A New BGL Monitor ….and More on Avandia

An update from Hi-Tech Harold…

The U.S. Food and Drug Administration Monday approved a device that measures glucose levels continuously for up to seven days in people with diabetes.

While a standard fingerstick test records a person’s glucose level
as a snapshot in time, the STS-7 Continuous Glucose
Monitoring System measures glucose levels every five minutes
throughout a seven-day period. The FDA said that additional
information can be used to track patterns in glucose levels
throughout the week that wouldn’t be captured by fingerstick
measurements.

However, diabetics must still rely on the fingerstick test to
decide whether additional insulin is needed, the FDA added.
The STS-7 System, manufactured by DexCom Inc. of San Diego
uses a disposable sensor placed just below the skin in the abdomen to measure the level of glucose in the fluid found in the body’s tissues. Sensor placement causes minimal discomfort and can easily be done by patients themselves. An alarm can be programmed to sound if a patient’s glucose level reaches pre-set lows or pre-set highs.

A three-day version of the device was approved in March 2006.

More on the Avandia Discussion: Early Critic of Diabetes Drug Says Don’t Panic…

Patients should not haphazardly stop taking the controversial diabetes drug Avandia, even though it has been linked to heart risks, an early critic of the drug said on Sunday.
Dr. John Buse, chief of endocrinology at the University of North Carolina at Chapel Hill and incoming president of the American Diabetes Association, was one of the first experts to query the safety of GlaxoSmithKline’s blockbuster drug.

He raised questions about the drug’s heart safety in 2000.

But Buse told the Endocrine Society’s annual meeting in Toronto that he does not believe patients should stop taking the popular pill just yet.

“We’ll have additional data in the near future and that would be the appropriate time to consider making judgments over Avandia’s safety,” Buse told Reuters in an interview.
Buse also said he would tell the U.S. Congress this week about how GlaxoSmithKline may have tried to pressure him about his early criticism of the drug’s safety.

A clamour about Avandia, taken by millions of people, arose from consumer groups, heart experts and Congress last month after Cleveland Clinic cardiologist Dr. Steven Nissen’s pooled analysis was published in the New England Journal of Medicine.

Nissen’s study linked the diabetes drug to a 43 percent increased risk of heart attack and a 64 percent higher risk of any heart-related death.
The U.S. House of Representatives Oversight and Government Reform Committee has scheduled a hearing on the U.S. Food and Drug Administration’s handling of the drug, approved in 1999.

Buse said he would testify at that hearing.

TROUBLING QUESTIONS

The New York Times quoted University of Michigan diabetes expert Dr. Charles Burant as saying that Buse had been troubled by pressure he had received from Glaxo about his questions over the drug.

It quoted Burant as saying Glaxo had contacted University of North Carolina medical school.

Buse declined to give any more details of what happened, saying he would wait for the hearing. He characterized the issue as “ancient history.”

“If I am asked a question about it, I’ll answer it. I don’t have anything to hide,” he told Reuters.

Glaxo said it did have discussions with Buse. “We regret if, at any time, Dr. Buse felt the conduct of any GSK employee was contrary to the spirit of open, scientific debate regarding his views on Avandia,” the company said in a statement.

Glaxo has disagreed with the study findings and says Avandia is safe.

“If there is a safety problem with Avandia it needs to be taken off the market. There is no doubt about that,” Buse said.

“I still have concerns but I don’t think Dr. Nissen’s analysis has changed the landscape dramatically,” he added.

“Dr. Nissen’s study is adequate to raise the question. It’s just not adequate to provide the answer.”

Dr. Hertzel Gerstein, director of the division of endocrinology and metabolism at McMaster University in Ontario, Canada, agreed.

“My big concern of summarizing this type of data is that none of the trials that were summarized were designed to answer the question of whether the drug increases or reduces the risk of heart attack,” Gerstein said in an interview.

“For patients, this creates a lot of anxiety,” he added.

Stay with ODB for more news on Avandia.

Technorati Tags: Avandia and Diabetes, DexCom Inc, Diabetes and drugs, Diabetes Avandia debate, drugs and diabetes, living with diabetes, problems with Avandia, Risks with Avandia, STS 7 System

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Tuesday, June 12, 2007

Quo Vadis Avandia?

Let me preface these remarks with the disclosure that
I have been using Avandia for nearly a decade; and, have
been very happy with the results. I have yet to make up
my mind on its future use. I was a member of the original
 evaluation panel. I was shocked as anyone with the news
last week…………………………………………………….

James Montgomery.

GlaxoSmithKline’s widely prescribed diabetes drug Avandia is linked to a greater risk of heart attack and possibly death, a new scientific analysis revealed, and the U.S. government issued a safety alert.

The Food and Drug Administration urged diabetics taking the pill to talk to their doctors, but stopped short of forcing a sharper warning label on the drug.
GlaxoSmithKline’s stock fell sharply on the news.

More than six million people worldwide have taken the drug since it came on the market eight years ago. Pooled results of dozens of studies revealed a 43% higher risk of heart attack, according to the review published by the New England Journal of Medicine.

Experts said the overall risk was small and cautioned people not to stop taking the drug on their own but to talk to their doctors.

