Management of DM in hospital. March 31, 2019

I was looking for many years what protocol used by doctors in hospital, and why in hospital every time my insulin injections stopped. It is told all the time that insulin should not be stopped. IThios action can lead to death.

 Hyperglycemia is a common, serious, and costly health care problem in hospitalized patients. Observational and randomized controlled studies indicate that improvement in glycemic control results in lower rates of hospital complications in general medicine and surgery patients. Implementing a standardized sc insulin order set promoting the use of scheduled basal and nutritional insulin therapy is a key intervention in the inpatient management of diabetes. We provide recommendations for practical, achievable, and safe glycemic targets and describe protocols, procedures, and system improvements required to facilitate the achievement of glycemic goals in patients with hyperglycemia and diabetes admitted in non-critical care settings.

 Management of Hyperglycemia in Hospitalized Patients in Non-Critical Care Setting: An Endocrine Society Clinical Practice Guideline 

The Journal of Clinical Endocrinology & Metabolism, Volume 97, Issue 1, 1 January 2012, Pages 16–38, https://doi.org/10.1210/jc.2011-2098

 

Published:

01 January 2012

https://academic.oup.com/jcem/article/97/1/16/2833111

Now, what are recommendations?

 3.1 We recommend a premeal glucose target of less than 140 mg/dl (7.8 mmol/liter) and a random BG of less than 180 mg/dl (10.0 mmol/liter) for the majority of hospitalized patients with non-critical illness. (1|⊕⊕○○)

        I did not get it, what are the point between 140 mg/dl and 180 mg/dl? This is the target to diagnose diabetes. But not in hospital. In hospital it is recommended that patient come with good blood sugar control. Otherwise what? Probably it is my misunderstanding, but for whom all these recommendations? and what does it mean they recommend?
      If it was I who look at the treatment patient in hospital then I would recommend, if patient come to hospital with BG> 140mg/dl, more obvious it is fasting level because of ill people usually fast rather then overeat, to start to use insulin therapy right away, regardless of any other medical conditions. In diabetes if BG is high then other medical conditions are difficult to manage. Very often they are the consequence of poor BG management. 
      But I am not doctor. So, millions of diabetics live without being diagnosed with diabetes, and only when condition is critical they are in hospital to get last medical though.

3.3 For avoidance of hypoglycemia, we suggest that antidiabetic therapy be reassessed when BG values fall below 5.6 mmol/liter (100 mg/dl). Modification of glucose-lowering treatment is usually necessary when BG values are below 3.9 mmol/liter (70 mg/dl).

     Well, in this situation it is better to be aware of low blood sugar, and the actions to avoid the fall of BG down to the fatal level. It is easy to recommend to be healthy and wealthy, we all do know it is best. Still, we getting old, ill, and never wealthy. We are happy if our ends are met.What are those recommendations? What MD in hospital cross the street must to do when I am in ER? How to use these recommendations? I take 500 units insulin every day. If insulin stopped my sugar rise above critical level. If insulin delivered I got low blood sugar and sugar may be so low that it would be fatal.
      There are millions of pages how to recommend, and how to use recommendations, but at the bottom line there is diabetic and MD, only two if us, and Death between.
    All what I do see in these recommendations, all those authors have  recommend to us to be healthy, wealthy, and young. They have no one idea how to treat un-healthy people, those who are ill. 

 4.1.1 We recommend that MNT be included as a component of the glycemic management program for all hospitalized patients with diabetes and hyperglycemia.

     These recommendations are all the time very well followed. Because of according to ADA Starvation is cure for diabetes type 2, hospital provide Starvation Diet to all its patients, regardless diabetes, high blood sugar or low blood sugar, or no sugar at all. 

4.1.2 We suggest that providing meals with a consistent amount of carbohydrate at each meal can be useful in coordinating doses of rapid-acting insulin to carbohydrate ingestion.

      Did some one saw at any hospital that diabetic were on different diet then general patients? I did not. Usually I do have the same meal as everyone else. So, regardless of dose of rapid acting insulin we all do have the same amount on our plates.Probably it is the best. If meal is good in hospital then many will never leave it.

4.2.1 We recommend insulin therapy as the preferred method for achieving glycemic control in hospitalized patients with hyperglycemia. 

     I posted many times, in hospital if sugar is high they will initiate insulin therapy. Sugar will drop. Patient go home to modify life style. No insulin. Just SU and Metformin and Starvation diet. It is all the time published that diabetics come to hospital too often. Why? Probably if diabetic will go home with Rx to insulin this diabetic will not be back in hospital  one week later. A few visits to ER and next appointment to the Morgue would be provided.

4.2.3 We suggest that patients treated with insulin before admission have their insulin dose modified according to clinical status as a way of reducing the risk for hypoglycemia and hyperglycemia.

     It is easy to recommend, but really how to modify? Do not try to find any  recommendations. This is why "individualization" is so important. Good cover to hide in safe place. Let someone take the risk to modify, and stay with recommendations. It is safe and honorable.

4.3.2 We suggest that prolonged use of sliding scale insulin (SSI) therapy be avoided as the sole method for glycemic control in hyperglycemic patients with history of diabetes during hospitalization.

      Why this method is not good? Because of in this case it is MD and hospital who will be blamed to low blood sugar. When diabetic use these recommendations at home, it is diabetic to be blamed  for wrong use of insulin. Smart, very smart.

 4.3.3 We recommend that scheduled sc insulin therapy consist of basal or intermediate-acting insulin given once or twice a day in combination with rapid- or short-acting insulin administered before meals in patients who are eating.

     Sorry, I did not get it. If I take 500 units daily dose of insulin then what dose of insulin would be injected at once? BTW, to take rapid acting insulin is very complicating. How combine two actions, insulin which will use all sugar I got from Starvation Diet, less then withing an hour, and  then basal insulin demand more insulin. There is no meal, no sugar in blood.
     This is why I do not go to hospital when sugar is too high or too low. They are easy to kill, no responsibility or any protection of diabetics in hospital, the same as everywhere. At home I can take chicken brow when I hungry, and survive. The matter of fact, to decrease diabetics population it is best way to admit diabetics type 2 in hospital as often as it is possible.

4.4.3 We recommend that patients and their family or caregivers receive both written and oral instructions regarding their glycemic management regimen at the time of hospital discharge. These instructions need to be clearly written in a manner that is understandable to the person who will administer these medications.

      What instructions they will give? That the cap on needle must be removed before injection of insulin will be given. What else they are able to recommend?  Is patient discharged from hospital with good blood sugar A1c? No. Is patient must take the same dose of insulin as it was used in hospital? No. How regime of glycemic control was determined? Which regime diabetic must use, this one which was in hospital, or another one, which is not known? Instructions, recommendations, and it is diabetic who must know how to control blood sugar, the action no one MD or Endocrine Society able to determine. After that they all pretend, we are, diabetics type 2, so stupid that we need instructions how many spoons of soup we have to take with every meal.

via Ravenvoron

ADA and ACP Docs Debate Diabetes Goals. March 30, 2019

My Theranos Story

I'm listening to the book "Bad Blood" by Carreyrou.  It is a fun read, and I think it is very valuable for me.  I'm a big cheerleader of Silicon Valley; a strong proponent of the risk-taking culture found here.  And I also follow a lot of medical research (obviously).  Therefore it is even more important for me to be reminded of the weaknesses both of Silicon Valley specifically and medical research in general.  This book is all about those weaknesses.

My Theranos Story

I'm on a mailing list of parents of kids who have type-1 diabetes.  It is a great resource, and I recommend everyone connected to type-1 diabetes join some sort of support and information sharing group.  In Dec 2013 there was a posting about a Silicon Valley blood testing start up called Theranos, that was going to make cheap, quick blood tests available which used only a few drops of blood.  Their first site was a Walgreens in Palo Alto.  They had a price list online (as I remember) and C-peptide tests were just a couple of bucks.  Less than the cost of a sandwich.  I had this idea to invite a bunch of parents and children from the email group to meet at the Walgreens one weekend morning.  We could all get tested, get the results, and maybe afterwards go out for ice cream later and talk about type-1 diabetes.  Since the parents would mostly have normal C-peptide numbers, and the kids (with type-1) would have nearly zero C-peptide numbers, it would immediately be obvious if the test worked or not.

