INHALED INSULIN A new era in diabetes care is about to begin with the approval by the FDA of the inhaled insulin – Exubera. This is a joint venture by three giant pharmaceutical companies – Pfizer, Nektar Therapeutics, and Sanofi-Aventis. Exubera will be in powder form and self-administered, utilizing a device not dissimilar to the one used by asthmatics who introduce vaporized drugs by inhalation (although larger). The activity-profile of Exubera will be similar to that of Regular Insulin administered subcutaneously. The glucose-lowering effect will start in 10-15 minutes, and will probably last for several hours. This means that patients will likely need to use it several times daily, and mainly before meals. Exubera has been delayed in coming to the marketplace because of safety issues. The powder can apparently cause some side effects such as coughing and an allergic reaction. Since it is a short-acting insulin, patients will likely need an injection of a long-acting insulin in order to maintain their basal level. This is an initial effort to circumvent injections, only time will tell if it will prove effective.     NEW DRUGS Two new same-family drugs are coming to the market. Both belong to the “glitazon” group of which currently there are two available: 1) Avandia, and 2) Actos. The two new ones are called Pargluva, and Galida. These latter two claim to have a wider scope of activity, and will address both the glucose and the triglyceride/HDL issues. The data that has accumulated thus far shows some advantage to these newer agents. In order to keep track of all the new drugs in diabetes, one may soon need a spreadsheet. Please don’t despair.
RETINOPATHY IN PRE-DIABETES The Diabetes Prevention Program (DPP) is a very large study looking at the progression into diabetes by two pre-diabetic groups who were either maintained on diet and exercise regimen or on the oral hypoglycemic agent Metformin. Monitoring for retinopathy showed that 15.4% of pre diabetics who later developed diabetes had retinopathy prior to their diabetes, versus only 9.6% in those who did not develop diabetes. This has set-off a lot of bells and whistles among diabetologists to maintain stricter monitoring of the retinas in patients suspected of developing diabetes. Please make sure you are seen by a retinal specialist annually.
THE POLITICS OF FOOD According to Marion Nestle who is a professor of nutrition at New York University, “the amount of food available in the US food supply is approximately 3,900 calories per day per person”. “This is roughly twice the amount that the average person needs, and has increased by 600 calories since 1980”. She goes on to further to say that “the food industry represents more than $1 trillion annually in the US alone”. With such capital, no wonder this industry is a major contributor to political campaigns, and consequently commends much clout to sway government decisions. Unfortunately, the socio-economic groups most at risk for obesity, seem to be the ones that are also most at risk from Katrina.
HEART ATTACKS IN DIABETICS TYPE 1 Heart attacks have traditionally been attributed to complications of diabetes type 2 – or the adult-onset type. Diabetics with type 1 are usually thin, and don’t have the typical cholesterol/triglyceride picture that is seen in type 2. A new study, however, shows that this is not true. After 17 years of following patients with type 1 who were either treated conventionally – only one or two insulin injections daily – vs. the intensive group who were treated with either 3 injections daily or with the insulin pump; the intensive treated group had 57% less coronary events (heart attacks) than the conventionally treated one. This means that even type 1s are prone to heart disease, and should be treated just as aggressively as are type 2s.
PATIENT A1C RECOGNITION AND GLYCEMIC CONTROL A small survey conducted at a diabetes clinic affiliated with Emory University found that greater knowledge of the A1c test and its goal, translates into better actual control of the patient’s diabetes. Patients should know what the test stands for – a 3 month cumulative average of their blood glucose, and its goal – 6%. Please refer to my ten commandments blog.
ERECTILE DYSFUNCTION(ED) MORE COMMON IN DIABETICS ED worsens with the elevation of blood glucose. Not only do diabetics in general suffer from ED as a complication caused by their neuropathy, they also seem to get worst with the deterioration in their hyperglycemia. This bears out with my clinical experience, as well. Patients who are out of control, will respond less well to Viagra-like medications than they would when their blood glucose is closer to normal. The reasons for this are multiple and complex, but what I like to tell my patients is that their erections won’t hold if their blood is like honey. That sometimes convinces them to strive for better control.
FOOD SUPPLEMENT THAT CONTAINS A HYPOGLYCEMIC DRUG The FDA has issued a warning for all consumers that the “Liquiang 4 Dietary Supplement Capsules” contain the drug Glyburide. This drug is prescribed to diabetics and is a very potent blood glucose lowering agent. The Liquiang 4 capsules are manufactured in China and are available in herbal stores or by mail order, and are promoted for diabetics as containing only natural ingredients. This is obviously very dangerous, and I would like therefore to take this opportunity and ask all diabetic patients not to take any herbal supplements made in China.
NEW DIABETES SUPPLIES SECTION ON: 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. Coming soon under "Diabetes Supplies" will be products for sale for diabetics. We here at the LCD are committed to finding new ways to make living with diabetes easier on our patients and loved ones. We have a collection of products that we will offer soon. We will keep you posted........
READ DR. LITVIN'S SEPTEMBER BLOGS If you haven't had the pleasure of browsing through Dr. Litvin's blogs, you're in for a real treat. Dr. Litvin provides us with his commentary on diabetes and diabetes in the news. The following are some of the Blogs Dr. Litvin has recently written: The Ten Commandments for the Diabetic Olive Oil Darwinism vs. Intelligent Design Gaza Tragedy On Being A Patient Beautiful Country Sweet Cat Stress and Our Waist Famine in Africa Rumania - Personal

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

Unsubscribe Instructions If you wish to remove yourself from future e-mailings from Litvin Centers For Diabetes, simply reply "remove" in the subject line. Please note that it may take up to  30 days to process your request. Privacy Statement For details on our e-mail practices, please visit our Privacy Policy.

Copyright © 2005 Diabetes-Doctor | All Rights Reserved