Diabetes Pharmacist Blog : Focus Express Mail Pharmacy : Insulin Pumps, Diabetes Supplies and Information

Which came first? The chicken or the egg? Does a diagnosis of diabetes lead to depression or does depression lead to diabetes? Probably both according to new research reported on Newsday.com.

People with diabetes are more likely to become depressed as they face a lifetime of keeping their disease in check, researchers said. About 21 million Americans have diabetes, which requires patients to adhere to a strict diet and exercise routine and to monitor their blood sugar levels regularly. People being treated for Type 2 diabetes, the most common form, were 52 percent more likely to develop depression than those without the disease, according to a paper published in a recent Journal of the American Medical Association. John Buse, the American Diabetes Association's president of medicine and science, said. "It's a very tough business to take care of diabetes."

On the flip side, depression may cause patients to develop behaviors that cause diabetes or make it worse. For example, research has shown that many people who are depressed don't exercise, smoke, and/or overeat. "It's important that doctors be attuned to look for both conditions in patients at risk for either diabetes or depression," lead author Sherita Hill Golden, an associate professor of medicine and epidemiology at Johns Hopkins University in Baltimore, said in a statement. "We may want to develop interventions for both treatments, instead of just one or the other."

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A cup of hot tea, a glass of red wine, and now a mug of hot cocoa all have one thing in common; they all contain natural plant compounds called Flavonols.  New research suggests that by satisfying a craving for cocoa,  you can actually help blood vessels to function better. Furthermore,  cocoa  might soon be considered part of a healthy diet for the prevention of cardiovascular disease, the number one cause of death in people with diabetes.

Remember, it's the Flavonols that are responsible for cocoa’s healthful benefits.

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 Novo Nordisk has submitted a new drug application to the FDA in the U.S., for the approval of liraglutide, a once-daily human GLP-1 analogue, for the treatment of people with type 2 diabetes.

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So you don't like taking those big Metformin tablets because they're hard to swallow, taste awful, and what's more, they really do major damage to your stomach. Well, there may be an alternative sometime in the near future. Now in the testing phase, a chewing-gum product, called MetControl, will be given to 36 volunteer patients to test its speed and efficacy compared with that of immediate-release metformin pills according to the manufacturer, Generex Biotechnology Corporation of Toronto, Canada. Generex believes that metformin in good-tasting chewing gum would make it more acceptable to  patients and thereby increase adherence with diabetes therapy. 

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Researchers at MedStar Research Institute in Washington D.C. hope that a new light machine could replace the traditional diabetes testing method of doing a fasting blood sugar which involves fasting for 12 hours, drinking a sweet glucose solution, and taking a blood test; a process that takes a couple of hours. 

Instead,  the Vera-light scout system would have patients in and out in a flash. It uses fluorescent light to non-invasively measure the effects of high glucose levels in the forearm's connective tissue.                                                                                                                                                                               

It is estimated that 6 million people have undiagnosed diabetes and many of them don't know it for years. When they are finally diagnosed, it's because diabetes complications like blindness or kidney disease have set in.

This painless and quick test should be given to everyone so that an early diagnosis is made, treatment started, and complications avoided.

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"The prevalence of arthritis is astoundingly high in people with diabetes," said Dr. John H. Klippel, president and CEO of the Arthritis Foundation. "Over half the people with diabetes have arthritis."
Although there appears to be a connection between arthritis and diabetes, the reason for it isn't known, Klippel said. A possible explanation is obesity, which is a risk factor for both osteoarthritis and diabetes, he speculated.

Maybe the REAL reason is that most people with diabetes are over 40 years old and would have arthritis anyway! The overall population is getting older, the "Baby Boomers" are getting older, and, the average age in this country is going up because we are all living longer! Check out these statistics that prove me right.

According to information from Steven Reinberg of HealthDayNews: "With two-thirds of U.S. adults overweight or obese, the number of people with type 2 diabetes continues to rise while their ages at the time of diagnosis drops, a new study finds. In the late 1980s and early '90s, the average age of an adult diagnosed with type 2 diabetes was 52, but now people are being diagnosed in their middle 40s. " And, according to a graph from the National Diabetes Information Clearinghouse (NDIC), in 2005 there were 1.5 million people over the age of 20 diagnosed with diabetes." But, almost all, 1.3 million people, were over the age of 40!  Now, 3 years later, the number of Type 2 is increasing dramatically. There are many more type 2 adult diabetics in the diabetes population than Type 1 insulin dependent diabetes.