However, based on many years of blogging about research, before I suggested this to the group, I figured I'd look up the research on their new testing machine.  So I did some of my standard queries on Pubmed (a US government database of publications), and scholar.google.com (Google's big research database), and clinicaltrials.gov (the FDA's clinical trials registry), and a few other places.  Nothing.  Not one paper.  I was really shocked.  Normally, you can't sell a treatment until it has gone through at least four human trials, so I was really surprised that I could find nothing for this new testing system.  (I did not know at the time that tests were regulated by a completely different US government agency, and in a completely different way, than treatments.)

Anyway, desperate for information, I looked online for the company's organization and basic balance sheet.  At that time, I had worked for Silicon Valley start ups for over 20 years, and I knew how to read a balance sheet, and how stock worked.  But there was none of that.  The only information that I found was Theranos's board of directors.  My years of working for start ups had given me experience with many different boards of directors, so I knew what to expect.  Or I thought I did.

The first name was George Schultz.  A guy famous for lying, and for being a Secretary of State (ie. foreign relations).  The next name I noticed was Henry Kissinger.  Another guy famous for lying, and foreign affairs.  [Note: I'm telling this story from my point of view.  I realize that other people may consider these two famous for other things.]  There was some long time senator (Sam Nunn, I think), and a big time general (Mattis?).  I was flabbergasted.  Why were these guys on the board of directors for a medical device company?  Where was the medical expertise?  Where were the expert venture capitalists (VCs) who funded medical devices?  Where were the people who had actually run a company before?  It was like a Saturday Night Live skit.

I thought about this for a while.  Should I judge a company based on its board of directors?  Maybe there was some reason all these guys were there.  Shouldn't I be deferential to all these famous, important people?  Maybe I could imagine some good reason for this.  But then I caught myself.  The only reason I was even looking at their board of directors was because there was no actual/published clinical trials showing the testing system worked.  There is no excuse for that.  If a treatment for type-1 diabetes had zero clinical trials, I would ignore it.  Well, I would wait until they started a clinical trial, and then evaluate it based on the results.  I should have the same standard for testing companies;  I would not evaluate their board of directors.

So I dropped the idea of getting a crew together to get tested by Theranos.  I decided to wait until they published results showing their tests worked.  They never did.  Years later Carreyrou published a series of newspaper articles describing what a fraudulent house of cards it was.

Learning From Theranos

After reading the book, and reflecting on my own experience with Theranos, a question popped into my head: why was it that in a couple of hours on a weekend morning, with no special insider data, and making a minor decision about how to spend a morning, I decided Theranos was not worth even a little time.  Compared to the venture capitalists (VCs) who spent weeks researching Theranos, could ask for insider information, had direct contact with the CEO/founder of the company, and were making million dollar decisions, and yet they decided Theranos was worth it.

Was I just lucky? Maybe.  But I do think I was helped by two things: (1) when I was making the decision, and (2) that I did not have direct contact with Theranos.

When Decisions Get Made
I had a big advantage over most of the investors, in that I was making my decision relatively late in the game, and therefore it was completely reasonable for me to expect public results.  When those were not available, I realized there was a problem.  Most of the investors made their decisions much earlier in the process, when less data was expected to be available.  Therefore, the lack of data did not make them suspicious.  How do we avoid that problem?   In two ways:

First, be willing to delay your judgement on new research.  The VCs wanted to invest early because they would make more money that way.  We need to invest early to nurture early stage research, but we don't need to decide that one particular line of research is going to be the cure.  That decision, the decision to emotionally commit to the research (to be a cheerleader), we can hold off on.  And we should.  If you think something might be the cure, you can always donate some money initially, but wait a few years, and check on their progress, to see if it really is the cure.  (Type 1 is forever, so waiting a few years is reasonable.)

Second, be willing to change your mind as the situation changes.  Most people have a hard time changing their minds, and this was on display during the whole Theranos saga.  Several VCs who had decided the company was going to revolutionize testing in 2006 still believed it in 2016, by which time they should have known better.  A good scientist changes their mind when new data is available, but that is the easier part.  The harder part is to change your mind when no new data is available, but forward progress should have resulted in new data, but hasn't.  The hard part is to realize when no new data is (in fact) bad data.

Answer The Right Question
The right question is: what is the data available that shows this is working (compared to the data that should be available).  The answer to that question was obvious when I did my web searches.  However, the questions that most of the investors were asking were different: Is what Elizabeth Holmes says is going to happen, really going to happen?  Is she going to revolutionize blood testing?  Is she telling the truth?  Those questions are much harder to answer, much more emotional, much more personal, than the question that I tried to answer.

Asking the right questions is harder than it sounds.  Humans have been making decisions about people and trustworthiness for over 100,000 years.  Our brains are hardwired to do that, because we lived and worked in small groups who knew each other well.  We worked with them every day and for our whole lives.  The scientific method has existed for only a few 100 years.  It is not the go-to method our brain naturally uses.  But the world has changed so that we are now making decisions about people who we fundamentally do not know, not in the way our brains evolved.

I do think that every one of us, when presented with new research, can ask the right question.  The moment we even start to think about "is this person right" or "are they trustworthy" or "are they going to change the world", to just immediately de-personalize the question: do they have the data that they should have at this point in the research?  Ignore excuses; ask about data.

Finally

These are a little off the beaten path, but well worth a read:
https://mondaynote.com/theranos-could-have-been-stopped-9670793e3431
https://www.stanforddaily.com/2019/01/15/theranos-whistleblowers-reflect-on-failure-of-the-silicon-valley-unicorn/
https://www.entrepreneur.com/article/311036
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3275363/
(On March 16 I asked for this paper to be retracted. We'll see how that goes.)

A reminder of how this fraud was presented in the news prior to the "Bad Blood" reporting:
https://www.wired.com/2014/02/elizabeth-holmes-theranos/
http://fortune.com/2014/06/12/theranos-blood-holmes/



Joshua Levy
https://ift.tt/29DuN3o 
publicjoshualevy at gmail dot com
All the views expressed here are those of Joshua Levy, and nothing here is official JDRF, JDCA, or Bigfoot Biomedical news, views, policies or opinions. In my day job, I work in software for Bigfoot Biomedical. My daughter has type-1 diabetes and participates in clinical trials, which might be discussed here. My blog contains a more complete non-conflict of interest statement. Thanks to everyone who helps with the blog.


via Cure Research

Semaglutide, SGLT-2 ,Body Weight, and Diabetes type 2. March 27, 2019

In the SUSTAIN 9 trial, type 2 diabetes patients with HbA1c levels of 7% to 10% despite being on an SGLT-2 inhibitor for at least 90 days were randomly assigned to semaglutide or placebo for 30 weeks. Most patients (71.5%) were also taking metformin, and 12.9% were on a sulfonylurea.


Semaglutide Plus SGLT-2 Inhibitor Reduces HbA1c, Body Weight
by By Reuters Staff
https://www.medscape.com/viewarticle/910618?nlid=129008_1521&src=WNL_mdplsfeat_190326_mscpedit_wir&uac=164666HZ&spon=17&impID=1919089&faf=1

What is "semaglutide"?
This is the medicine used to treat diabetes type 2 by forcing already impaired insulin secretion system to secret more insulin. If SGLP-2 such as Invocana taken orally daily, then  semaglutide is injectable and taken one times weekly. So, semaglutide is about the same, medicine which destroy natural insulin secretion. But naive diabetics do not know too much about medicine. They trust in MD, doctor. Big mistake. Doctor has different goal then diabetic patient. For diabetic most important is to survive and get as healthy as one can. For doctor the goal is to get as much from patient as MD can. So, what is good for MD is really too bad for diabetic patient.
     Trail:
diabetic patients with A1c from 7% to 10%,
medicine to control glucose level is:

•      SGLP-2,  very strong diuretic, to reduce weight it works for awhile, but then heart and kidney failure, death;
•     a sulfonylurea, medicine which effect insulin secreting beta cells to secret more insulin, even at the time when insulin is not in demand. With time beta cells wearied out, and SU no longer effective. The normal life duration on SU is less then 10 years after starting this medicine;
•    semaglutide, the same medicine as SU but taken in injections and only one time a week. It can work on another inhibitors then SU, still it is medicine which force to secret insulin and does not improve medical condition;  
•    metformin, medicine wich effect liver and muscles to demand more insulin, at the time when insulin secretion is limited.

