John Hawks Says Humans Haven’t Stopped Evolving 

Posted on August 3, 2016 | Comments Off on John Hawks Says Humans Haven’t Stopped Evolving 

Writing at TheScientist:

“Skin color is a classic example. One of the largest and most obvious physiological differences between populations, skin color is influenced by more than two dozen genes in a pathway that produces the pigment melanin and regulates the amount of this pigment in different tissues. Changes to these genes interrupt the generation of the dark pigment eumelanin, leaving skin with larger amounts of the reddish pigment pheomelanin, leading to various skin tones and patterns of coloration, such as freckles. Despite its complex genetics, skin color shows consistent patterns of evolution across the globe. People whose ancestors lived in the tropics tend to be dark-skinned, while those who lived further north and south tend to be lighter. One of the revelations of the last 15 years is just how recent this pattern really is. According to analyses of ancient DNA, people who lived in northern Europe only 10,000 years ago would not have had the extremely light skin of today’s people in that region.”

Source: Humans Never Stopped Evolving | The Scientist Magazine®

Hawks also discusses lactase persistence, eye color, blood types, and malaria resistance.

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Posted in Evolution

Drugs for Diabetes: Insulin Degludec (Tresiba) – A New Long-Acting Insulin

Posted on August 1, 2016 | Comments Off on Drugs for Diabetes: Insulin Degludec (Tresiba) – A New Long-Acting Insulin

Tresiba joins other long-acting insulins like insulin glargine (Lantus), insulin detemir (Levemir), and good ol’ NPH insulin. While FDA-approved in the U.S. only this year, it’s been used in other countries for some time. Insulin degludec will have different names depending on the country.

Who Is It For?

  • Adults with type 1 and 2 diabetes
  • Not for diabetic ketoacidosis
  • We have no good data on use in children (under 18), pregnant women, and nursing mothers

How Long Does It Work?

It will last for at least 30 hours in most users. After that, effectiveness starts to taper off but some effect may be seen as long as 42 hours after the injection.

What Is Its Role In Treating Diabetes?

Insulin degludec is a basal insulin, meaning that it runs in the background continuously. It’s not designed to reduce blood sugar that rises after a meal. If your pancreas still makes insulin, release of that insulin may reduce after-meal glucose levels adequately. Otherwise, after-meal glucose elevations are addressed with bolus insulin injections. Bolus-type insulins are the rapid-acting ones like Humalog and Novolog.

Most NPH insulin users, and some insulin glargine (Lantus) users, need the injection twice daily. Because of its long duration of action, Triseba users should never need more than one injection daily. I don’t have much experience with Levemir because the hospital where I work doesn’t stock it.

Triseba users should take it at about the same time daily. If you miss that time by up to five or six hours either way, it probably won’t matter.

What’s the Dose?

For type 2 diabetics who have never used insulin, the starting dose is typically 10 units/day.

For type 1’s switching from other insulins, the usual starting dose is one-third to one-half of the total daily insulin dose, plus rapid-acting bolus insulin around meal times for the remainder.

Change the dose no more often than every three or four days.

How Much Does It Cost?

I don’t know. Likely more than some of the other basal insulins.

Steve Parker, M.D.

PS: Click here for full prescribing information.

PPS: If glargine, degludec, and detemir sound like Greek to you, you’ll appreciate my book.

No degludec up in here!

No degludec up in here!

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Is Alzheimer’s Disease Caused By Type 2 Diabetes?

Posted on July 31, 2016 | Comments Off on Is Alzheimer’s Disease Caused By Type 2 Diabetes?
dementia, memory loss, Mediterranean diet, low-carb diet, glycemic index, dementia memory loss

“More basic research is critical.”

Several scientific studies, but not all, link type 2 diabetes with Alzheimer’s disease. Some go so far as to say Alzheimer’s is type 3 diabetes.

My Twitter feed brought to my attention a scientific article I thought would clarify the relationships between diabetes, carbohydrate consumption, and Alzheimer’s dementia (full text).

It didn’t.

Click the full text link to read all about insulin, amylin, insulin degrading enzyme, amyloid–β, and other factors that might explain the relationship between type 2 diabetes and Alzheimer’s dementia. You’ll also find a comprehensive annotated list of the scientific studies investigating the link between diabetes and Alzheimer’s.

Bottom line: We still don’t know the fundamental cause of Alzheimer’s disease. A cure and highly effective preventive measures are far in the future.

Action Plan For You

You may be able to reduce your risk of Alzheimer’s disease by:

  • avoiding type 2 diabetes
  • preventing progression of prediabetes to diabetes
  • avoiding obesity
  • exercising regularly
  • eating a Mediterranean-style diet

Scientists have no idea whether a Stone Age diet prevents dementia.