According to Arthritis Pain Self Help, there are 16 million sufferers of various forms of arthritis in the US, 8 million in the UK and 3 million in Australia, with an average age of 45, that are using arthritis drugs and pain relievers.

So, I have to conclude that it is purely coincidental that most diabetics have arthritis. I would love to see what the average age was of the people in the Arthritis-Diabetes Study. I bet they were over 40. It would be interesting to find out.

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Focus Express Mail Pharmacy Inc. of Horsham,PA  donated more than $25,000 in pedometers, educational materials, programs, and grant money to the Haverford School District elementary schools to kick off Peds for Prevention, a program to increase children's physical activity and healthy food choices. Each elementary school participated in a walking program sponsored by the company and raised money for the district's Education Foundation. Focus Express also donated $3,000 for health and wellness initiatives to the three top performing schools.

Pictured above, walking the final 2000 Steps on April 26, 2008 in foreground are Greg Vitali (PA State Representative), Nick Braccia (Focus President), Ellen Fisher (President of The Haverford Township School District Education Foundation) and Joel Shpigel R.Ph.  (Focus CEO)   along with the hundreds of children and parents who participated.

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So So there's been a study that shows that people who live in neighborhoods where there are more fast food restaurants have higher rates of diabetes and obesity. Is it me or is that a no brainer?And, what's more, this rate increase goes across all racial lines, all ethnic lines, AND all income lines! 

The study found obesity rates to be 20% higher in neighborhoods with five or more times as many fast-food outlets as produce vendors, compared with those with three or fewer and Diabetes rates were 23% higher! That's quite significant. It's been suggested that all restaurants post caloric and nutritional content for all of their food like what New York was just mandated to do. That's ok but I have a better idea. Why doesn't someone set up a MAXIMUM healthy caloric content figure per sandwich, snack, side order, etc and if a food goes over that, a CAUTION NOTICE must be posted and/or printed on wrappers or boxes of take out food saying the following:

CAUTION: THIS FOOD IS OVER THE RECOMMENDED CALORIC INTAKE LEVEL PER MEAL AND REPEATED INGESTION MAY LEAD TO OBESITY AND/OR DIABETES.

Kind of similar to a label on a package of cigarettes. Nah, it won't work.

People still smoke and that can lead to CANCER!

(Picture from http://www.obesity-experts.com/Fast-Food-Obesity.html)

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It's a connection that wouldn't surprise Dr. Ulysses Magalang, a sleep expert with Ohio State University Medical Center. He says that depriving your body of oxygen often takes its toll.
"We do not know whether sleep apnea actually causes diabetes. What we do know is that patients with sleep apnea have an increased insulin resistance, which is a hallmark of patients with diabetes," says Magalang.

Dr. Magalang also says that  "obesity is a common risk factor for both diabetes and sleep apnea, and fat cells seem to function similarly in both. Studies have shown that wearing airflow masks at night can prevent problems with those fat cells. The problem is, getting patients to wear them."

Research will continue to see if, in fact, there is a direct link between sleep apnea and diabetes.

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 It seems like everyone I know goes to a gym or participates in some type of regular exercise program. For most of us, that just means doing a little stretching and then off you go to the weight room,  treadmill,  elliptical etc. But for those people with diabetes, a lot of thought and preparation should be done before exercising. Exercise will lower blood sugar, and since insulin is more effective during exercise, a dangerous drop in blood sugar can occur.

The University of Michigan Health System offers these tips for people with diabetes to maintain healthy blood sugar levels when exercising:

1. Check your blood sugar before and after exercise -- and during if you can -- and record your results.
2. If you are going to exercise strenuously, make sure you eat a meal first.
3. Keep snacks -- especially some with sugar -- on hand when you exercise.
4. Talk to your doctor about possibly adjusting your insulin dose for exercise.
5. Don't inject insulin into a part of the body that will be strenuously used during exercise, as it will absorb more quickly. For example, if you will run, inject your abdomen instead of your leg.