       I did not look at the trial. No need for me. I am not diabetic educator, do not consider myself as one. I am just diabetic type 2. Will I take this medicine? Of cause not. I wish to live longer. And I do. I was diagnosed back in 2001. I took Metformin and SU, Glipizide. Less then 10 years and one after another MI, stroke, and how did I survive? Just pray in God. And use my own mind in stead of brain washing media and medical laundry machines. I switched to insulin in 2011. Now it is 2019. I am disable, but partially mobile and live in NYC in rented apartment on full support of my family, financial and physical. I use mobile wheelchair, thanks to my man working company.
      Why really diabetic will take this semaglutide? Because of right now many diabetics do know very well that oral medicine is not good for us, and we need insulin, injections. So, diabetics are fooled. Semaglutide taken in injections. Is this insulin? Not at all. Not even closer. This medicine increase insulin secretion by forcing insulin secreting system to secret more insulin, so, MD will fake diabetic type 2 that this is insulin, or it is the same as insulin.
       There is no such Rx to insulin. Every insulin has own name, so, it is very easy to fool everyone who is not very sure about medicine one take or need. In office MD Rx to me Atrovastatin. I said, I do not take this medicine, I take Lipitor. "It is the same," - doctor replied. "No. Atrovastatin is generic, and Lipitor is brand medicine. Generic of all kind does not work for me." I do know my medicine. I am not so easy to fool. But it took time, good reading, and a lot of money spent to books, text books, medical text books.
     Let us take a look at, would semaglutide lead to control blood sugar level? Show me how. We take one injection, about 1.0 mg of semaglutide in injection, and what next? This amount of medicine will work for the full week? Take a look at the beginning. Diabetics with A1c from 7% to 10%, and the treatment for them the same, 1mg of injected semaglutide for week? Good Lord!!!!!!! What will happened after week? Where medicine will go? But if this medicine is go somewhere after week then why this medicine is going to stay in system for week?
      It is clear for every one that all medicine come in dose, why? Because of if 1mg good for diabetics type 2 whose A1c=7% during full week, then for diabetic type 2 whose A1c=10% need more medicine, higher dose of medicine, or another medicine with different effect or concentration. To understand this simple logic no one need Medical Degree. But to fight MD medical degree is very effective. At least one will show, I am not full fool.

NEW YORK (Reuters Health) - Semaglutide is an effective add-on treatment for patients whose type 2 diabetes is not well controlled on sodium-glucose cotransporter-2 (SGLT-2) inhibitors, new research shows.

        SGLP-2 did not lead to glucose control, why? Before add-on another medicine take a look why this one did not work. If it is right medicine, then just increase dose of medicine to get better effect.  No one trail show that increased dose of SGLP-2 provide blood glucose control. Regardless how high dose of SGLP-2, the effect is the same. With time effect getting lower, and finally take opposite direction. All weight which was lost with SGLP-2 will return and no way to get it back.
      If SGLP-2 is not effective, then why another medicine must be add-on in stead of to take SGLP-2 off and replace it with a new medicine, more effective. Would Semaglutide do the job? No way for that. It is fixed amount of medicine injected once a week. The level of sugar in blood is different day from day, day from night, and many issue such as weather, rain, season, or flu or stress or .... you name it. Now, how Semaglutide suppose to control all that factors, with the same amount of active ingredients? Obviously, it is not possible.
     If  Semaglutideis good and effective then why take metformin and SU in addition to SGLP-2? Take a look at this medical list,
Semaglutide
metformin
SGLP-2
a sulfonylurea
all for just one goal, to control blood sugar number. No one of these named medicine control glucose level alone. No one of them can be increased in dose to increase the effect of medicine, and no one of these medicine act to improve other health problem but only symptom of diabetes, elevated level of sugar in blood, in urine, in bones, in .... . No one care. Only number on glucose meter is important. This number cannot be improved with wrong medicine. So, take one after another, taken all together, or taken separately, weekly or daily, they simple do not work, and diabetic type 2 getting from A1c=7% up to A1c=10% and above.

HbA1c was reduced by 1.42% and body weight by 3.81 kg, on average, with semaglutide compared with placebo.

HbA1c 10% - 1.42%- HbA1c=8.58%
Normal: HbA1c below 5.7%
How many different names of medicine must diabetic type 2 take to get control over glucose numbers? Of it is simple, just not possible with any oral medicine, but only with Insulin.
      It is interesting about weight loss. 8 pounds, it is all what diabetic will get with add-on medicine. But it is proudly pointed out, It Is weight Loss!
     
I do not trust in doctors. They are the same as every one else. For them patients are just business. They need us. and there is no way that they try to let us loose from the hook. This is why there are hundreds add-ons as tablets or injectables, but  there is no insulin, simple plane insulin, to let diabetic type 2 system rest and time for recovery, to full out insulin content in every diabetic type 2 cell, and let us live with light inconvenience of daily injections rather then blindness, amputations, CVD, to let us to die at home rather then in public facilities away  from public eyes.

via Ravenvoron

Dat by Day. March 25, 2019

Sugar is 74 mg/dl
 Dose of insulin Yesterday was 467 units for full day.
Looks like it is my normal dose of insulin for now. If I try to take lower dose of insulin sugar getting up. So I have to adapt to this dose, three shoots 169 units, or 147 units. One pen for in two shots.
      Headache, I feel it even in dream. I take more then usual Excedrin. If I avoid it, headache getting worse. Then it will be unbearable. I do not like to go to any hospital. What good in hospital for me? Nothing. I easy became guinea pig. Every one like study. How many of us like to be a subject to any studies? This is the question. In hospital no one every see me as I am human being. Doctors know best. So, I have medicine I am allergic for, and medicine which cannot be stopped, insulin, would be stopped at once. I posted what happened even when dose of insulin reduces, when I take 300 units in stead of 460 units. Sugar getting up. What will be good if insulin stopped completely? I can say, it is suicide by MD is I go to hospital.
        I stay home. I take Excedrin and take a seep as much as I can.
       I got a new Compression Pump System. It is costume to compress body to reduce edema. I cannot put it on by myself, but my man do the job and now I use it. I do not see reduction in weight or in edema so far. But it is just less then two weeks in use, so it is too early to say. We still wrap my legs. Left unwrapped they get swelled next day. I never see what will happen two or three days after legs stayed unwrapped, we do not take this rick. Warping is good, but too costly. Every roll cost about $3 to $4 and I need two of them for every wrap. Also We have to re-do wrapping every day. Swelling going down under wrap, and it is hurt. So, every day we re-do wrapping. I try to use one roll a few times. Still, it is costly.
     The Winter is finally over. Looks like worm days coming. Soon we will go to camp.  I booked all season, so from the may to September we will come-in and going out to Catskills and Adirondacks. I try to be ready for camping, but every move I take need energy, so most time I simple sit and watch video on my computer. There are many of them on Amazon Prime. This is how my day going on. Day after day. Bore. The same day over and over.

via Ravenvoron

The Endocrine Society doing Con Man job. March 24, 2019

The new study included 9,000 adults without a diabetes diagnosis. The participants got both an A1c test and an oral tolerance glucose test, and the researchers compared the results. The researchers found the A1c test didn't catch 73 percent of diabetes cases that were detected by the oral glucose test. "The A1c test said these people had normal glucose levels when they didn't," Chang Villacreses said.
 A1c test misses many cases of diabetes
by The Endocrine Society

https://www.sciencedaily.com/releases/2019/03/190323113744.htm?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+sciencedaily%2Fhealth_medicine%2Fdiabetes+%28Diabetes+News+--+ScienceDaily%29

