Tag Archives: diabetes

Managing Diabetes on Sick Days

Posted on October 29, 2020 | Comments Off on Managing Diabetes on Sick Days
home glucose monitor, diabetes
How old is this device?

For folks taking insulin, Diabetes Daily has a good article by endocrinologist Dr Francine Kaufman. An excerpt:

Everyone with diabetes who takes insulin needs to have a sick day plan. This is something you develop with your healthcare professional to help you manage the high and low sugar levels that can be associated with an illness. The following advice applies to people with type 1 diabetes and people with type 2 diabetes who take insulin – the advice may be different if you have type 2 diabetes and do not take insulin.

Here’s what’s covered in the article:

  • Track your important numbers in a sick log
  • Glucose levels
  • Ketone levels
  • Temperature
  • Fluid intake
  • Urination
  • Vomiting, diarrhea, and dehydration
  • Insulin, amount and time
  • Medications

Key messages from Dr. Kaufman

When you get sick, you are at risk of becoming dehydrated from poor intake or from excessive loss of fluids due to nausea, vomiting, diarrhea, and fever (your body may lose more water when you have a high temperature). In addition, dehydration is common in diabetes because high glucose levels (above 180-200 mg/dL) cause sugar to enter your urine, dragging an excess amount of fluid with it. Illness also puts you at risk of developing ketones, which when coupled with high glucose levels can lead to diabetic ketoacidosis (DKA), a very serious condition. How do you know if you have ketones? Good question, click here!

The purpose of your sick day plan is to try to keep your glucose levels in a safe range – to avoid dehydration and to prevent ketones from rising to a dangerous level.

Source: Zoning in on Sick Day Management: Practical Tips, Strategies, and Advice – Diabetes Daily

Steve Parker, M.D.

PS: Avoid the medical-industrial complex by getting and staying as healthy as possible. Let me help:

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Does a Low-Carb Vegetarian Diet Work for Diabetes?

Posted on March 30, 2017 | Comments Off on Does a Low-Carb Vegetarian Diet Work for Diabetes?

Spaghetti squash with parsley, olive oil, snow peas, garlic, salt, pepper

Spaghetti squash with parsley, olive oil, snow peas, garlic, salt, pepper

It does for type 2 diabetic David Mendosa, who’s been doing it for three years. He shares some ideas on how to do it at the link below. From the intro:

About nine years ago, I started to eat only food low in carbohydrates that don’t have a high glycemic index.  I knew that this was the only proven way to bring my blood glucose level down where I wanted it to be without using drugs or supplements. My most recent A1C test showed that my level is 5.1 percent, well within the range considered normal.

While continuing to eat this way, about three years ago I added the further restriction of eating no meat, fish, or seafood. This was a substantial shift in what I was eating, and I made it mainly because I don’t want to be intentionally responsible for the death of animals or other sentient beings. Only later did I begin to realize its health benefits.

Source: How to Manage Your Diabetes with a Low-Carb Vegetarian Diet – Diabetes

David seems to adhere to the lacto-ovo strain of vegetarianism, rather than vegan or pesco-vegetarian. In other words, he’ll eat eggs and milk products but not fish. I suspect he eats under 40 grams/day of digestible carbohydrate.

Here are more of David’s ideas on implementation of a very low-carb vegetarian diet.

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Soft Drinks Raise Risk of T2 Diabetes and LADA

Posted on February 2, 2017 | Comments Off on Soft Drinks Raise Risk of T2 Diabetes and LADA

I enjoy an aspartame-flavored Fresca now and then

I enjoy an aspartame-flavored Fresca now and then

LADA is latent autoimmune diabetes in adults.

This new study is out of Sweden. The potential disease-inducing soft drink dose was 400 ml or 13.5 fl oz per day. In the U.S., a typical soda can is 10 fl oz or 355 ml. Surprisingly, artificially-sweetened soft drinks were just as guilty as regular beverages.

From MNT:

“The study included 2,874 Swedish adults, of whom 1,136 had type 2 diabetes, 357 had LADA, and 1,137 were healthy controls.

The team analyzed the self-reported dietary data of each adult, looking specifically at the number of soft drinks consumed up to 1 year before a diabetes diagnosis. Participants’ insulin resistance levels, beta cell function, and autoimmune response were also measured.

The researchers found that adults who reported drinking at least two 200-milliliter servings of soft drinks a day – whether they contained sugar or artificial sweetener – were twice as likely to develop LADA and 2.4 times more likely to develop type 2 diabetes, compared with those who consumed fewer than two soft drinks daily.