Carbohydrate restriction helps some folks prevent or resolve obesity, prediabetes, and type 2 diabetes. A low-carb Mediterranean diet is an option in my Advanced Mediterranean Diet (2nd edition).

Steve Parker, M.D.

Reference: Schilling, Melissa. Unraveling Alzheimer’s: Making Sense of the Relationship Between Diabetes and Alzheimer’s Disease. Journal of Alzheimer’s Disease, 51 (2016): 961-977.

 

 

 

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Posted in Dementia, Diabetes Complications

Increase in consumption of refined carbohydrates and sugar may have led to the health decline of the Greenland Eskimos 

Posted on July 30, 2016 | Comments Off on Increase in consumption of refined carbohydrates and sugar may have led to the health decline of the Greenland Eskimos 
Not much edible carbohydrate this time of year...

Not much edible carbohydrate this time of year…

From Dr. James Dr. DiNicolantonio:

“In conclusion, an increase in the intake of refined carbohydrate and sugar paralleled the rise in atherosclerotic disease in the Greenland Eskimos. While the total carbohydrate intake of the Greenland Eskimos was just 2–8% of total calories in 1855, this increased to around 40% of calories by 1955.5 The Greenland Eskimos studied by Bang and Dyerberg in the 1970s no longer consumed a traditional healthy Eskimo diet. Indeed, the intake of refined sugar in the Greenland Eskimos increased by almost 30-fold from 1855 (6 g/person/day or around 1½ teaspoonful of sugar) to the 1970s (164–175 g or around 40–44 teaspoonful of sugar). Moreover, the intake of refined carbohydrate increased 5–7-fold from 1855 (18 g/day from bread) to the 1970s (84–134 g/day from bread, biscuits and rye flour).

In summary, the intake of refined carbohydrate and sugar by the Greenland Eskimos increased in parallel to the rise in atherosclerotic disease. Considering that a similar event occurred in the USA and that the overconsumption of refined sugar is a principal driver of type 2 diabetes, hypertension, and coronary heart disease, this most likely explains the health decline of the Greenland Eskimos.”

Source: Increase in the intake of refined carbohydrates and sugar may have led to the health decline of the Greenland Eskimos — DiNicolantonio 3 (2) — Open Heart

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Posted in Dietary Carbohydrate, Heart Disease, Low-Carb

More Patients With Impaired Kidney Function Qualify for Metformin

Posted on July 28, 2016 | Comments Off on More Patients With Impaired Kidney Function Qualify for Metformin

Recently the U.S. Food and Drug Administration revised their guidelines for physicians regarding use of metformin in patients with kidney impairment. This may make more patients candidates for the drug.

Physicians have been advised for years that type 2 diabetics with more than minimal kidney impairment should not be given metformin. Why? Metformin in the setting of kidney failure raises the risk of lactic acidosis.

The traditional test for kidney impairment is a blood test called creatinine. When kidneys start to fail, serum creatinine rises. Another way to measure kidney function is eGFR, which takes into account creatinine plus other factors.

By the way, you can’t tell about your kidney function simply from the way you feel; by the time you have signs or symptoms of renal failure, the process is fairly advanced.

The FDA now recommends not using  metformin if your eGFR (estimated glomerular function rate) is under 30 ml/min/1.73 m squared), and use only with extreme caution if eGFR drops below 45 while using metformin. Don’t start metformin if eGFR is between 30 and 45. Your doctor can calculate your eGFR and should do so annually if you take metformin.

Steve Parker, M.D.

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Posted in Drugs for Diabetes

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Moderately Low-Carb Diet Beats Calorie-Restricted “Balanced” Diet in Overweight Japanese Type 2 Diabetes

Posted on July 27, 2016 | Comments Off on Moderately Low-Carb Diet Beats Calorie-Restricted “Balanced” Diet in Overweight Japanese Type 2 Diabetes
This meal is low-carb, and probably low-calorie too

This meal is both low-carb and low-calorie

A randomized controlled clinical trial found superior results in diabetes with a low-carb diet, judging from weight loss and hemoglobin A1c.

I don’t know how many carbs the typical Japanese person eats in a day. In the U.S., it’s 250-300 grams. Here’s how the study at hand was done:

“This prospective, randomized, open-label, comparative study included 66 T2DM patients with HbA1c >7.5% even after receiving repeated education programs on Calorie-Restricted Dieting (CRD). They were randomly allocated to either the 130g/day Low-Carb Diet (LCD) group (n = 33) or CRD group (n = 33). Patients received personal nutrition education of CRD or LCD for 30 min at baseline, 1, 2, 4, and 6 months. Patients of the CRD group were advised to maintain the intake of calories and balance of macronutrients (28× ideal body weight calories per day). [If I understand correctly, a 170-lb (77.2 kg) person would be recommended to eat 2160 calories/day.] Patients of the LCD group were advised to maintain the intake of 130 g/day carbohydrate without other specific restrictions. Several parameters were assessed at baseline and 6 months after each intervention. The primary endpoint was a change in HbA1c level from baseline to the end of the study.