The company strongly disputed the results, saying the analysis by Dr. Steven Nissen and statistician Kathy Wolski at the Cleveland Clinic is not definitive scientific proof. In a conference call, Dr. Lawson McCartney who leads Glaxo’s diabetes drug development, said the company is not seeing “anything like” the problems reported in the medical journal.
“We remain very confident in the safety and of course in the efficacy of Avandia as an important diabetic medicine,” McCartney said.

The government will take no immediate action on a label change or other measures regarding the drug, said Dr. Robert J. Meyer of the FDA’s Center for Drug Evaluation and Research.

Some data suggests “that there is a potentially significant increase in the risk” but there also is risk if patients switch drugs or do not keep their blood-sugar under control, an FDA statement says.

FDA officials acknowledged that Glaxo submitted information last August indicating some increased risk from the drug but that other studies were contradictory. However, several members of Congress expressed alarm and said they would hold hearings on the safety issues.

Statement from the American College of Cardiology, American Diabetes Association and American Heart Association Related to the article in the NEJM

May 21, 2007; the following is a Statement from the American College of Cardiology, American Diabetes Association and American Heart Association Related to NEJM article, ‘Effect of Rosiglitazone on the Risk of Myocardial Infarction and Death from Cardiovascular Causes’:

Today the New England Journal of Medicine published an article entitled, ” Effect of Rosiglitazone on the Risk of Myocardial Infarction and Death from Cardiovascular Causes.” The conclusions of this analysis of previous studies of rosiglitazone (brand name, Avandia) suggest that this oral agent used to treat type 2 diabetes may be associated with increased risk of heart attack and death from cardiovascular causes.

According to ACC, ADA and AHA, this study deserves serious thought and follow-up. As estimated here, the overall level of the risk associated with rosiglitazone appears to be small, but nonetheless one that must be considered carefully.

In the meantime, patients using this drug should talk to their health care provider to determine the most appropriate course of action. Patients should not stop taking any prescribed medications without first discussing the issue with their health care provider. Further research will be needed in this area to provide conclusive evidence.

It is very important to prevent diabetes when possible and to effectively treat it when it is present. The treatment of diabetes should be a team approach, with health care providers and patients working together to ensure patient education and empowerment.

Glaxo replied with a letter to the UK Journal: Lancet.

Two excerpts:

In response to your Editorial (published online May 23)1 regarding the study in the New England Journal of Medicine by Steve Nissen and Kathy Wolski,2 I would like to provide further perspec-tive. Nissen and Wolski estimate a 43% increase in myocardial infarction associated with rosiglitazone. In an associated Editorial, Bruce Psaty and Curt Furberg3 allege that if their estimate is valid there has been a failure of drug use and approval.

We believe that these studies pro-vide clear evidence of the cardiovas-cular safety of rosiglitazone and that the estimates of cardiovascular morbidity from the meta-analyses completed to date are not robust. The drug use and approval system is working. We should stay the course and allow ongoing trials to provide their definitive answers.

Ronald L Krall
ronald.l.krall@gsk.com
Chief Medical Officer, GlaxoSmithKline

My bottom line will be to continue with my Avandia and closely follow the next steps in the USA with both the FDA and Glaxo – you will read about it here: as it happens and unvarnished.

James Montgomery.

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Tuesday, June 5, 2007

The Satiety Index … a calorie is NOT a calorie

It is with great pride ODB presents the next level of using the GI Index from the SUGIRS team at Sydney University. This article is written by Prof. Jennie Brand-Miller and PHD candidate:  Rebecca Reynolds …. James.

Why do some foods give us the munchies? We just can’t stop at one bite … or two … or three … think chocolate chip cookies, potato crisps, jelly beans … No wonder we call them “more-ish”. Compare this to “old-fashioned” foods (think porridge and beans) that positively stick to the ribs. How hard is it to get more than one bowl of steaming oats down our gullets?

Many experts lay the blame for the current epidemic of obesity right at the food industry’s door. Do they have a secret ingredient that makes us eat more, so we can hold up our arms in resignation and say it’s “dietary trickery”? There may be some merit to this idea. Researchers have conjured up a way to rate foods according to how full they make us feel.

The reasons we start and stop eating are complex. Meal size is partly determined by how quickly you “feel full” during eating, and to what extent. This is called “satiation“. Similarly, the time between meals is determined by how long you feel full for. This is called “satiety“. Psychological factors are of course paramount concerning both, with learned habits, social cues and emotional states having the capacity to override the “basics” underlying eating. However, if one feels full quickly during a meal and for a long time subsequently, psychological factors lessen in significance.

How easy, and enticing, is it to gorge on fruit after a bad day at work? Any takers for eating ten apples in 10 minutes? Conversely, anyone for a warm, moist croissant? Both ten apples and a croissant provide similar amounts of energy, but differ in all other aspects, namely macronutrients, such as fat, protein and carbohydrate, and water, all of which contribute to how full you feel.

“Fullness” is a new buzz word in the world of diet today, and was quantified over a decade ago by Jennie Brand-Miller, Sue Holt and others at Sydney University’s Nutrition Department. Brand-Miller’s team invented a new “scientific” measure of fullness, the “satiety index” (SI). The SI refers to the short-term satiating capacity of a food, i.e. how full one “feels” after ingestion. It was ascertained via a subjective (personal rating) satiety questionnaire, filled out every 15 minutes by healthy human subjects, after a 1000 kilojoule (kJ) portion of a test food was served for breakfast, for a period of two hours.