What is more, adults who consumed five 200-milliliter servings of soft drinks daily were found to be at 3.5 times greater risk of LADA and 10.5 times greater risk of type 2 diabetes, regardless of whether the drinks were sugary or artificially sweetened.”

Source: Diabetes risk doubles with more than two soft drinks daily – Medical News Today

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Women Reduce Risk of Cardiovascular Disease and Diabetes With Strength Training

Posted on December 9, 2016 | Comments Off on Women Reduce Risk of Cardiovascular Disease and Diabetes With Strength Training

That's a dumbbell in her right hand. I work-out with those myself.

That’s a dumbbell in her right hand. I work-out with those myself.

I don’t have access to the full scientific report, but I’ve posted part of the abstract below.

The biggest problem with the study at hand is that physical activity apparently was surveyed only at the start of this 14-year study. Results would be much more robust if activity was surveyed every year or two. My overall activity level seems to change every two or three years. How about you?

Moving on.

“Compared to women who reported no strength training, women engaging in any strength training experienced a reduced rate of type 2 diabetes of 30% when controlling for time spent in other activities and other confounders. A risk reduction of 17% was observed for cardiovascular disease among women engaging in strength training. Participation in both strength training and aerobic activity was associated with additional risk reductions for both type 2 diabetes and cardiovascular disease compared to participation in aerobic activity only.

CONCLUSIONS: These data support the inclusion of muscle-strengthening exercises in physical activity regimens for reduced risk of type 2 diabetes and cardiovascular disease, independent of aerobic exercise. Further research is needed to determine the optimum dose and intensity of muscle-strengthening exercises.”

PMID 27580152

Source: Strength Training and the Risk of Type 2 Diabetes and Cardiovascular Disease. – PubMed – NCBI

Steve Parker, M.D.

PS: Cardiovascular disease includes heart attack, cardiac death, stroke, coronary angioplasty, and coronary artery bypass grafting.

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Grant Schofield Defends the Paleo Diet for Diabetes

Posted on August 10, 2016 | 1 comment

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Schofield is a Professor of Public Health at Auckland University of Technology and Director of the Human Potential Centre. Prof. Sofianos Andrikopoulos authored an anti-paleo diet editorial in the Medical Journal of Australia.

Schofield penned a rebuttal at Sciblogs. A sample:

“The paleo diet – the idea that we should be guided in human nutrition/public health nutrition by evolutionary history is steeped with controversy. Health experts and authorities are seemingly going well out of their way to make sure people are warned off such ways of eating.

Proponents are often mystified by this, because the idea of using human evolutionary history to understand human function is common in human biology. In fact its a guiding principle. As well, in the midst of a chronic disease epidemic, including diabetes and obesity which are potentially improved by this approach, you’d think approaches which are based on whole food eating, and appeal to at least some of the population would be welcomed.

I find it curious that other approaches such as vegetarianism, which are often based not around science, but religion and other beliefs are welcome in public health nutrition advice. Yet the paleo approach is not.

Yes, people who are follow this way of eating are restricted to eating much less processed food and often lower carbohydrate diets. Neither of these approaches are known to be anything but beneficial for human health, especially in the context of diabetes.”

Source: Sciblogs | Anti-paleo diet attacks miss the point Read the whole thing.

Steve Parker, M.D.

No degludec up in here!

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President of Australian Diabetes Society On Paleo Diet for Diabetics: Don’t Do It

Posted on August 9, 2016 | 3 comments

Really?

Really?

From SBS.com:

“People with type 2 diabetes should ditch the paleo diet until there’s substantial clinical evidence supporting its health benefits, warns the head of the Australian Diabetes Society.

It may be popular among celebrities but there’s little evidence to support the dozens of claims it can help manage the disease, says Associate Professor Sof Andrikopoulos.

“There have been only two trials worldwide of people with type 2 diabetes on what looks to be a paleo diet,” he said.

“Both studies had fewer than 20 participants, one had no control diet, and at 12 weeks or less, neither study lasted long enough for us to draw solid conclusions about the impact on weight or glycemic control.”

In a paper for the latest issue of the Australian Medical Journal, Andrikopoulos recommends people with type 2 diabetes seek advice from their GPs [general practitioners], registered dietitians and diabetes organizations.”

Source: Diabetics should put paleo on hold: expert | SBS News

I disagree with Prof. Andrikopoulos. We have adequate evidence to support a paleo-style diet for people with diabetes. I review it in 32 pages of my book. If you want to see the evidence right now, search this site for key words: O’Dea, Lindeberg, Jonsson, Frasetto, Ryberg, Mellberg, Boers, and Masharani.