At baseline, body mass index (BMI) and HbA1c were 26.5 and 8.3, and 26.7 kg/m2 and 8.0%, in the CRD and LCD, respectively. At the end of the study, HbA1c decreased by −0.65% in the LCD group, compared with 0.00% in the CRD group (p < 0.01). Also, the decrease in BMI in the LCD group [−0.58 kg/m2] exceeded that observed in the CRD group (p = 0.03).

Conclusions: Our study demonstrated that 6-month 130 g/day LCD reduced HbA1c and BMI in poorly controlled Japanese patients with type 2 diabetes. LCD is a potentially useful nutrition therapy for Japanese patients who cannot adhere to CRD.”

Source: A randomized controlled trial of 130 g/day low-carbohydrate diet in type 2 diabetes with poor glycemic control – Clinical Nutrition

The calorie-restricted diet did nothing for these folks in terms of glycemic  control.

Steve Parker, M.D.

PS: In case you’re wondering, the Paleobetic Diet reduces digestible carbs to 45-80 grams/day.

 

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Posted in Diabetic Diet, Low-Carb

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16,700-Year-Old Tools Found in Texas Change Known History of North America

Posted on July 26, 2016 | Comments Off on 16,700-Year-Old Tools Found in Texas Change Known History of North America

“Archaeologists in Texas have found a set of 16,700-year-old tools which are among the oldest discovered in the West. Until now, it was believed that the culture that represented the continent’s first inhabitants was the Clovis culture. However, the discovery of the ancient tools now challenges that theory, providing evidence that human occupation precedes the arrival of the Clovis people by thousands of years.”

Source: 16,700-Year-Old Tools Found in Texas Change Known History of North America | Ancient Origins

When I first read this, I thought it outdated my Paleobetic Diet book. But no. On page 33 I wrote, “Northeast Asians moved into North America (Alaska) 12 to 30,000 years ago.”

Paleobetic Diet-FrontCover_300dpi_RGB_5.5x8.5

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Posted in Evolution

Monthly Hormone Changes May Affect Insulin Dosing in T1 Diabetes

Posted on July 26, 2016 | Comments Off on Monthly Hormone Changes May Affect Insulin Dosing in T1 Diabetes

I’ll confess I haven’t put much thought into this, but Kelly Schmidt has. She has type 1 diabetes and has to deal with it. Kelly writes:

“Some woman will use a higher basal [insulin dose] the week before and during a period, where others need less insulin as blood sugars plummet upon a period. Take notes each month, even if you just insert a few sentences in your calendar. We all say we will remember next month, but trust me, these notes will be handy. A quick example of how I use 2 basals: my normal, non-period basal is just shy of 10 units, and then my PMS basal is 11.5 units of Humalog. As you can see, I just need a pinch more of insulin, but it’s so helpful.

Know that with every month, the fluctuations and impact a period has on someone not only varies with the person, but can vary from month to month.”

Source: Diabetes and Womanhood » Kelly Schmidt Wellness

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Posted in Uncategorized

Five Essential Diabetes Tests 

Posted on July 26, 2016 | Comments Off on Five Essential Diabetes Tests 

Paleobetic Diet-FrontCover_300dpi_RGB_5.5x8.5Click the link below for details. I mention these also in my Paleobetic Diet book.

“Diabetes does not just affect a person’s blood glucose levels, but it also impacts other parts of the body, such as kidneys, eyes, and even feet. To lower your risk for diabetes-related complications, it’s important to maintain good control — and have these routine tests during your visit with your healthcare team to check on how you’re doing.”

Source: 5 Essential Diabetes Tests | Speaking of Diabetes | The Joslin Blog

 

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Do Statin Drugs Cause Diabetes?

Posted on July 26, 2016 | Comments Off on Do Statin Drugs Cause Diabetes?

Roni Rabin at the New York Times suggests an answer:

“The Food and Drug Administration updated its advisory about statins in 2012 to include warnings about the slightly increased risk of higher blood sugars and Type 2 diabetes, based in part on two large analyses of earlier studies that controlled for diabetes risk factors like being overweight or being older. One found a 9 percent increase in the risk of diabetes among statin users, and the other a 12 percent increase, with a greater risk for those on intensive rather than moderate doses of the drugs.

The 2012 F.D.A. advisory also warns of other side effects of statins, such as muscle injury, rare cases of liver damage and reports of memory loss and confusion.”

Source: Can Statins Cause Diabetes? – The New York Times

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Posted in Causes of Diabetes

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