So, first question, why those 9,000 adults were tested for diabetes?
         This is very important to understand, why those 9,000 were tested for diabetes? And why today millions of diabetics do not diagnosed with diabetes? Why today level of sugar is not vital? The answer is, why diabetes must be diagnosed in first place? There is no problem to Rx Healthy Life Style when anyone enter into any medical clinic, dental including.  There is no limits to Rx to healthy people Metformin, and make them diabetics type 2. Many other anti-diabetes types medicine may ne also Rx without any diagnose, Tromadol for instance. It is very well known what healthy BMI must be. Also there is no need to diagnose diabetes to know that elevated BMI level leads to development diabetes type 2. So why diabetes type 2 must be diagnosed in first place?
      To understand the problem better, it is must be known that diagnosed diabetic type 2 lives less then 10 years after being diagnosed with diabetes type 2. Not diagnosed diabetic type 2 will live X years till one would be diagnosed with type 2 diabetes + 10 years till treatment for diabetes type 2 finally will kill its victim.
      Now second, about test. A1c test show if sugar level elevated during three last month. It is average of blood sugar level during three last month. Some smart people take reading, and convert these reading into A1c in %. For instance, if sugar reading right now is 275 then it is A1c= 10%. It is not. The same way that if sugar reading right now is 118 mg/dl then A1c= 5.6%. It is not.
     So, before say that 73% of cases were detected wrongly, and A1c did not accurate to diagnose diabetes, it is better to say, how A1c level was detected? If it was taken by using the table that A1c %= mg/dl in average then it is just wrong test interpretation.
     Probably, I did not say it clear. A1c test must be taken in lab, and it is show the average level of sugar within three month. This average level of sugar cannot be counted with glucose meter readings. Glucose meter readings show only present time level of sugar. Never average of glucose level for any time. The same we can say about GTT. GTT show glucose reading at the precise time, in mg/dl. This test does not show what is average of sugar withing day, or week, or even an hour. There is no average reading with GTT. If we take reading 180 mg/dl, and then 30 min later another reading will be 280 mg/dl this does not mean that A1c was 10% compare with 7.5% previous reading 30 min early. Glucose readings are very different one from another. Even different fingers will give different results. But A1c still the same, even reading different one form another such as 120 mg/dl in the morning and 480 mg/dl in the eve after meal.
       There is no way that A1c can be less accurate then GTT, but more accurate. And the difference such as 73% show that The Endocrine Society doing Con Man job.

via Ravenvoron

Azithromycin Starts A Phase-II? Clinical Trial (AIDIT)

Azithromycin is an antibiotic which has been available since 1988, and is widely prescribed, with a good safety record.  Antibiotics are effective in curing bacterial diseases, but not viral diseases.  This trial is the first I've covered where an antibiotic was tested to treat, prevent, or cure type-1 diabetes, so it represents a new treatment path.

Why Azithromycin?

There are several different theories about what causes type-1 diabetes, one of which is that bacteria moving from the duodenum to the pancreatic duct causes type-1 diabetes.  The duodenum is the part of the small intestine closest to the stomach.  This is one of the "stomach flora" or "gut bacteria" theories which have been in the news recently.

If the cause is bad bacteria in the pancreatic duct, then (these researchers theorize), maybe the cure is to give the patient a dose of antibiotics to kill the bacteria, extra insulin to lower the stress on the remaining beta cells, and dietary guidance to prevent excess bacteria from moving from the duodenum to the pancreatic duct in the future.  All this would be done very quickly after diagnoses of type-1 diabetes.  That is the quick summary of the rationale behind this clinical trial.

This Clinical Trial

This trial is called the "Azithromycin Insulin Diet Intervention Trial in Type 1 Diabetes (AIDIT)" to include all three of the interventions being used.  This trial will enroll people between 6 and 16 years old, who have been diagnosed within the last 10 days, so only "just diagnosed" people can participate. 

The plan is to recruit 60 people, half of whom will get the treatment, and half will not.  The study is not blinded.  It started in Sept-2018 and they expect to finish in Dec-2021.

People will get three doses of Azithromycin per week, which is based on a protocol which has been used for years to treat people with cystic fibrosis.  On a monthly basis, they will be given extra insulin via an IV, which is designed to give beta cells a rest and help them regrow.  Finally, they will also be given dietary advice designed to have them drink less at meals, and eat meals more slowly, which is designed to prevent bacterial migration.

The study will run for a year, with C-peptide numbers being the primary end point.  There are a total of 21 different secondary end points, including time within BG range, A1c, several measures of diet, quality of life, etc.

They are recruiting at one site in Sweden:
The Queen Silvia Children's Hospital / Sahlgrenska University Hospital, Gothenburg, Sweden
Contact: Gun Forsander   
Contact: Olle Korsgren, MD, PhD +46176114187 olle.korsgren@igp.uu.se

Funding is from Barndiabetesfondens (Child Diabetes Foundation) in Sweden.

US Clincial Trial Record: https://clinicaltrials.gov/ct2/show/NCT03682640
EU Clinical Trial Record: https://www.clinicaltrialsregister.eu/ctr-search/trial/2018-002191-41/SE
Wikipedia: https://en.wikipedia.org/wiki/Azithromycin

Joshua Levy
https://ift.tt/29DuN3o
publicjoshualevy at gmail dot com
All the views expressed here are those of Joshua Levy, and nothing here is official JDRF, JDCA, or Bigfoot Biomedical news, views, policies or opinions. In my day job, I work in software for Bigfoot Biomedical. My daughter has type-1 diabetes and participates in clinical trials, which might be discussed here. My blog contains a more complete non-conflict of interest statement. Thanks to everyone who helps with the blog.


via Cure Research

What is Diabetes? Merck 1950. Part 2. March 22, 2019

The Merck Manual.
Eight Edition.
Published by Merck & CO,. Inc. Rahway , N.J., U.S.A. 1950

Diet was always the number one treatment option for diabetics, regarding of type of it.
There is diet :
To maintain ideal weight :
Calories
short body 1800 cal;
medium body 2400 cal;
tall body 3000 cal.
This is ideal numbers to maintain ideal weight. How accurate these numbers can be? "0" accuracy. In ideal weight there are only how tall or short one is. But every one do know very well, men and women are different in body constitution and shape of body. Also men and women do different job, and have different abilities to do the job. Women bend easily, man have straight force. Now the question, does men and women bodies require the same amount of meal and the same type of meal?  
     So, the idea about ideal weight maintenance  is ill presented in the beginning with.

"Patient taking a large amount of insulin frequently will be better controlled if the total daily food intake is divided into 4 to 6 feedings." (page 274)

       It is easy to recommend to take food into small portions. The real question is, how to find out what portion of food must be taken according to the dose of insulin?  As it is easy to see from recommendations, they are only for those who do not take insulin, do not have diabetes, ether type of it.  The recommendation take into consideration weight and the point of lose it, keep it, or gain it. According to the all that recommendations, blood sugar will be dropping. In case of diabetes most important question is, how many units inject every time? Try to find how restricted diet and meal consumption effect blood sugar numbers, and how according to the number on the glucose meter find out the dose of insulin injection. There are no such recommendations. Every one do know what diabetic have to eat or must do not eat. No one will say how find out what dose of insulin to inject every time every day. So simple. And no one recommendation. They simple forgot, they are talking about treatment of chronically ill people.

"The amount of insulin necessary to control diabetes varies greatly: usually it depends on the type and time of injections, the carbohydrates content of diet, high calorie, body mass, amount of exercise, the presence of acidosis, fever, infection, or severe trauma, and hypo- or hyperfunction of the thyroid, anterior pituitary, or adrenal cortex. Rarely, there may be insulin resistance, sometimes associated with the development of antibodies, which requires the administration of over 1,000 units daily." (page 275)

         As it is easy to see, calories intake is only one point to find out the dose of insulin injection. There are many other issue work to develop diabetes. Removal of adrenal glands, leads to diabetes development, so the fibrosis of adrenal  glands also lead to decreased insulin secretion. Most important in this statement the point regarding of insulin resistance. Resistance to insulin leads to need of administration high dose of insulin, as high as over 1,000 units daily. In present time all diabetics type 2, insulin resistant type of diabetes, denied insulin not only high dose, but any dose of it. Needless to say, treated with metformin and Glipizide, Invokana and Actos, diabetics type 2 leave less then 10 years after being diagnosed with diabetes. Amputation, COPD, MI, Stroke, you name it, diabetics type 2 do have it. In some point one of these conditions strike hard, and finally diabetic type 2 gone. The end of abuse, mocking, discrimination, and suffering. The end of pain and misery.

via Ravenvoron

Reverse diabetes type 2 Vs Reverse of damage Insulin secreting tissue. March 22, 2019