If you seek diet advice from your general practitioner, endocrinologist, registered dietitian, and diabetes organizations, you’ll likely be told to eat too many carbohydrates, including processed man-made foods, which will wreck your glycemic control. The drug companies and medical-industrial complex will benefit at your expense.

Steve Parker, M.D.

No degludec up in here!

Front cover

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Posted in Diabetic Diet, Paleo Diet, Paleo Movement

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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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Do Potatoes Make You Fat or Diabetic?

Posted on July 16, 2016 | 1 comment

Researchers in Denmark say “no.” French fries, maybe.

“The identified studies do not provide convincing evidence to suggest an association between intake of potatoes and risks of obesity, T2D, or CVD. French fries may be associated with increased risks of obesity and T2D although confounding may be present. In this systematic review, only observational studies were identified. These findings underline the need for long-term randomized controlled trials.”

Source: Potatoes and risk of obesity, type 2 diabetes, and cardiovascular disease in apparently healthy adults: a systematic review of clinical intervention and observational studies

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Do SGLT2 Inhibitors Increase the Risk of Amputations in Diabetics?

Posted on July 10, 2016 | 1 comment

Good question. But we don’t know the answer yet.

European authorities and even the U.S. Food and Drug Administration are looking into the possible connection. Stay tuned. Visit The Low Carb Diabetic site (link below) for more details.

“The European Medicines Agency (EMA)’s Pharmacovigilance Risk Assessment Committee (PRAC) has extended the scope of its investigation into the possible link between the sodium glucose cotransporter 2 (SGLT2) inhibitor canagliflozin (Invokana, Vokanamet, Janssen) and amputations to include other drugs of the same class.

Now, the PRAC’s review will include the other SGLT2 inhibitor medicines dapagliflozin (Farxiga, Xigduo XR, AstraZeneca), and empagliflozin (Jardiance, Boehringer Ingelheim), based on the determination that the potential risk may be relevant for them as well.”

Source: The Low Carb Diabetic: EMA Extends Amputation Investigation to All SGLT2 Inhibitors

Steve Parker, M.D.

PS: SGLT2 inhibitors are the drugs that reduce blood glucose by shunting it into your urine. Makes more sense to me instead to reduce your blood sugar by eating fewer carbohydrates, the primary source of blood sugar in most folks.

Update May 17, 2017: On May 16, 2017, the U.S. Food and Drug Administration ruled that canagliflozin doubles the risk of foot and leg amputations, compared to placebo.

 

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Is Insulin Making You Hungry All the Time?

Posted on May 8, 2016 | 7 comments

So easy to over-eat!

So easy to over-eat! Is it the insulin release?

No, insulin probably isn’t the cause of constant hunger, according to Dr. Stephan Guyenet. Dr. G gives 11 points of evidence in support of his conclusion. Read them for yourself. Here are a few:

  • multiple brain-based mechanisms (including non-insulin hormones and neurotransmitters) probably have more influence on hunger than do the pure effect of insulin
  • weight loss reduces insulin levels, yet it gets harder to lose excess weight the more you lose
  • at least one clinical study (in 1996) in young healthy people found that foods with higher insulin responses were linked to greater satiety, not greater hunger
  • billions of people around the world eat high-carb diets yet remain thin

An oft-cited explanation for the success of low-carbohydrate diets involves insulin, specifically the lower insulin levels and reduced insulin resistance seen in low-carb dieters. They often report less trouble with hunger than other dieters.

Here’s the theory. When we eat carbohydrates, the pancreas releases insulin into the bloodstream to keep blood sugar levels from rising too high as we digest the carbohydrates. Insulin drives the bloodstream sugar (glucose) into cells to be used as energy or stored as fat or glycogen. High doses of refined sugars and starches over-stimulate the production of insulin, so blood sugar falls too much, over-shootinging the mark, leading to hypoglycemia, an undeniably strong appetite stimulant. So you go back for more carbohydrate to relieve the hunger induced by low blood sugar. That leads to overeating and weight gain.

Read Dr. Guyenet’s post for reasons why he thinks this explanation of constant or recurring bothersome hunger is wrong or too simplistic. I agree with him.

The insulin-hypoglycemia-hunger theory may indeed be at play in a few folks. Twenty years ago, it was popular to call this “reactive hypoglycemia.” For unclear reasons, I don’t see it that often now. It was always hard to document that hypoglycemia unless it appeared on a glucose tolerance test.

Regardless of the underlying explanation, low-carb diets undoubtedly are very effective in many folks. And low-carbing is what I always recommend to my patients with carbohydrate intolerance: diabetics and prediabetics.

Steve Parker, M.D.

front cover

front cover

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