The higher a subject’s rating of fullness over the two hours, the higher the SI of the food, as compared to a reference food, white bread (which was assigned a SI value of 100). Subjective feelings of satiety were validated by a direct correlation with prospective ad libitum, eat as much as desired, food intake at a buffet lunch after the two-hour test period (i.e. when a subject reported high satiety after breakfast, he or she ate less at lunch). Thirty-eight common foods were tested in this way, each in 12 subjects, with some interesting results.

Croissants had the lowest SI (47) and potatoes the highest (323). In other words, croissants were only half as filling as the same energy load of white bread, while potatoes were over three times more filling. The most satiating foods weighed more and had the highest protein, fibre and water content, less fat content and lower palatability (“tastefulness”). Modern foods, ideally illustrated by the bakery and snacks/confectionery groups, scored low on the SI. Donuts and Mars Bars made subjects feel hungrier and inclined to eat more at lunch. “Wholesome” foods, high in protein and carbohydrate, on the other hand scored highly, with foods like fish and pasta making subjects feel fuller for longer.

The level of distention of the stomach and small intestine is likely to be the main factor eliciting high levels of satiety in the study, reflected by the strong correlation between the weight or water content of the food and SI, i.e. foods with the highest water content, and hence “bulk” were associated with increased feelings of fullness, potatoes being the best example.

This forms the basis of work conducted Dr Barbara Rolls, a US nutritionist, who recommends the use of food volume in weight loss, based on the higher SI of bulky, “watery” food. However, it should be noted that mechanical distention of the gut wall (via mechano-receptors) is only one contributing factor to feelings of fullness. Less obvious characteristics of bulky foods are also important. These include a low glycemic index (GIs), low fat content (and hence low energy density) and high fibre level.

On this note, let us talk about potatoes and GI. Scientists think glucose is a key player in the hunger and satiety tug-of-war via stimulation and inhibiton of “appetite centres” in the brain’s hypothalamus. Potatoes are well known for their high GI and high GI foods are often associated with less fullness (satiation). A blood sugar spike followed by a rapid fall in blood glucose levels can stimulate feelings of hunger. Yet potatoes were the most filling food despite their high GI. Why? Well, one reason may be the fact that the subjects did not rate their hunger beyond two hours. Perhaps potatoes are one of those foods that make us feel only temporarily full. But more important, when we compare high and low GI foods, it is necessary to compare like with like (bread with bread, breakfast cereal with breakfast cereal). With any luck, the potato breeders will come up with a low GI, even more filling potato in the near future.

Previous work has ranked fat as the least, and protein the most, satiating macronutrient, findings supported by the SI, but has often omitted detail on type of carbohydrate and satiety, which was highlighted in Brand-Miller’s study. For example, food with a mix of slowly digestible and indigestible carbohydrate (fibre), such as porridge, scored high on the satiety scale. Oats have high levels of soluble fibre, which forms a gel in the stomach, slowing gastric emptying and hence delivery and absorption of nutrients to and from the gut. Such a viscous mix also “sticks” to the walls of the stomach and upper small intestine, activating mechano- and chemo-receptors and enteroendocrine cells which relay information to the brain via gut-brain signals (such as glucagon-like peptide-1).

These hormones signal the presence of food still in the gut, reminding us that it can take only so much food. In addition, the carbohydrate “inside” a porridge oat is generally harder for the body to process than, for example, white bread. The physical fibrous barrier encasing the oat makes it harder for digestive enzymes to access the interior. White bread in comparison contains starch that is readily available, as all the “tough” outer layers of the original wheat grain have been removed during processing. Indigestible fibre that reaches the lower climes of the small intestine has further effects of stimulating the release of a wider array of gut hormones that signal satiety (for example, peptide YY from the ileum). Similarly, anti-nutrients found in some protein-rich foods, such as baked beans (for example, trypsin inhibitors), may result in some undigested protein reaching these areas and increasing fullness.

Palatability is an important factor to consider, as individual preferences will always influence a subject’s perceived fullness. Measures to control for this were taken by serving 27 of the 38 foods under an opaque plastic hood, to minimise influences of sight and smell, as well as preconceived ideas of the level of fullness a certain food “should” elicit (11 of the foods contained liquid; for example, breakfast cereal with milk, and hence could not be served in small pieces via a hole in the hood).

It makes sense that the more palatable a food, the lower the SI, which is generally the case with high fat foods, as humans have an innate liking of the “rich” mouth feel and taste of fat. This has been hypothesised to maximise the intake of energy-rich fuel (fat is the most energy-dense nutrient) during periods of food abundance in our evolutionary past, in preparation for inevitable times of scarcity. However, today’s times are of abundance, and it is easy to passively over-consume energy via fatty foods, such as cake and french fries. High-fat foods seem to be less capable of proclaiming, “I’m here and I’ve got lots of yummy energy for you” loud or fast enough for our bodies to hear.