Sugar is 175 mg/dl, fasting.
It is too high. Last week, full week insulin dose was only 307 units, the amount of insulin in one pen. Sugar started to rise right after first day on decreased dose of insulin. Usually I take three pens withing two days. So, sugar was under control, as I hoped.  It is fife, and very often our plans cannot be followed. We had tickets to The Met. If I took shot before I go to opera sugar will drop low, and I would be in Metropolitan Opera House. Usually we do not go out in intermission. Our seats on the Family Circle. It is difficult for me to walk down and then up. When we returned home I took shot.
     Then there was use of Compression Pump System. I felt sick, and still sleep after system done the job. So, another day it was only two shots, 307 units, one pen. So, for every day dose of insulin was decreased there is some reason. After all reasons sugar in blood go up. Just one week, and sugar is out of control. Also I can say, it is not the case I did not take insulin, I did. Just in stead to inject 480 units I injected only 307 units. Sugar started to rise. This is the reason I do not go to ER or hospital for any reason. At first all the time when I am in hospital insulin treatment stopped, and replaced it with Metformin and diuretics. just one night in hospital rise my blood sugar level over 400 mg/dl. There is no one treatment will work if sugar is high. Then longer I would stay then more difficult for me to leave hospital alive. So, I try very hard do avoid any visits to the professional treatment.
    It is all the time presented that health plans resist to pay for insulin, and diabetics cannot afford to pay co-pays for insulin. It is presented that there is our choice of medicine, insulin or metformin.  It is even presented that diabetics so stupid, afraid to inject insulin because of it is injection and they afraid needles. There are a lot of lie about diabetics type 2. We live with it. No resistance, no fight.
       Now, let us take a look how dose of insulin determined by doctors.
Weight (lbs) / 4. So if my weight is 400 pounds then dose of insulin must be 100 units a day. As I just said, with 300 units my sugar is 175 mg/dl fasting. This is only one week of reduced dose of insulin. Would I be able to keep blood sugar under control with 100 units of insulin daily? No. It is also very often presented the sensitivity to insulin, how many units of insulin must one to inject according to the diet, X calorie consumption. With this accounting dose of insulin never will be correct. Why? We do not know how insulin used in our body system. Really, where insulin go when we inject 720 units? over 1000 units? 720 units was highest dose of insulin I injected. Then dose dropped and not it is about 500 units daily. Some day a little bit less, other day is a little bit higher.
      We do not know where injected insulin going and how it is used by our system. We do not know what are the limit in dose of insulin injection. All what we can do just going, and try to keep our numbers in healthy range. Regarding of what dose of insulin we need to inject, just do it.  Probably with time the nature of diabetes would be opened and diagnose of diabetes would be made not according to the level of sugar in blood but according to damage of beta cells and pancreas. Today all what is possible, just accept that diabetes has not types such as type 1 or type 2, but stages. Then less damage to insulin secreting tissue or organ then lower stage of diabetes, And highest stage is when damage no longer reversible. It is presented that diabetes type 2 can be reversed with diet, starvation. It is not. No one diet will reverse damage of beta cells and fibrosis of pancreas. Insulin can prevent that damage, and reverse it if stage of diabetes development is not fatal.

via Ravenvoron

Prenatal Metformin Exposure Linked to Adiposity, Obesity in Children

Prenatal Metformin Exposure Linked to Adiposity, Obesity in Children
By Anne Harding
https://www.medscape.com/viewarticle/908994?src=WNL_infoc_190322_MSCPEDIT_TEMP2&uac=164666HZ&impID=1913995&faf=1 

"This is the first follow-up study on children who were metformin-exposed in utero, compared to placebo. Our study indicates that metformin increases the risk of higher BMI, abdominal fat deposition and obesity in childhood. These findings might be markers of future increased risk of inferior cardio-metabolic health," Dr. Liv Guro Engen Hanem and Dr. Eszter Vanky of the Norwegian University of Science and Technology in Trondheim told Reuters Health in a joint email.

 How children were exposed to metfornin?

Metformin is increasingly being prescribed to pregnant women with PCOS, gestational diabetes and obesity, the two researchers and their colleagues note in The Lancet Child & Adolescent Health, online January 28. But evidence for the drug's efficacy and safety in pregnancy is lacking.

        The same as diagnose of Diabetes type 2 the treatment with metformin just  stick with diabetics, and more and more diabetics will pay ultimate price. Child which is still not born yet, already blamed that too much carbs or too little work out lead this victim of medical greed to diabetes type 2. Never mind that this child ever will have insulin in  injections. Metformin to reduce obesity which will be only medicine for corrupted medical care industry. Blood sugar will go up and up. Obesity will ride up. Loss of mobility, high mortality, high medical bills will always in need. In present time if left untreated diabetics type 2 live to up to 50 years. When treatment diabetes type 2 started, regardless of age diabetic type 2 gone less then within 10 years. Children will not survive 10 years.
       What is PCOS? It is fibrosis of ovarian, one or both. It is treatable. Not with Metformin but with surgery. All fibrosis can be cleaned up, ovarian will left free of fibrosis, and with proper treatment with low dose of insulin woman will recovery, get pregnant, and delivery healthy full term baby. At the same time with PCOS fibrosis probably attacked pancreas. The cause of fibrosis is still unknown. The  secretion of insulin getting more limited. The treatment with insulin injections at that time is not so expensive, and dose of insulin is not too high, less danger to drop blood sugar low.
      As we  see in article, there is no insulin as treatment option. Metformin, with all side effects of it. What good metformin can do? Nothing. It leads to CVD , deposit of it in blood vessels. That deposits diagnosed as cholesterol, and treatment with wrong medicine started. Statins such as Atrovastatin, simvastatin, provastatin, do nothing good, and level of cholesterol skyrocket. At the same time TG getting above the level of survival. My level of TG was above 1000. I stopped to take all statins, and now only Lipitor is in my medical box. Usually doctors try to push me to statins, generic version of Lipitor. "It is the same!" - doctors usually insist. It is not, and I do know it way too well.
      With lipitor my cholesterol level is good, TG is above normal, but it is reflection to  my heart condition.

"Metformin is now recommended in line with insulin as medical treatment of GDM in both Norwegian guidelines, the guidelines of the National Institute for Health and Care Excellence, and the American Society of Maternal-Fetal Medicine (SMFM), but not in the guidelines of the American Diabetes Association," Dr. Hanem and Dr. Vanky noted.

        It is very good combination, just add some poison into honey and high profit will follow. Before that children and pregnant women were treated with insulin. What are the evidence that lead to add metformin to insulin? Obesity? Well, simple look at  the modern human population show big difference  in size. We are taller then we used to be. Compare new born babies, how long they are? Take a look at the teens. They are very tall. Chinese youngest  no longer tiny and short. They are slim, and really very tall. Take a look at the Chinese on Flashing China Town in NYC. They are born in America. Other American young also tall. It is easy to see in Lincoln Center, how different new generation of patrons. Really, what ADA and all our medical care will suggest now? Would metformin make new generation shorter? At least if population must be the same as in 1850 then something must be done to keep shortness in check.

In the new study, the authors looked at body composition in 141 PregMet study offspring when they were 5 to 10 years old. Twelve (17%) of the metformin-exposed children were obese, compared to one (1%) of the non-exposed children.

      As I published many times, stop to kill and start to heal. Diabetes cannot be treated as behavior misconduct and wrong life style.  Diabetes is medical condition. Treated with insulin diabetics live almost normal life. With time less diabetic will be born, and less diabetics will die. Well being of all humanity is on the stake  when diabetes treated right or wrong.

They concluded, "Randomized controlled studies are necessary for clinical evidence and good patient care. We, doctors and other caregivers have to continue performing them, even if they are laborious, challenging and expensive."

     Of cause  more studies needed. Also a new studies all the time show the same result as old studies? They show what studiers were paid for. 

via Ravenvoron

Lower-Extremity Amputations in Diabetes Are Back on the Rise, but Why?

Commentary:
Medical Student:

As you know, SGLT2i’s improve cardiovascular outcomes and provide the benefit of weight loss (as well as potential benefits for HF) and are generally a well tolerated class overall. I would hope that doctors would inform their patient of the small and controversial risk of amputation from starting a SGLT2i and it is excessively inflammatory to say that an informed patient should sue their doctor for prescribing it. Of course medications have side effects, but is it likely to benefit the patient overall is the main question.

        Probably author know benefits of SGLT2i's for CVD, I do not see any of them for me. It is very strong diuretic, and diuretics are danger for diabetics type 2.  They lead to MI, stroke, and severe increase of sugar in blood. At first any diuretic leads to decrease weight, but then this effect reversed, and replaced by severe water retention, Edema. No treatment at all. On one hand diabetic cannot take diuretic due to heart failure. On the other hand, severe edema effect lungs, and increase severity of COPD, every one diabetic type 2 do have diagnosed or not.
      Severe edema lead to lost circulation, and as a result, to inflammation and amputation. No effective treatment for this condition. At first rise of sugar in blood must be stopped, but only effective medicine is not in diabetic type 2 medical box. Diabetes type 2 is non insulin dependent diabetes mellitus, so no insulin needed. At first there are small amputations, then full leg would be removed, above knee. I would not say it is small amputation. After first leg removed the second will be taken off. Really, diabetic type 2 beg God for Mercy.
     The amputations can be prevented with proper and timely diabetes type 2 treatment. It is insulin, and insulin only. In stead, there are all junk in diabetic's type 2 medical box, but no insulin. BTW, insulin does not have side effect, only low sugar, the effectiveness of therapy.

