| Litvin Centers for Diabetes Newsletter |
Volume 26
November, 2007 |
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Dear Patients and Friends,
This issue of the newsletter introduces a new section called "Cuisine Corner" devoted to recipes. I shall try to select items of interest for the diabetic patient, and would also like to encourage you to send us recipes of your own. Should you have any comment to make regarding the finished product, you may email it to us and we may select it to be published in our newsletter (with your permission).
Sincerely,
YL |
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Recent Diabetes News
Sleep Apnea and Diabetes
A very high association has been shown between people with sleep apnea and either diabetes, hypertension and/or obesity. Sleep Apnea or obstructive sleep apnea (OSA) has been defined as an apnea-hypopnea index of 5 events or more per hour. In fact, one third of diabetic patients were found to have at least 15 events per hour! These were more likely to be men, older than age 62 years, with a BMI greater than 30 kg/m2, and snoring. The nature of the association is unknown, but there is a suggestion that people with OSA are more insulin resistant. Treatment with CPAP (continuous positive airway pressure) reduces both the apneic episodes, and the cardiovascular and metabolic abnormalities. This treatment reduces insulin resistance, and causes marked improvement of the diabetic control. Who knows, maybe all type 2s should be tested, and treated with CPAP, for better diabetic control.
Adult Obesity in the USA
According to a recent study, obesity is on the rise in 31 states, and on a drop in none. Mississippi is the fattest, with more than 30% of the adult population, and Colorado ranked the "leanest", with only 17.6%. The stated goal of the federal government is to reduce obesity to 15% in every state by 2010 ("fat chance" that that's going to happen). In 1991, no state had an obesity rate exceeding 20%! But even more alarming is the rate of obesity among children and teens, where the rate is up to 22.8% in Washington D.C. A much-needed federal policy is needed in order to combat this ongoing epidemic!!
Diabetic Adolescents Omitting Insulin
More than 90% of all teens with type 1 diabetes omit insulin doses at least occasionally in order to prevent weight gain - shocking, but true. Both males and females indulged in this practice equally. Thus, from a study involving 2,062 teens aged 11-18 from 21 centers in Europe, Japan, Australia, and North America. What to do about this is not clear. Education is likely the only option. |
Information to Help Manage Diabetes
Influenza Vaccine
Influenza infection can be dangerous to people with diabetes. The National Foundation for Infectious Diseases has called for the medical and public health community to encourage an increase in influenza vaccination among people with diabetes. As per that body, people with diabetes are much more prone to develop complications from influenza, if contracted. These complications may lead to pneumonia, and even death. Unfortunately, only half of the diabetics are vaccinated, and that is despite a recommendation of the CDC (Center for Disease Control) that all people six months or older with diabetes should be. The CDC even goes further to recommend that all people in close contact with diabetics should be vaccinated, as well. Please make an effort and get yours.
Post-Meal Glucose Levels
A summary document release by The International Diabetes Federation suggests that both fasting and post-meal glucose levels are important in the management of diabetes. The American Association for Clinical Endocrinologists (AACE) has recommended a 2-hour post-meal glucose level of 140 mg/dL or less for all diabetic patients, whereas the American Diabetes Association suggests 180 for any non-fasting state. These kinds of levels cannot be achieved if the fasting level is elevated, so the initial task is to lower the fasting level. By focusing on the fasting, one can get to an A1c of about 7.5%, but if one wishes to improve on that and get closer to the normal level (below 6.5%), one must focus now on the post-meal levels. That can be achieved by both eating lower glycemic index foods, and by using medications which focus on the meal-related hyperglycemia.