In conclusion, the SI ideally illustrates the fact that a calorie is NOT a calorie, i.e. not all kJs are equal. Eat 1000kJ of a fat-laden food and feel less full than after an isocaloric (equal energy) portion of a protein-rich food. In addition, different foods promote varying levels of dietary-induced thermogenesis (DIT, heat production) and fat storage. So, both sides of the energy balance equation have the potential to be manipulated; eat more filling foods to decrease food intake and foods that promote DIT and decrease fat storage to maximise energy output.

The SI is an important concept that has thus far been under-utilised and has huge potential as an anti-obesity tool. So, after reading this article, I’m afraid to say any excess fat “IS your fault”, as now you are equipped with the knowledge of how to identify those foods which try to “go behind your back” and trick your body into letting more of them in. Revert to a more traditional diet, full of foods that score high on the SI, such as porridge, fruit and fish, and stop such “dietary trickery” now.

Professor Jennie Brand-Miller is in the School of Molecular and Microbial Biosciences at the University of Sydney and Rebecca Reynolds is a PhD student, Human Nutrotion, in the School of Molecular and Microbial Biosciences. Many people consider Prof. Brand-Miller to be the ‘Godmather of GI’! Want more like this?

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Thursday, April 5, 2007

From the Diabetes Desk…

Meet High-tech Harold

Exclusive to the ODB, H-t H is your source
for all that’s new in high-tech battle against
diabetes and its eventual cure.

He will be a regular feature in our new layout
coming soon – all you need to know about
diabetes –especially down under – in one site.Till then you can always read his column right here.

H-t H works for the ODB! 

The Diabetic Lojack

Very much like a prisoner being tracked in a work-release program (except it’s implanted on the inside of your upper arm) — the VeriMed microchip stores your vital health information for times when you are unable to disclose it yourself. It’s about the size of a grain of rice and VeriChip says the procedure is painless.  

Technorati Tags: diabetes, Diabetes Treatments, Glucose reducing drug, living with diabetes, Medication for diabetes, Metformin, Microchip and diabetes, New Diabetes Treatments, RFID Microchip, treating diabetes, Type 2 Diabetes, Verichip Corporation, VeriMed Microchip

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Tuesday, April 3, 2007

From the Diabetic Desk…

Diabetes Alert Day …. And pre-Diabetes!

In the US, today is Diabetes Alert Day.
 

Diabetes Alert Day is held every year on the fourth Tuesday of March to call attention to diabetes and to encourage everyone to find out if they are at risk. While diabetes is often a hereditary condition, it is still possible to develop diabetes even if you have no known history of it in your family. In addition, type 2 diabetes is often preventable through regular medical checkups and a healthy lifestyle.

The focus this year is on prevention and a condition called Pre-Diabetes. You can find out if you are at risk by taking the Type 2 Risk Assessment and then read more below about what you can do to prevent or manage type 2 diabetes.

Prediabetes: Prevention And Treatment

The recommended treatment for prediabetes is similar to the prevention strategies for type 2 diabetes. In many cases, the progression of prediabetes can be halted, and even reversed, by making healthy eating and fitness habits a daily routine.

The Diabetes Prevention Program (DPP), a large-scale study of diabetes prevention strategies in those at high risk for type 2 diabetes (including those with impaired glucose tolerance), found that even moderate lifestyle changes can make a big difference in preventing diabetes and reversing prediabetes in some people. DPP participants who engaged in 30 minutes of physical activity daily and lost 5 to 7% of their body weight cut their risk of getting type 2 diabetes by 58%.

If you have prediabetes, losing excess pounds through proper diet and exercise can improve the body’s ability to use insulin and to process glucose more efficiently. A dietitian or a certified diabetes educator [CDE} can help you develop a food plan that works for you. Our choice is a low-GI diet. Always check with your physician before starting a new fitness program, especially if you have a chronic illness or other health problems.

The DPP also found that the type 2 diabetes drug metformin was beneficial to some individuals with prediabetes/impaired glucose tolerance. Those study subjects that were treated with metformin reduced their risk of getting type 2 diabetes by 31%.

Take the test – as we used to say in parachute school: ‘Knowledge Dispels Fear”!

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Wednesday, March 28, 2007

From the Diabetes Desk…..

What is Byetta?

There has been a lot of talk in the US over the last 18 months about this new approach for type 2 patients, with the major promotion being headed up by celebrity T2: Delta Burke.

Previous drugs for type 2 diabetes have focussed on doing one of two things – getting the pancreas to produce more insulin or making your insulin work better. Now, a novel approach is enlisting the help of other body organs in the fight against diabetes. 

New classes of drugs are targeting the stomach and the liver, bringing hope for future years of diabetes management and a reduction in side-effects.
Introduced in the USA in June 2005, Exenatide injection Byetta is now taken twice-daily by around 200,000 Americans. It is not an insulin and does not replace insulin, instead it acts to make the body’s insulin work better.

The drug has been reported to have less side-effects than is generally associated with other diabetes drugs. Its most common side-effect is nausea. Some patients using Byetta report losing weight - which can be a bonus in helping to improve management of their diabetes. The drug works by simulating the gut’s reaction to food. It signals the pancreas to make the right amount of insulin after meals to help lower blood glucose closer to normal levels. Once this takes place, it stops the pancreas producing more insulin. The drug also helps stop the liver from producing too much glucose when it isn’t needed, helping to avoid high blood glucose levels (BGLs). Byetta also slows down and moderates the rate at which glucose enters the bloodstream, helping avoid high BGL peaks.