My main concern is medical-legal fear of surgery by surgeons who are capable of these procedures. I did these procedures routinely with uniformly good results. If a DPM/DO/MD surgeon is in a position to offer these procedures to their diabetic patients, but fear them for medical legal reasons, they should REFER the patient to a large medical center with the resources to back courageous surgeons who are willing to offer diabetic patients the surgery they need.

There is the problem with surgery.  After one part of body was removed, the cause of problem why this must be done left un- addressed, and so soon after another surgery will be needed. This is difference between wounded military who undergo amputations and diabetics type 2. Surgery caused by trauma is final, and patient recovery. Diabetic will not recovery because of surgery did not remove cause of complication. Diabetic's body slow rotten, regardless of amount of carbs of fat or calories diabetic type 2 eat. Check up level of sugar in diabetics type 2 who need surgery, small one or big one. Sugar is high. With surgery it is going higher. Next surgery will be needed sooner.
    I was able to stop this process. My man wrap my legs every day. Now there is no opened wounds. But the color of skin still dark. If legs are not wrapped for some time the inflammation stated deeper onside, pain, deep inside, and soon after wounds are opened.  This was condition I was discharged from hospital. There was only the matter of time when I would be amputated. Now my legs are both dry and no wounds at all. 450 units of Lantus Solo Start daily done good job.

Why is a diabetes patient noncompliant or why is opiate addiction and obesity growing? Are those who suffer just lesser humans who are lazy or careless, or might there be genuine reasons why it's more difficult for some people. Sometimes it's obvious, such as one who simply can't pay for their meds if they wish to eat and pay for housing. Lack of funds affects many aspects of people's lives and care. There are also other factors such as lack of a support network that make everything in life more difficult. More compliant patients often have adequate, or better finances and good social and family support.  

At first, why obesity growing?  Take insulin in stead of Glipizide and Metformin, and there would not be diabetic type 2 obesity. But who will be in medical clinics? That's right. Too little patients will have diabetic complications, and will be needed surgery and home care. Diabetes type 2 is not metabolic disorder. In is social issue. Wrong medicine the same as right medicine can do fantastic job, but in opposite directions. With diabetes type 2 which effect millions medical clinics never will be empty. Insulin will take profit from MD and all medical industry.  This is why insulin is not in medical box of diabetics.
       Do not say it is too expensive and diabetics cannot pay for this medicine. Many do have health plan which will pay for insulin. The problem is, insulin is Rx medicine, and only MD can give that Rx.  As usual, there are a lot of those to whom to blame. Diabetics type 2 are careless and lazy, insulin is expensive, doctors do not have time, too little of diabetics educators, and so so so on.  But only one stone, right classification of diabetes that it is chronicle disease which is resulted by unknown cause of insulin producing beta cells, and this disease can be effectively treated with right insulin daily dose.

bad control of diabetes is the main cause of need to do below knee amputation,if a doc examines suck case every-time he evaluates the pt and adjusts drugs it may reduce the amputation.with teleygliptin or sitagliptin oral dosage,the resistance to inj insulin may not matter;in older cases,hypoglycemia causes more damage to cvsone must always avoid hyperglycemia,acidosis and neuropathy.

Very interesting post. It is doctor. Can I trust in this doctor? Does this doctor know what he is posting? I am very doubt it. Well, I am ESL, and I did not study in college for so long as MD suppose to do. But the post?! If it possible to understand it? I am sure author has no one idea in brain.
 They Are Our Educators!!!!!!!!!!!!!!!!!
If someone expect to have better future for diabetics type 2 and for all our human population, then I am not. What I do very hope that AI will successfully replace idiots like this one, and finally this nightmare with diabetes type 2 would be over. 

 Lower-Extremity Amputations in Diabetes Are Back on the Rise, but Why?
by Gregory A. Nichols, PhD
March 14, 2019

https://www.medscape.com/viewarticle/910139?nlid=128730_1521&src=WNL_mdplsfeat_190319_mscpedit_wir&uac=164666HZ&spon=17&impID=1912505&faf=1  

via Ravenvoron

What is Diabetes? Merck 1950. Part 1. March 21, 2019

Diabetes is a chronic disorder of carbohydrate metabolism due to inadequate production or utilization of insulin and characterized by hyperglycemia, glycosuria, polydigia, pruritus, weaknesses, and loss of weight.
The Merck Manual.
Eight Edition.
Published by Merck & CO,. Inc. Rahway , N.J., U.S.A. 1950

     This definition of diabetes was published in 1950 by The Merck and CO. After insulin discovery and before 1980 when WHO published recommendations to define diabetes and how to treat it, there were studies. Many studies. In every one study or treatment recommendations  insulin was present as first lime medicine after diet and exercise. In 1980 WHO published recommendation to a new classification of diabetes, I rather say, diabetics. In present time it took me a lot of time and money spent to finally find out how diagnose diabetes type 2 took off.  Before 1980 diabetes type 2 was not in diagnose, and it was not so popular. More then that, children as little as 9 years old were treated with SU. Today this therapy only for adults type 2 diabetics, never for type 1 diabetics. I wonder, if child diagnosed with type 2 diabetes, would this child treated with SU, glipizide? Most important, for how long this child would need medicine?
       Level of sugar was diagnostic criteria as in 1950, the same right now, in 2019. Still, the numbers of normal or abnormal reading changing with time.  Why? If one is ill then mark of diagnostic is different from marks of healthy individual. Abnormal marks must be elevated or less then those who are healthy.
  Hyperglycimia 160/180 mg/dl.
In present time it is 200 mg/dl random readings.
     Glucosuria is the excretion of glucose into urine.
In present time this rarely checked because of level of sugar in blood is more accurate, and diagnostic can be done early then with test of urine. Glycosuria may be caused by high level of sugar in blood, or excessive loss of water into urine, ostomac diuresis.
       In healthy way there are mechanism that prevent glucose from sleeping into urine by re-absorption sugar from urine and sent it back into blood stream. In present time there is medicine to brake this healthy way and prevent re-absortion of sugar by kidney, medicine such as Invokana and its-like. Involana works as very strong diuretic. Invokana lead to weight loss, so it is widely welcome as medicine. But the price is too high. Not price in $$$$ but price in damage Invokana bring to those who take it, to diabetics type 2.
   Polydipsia Is excessive thirst of excess drinking of water. So, in one hand body try to get rid of water. On another hand, water must be replaced as soon as it was discharged. The effect which can be very good to clean system and get rid of wastes. This cannot work forever. With time kidney fail and water stay in body of diabetic, between cells. The condition known as Edema, Water Retention. Highly increased weight, and size of body. No one diet or calorie counting will bring weight down. Only in final stage of this condition  water going down, sugar in blood getting severely up, heart failure or Pulmonary Embolism, or many other names of such condition end suffering and life.
       Pruritis is dry skin or itching. Skin get red, rough, leathery or scaly, bumpy, creaked, and often infected. Carbuncles, other skin infections, eye infections including, very often accompany diabetics.
    