Lower Blood Pressure for Diabetics
A new clinical trial has finally supplied proof that the 2003 recommendation of JNC 7 for blood pressure control for diabetics should be 130/80. The trial is called the ADVANCE trial, and was run at 215 centers in 20 countries. More than 11,000 diabetic patients were involved, and followed for 4.3 years. The treated group was maintained on BP of 135/75, and the control group on 140/77. Even at these small differences, the control group showed a significantly higher level of cardiovascular complications than the treated group, underlining the need to treat diabetics to recommended blood pressure levels. |
Cuisine Corner
Cream of Carrot Soup [recipe from Diabetes Forecast Magazine].
General Info - 12 servings. Serving size: ¾ cup. Preparation time:27 minutes. Cooking time:1 hour and 15 mins.
Ingredients: 1 Tbsp canola oil; 2 lb. carrots, peeled and sliced into 1-inch pieces; 2 medium onions, chopped; 2 medium potatoes, peeled and cut into 1-inch cubes; 8 cups low-fat, reduced-sodium chicken broth; 1 cinnamon stick; 1 bay leaf; ½ tsp. dried thyme; ½ tsp. ground nutmeg; ½ cup plain nonfat yogurt; ¼ cup chopped pistachios; salt and pepper for taste.
Preparation instructions: 1. Heat the oil in a large (8-quart) soup pot over medium heat. Add the carrots, onions, and potatoes. Cook, stirring occasionally, until tender but not brown, about 25 to 30 minutes. 2. Add the broth, cinnamon stick, bay leaf, and thyme. Bring to a boil, reduce the heat, and simmer for 45 minutes. Remove the cinnamon and bay leaf. 3. In a blender or food processor, puree the carrot mixture in batches. Return to the pot and warm over low heat. Add the nutmeg and salt and pepper t taste. 4. Ladle the soup into warmed bowls. Swirl in the yogurt and top with pistachios just befor serving.
Nutrition Facts: serving size: ¾ cup. Amount per serving : calories :100, cholesterol : 0, Sodium: 390 mg. Total carbs :16 gm. Bon Appetite!
Nutrition
A Paleolithic Diet
 In an article appearing in the European journal Diabetologia, a group of authors from Sweden compared a current (Mediterranean) diet, to a pre-processed food diet ("Old Stone Age"). The Paleolithic diet consisted of lean meat, fish, fruits, vegetables, root vegetables, eggs and nuts, whereas the Mediterranean diet consisted of whole grains, low-fat dairy products, vegetables, fruits, fish, oils, and margarines. Twenty nine patients with ischemic heart disease plus either glucose intolerance ("almost diabetes") or type 2 diabetics were randomized to receive either of the two diets. What was looked at were changes in weight, waist circumference and plasma glucose and insulin levels. Over 12 weeks of follow up there was a decrease of 26% in glucose in the stone-age diet compared to only 7% in the other group. Waist circumference decreased by 5.6 cm in the stone-age group compared to only 2.9 cm in the second group, and even some lowering of insulin levels in the stone-age group was demonstrated. It seems from this data that pre-processed food is healthier for us. |
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Medication Information
Exubera ran out of breath
Pfizer has decided to take the recently introduced inhaled insulin off the market, for lack of profitability. What is upsetting about this story is the fact that after the long journey that most physicians had to traveled in order to accept this treatment modality, along comes the manufacturer and pulls the plug. It left most of us speechless. As the saying goes - only in America.
Byetta and pancreatitis
The FDA has issued a warning and a report that about 32 patients on Byetta have contracted the very sever condition of pancreatitis. The association between the two is not clear, but suffices to say that caution is prudent. As some of you know, I am a prescriber of Byetta, and despite this report shall continue to do so. Of course, if any of you on this drug develop sever abdominal pain, please seek medical attention.
The "Glitazones"
Whereas Rosiglitazone or Avandia has been implicated in coronary artery disease, and Pioglitazone or Actos, has not, both drugs have been implicated in congestive heart failure due to fluid retention. Other issues which can be attributed to both are weight gain (not necessarily related to fluid retention), anemia, and osteoporosis. Regardless, both are very good at lowering glucose levels, so don't completely discard just yet. | |