And here's a tip from me: if you're just starting to exercise, don't overdo it. Gradually increase your time on cardio equipment and gradually increase your weights for weight training. Good Luck!

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I have a question.

How can you have a story about higher rates of diabetes and obesity in New York than elsewhere  and have a banner ad for Dunkin Donuts smack in the middle? Ok, I'll give them the benefit of the doubt because I understand how "key words" in stories trigger certain advertisers on websites but I just don't think it's right that just after the AP writer states that "health officials say a big reason for the gain is sugary sodas and sweetened drinks which add a lot of calories", a banner ad for Dunkin Donuts appears, Check it out for yourself. You may not see it right away because the ad alternates with other advertisers but it's there. Believe me. I printed it out. It may not cause the obesity and diabetes rate to increase but it sure doesn't help.

 APRIL 30, 2008 UPDATE: The ad is no longer there but the article is. We'll keep checking to see if it comes back! JDS

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Vitamin D supplements in early childhood may ward off the development of type 1 diabetes in later life, reveals a research review published ahead of print in the Archives of Disease in Childhood.  MORE.

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In a project described in the March/April Journal of the American Pharmacists Association, employers in 10 U.S. cities agreed to waive copays for employees’ diabetes meds, and to fund regular meetings between pharmacists and diabetic employees. A year after the project launched, 914 patients who had been enrolled for at least three months ....MORE

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Randy Jackson, of American Idol, is holding a casting call for people living with Type 2 diabetes. Randy has partnered with the American Heart Association to speak on behalf of The Heart of DiabetesTM, a national campaign to help those living with type 2 diabetes manage the disease and learn about its connection to cardiovascular disease (CVD). He also has some tips that he wants to share that have helped him manage his own diabetes and lead a healthier life.MORE......

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     My wife and I are both "dog people". We have three Airedale terriers, all of whom were "rescued". But as much as we love our dogs and think that they're special, there is another class of  dogs who perform some very important and possibly life saving functions.

We all have seen dogs who have been trained to help people who are blind or dogs who help those who have lost their hearing. Now there are specially trained dogs who can identify low blood sugar in humans. According to the website www.dogs4diabetics.com, these dogs can detect "subtle scent changes that hypoglycemia (low blood sugar) creates in body chemistry, changes undetectable to their human companions."

Hypoglycemia can have some very scary consequences. Our brain needs a steady supply of sugar (glucose), because it doesn't  store or manufacture its own energy supply. If glucose levels become too low, as occurs with hypoglycemia, the following symptoms  can occur:

• Confusion,abnormal behavior, or both, such as the inability to complete routine tasks.
• Visual disturbances, such as double vision and blurred vision.
• Seizures or loss of consciousness can occur but are uncomon.

Another program, www.allpurposecanines.com , trains dogs who can detect  BOTH low and high blood glucose levels. They say that "a strong team concept is essential to the success of a service dog  partnership. Parents, family members, healthcare professionals and educators all have important roles to ensure the team's success." Is their program successful? They are "especially proud of the 100% success rate with this program."

In an article in the March 2008 issue of Diabetes Forecast,  "what is uncanny is the reliabilty" of these dogs. Trainers at Dogs for Diabetics in Concord, California say that these trained dogs are "right 90% of the time".And what's more, some have "the ability to sense a dangerous drop in blood glucose BEFORE the drop occurs."

From my  years of helping people who have diabetes, I think  the most important and critical time to know when a blood sugar drop occurs is during sleep. For example, If too much insulin is given before bedtime, a hypoglycemic event may occur during sleep, and the person with diabetes would not be awake to react and treat the symptoms. A Diabetes "Scentry" Dog could save this person's life.

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In a given day:

• 4000 new cases of diabetes will be diagnosed.
• 600 people will die from diabetes complications.
• 200 people will undergo an amputation due to diabetes.
• 100 cases of kidney failure will occur due to diabetes

These statistics were grimly uttered by Ann Albright, Director of the Division of Diabetes Translation for the Center for Disease Control (CDC).Additionally, she said that "of the children born in America in 2000, one in three will develop diabetes in their lifetime."