Byetta is an injectable medicine and comes in a 
a pre-filled pen with fixed doses.

How does it work?

In other words Byetta is working four ways:

Exenatide works to help improve glucose control in at least four ways:

Exenatide augments pancreas response to release a higher, more appropriate amount of insulin in response to eating meals; this helps lower the rise in blood sugar rise from eating to more normal, flatter response levels. If blood sugar levels get closer to normal, the pancreas response to produce insulin is reduced. Other drugs (like injectable insulin itself) are effective at lowering blood sugar, but can “overshoot” their target and cause blood sugar to become too low, resulting in the dangerous condition of hypoglycemia.

Exenatide also suppresses pancreatic release of glucagon in response to eating, which helps stop the liver from overproducing sugar when it is unneeded, which prevents hyperglycemia (high blood sugar levels).

Exenatide helps slow down gastric emptying (the rate at which sugar enters the bloodstream) which also helps avoid hyperglycemia.

Exenatide has a subtle yet prolonged effect to reduce appetite, overeating and weight gain. Most people using Exenatide slowly lose weight. Clinical trials have demonstated that the weight reducing effect continues at the same rate through 2.25 years of continued use.

The Future?

Eli Lilly & Co., Amylin Pharmaceuticals and Alkermes, Inc. are currently developing a long-acting-release (LAR) formula of the drug, which would be injected once per week. The initial trials for the medication have shown the LAR formulation to be approximately twice as effective as the original twice-daily injectible form, with a similar safety, lower nausea rates and greater weight loss profile.

And, Australia?

The developers of the drug - Amylin Pharmaceuticals Inc and Eli Lilly - plan to make the drug available in Australia, however a spokesperson from Eli Lilly said it was unknown when Byetta may be available for Australians.

“Eli Lilly has lodged an application with the Therapeutic Goods Administration to register the product in Australia,” she said. “If Byetta is successfully registered, Eli Lilly intends to lodge an application to have it listed on the Pharmaceutical Benefits Scheme (PBS).”

Stay with ODB for the countdown to Byetta in Australia.

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Tuesday, March 27, 2007

The First Step …. Buy the best Diabetic Cookbook!

One of the first steps new diabetics take is to seek out a good diabetic cookbook. The problem many find, however, is that there are hundreds out there. Each one states that it is the top and sells itself as the best thing since high-fibre, low-GI, sliced bread. It is important for a new diabetic, or pre-diabetic, seeking a good resource for cooking to learn their body’s reaction to certain foods and ingredients so adjustments can be made as needed.

Unless you like doing math in your head; it is equally important to make sure it’s an Australian book with our metric weights and measures and available products. With a base of 300M people, they have many more diabetic products sitting on supermarket shelves!

[see that GI label!]

One of the first lessons everyone learns early on in the disease is that they may not react to all foods the same as other diabetics. Some diabetics can eat high fibre, low sugar foods and have no rise in blood sugar levels. Some people have no response to sugar alcohols (such as maltitol, sorbitol, or xylitol.) Part of this response has to do with the current level of pancreatic function, while medications also affect the body’s ability to handle some substances. No single diabetic cook book can take all of the variables into account but good ones allow for substitutions and adjustments for people with varying levels of carbohydrate tolerance.

When looking for a diabetic cook book, it is important to find one that explains the recipes in detail and also supplies alternative ingredients for those that may cause problems for people. Some recipes may call for the use of sugar and the recipe should offer alternatives (and proper conversion amounts) such as Equal, alternative sweeteners (sucralose, etc.), and sugar alcohol products. Some recipes even give combination alternatives such as adding cinnamon and Equal to replace sugar. A recipe that calls for flour should offer alternative suggestions for those people who react adversely to processed flour.

Offering alternatives in the diabetic cook book is important, but it is also essential to offer conversion amounts. For example Equal (and some other sugar alternatives) are much sweeter than sugar itself. Knowing this, recipes that call for a certain amount of sugar may need less Equal, however the bulk needs to be made up for with other ingredients. Some flour alternatives can only be substituted for a portion of the whole flour amount. Heavy cream can be used in place of milk but must be mixed with water, and therefore amounts need to be adjusted. A good diabetic cook book must take these adjustments into consideration.

Lastly, a good diabetic cook book must have recipes for foods that an individual would enjoy making and eating. Any nutritional plan is doomed to failure from the start if the meals selected are forced or do not offer variety. A person who ate a lot of sweet and Hi-GI food before being diagnosed with diabetes may find it difficult to adjust to a bland diet. In this case, a diabetic cookbook with recipes for low-GI, sweet snacks will be beneficial. Flip through the pages of a diabetic cook book that you are interested in and see if it holds recipes that you are interested in, and if those recipes offer alternative ingredients and adjustments it may be the right fit for you.

Pick of the Australian Diabetic Cookbooks

There are several available from the GI Team – make sure you are looking at the Australian section – including Low GI Eating - Made Easy … a beauty for new comers to the field…. The Low GI Diet – Cookbook with offerings even from the great Margaret Fulton. These have the obvious advantage of having all the GI ratings built into the recipes.