      What caused diabetes? This question is still open, even after insulin discovery so long time ago.
Before 1980 there were many studies. In present time all studies replaced by Cook Bock Recipes. Modern Medicine has nothing to suggest, but only  Healthy Life Style. Is this humor? Not at all. When patient come to doctor and his or her level of sugar elevated, what treatment MD suggest? Healthy life style. This is treatment, recommendations, advice, anything one wish to name. What is not in any Cook Book Studies or Cook Book Medicine, is benefits for patient, relieve, or cure. Nothing. In modern time Medical Care better to be named MC, Money Collectors. Regardless how many clinics, or how often diabetic type 2 come to visit, the result of any visit, and all of them together is recommendation: Healthy Life Style. The problem is only one, how to be healthy if one is ill?
      Cause of diabetes:
Damage of insulin producing cells.
When this damage started? Does it started because of too much calorie consumption? If so then why it is caused diabetes? Damage causing must be treated long before blood sugar started to take off. But it is not. Diabetes diagnose based on level of sugar in blood, and the process of damage of insulin secreted cells already in full bloom.
Prolonged, continues high blood sugar  produce permanent damage.
      So, it is already  process which leads to diabetes started long before  diabetes will be diagnosed. At first Beta Cells damaged by unknown cause, and then because of damage insulin secreting cells blood sugar rising, leading to development of diabetes. How diet can help to fix damage of Beta Cells? The cause of this damage is unknown. The treatment is universal: Starvation.
Increasing insulin requirement.
This may cause of diabetes. So, increased need in energy which is obvious during exercise, does not lead to reverse of diabetes, but leads to right opposite result, increased beta cells damage and decreased insulin secretion.
    No one of these cause of diabetes prove that high carb or calorie consumption leads to development of diabetes. No one. To say that any meal consumption leads to increased damage on insulin secreting beta cells at first must be presented evidence of such effect. There is no one evidence to blame diabetics that diabetics type 2  developed diabetes by high consumption fat or carbs or proteins, or calories.  No prove for that so far.
The pituitary gland, adrenal glands. 
In experimental animals pancreas was removed, and diabetes was developed right away, with fatal result withing two weeks. But it is not only pancreas removal leads to diabetes development. Removal of pituitary gland (the pituitary controls the function of most other endocrine glands and is therefore sometimes called the master gland) give the same result, diabetes. Removal of both adrenal glands, also responsible for hormone secretion, and healthy metabolism, leads to diabetes development.
Heredity play significant role in diabetes. But if so then even diabetes happen as a result of heavy calorie consumption by grandmother, it does not mean that granddaughter must be blamed in diabetes development.  Any victim of diabetes must be treated with respect and right medicine, without discrimination and abuse. The treatment with insulin is costly, but most effective. It works for everyone with elevated blood sugar as in first stage of diabetes development such in last stage of it, for little one and for old one.
Infections.
It is difficult to say, does infection caused diabetes or diabetes caused infection? Both way the result is the same, increased demand in insulin to fight this infection. This is why it is important that level of sugar in blood be Vital, as it is Temperature of body and blood pressure. Regardless of cause if level of sugar elevated in blood, insulin therapy must be started.  Insulin can be injected even when there is no increased blood sugar, just to stimulate recovery. Dose of insulin less then 10 units is effective and safe for any non diabetic patient.

via Ravenvoron

The Carbs Are In The Details: Slider Specifics

Not a picture of my sliders - but very similar!
The image is from the interwebz~ 

Recently, I went out for much needed Happy Hour with a friend. Cheeseburger sliders were on the menu, I was craving red meat, and I had a few questions for the Server before "officially" placing my order.

1. Were the cheeseburger sliders meaty as opposed to being more bun than meat, or did the meat/bread ratio meet somewhere in the middle? 

2. What was the deal re: the buns? Were they more of a brioche, did they boarder on a potato roll, or were we talking your basic hamburger bun, but shrunk down to slider proportions? 

The waitress was patient and answered my questions with a smile - which the former Server in me greatly appreciated - because I knew my questions were on the finicky side.

She told my that the the sliders meat to bread ratio met almost met in the middle  - with slightly more meat than bun -  and that said slider buns had a brioche feel and texture to them. 

I thanked her, placed my order - 3 cheeseburger sliders, medium, and a glass of the 

House Red. My friend immediately ordered the same and our waitress went off to place our order and retrieve our drinks from the bar.

When the waitress was out of earshot my friend looked at me and said: You asked some detailed questions for a few cheeseburger sliders! 

I grabbed my Omnipod PDM out of my handbag to pre-bolus for my sliders (because buns,) and said with a smile: I’m not picky - at least I don't mean to be. I just needed to know some slider specifics so I can take my insulin accordingly. 

Short Answer: I needed more info so I asked.  

Friend: Ohmygod, that’s right - you did need more info - I’m so sorry, Kel - I completely forgot! 

I told her it was OK - that my diabetes didn’t need a special spotlight, and that much like the devil, the carbs are in the details.  

Then we laughed out loud and started talking about 50 other things - none of them having to do with diabetes. 

FTR: The sliders were delicious; the House Red was damn tasty, my bolus wasn't quote on point, but I figured it out. And most importantly, a wonderful time was had by all! 

via Diabetesaliciousness

Diet in Diabetes type 2 treatement. March 19, 2019

One of the earliest decisions the physician must make is whether diet alone will suffice or whether insulin is needed in addition. Often the obese elderly patients, after weight reduction, can get along with dietary supervision alone. Generally , the younger patients and older ones with acute diabetes require insulin also. (page 273)
The Merck Manual.
Eight Edition.
Published by Merck & CO,. Inc. Rahway , N.J., U.S.A. 1950

       Now let us see, how does it work. If it work at all. Diet alone probably will suffice  to control diabetes, how? Take a look at any diet, what is important in diet? Amount of calories, fat, carbs, proteins. The same amount day after day. Not take another look. Look at the glucose numbers on glucose meter. Are that numbers the same day after day? No. Numbers are all the time different, and one day is different then another. Also take a look at the activity, or daily life. Are one day is the same as another? Not at all. Every one do know that. So, the amount energy we need to go trough daily life is different. And no question, one day we need more food then another day.
       How diet, day after day the same amount of carbs, proteins, and fats can suffice patient's needs and control blood sugar? It never worked. It never will.
      There is another look  at the blood sugar control and diabetes therapy. Physician make decision once and diagnose diabetic as insulin needed or not insulin needed diabetic. This is earliest diagnose, and ... this diagnose stay with diabetic forever. How this diagnose can be so right? Diagnose like that can work only is disease is not chronicle. For instance, flu. Short time and patient recovery. Then patient do not have inflammation or infection, or virus. Diabetes is not the same as flu. It is progressive. With time diabetes getting worse, and many complications will be developed. But the treatment for diabetes still the same, diet alone. Does diet treatment for diabetes? Not at all. No one restrictions in diet will bring glucose level down.
      The most important point is that once diagnose of diabetes was given by MD, it stick with patient, and now diabetic treated with all types of junk medicine but not with insulin. Diabetic is non insulin dependent, according to diagnose, regardless when it was given and based on what condition diabetic in. Because of acute diabetes cannot be treated with diet, diabetic in hospital treated with insulin. as soon as numbers going down and patient discharged from hospital, insulin therapy stopped, and diet only treatment diabetic will have to reduce numbers. There are many other medicine developed for non insulin dependent diabetics. All these medicine works perfectly, and this is why diabetics type 2 gone less then withing 10 years after being diagnosed as non insulin dependent diabetics.

via Ravenvoron

Tramadol Linked to Higher Mortality in Osteoarthritis. March 18, 2019

Tramadol (multiple brands) was associated with significantly higher all-cause mortality compared with nonsteroidal anti-inflammatory drugs (NSAIDs) among older patients with osteoarthritis (OA) in an observational study of more than 88,000 patients. The mortality risk with tramadol was similar to that associated with codeine.

Tramadol Linked to Higher Mortality in Osteoarthritis 
by  Janis C. Kelly.
https://www.medscape.com/viewarticle/910232?nlid=128661_381&src=WNL_mdplsnews_190315_mscpedit_wir&uac=164666HZ&spon=17&impID=1909067&faf=1

          So, what is "Tramadol" and for what condition it is prescribed? It is pain relive medicine. But in modern medicine there are a lot of attempt to put patient to weight reducing medicine. Diuretics is one of that kind. Tramadol is another. Tramadol was approved by FDA to treat patient who wish to lose weight. It is widely used by neurologist and by prime doctor to obese patient.  Diabetics type 2 usually obese, the edema all the time accompany diabetics with CVD and diabetics type 2 all do have it as a complication of wrongly treated or not treated diabetes. There is no diabetic without pain. Usually we do have headaches. Osteoarthritis is usually accompany diabetic type 2.
      When I started to take Tromadol I did not know about opiates. I simple followed to doctor's order. As soon as I took Tromadol the severe headache put me in bed. Nausea and vomiting followed. I hardly was able to breath. I do have COPD and Asthma. Cough is one condition I am in all the time. With Tramadol all get so bad, I did not know if I will be alive next morning.
      Then I called to doctor. What doctor said? He does not have any medicine for me. He tried all what he could. All medicine was to treat pain. No medicine to address to the cause of pain. Needless to say, medicine will never work, and pain will go nowhere.
      I do understand when people take this medicine because of they need it. To live with pain is misery. We are all the same, we will do all what is possible to get rid of pain. So, what is important part in treatment patient who is in pain? To set patient on the hook. Just go to Neurology clinic early in the morning. There are many people who sit in lobby awaiting doctor to come. Then one after another they go into doctor's office, and soon they leave. Now it is time to pay attention to the new comers, patients with moderate pain. It is time to re-stock medically dependent patients. We all get Rx to pain medicine, and it is opiates, highly addictive type of medicine. With time it will be no way to separate when pain is result of medical condition, and when pain is medically induced by doctor.
      First what doctor said to me when I come into his clinic:"No More Excedrin!" And it is Excedrin which keep me functional and alive more then 25 years by now. I am very sensitive to medicine, to food, to water. I will not be able to take medicine which bring harm to me. With time I accepted this lesson, and now I do not take any medicine which give me pain or any other side effects.