In addition, according to the American Diabetes Association (ADA), there are 21 million people in the United States who are diagnosed with diabetes and if something dramatic does not occur in the next 20 years, this number will double! The costs for diabetes will exceed $174 billion dollars in 2008.

• $116 million on medical expenditures
• $58 million on reduced national productivity

"We are spending $174 billion dollars each year on diabetes, just imagine what that will be like when the number of diabetics double" says former Acting US Surgeon General Dr. Kenneth Moritsugu.

The ADA further states that "individuals with diabetes have medical expenditures at about 2.3 times higher than those without diabetes. The average cost incurred among individuals with diabetes is $11,744 per year with $5,649 attributed directly to diabetes."

This has gone from being a serious problem to one that will soon affect every person in this country! Why you ask? Here's why:

• Insurance companies will be paying more for medical costs which will raise EVERYONE'S insurance premiums.
• There will be lower productivity in the workplace which will hurt these same employers who will be paying the higher premiums.
• There will be reduced earnings for individuals and families.
• There will be higher taxes for us all as a portion of the burden of increased health care costs will affect the government and guess who has to pay for that?
• All of this combined means a lower quality and standard of living.

These statistics do not lie. They're getting worse every day. Something has to be done NOW to help everyone who has diabetes but even more let's do all we can, as individuals,  to PREVENT diabetes (Type II)  from occurring in ourselves, our families, and our friends.

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According to Dr. Gabe Mirkin, exercise helps to prevent and treat diabetes by increasing the number of enzymes that transport fat from fat cells to muscle cells where it can be used for energy by the muscles. Before insulin can do its job of removing sugar from the bloodstream and putting it into cells where it can be burned for energy, it must first,,MORE

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A new study shows that diabetes and Alzheimer s diseases are more related than everybody thought. According  to Suzanne M. de la Monte,a Rhode Island Hospital neuropathologist and professor of pathology at Brown University Medical School ,insulin disappears early and dramatically in Alzheimer's disease and many of the unexplained features of Alzheimer's, such as cell death and tangles in the brain, appear to be linked to abnormalities in insulin signaling. MORE......

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According to the New York Times, the New England Journal of Medicine published a study this week showing that a three-pronged approach of managing Sugar, Blood Pressure and Cholesterol — combined with low doses of aspirin — prolonged the lives of people with diabetes. The patients who did best in that study did not reach the nearly normal sugar levels that were the aim of the Accord study. Instead, their levels were just slightly higher than normal. MORE.....

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According to Kusum Jain, when the life of your dog is on the line, vets will not quibble over the use of “signs” for “symptoms”, but when they talk to you about “signs of Diabetes”, at least you know exactly what they mean. The flashing red neon signs of Diabetes in your dog are..MORE

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According to a new study published in the Archives of Internal Medicine, increasing numbers and percentages of Americans older than 65 having diagnosed diabetes is growing fast, which together with reducing death rates and lack of improvement in treating side effects, is contributing significantly to the growing burden of paying for and providing their medical care. MORE......

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WEB-MD   Caffeine makes it hard for people with diabetes to control their blood sugar, new studies suggest. In the latest of these studies, Duke University researcher James D. Lane, Ph.D.,  MORE......

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Robert Langreth, in Forbes.com, writes about a new type of drug, called an anti-CD3 antibody, which aims for the first time to delay or prevent development of diabetes by arresting the immune system's attack on pancreatic islet cells. This new class of drugs, now entering final-stage human trials, are given to newly diagnosed patients for just a few days or weeks but appear to preserve some insulin-producing capacity for years. Ultimately the drugs may even be able to prevent the disease from striking people at high risk because of a family history of diabetes or bad genes. MORE.....

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According to Emilie LeBeau in the Chicago Tribune, among fiber's substantial benefits are weight control, lower cholesterol and diabetes prevention.
Adding fiber to your daily diet can be as simple as switching from processed to fresh foods. For people who avoid grains,fruits such as apples, berries, oranges, pears and prunes are high in fiber. Vegetables such as beans, broccoli, Brussels sprouts, cauliflower, carrots and peas also are high in fiber. More......

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 According to United Press International, Canadian researchers have discovered specialized T-cells lose their effectiveness over time in some people, leading to the onset of type 1 diabetes.