Even their handbooks – this is the brand new one: Diabetes & Pre-Diabetes handbook- include good recipes and food hints – such as feeding diabetic toddlers!

From Australian Women’s Weekly and endorsed by Diabetes Australia comes The Diabetes Cookbook. It stresses menus for people with diabetes and their families! “Every delicious recipe has been selected by an expert nutritionist and is endorsed by Diabetes Australia so ALL the ingredients are on the ‘allowed’ list.”
It is a good staple and can usually be found for under $13 making it good value for money.

A little harder to track down but worth the effort is an Australian treasure called: The Ultimate Diabetes Cookbook by Virginia Hill and Lorna Garden. Now it is important to check the author’s name as there is an American book with exactly the same name but not the same Aussie recipes! A bit of history: the first version was published as ‘Simply Delicious’ in 1996 and ‘Sweet Sensations’ in 1999 …. Just in case you spot one at the school fete.

Remember, it may be better to eat several small meals during the day instead of one or two big meals.

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Thursday, March 22, 2007

Type 2 – a Personal Approach to Diabetes Control

I am now 65 – was diagnosed over a dozen years ago and have maintained a pretty constant HbA1c below 7.0.  This contrasts pretty much with my very busy lifestyle and home life; starting new businesses and raising an 8 year old daughter. The majority of my business associates don’t know that I am a diabetic.

My regimen is based on simple and easy to follow rules in my diet, my exercise and my medication.   This works for me; it doesn’t necessarily work for you … I have been lucky to work with some of the best GP’s and endocrinologists below the equator.  So the first step in my program is – talk to your doctor, see him or her every three months. This is not one to do on your own!

DIET

If this is not your first visit to the ODB, you will know we are great supporters of the Glycemic Index.
Not all carbohydrates are evil is the motto of the low GI diet. As a measurement of how quickly a particular carbohydrate is used by the body, the Glycemic Index is already found on nutritional labels in Europe and Australia, but has yet to be endorsed any American organization.

Manufacturers have prepared low-GI foods and I make great use of their products.
Bread is a staple in my house and I make sure it’s a low-GI product.
That’s what’s so different about the GI, it’s not low carbohydrate, it’s more selective carbohydrate.

Foods with low GI are metabolized slower, meaning they sit in your digestive track longer and are gradually absorbed by the body. This leads to a more gradual blood glucose increase, keeping your hunger satiated longer. You feel ‘fuller’! More on feeling full later in the week.

How do I fit this into my lifestyle – in my wallet is a go/no-go list … last week I gave you my list of go foods …. now for my list of no-go

No-Go No. 1  Spuds   I have learned to swap white potatoes with sweet potatoes and yams; not to eat them when I am out.  If you must occasionally scratch your potato itch, cook them the day before in a salad and put them in the fridge overnight … it slows down the rate of digestion of the starch.

No-Go No. 2  Breakfast Cereals  I obviously don’t chow down on Coco Pops; but you may be surprised at the others in the hi-GI list; they include Cornflakes, Bran Flakes, Total, Rice Bubbles, Sultana Bran, Cheerio’s, Weet-Bix is borderline.

No-Go No. 3  Staples  Poor old potatoes, they get a pasting again [no fries and no mash] along with short grain white rice and tapioca.

No-Go No. 4  Snacks   Not what you think: the drop-em list includes pretzels, water crackers, rice cakes, the ubiquitous scone and as you would expect: maple syrup and donuts.

No-Go No.5   Fruits    The two traps for the unwary are watermelon and dates.

No-Go No. 6  Vegetables  There are two here too: parsnips and pumpkin.

No-Go No. 7  Bread   The usual culprits: white [unless modified and proudly wearing its low-GI label], bagels and French baguettes.

And, that’s not that hard to remember! Here is a full list online … David Mendosa is a diabetic treasure!

EXERCISE

This is a no-brainer!

You can prove the effect of exercise to yourself simply by checking your BGL before and after a half hour brisk walk. I sometimes even risk a hypo.

New research shows that moderate exercise, such as walking, cycling, or jogging, can significantly reduce the risk of death for people with Type 2 diabetes. This study followed over 3,300 people and correlated their level of physical exercise with mortality to find that moderate exercise reduced the chance of cardiovascular death by 9%, and more vigorous exercise reduced the total chance of death by 33%.

To people with diabetes, this probably isn’t new news. We have long been advised to pursue physical exercise, especially cardiovascular exercise, in order to improve their overall health and reduce their chance of death. This study simply adds support to the notion that physical exercise is the number one way to enhance your health and avoid the downward health spiral associated with diabetes.

Now, don’t rush off and join a gym. Healthy exercise can be as little as three thirty minute workouts a week with time beforehand to warm up and a cool down time afterwards.

I do some stretching exercises and speed walking for twenty minutes.

A couple of do’s and don’t’s: drink plenty of water and take it easy –this is meant to be moderate.   Don’t hold your breath when you feel the strain, breathe out; don’t stand still after your twenty odd minutes of speed walking, walk around slowly as part of your cool down.

You want to get into this deeply –try Professor Bob Montgomery’s book: Your Good Health –it also contains a good section on giving up smoking as well. My last puff was over 25 years ago! Bob was a pioneer in so many areas of good health.