"Among patients aged 50 years and older with osteoarthritis, initial prescription of tramadol was associated with a significantly higher rate of mortality over 1 year of follow-up compared with commonly prescribed nonsteroidal anti-inflammatory drugs, but not compared with codeine," the authors write. "However, these findings may be susceptible to confounding by indication, and further research is needed to determine if this association is causal."

Just one year, and patient gone. Less then 10 years after being diagnosed with diabetes type 2 diabetic type 2 die, due to diabetes but more often due to all cause mortality. As I do remember doctor did not take a look at why do I have pain. He ordered some tests, and he said that all is well. No one test results was in my hands, why? Patient in condition of having stroke cannot be treated without medicine. But it is not what doctor needs.  Doctor Rx all medicine which is profitable to him or to his business. I got Rx to Botox. He said, it will help me to be headache-free. I had good Health Care Company. They paid all what doctor Rx. There were no pain relieve for me. When I come to office next time doctor said, he already sold the rest of Botox. A little bit for patient, more to the doctor's benefits.

 The authors explain, "participants in the tramadol cohort, in general, were older; had a higher BMI [body mass index]; had a longer duration of osteoarthritis; and had a higher prevalence of comorbidities (eg, peptic ulcer, chronic kidney disease, diabetes, hypertension, and cardiovascular diseases), other prescriptions (eg, other NSAIDs, other opioids, aspirin, statin, antihypertensive medicine, and antidiabetic medicine), and health care utilization than participants in the NSAIDs cohorts before propensity score matching. After matching, the characteristics between the 2 matched cohorts were well balanced, with all standardized differences less than 0.10."

Every diabetic type 2 has:
hypertention;
CVD;
CKD.
Every diabetic type 2 take statin, which never work, but Lipitor is too expensive, it is Brand medicine, not generic. It is working well but never in diabetic type 2 medical box.  
There are a lot of medicine to reduce hypertension. What type of this medicine is right for particular patient? What dose to use? No clue usually. There is some medicine in medical box to deal with high blood pressure, but this medicine does not work because of too low dose, or wrong type of medicine. 
Finally it is antidiabetic medicine. The name of medicine is perfectly answer to the goal of medical care. It is medicine do not help to live but to reduce diabetic type 2 population. It is
antidiabetic medicine! So,why do not add one more to get best result? Tromadol is perfect medicine to Medical Care goal. And very profitable for provider. If in stead of Life style modifications diabetic will use Lantus Solo Star then less painkillers will be needed. Less all cause mortality will be. It is not the goal. No one need old weak population. Every one need strong healthy well looking young. So, caravans of immigrants enter into US. Our time is up. This is why Tromadol approved by FDA as weight loss medicne for obese population. Tromadol will work much better then Metformin or Glipizide. Its effect work withing one year, compare with antidiabetic medicine which need to be taken at least 10 years. For that time diabetic type 2 get educated, stop to take trash medicine, and switch to insulin. Life going on. 

The study cohorts included 44,451 patients in the tramadol group, 2397 in the naproxen group, 5674 in the celecoxib group, 2946 in the etoricoxib group, and 16922 in the codeine group. The mean age of the patients was 70 years, and 61.2% were women.
All-cause mortality was determined for tramadol in comparison with each of the other drugs in matched cohorts during the 1-year follow-up. All-cause mortality per 1000 person-years was 23.5 vs 13.8 for tramadol vs naproxen (hazard ratio [HR], 1.71; 95% confidence interval [CI], 1.41 – 2.07); 36.2 vs 19.2 for tramadol vs diclofenac (HR 1.88; 95% CI, 1.51 – 2.35), 31.2 vs 18.4 for tramadol vs celecoxib (HR, 1.70; 95% CI, 1.33 – 2.17), 25.7 vs 12.8 for tramadol vs etoricoxib (HR, 2.04; 95% CI, 1.37 – 3.03), and 32.2 vs 34.6 for tramadol vs codeine (HR, 0.96; 0.83 – 1.05).

One comment: "Studies consistently show that alternating OTC doses of acetaminophen and NSAIDs provides superior pain relief with fewer side effects than opioids. However, that is more complicated and requires patient education, and most prescribers are unwilling or unable to take that additional 2 minutes with a patient." 
         For the same reason there is no time doctor has to listen to the patient and Rx insulin. No, to Rx life style modification is better, never any responsibility, and no wrong treatment. Who can say that live healthy life style is wrong? No one. It is right all the time. Just come to patient bed, and say, Live Healthy!!!!!!!!!!!!  If patient does not go out of bed, this mean, he/she does not want to live healthy, and it is patient's choice to be ill. Brilliant! We even do not need trash medicine. Just live as doctor ordered.

via Ravenvoron

Dr. Oz and his Pussy Hats. March 16,2019

         Dr. Oz in video in interview with Oprah  speak about diabetes. He present that it is sugar consumption to blame why diabetes type 2 today one of the leading causes of Death. Why it is simple sugar to blame? Because of Sugar Industry does not pay to Dr. Oz. As soon as Domino or other sugar purifying manufacture will give $$$$$ .... $$$$ to American Medical Corps sugar would not be danger anymore, and Dr.Oz and Oprah will discuss how actually purified sugar beneficial to humanity.  Simple, we eat what we pay for.
      Does Dr. Oz know what is diabetes? Of cause he does. Diabetes is money making industry. Talk about diabetes and MD never will be out of business. This is why every one MD teach Americans what to eat and how to cook. Take a look at any medical journal. In every issue there are Cook Book Medicine dominate how to treat and prevent all medical conditions. Sorry, does anyone developed what meal to eat before sex to prevent pregnancy? I am not very good in reading. Doctors "beg" Americans to give up these foods and that meals, and so so on. Now there is the question, if Americans stop to eat what MD recommended what would be the next step?
      The next step would be another studies and these studies would show how the food Americans stopped to eat to prevent diabetes is beneficial to prevent diabetes. This is the logic of medical care. Regardless what is on table, just follow MD orders, stop to eat.
     Why Dr. Oz is so popular and so powerful that even President Trump was on his show? It is perfect brain washing show. The same population march on NY streets every January since President Trump was elected in protest. What they are protesting? Is this really matter? They just love Pussy Hats colors. And they like how Pussy Hats looks on TV.
       There are too many of them They are not only barking, they are bite, and very painfully.
      Now let us take a look at the people on the streets. I go to The Metropolitan Opera house for many years. When we just started to subscribe for Opera there were no people like myself today,  obese, and in wheelchairs. Now there are we are. The seats in Metropolitan Opera house are too narrow for us. Often we cannot place ourselves inside the seat. Obesity? Yes. But not only. It is how tall population getting. This fact is usually skip attention of Pussy Hat Barking society. People getting higher. And as a result, there are no spot for legs between seat and next row. What American Barking Society would bark about now when population getting too tall? To blame tallness why diabetes type 2 developed?
      Really? Of cause it is easy to blame victim then treat patients. That is why Dr. Oz no longer practice in surgery but preaching every one how important prevent diabetes type 2 by stop eating and start to buy his Diabetes Destroying System.  Every one see how obesity spread in America. No one see, how many those who survived stroke and heart attack still going into Metropolitan Opera house, and keep subscriptions for next many incoming years.
      LOL! The Met is getting more and more popular. In next season The Met open doors on Sundays. Why? It is too high demand for tickets. Recently we went to listen Wagner, first opera of The Ring. There were no seats on Family Circle, on balcony, and just a few in Dress Circle. I did not look at the other levels. The House was full. Opera was Great!!!!!!!!!!!! Now I try to get tickets to the third and four operas, and what? Not less then $200 for seat. I think, this is the reason that obesity presented  as a shame for people. We have to give up our seats! We are not going to do so.
      I am sure The Met will find the way to solve any problems. This is difference between Opera Providers and Medical Providers. Dr. Oz and he-like create problems to get more business. Opera Providers work out to increase service and its quality to meet high Demands. Pussy Hats are not welcome in House. Their place on the streets. There they belong.

via Ravenvoron