Difficulty Determining Type 1 From Type 2 In Teens Teenagers with diabetes have been posing a difficult diagnostic problem to their physicians. Looking like typical obese-type 2s, they nevertheless were found to have anti-islet cell antibodies that are typically found only in type 1s. Even more confusing, some teenagers presenting with Acanthosis Nigricans (darker skin folds around the neck) which is typically found in insulin resistant type 2s, is found in teenagers with antibodies(which are typically found in type 1s). A common denominator among all, however, is their obesity. Today's teenagers, like their adult parents, but only more so, are either overweight or obese. Being obese immediately translates into a state of insulin resistance, which is typically defined as type 2. But many of these teenagers – up to 43% among African-American – also have a predilection to make anti-islet cell antibodies. Regardless of their exact diagnosis, most need insulin therapy at least initially. The diagnosis of diabetes is yet in a state of flux. Despite the complexity, however, the health of the insulin-producing beta cell is central to both types of diabetes.     Inhaled Insulin Safety Two recent studies supported by Pfizer have looked at the safety of Exubera – inhaled insulin. As you may know, Exubera has been approved by the FDA for use in diabetics, and is interchangeable to Regular Insulin. It is short-acting and is inhaled. The two studies presented by Dr. Jay Skyler (Univ of Florida) showed only a 2% reduction in pulmonary function tests, which reverse when Exubera was discontinued. Cough was more prevalent – in 38% vs. 13% in the control group. Benefits were in the form of less sever hypoglycemic episodes, and less weight gain. Interestingly, the immune system reacted more vigorously to the inhaled insulin by forming more antibodies. The significance of this is unclear at this time. The conclusion of the authors is that Exubera is safe for use in both type 1s and in type 2s.
The Dream Trial The results of the Diabetes REduction Assessment with ramipril and rosiglitazone Medication trial(dream) have recently been published in the public media. This is a large study trying to see if these medications can make a difference in patients with "pre-diabetes". Ramipril is an "ACE", which is a drug that we usually use in order to prevent kidney problems in diabetics, and Rosiglitazone(Avandia) is a "TZD", which is a sensitizer to insulin and thereby improves glucose levels in diabetics. In this study 5,269 adults without diabetes but with "pre-diabetes" were followed for 3 years on either one of the above drugs or on a placebo (inactive pill). What was looked for was either death, or the appearance of diabetes. Significant results were observed in the rosiglitazone group only, where the incidence (appearance) of diabetes was 25% lower vs. only 11% in the placebo group. This translates to: for every 1,000 people treated with rosiglitazone (Avandia), 144 cases of diabetes will be prevented. Despite the above, diabetes should be prevented by life-style changes and not by medications. This means maintaining ideal body weight and adhering to proper nutrition.
Koreans And BMI A large 12-year study of Korean Americans was recently published in The New England Journal of Medicine. Researchers from Johns Hopkins School of public health followed adults aged 30 to 95 and found a tight correlation between death from any cause and the subject's BMI (body mass index). BMI of 25 to 30 is considered overweigh, whereas above 30 is considered obese. Koreans with a BMI between 23 and 24.9 (normal) had the lowest risk of death from any cause. As the BMI increased, so was the likelihood of death, but even more so if the subject is/was a smoker. The association between BMI and cardiovascular disease was correlated all the way through – the researchers reported. This study highlights the fact that Asians may be at risk for cardiovascular disease and/or diabetes at a lower BMI than Caucasians.
Toxic Environment For Children A professor of pediatrics from UCSF has stated that a key reason for the epidemic of childhood obesity is the high-caloric, low-fiber Western diets which promote hormonal imbalances that encourage children to overeat. Furthermore, the Professor has stated that the food industry has created a "toxic environment" that dooms children to being overweight. The current diet in the West is highly "insulinogenic", meaning that it caused secretion of the hormone Insulin. This is due to foods which have a high fat content, increased fructose composition, and decreased fiber. Consequent elevated insulin levels travel to the brain, where they stimulate eating activity, bypassing other physiological "brakes". Children, he further goes to say, should not be held responsible for their eating behavior. It is rather the responsibility of society to provide an environment which is supportive of a healthy life–style. This has been long in coming, and it should be applauded by all (YL).
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.
Gadgets For Diabetics Courage Bag: This specialized bag from Travelon allows people with diabetes to organize their medical supplies. The bag includes a pocket for needles disposal, an insulated compartment for chilling medications, cell phone pocket, elastic loops for securing lancets, etc, and much more. Travelon, 847-621-7000. www.travelonbags.com. Clip and Stor: this offers diabetics a convenient and safe way to dispose of and store insulin syringes and pen needles. Links Medical Products, Inc., 888-425-1149. www.linksmed.com. D-Diabetic software tracks daily food, exercise and medication information. This is a complete management program. It can be downloaded from www.diabetic-software.com. The DexCom STS continuous sensor: This is a sensor approved by the FDA for use in adults for a 72 hour period. It reads every 5 minutes, and has alarms for both high and low levels. The cost of this unit is about $800, with each sensor costing $35 each. It is not yet approved by most insurance plans. GlucoTel: a German company has developed a blood glucose meter that can wirelessly transmit your blood glucose test results. It is supported by Bluetooth wireless technology, and should be on the market by Jan 1, 2007. It will sell for $40 with strips prices at $25 for a vial of 50.
Commercial Site Lookout for our commercial site soon-to-be-launched. We plan to have a place for you to shop for diabetes-related items which may be difficult to find at other locations. This will be supported by credit card-paying capability and linked to the diabetes-doctor site.

Fort Lee Office Hours	West Orange Office Hours
Day From To Mon 8:30 am 5:30 pm Tue 8:30 am 5:30 pm Wed CLOSED CLOSED Thu 8:30 am 5:30 pm Fri 9:00 am 1:00 pm Sat CLOSED CLOSED Sun CLOSED CLOSED	Day From To Mon CLOSED CLOSED Tue* 9:00 am 3:00 pm Wed 9:30 am 5:00 pm Thu CLOSED CLOSED Fri 9:30 am 4:30 pm Sat CLOSED CLOSED Sun CLOSED CLOSED *Dr. Litvin is in every other Tuesday of the month.
Fort Lee Address 158 Linwood Plaza Fort Lee, NJ 07024 201-461-0585	West Orange Address 622 Eagle Rock Avenue West Orange, NJ 07052 973-736-1221

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