Now that I am over 60, I make that five mornings a week rather than the minimum three whenever I can. It makes me feel good!

MEDICATION

Keep in mind that drugs are not magic. If you are taking a drug for diabetes control, it is still essential that you follow a good diet and get regular exercise. These two elements of diabetes control are the pillar on which all other diabetes treatment rests.

I have a cocktail of three prescription medicines:
Metformin:  It works by helping the insulin that your body is still making work better. It also has a side effect which is very beneficial for most people with Type 2 diabetes—it makes you lose a little bit of weight by decreasing appetite. Another good side effect for some people is that it tends to lower triglycerides (certain fats in the blood), which is great if you tend to have high triglycerides.
Glibencalmide: It works by making your body produce more insulin. As you probably know, when you have type 2 diabetes, your body is able to make some insulin, but not quite enough to overcome the insulin resistance that your body has. When you take these drugs, your body is able to make a little more insulin.
Thiazolidinediones: I use a brand name called Avandia. These drugs work by helping the insulin that your body is already making work better, but they work on different parts of your body than metformin does.

Each performs a slightly different function.

I cannot stress too much that this works for me and you need to discuss dosages and oral mixes with your own doctor.

As I said, I was diagnosed as a T2 nearly fifteen years ago now, I have a heavy family diabetic history, so I guess it was inevitable …but, touch wood, the above regime has kept my HbA1c below 7.0 for the last five years. It’s not meant for you, it is meant to make you think!

Note: the cartoons are from a cool diabetic information site and the clever wit of Mike Adams and with help from Dan Berger.

Technorati Tags: control of diabetes, controlling diabetes, diabetes and diet, diabetes and exercise, diabetes control, diet and diabetes, GI, information on diabetes, living with diabetes, medication and diabetes, Type 2 Diabetes

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Monday, March 12, 2007

The Glycemic Index for Dummies – The Label & Standards

Australia continues to lead on the GI front.  The GI label is checked and monitored.

In a world first, Standards Australia have developed a standard for determining the Glycemic Index (GI) of carbohydrates in foods for use by food manufacturers, accreditation bodies, governments and other regulators, educational institutes, testing laboratories, and research organizations.

The standard will play an important role in improving the accuracy and reliability of GI values, ensuring that Australian consumers can trust the GI claims made on food labels. The standard which sets out a recognized scientific method to determine the GI of foods has also been submitted to the International Organization for Standardization (ISO) for possible adoption by member countries around the world including Canada, China, France, India, Japan, Malaysia, South Africa, the UK and US.

Several cases of deceptive practice have been already been investigated by the Australian Competition and Consumer Commission (ACCC), including a brand of cous cous, which had a medium GI but was claiming to be low.

Mr John Tucker, Standards Australia CEO, said the new standard would set a recognised yardstick consumers and food producers can use to guarantee the health benefits of their products.

“Consumers looking for healthy foods need to be confident the claims made by food manufacturers on their labeling are accurate,” Mr Tucker said.
“Historically, not all GI values on food labels have been reliable, with some claims based on extrapolation or inappropriate methodology.

“A national standard, prepared by an independent body like Standard Australia, provides an alternative to industry using different in-house methods to obtain the GI value of a food,” Mr Tucker said.

Look for the Glycemic Index Tested logo

Alan Barclay, Acting CEO of Glycemic Index Ltd, says the standard will not stop otherwise unhealthy foods from making claims about GI but it will ensure that the GI claims are accurate.

 “Foods with the logo have been tested using the Australian Standard, and they must also meet a range of criteria for kilojoules, total and saturated fat, fiber and sodium in line with the Dietary Guidelines for Australians.”

It’s also timely with low GI food products gaining momentum worldwide as savvy consumers understand that blood glucose management matters and that a diet rich in slowly digested, low GI carbs, along with regular exercise will reduce their risk of diabetes and heart disease.

People who are choosy about their carbohydrates find that: they feel fuller for longer and are less likely to overeat:

– they have more energy
– their insulin levels are lower and they burn more fat
– over time, combined with some regular daily exercise, they lose weight

One criticism of the GI is that it’s not the best indicator of healthy food choices.

Professor Jennie Brand-Miller:  “Is there any one factor that it is a universal signpost? Fat is certainly not. We don’t recommend jelly beans and soft drinks because they are low fat. Indeed, the beauty of the GI is that so many healthy choices are ALSO low GI choices - legumes, nuts, low fat dairy products, pasta and noodles, most fruits and vegetables, whole kernel breads and breakfast cereals. The GI gives us another reason, a very good reason, to recommend these foods. And for the person with diabetes, there’s immediate payback (within 2 hours), not 20 years down the track.”

More from Jennie on that feeling of fullness later….   

Technorati Tags: Carbohydrates, G.I, G.I., GI, Glycemic Index, Low G.I, Low GI, Low GI Carbohydrates, Low GI Carbs

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Thursday, March 8, 2007

The Glycemic Index for Dummies - Glucose Loading????

A new concept, called the Glycemic load (GL), which was developed by scientists from Harvard University, USA, “fine tunes” the Glycemic Index (GI) concept. It is a little more complicated.