T-cells suppress and regulate the body's immune responses, but in diabetes mellitus, or type 1 diabetes, the body's own immune system attacks and destroys insulin-producing islet cells in the pancreas. Patients must thereafter inject insulin daily.

"The genetic and cellular mechanisms by which the immune system goes out of control and destroys the islets has been an enigma and an area of great interest over the last few decades," said Dr. Ciriaco Piccirillo of McGill University, one of the study's authors. "For the last several years, it's been postulated that non-functional regulatory T-cells are the critical mechanism, and this study proves it."

The research was conducted on mice that were genetically engineered to model human diabetes. Piccirillo and colleagues discovered the functional potency of T-cells in the mice declined with age, leaving autoimmune responses in the pancreas unchecked. Piccirillo said that finding could lead to the development of immune system-based therapies for a range of diseases.

The study appears in the journal Diabetes.

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The first  FDA approved consumer test to evaluate diabetes risk will be marketed exclusively in the United States by Glycemion, Inc. The BIOSAFE Diabetes Risk Assessment is a two-part process comprised of an immediate fasting glucose reading and a mail-in laboratory analysis for hemoglobin A1c, a blood glucose marker for the previous ninety-day period. More......

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Insulin pumps, about the size of a beeper, deliver to people with diabetes the potential for a more healthful life. Jeffrey Weiss of the Dallas Morning News wears an insulin pump and explains why he thinks it's a good idea in "simple terms" and why it's important to understand Type 1 diabetes. More....

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Daily care of your diabetes is hard enough when you're "well". Having  those miserable cold or flu symptoms makes it that much more difficult. The ADA (American Diabetes Association) has some tips for you to follow this cold and flu season. More.....

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A new study indicates that by decreasing prescription co-payments,  increased
adherence to drug therapy results for patients with chronic diseases like diabetes.

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An increased intake of legumes like peanuts and soybeans could reduce the risk of developing type-2 diabetes by 38%, reports researchers in this month's American Journal of Clinical Nutrition.The dietary habits of over 64,000 women were assessed and correlated with the development of type-2 diabetes over about five years. More.......

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 Smoking, already known to cause lung cancer, heart disease and stroke, also increases the risk  of developing type 2 diabetes by 44% when compared to nonsmokers, Swiss researchers found. More.....

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Takeda Pharmaceutical Co., Japan's biggest drugmaker, sought U.S. approval to sell alogliptin as a once-daily treatment for type-2 diabetes, it said in a statement today. If approved, it will be the Osaka- based company's first new medicine released in the U.S. in more than two years. More...

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As seen on MedGadget. com, the European Space Agency is reporting that technology originally developed for its space program has now been used to create the insulin pump of the future: one that you can wear on your wrist!.German student Nicole Schmiedel has come up with a design for a fashionable looking "wristwatch" that contains an innovative ultra-light insulin pump to help people with type 1 diabetes. For more, click here...

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According to an article in ScienceAlert.com. and published in the October 4, 2007 issue of the well known medical journal, Cell Metabolism, scientists from The Garvan Institute of Medical Research, have identified an enzyme that is active during diabetes and also blocks the availability of insulin. Click here for more

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In Diabetes Today magazine, which is published by the American Diabetes Association, there is a great article titled Overweight Kids Show Heart Risks As Teens. The article is based on an American Journal of Clinical Nutrition, September 2007 study which states:

“that overweight and obese 8-year-olds were seven-times more likely than their thinner peers to have multiple heart disease risk factors at the age of 15. These risks included high blood pressure, unhealthy cholesterol levels and elevations in blood sugar and insulin, a blood-sugar-regulating hormone.”
This is just another reminder of how important it is to safeguard our children and teach them good eating and exercise habits early in life. For more,click here....

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Dr. Neal Barnard claims that the approach of the American Diabetes Association and its diet is all wrong when it comes to preventing and treating diabetes. In his new book, Dr. Barnard comes up with an alternative that may be much more effective at preventing, treating and even reversing diabetes   Click here for more

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Diabetes humor site is forerunner in patient laugh therapy.  According to Chris Sparling, that's the prevailing sentiment over at the popular humor website LOL Diabetes.  Click here.

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