a similar A1c at the start (8.3%) and a similar A1c at the termination of the trial after 26 weeks (a drop of 1.11% in A1c in both groups). The main difference was the weight of the patients. While patients in the Lantus group gained almost 4 lbs, patients in the Byetta group lost 5 lbs! Patients on Byetta showed markedly more GI (gastrointestinal) side effects, causing almost 10% withdrawals from the study. In conclusion, it seems to make more sense to start patients with type 2 who are sub optimally controlled with pills on Byetta prior to starting them on Insulin.
PREDICTING TYPE 2 DIABETES IN HEALTHY YOUNG AND MIDDLE-AGE MALES Researchers at Stanford University announced the discovery of a new hormone which sharply reduced the desire to eat! The new substance is named Obstatin, is made in the stomach and in the small intestine, and sends a signal to the brain to eat less. Interestingly, the gene for this hormone is the same as for the hormone ghrelin, which makes people hungry. Nature works in mysterious ways where one gene can make substances with opposite effects. The pharmaceutical industry is obviously on high alert to produce drugs which will curb our appetite, and put a lid on the obesity epidemic. Let’s hope that this is indeed forthcoming.
LOW TESTOSTERONE IN DIABETIC MEN About one-third of men with diabetes have low testosterone levels. When they are 45 years old or older, they will be twice as likely to have a low testosterone, as a healthy individual. A low testosterone is defined as a level less than or equal to 300 ng/dl. Normally, men’s testosterone decline after age 30 by 10% per decade. Common symptoms of a low testosterone include decreased libido (sexual desire ), erectile dysfunction (the ability to maintain an erection and achieve penetration), fatigue or weakness, and mood changes. In general, all men with a low testosterone should be referred to an endocrinologist for an evaluation. Diabetes presents a particular diagnostic challenge, since in addition to the potential testicular (where testosterone is made) pathology, there is also the added diabetic pathology which involves obesity, and of course hyperglycemia. Almost all men with a proven testicular pathology which is responsible for a low testosterone level should be treated with replacement of testosterone. There are several therapeutic options available on the market, and the choice has to do with personal preference. It is important to remember that testosterone levels translate differently in different individuals. Some may have normal libido at a relatively low level, whereas others may suffer from erectile dysfunction at a much higher level. Consequently, it is imperative to appreciate that there are several other layers of complexity to a normal functioning male, than just the testosterone level, and that’s where the endocrinologist comes in.
ERECTILE DYSFUNCTION (ED) About half of men age 40-70 report about symptoms of ED. In men with diabetes this figure goes up to 85%! As the glucose levels rise, so do the erections fall… Other causes for ED in diabetics are heart disease and hypertension, and side effects caused by the medications used for these ailments. In general, the effectiveness of the various Viagra-like medications in the diabetic, is somewhat reduced compared with the effect in non-diabetics. And there are side effects. Viagra-like medications are not to be taken when a patient is taking nitrates (nitroglycerine), or alpha blockers (hypertension/prostate drugs). Patients who cannot walk a mile in 20 minutes or can’t walk up two flights of stairs in 10 seconds, probably don’t have the aerobic capacity for safe sex, and should be instructed first to improve it. Lastly, the FDA warns consumers not to purchase these or other drugs over the internet, since about 75% of them are counterfeit.
NEW DEVICES Quick-Fix key chain: This is a small plastic container which holds several glucose tablets for emergency. It is mounted on a key-chain ring, and is small enough to put in your pocket or in a hand-bag. You can inquire further at www.quickfixkeychain.com. A1cNow InView: This is a disposable test that can be used at home. It uses a drop of blood, and gives results in 5 minutes. Info at 408-524-2255, or at www.metrika.com. Nutrihand Pro: This is a free online health service that creates customized meal plans based on a person’s health needs. The database includes more than 35,000 food items, including foods from fast-food chains and restaurants. Info at 650-564-96—or at www.nutrihand.com SalivaSure: This is a fast-acting, self-dissolving relief lozenges for dry mouth in people with diabetes. The lozenge moisturizes the mouth, freshens the breath, and also protects the teeth from decay. It does not interact with any medications, and may be used several times a day without side effects. More at 215-453-2507, or at www.scandinavianformulas.com. Produce Partner: This is a unique guide to fresh vegetables designed to help people with diabetes or obesity to better follow dietary guidelines. These are cards that denote a vegetable’s peak season, how to identify if it’s ripe, herbs that go with it, simple recipes, and how to store and prepare the vegetable. Info at 303-440-8946 or at www.nutritionconnections.com.
VITA-BETIC SUPPLEMENT FOR DIABETICS The Litvin Centers for Diabetes is now offering Vita-Betic sugar-free multivitamins designed with diabetic nutrition in mind. Persons with diabetes need to safeguard their health. Vita-Betic is a multivitamin which in addition to all the standard/essential vitamins has other ingredients which have been found to be beneficial to the typical diabetic patient. Vita-Betic is specially formulated with essential Chromium and Vanadium which are helpful in improving insulin action and various herbs which promote anti-oxident activity. Many multi-vitamins contain sugar and do not include all the nutrients that may be valuable for a diabetic's nutritional needs. Vita-Betic was specially made with the diabetic in mind, it supplies vitamins, minerals, and nutrients that are essential for people with diabetes to achieve their optimum health. This is a special offer at a reduced cost. For more information, click here.
FREE DIABETES SUPPLIES FOR MEDICARE PATIENTS ---------- WWW.DIABETES-DOCTOR.COM We recently added a new area to our web site called "Diabetes Supplies." Patients with Medicare coverage may be eligible to receive FREE DIABETES SUPPLIES through the LCD (Litvin Centers for Diabetes). We offer FREE Shipping anywhere in the U.S. and the convenience of no paperwork to process. To find out if you qualify, call or Enroll today and our professional staff will contact you.

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