The Glycemic index (GI) is a numerical system of measuring how much of a rise in circulating blood sugar a carbohydrate triggers—the higher the number, the greater the blood sugar response. So a low GI food will cause a small rise, while a high GI food will trigger a dramatic spike. A GI of 70 or more is high, a GI of 56 to 69 inclusive is medium, and a GI of 55 or less is low.

The Glycemic load (GL) is a relatively new way to assess the impact of carbohydrate consumption that takes the Glycemic index into account, but gives a fuller picture than does Glycemic index alone. A GI value tells you only how rapidly a particular carbohydrate turns into sugar. It doesn’t tell you how much of that carbohydrate is in a serving of a particular food. You need to know both things to understand a food’s effect on blood sugar. That is where Glycemic load comes in. The carbohydrate in watermelon, for example, has a high GI. But there isn’t a lot of it, so watermelon’s Glycemic load is relatively low.

A GL of 20 or more is high, a GL of 11 to 19 inclusive is medium, and a GL of 10 or less is low.

The GI of apples is 38 and the GL of one medium apple is 5. This means that eating one apple will have hardly any effect on blood glucose levels. If you eat an entire 500 g packet of dried apples, however, its GL would be 50, which means that it will have a huge effect on your blood glucose levels, despite its being low GI. This brings us back to the old principle that there is no license to overindulge in “good” or “bad” foods. But should you indulge in watermelon, it will have an even greater effect on blood glucose levels, due to its high GI value!

The GI of  the average brown bread is high (GI = 81) and the GL of two slices (2 x 40 g slices) is also high (GL = 32), because the quantity of carbohydrate in a hand-cut slice of bread is substantial. This means that a sandwich made with two slices of brown bread will have a marked effect on blood glucose levels as the bread will have an “oomph” of 32. On the other hand, if you use a thin slice of bread (30 g bread) as part of a mixed meal containing low GI baked beans, ham and salad vegetables, the GL of the meal will be lower and more acceptable (GL = 22). Note that the two slices of bread on their own have a higher GL than an entire meal, in which only one thin slice of bread is used in combination with other low GI foods.

The Glycemic load (GL) of one slice of seed loaf is only 8. In contrast to this, a single hand-cut slice of brown or white bread has a GL of 16. This means that ordinary brown or white bread will spike blood glucose levels (higher GL), and the seed loaf will not (lower GL), but this still doesn’t mean that you can over-indulge in seed loaf. Fortunately, seed loaf is more filling and it is not as easy to over-indulge in this bread, as it is to over-indulge in brown or white bread.

In addition, the GL of a roll (equivalent to two slices of bread) is more than 20, and that of a bagel (equivalent to three slices of bread) is more than 30. Imagine what this does to blood glucose levels, as the GI is also high!

From this we can see that it is quite acceptable to include small quantities of high GI foods in a meal, as long as the bulk of the meal contains lower GI carbohydrate foods (vegetables, fruit, low GI starches, legumes and/or dairy).

New evidence associates high GL meals with an increased risk for heart disease and diabetes, especially in overweight and insulin-resistant people. Therefore, it is advisable to restrict the GL of a typical meal to between 20 and 25 as far as possible, but definitely to keep it below 30. The GL of a typical snack should preferably be between 10 and 15, but if your meals are all close to 30, the total of your snacks should be no more than 10. This means that you would have to eat fruit for snacks, in order to keep your total daily GL below 100, as the GL of fruit is usually below 10.

The GI indicates the extent to which a food will raise blood glucose levels, whereas the GL is the “power” or “push” behind the GI.

High GI and high GL means trouble – blood glucose levels will shoot up. This means the food in question will have a lot of “power” behind the already high GI, and even a small portion will have a marked effect. Examples of this are potatoes and regular bread.  These foods are high in carbohydrates and therefore a small portion already contains a lot of carbohydrate. In addition they have high GI values, which aggravate the effect on blood glucose levels.

Low GI combined with a high GL will also impact on blood glucose levels. Remember that the GL is based on the quantity of carbohydrate in a food, and represents the GI in portion size. So the more carbohydrate there is in a food, the higher its GL i.e. the more “power” or “push” behind the GI.

So even low GI foods, if eaten in large quantities, can affect blood glucose levels quite significantly, especially if they are concentrated sources of carbohydrates e.g. most cakes, dried fruit and dried fruit bars, fruit juices, crisps, chocolates, etc. Crisps and chocolates are also high in fat and/or saturated fat, making them undesirable.

And lastly, a high GI food with a low GL will not necessarily affect blood glucose levels significantly. A good example here is the high GI vegetables (carrots, pumpkin, etc). They contain only a little carbohydrate and therefore, in normal portion sizes, will not impact on blood glucose levels even though they have a high GI, as there is not enough “power” behind the high GI. The proviso is, though, that they are not eaten with other high GI or GL foods.

Three meals per day should add up to a GL of between 55 and 70, as most people will add salad and/or fruit to breakfasts and light meals, which also contribute to the GL. This leaves 30 – 45 GL points for snacks and drinks, as most of these have a GL of 10 – 15, except for fruit, which has a GL of below 10.

The aim is to keep the total GL per day under 100.

A little more complicated but worth the effort!

Technorati Tags: Blood Glucose Levels, Diabetes Diets, Glycemic Index, glyecmic load

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Tuesday, March 6, 2007