Tag Archives: diabetes


medications-257370_640The newer diabetes medication Januvia was recently found to cause severe joint pains in a few patients (28 cases) and it made the news as a result.  The FDA came out with a warning about this association and concern that this may be seen more commonly as it is an unexpected side-effect not seen during the drug trials to confirm safety.

The FDA is very good and identifying dangerous issues with medications, but it is an imperfect process, and post-marketing monitoring is an essential part of the safety protocol for all new medications.  Given the unexpected nature of these side effects from medications, I tend to delay prescribing new medications for a few years, until the initial roll-out of the medication to the public, unless the particular circumstances for a patient dictates otherwise.  Being conservative in prescribing new medications is a simple measure that can be used to prevent unintended issues from developing when new medications are released.  In fact, the pharmaceutical representatives will often chide me for being willing to finally write their prescriptions 5-8 years after they have been released.

Read more on Januvia >>>HERE<<<<


Baum Howard B-70838Dr. Howard Baum is a close friend of mine and an outstanding endocrinologist who is on the faculty of Vanderbilt University Medical Center.   During a recent visit I was able to ‘pick his brain’ on three topics of importance and interest to many patients who see me.  Check out his podcasts on:




You will learn practical information that will guide you in understanding these conditions, and you will be able to manage your own disease better.


stethascopeI always liked that saying about the canary.  Perhaps it wasn’t such a good job being the canary, but the idea of a simple measure to assess a situation is a great idea, and the latest information on diabetic patients gives us just such information.

Diabetic complications have fallen sharply over the past few decades, and this is due to progress in medicine.  Specifically it relates to reducing cholesterol and blood pressure.  There is some help from reduction in blood sugar, but the lion’s share of the reduced complications in diabetes are related to our ability to modify those aspects of diabetes that many of us share in common:  High Cholesterol and High Blood Pressure.

The modern area (past 30 years) have seen the advent of an array of medications that have changed the health of America.  They are:  Cholesterol mediations (statins) and ACE Inhibitors (blood pressure medications that are good for heart and kidneys).

So, if you have any question about the benefits of these medication, any many people do, we can look at the population of diabetic patients.  They are the ‘canaries’ as they will be the first to show issues, and the data is clearcut….these medications are preventing illness, making lives better, and making them longer.

Read more >>>>>>>HERE


dreamstime_l_3003410I’m not a big shopper….but I do love a bargain. Probably comes from traipsing around with my mom when I was a kid, or now with my kids when they are shopping. If it’s a sale item it looks so much better!
I’ve told you all before about shopping for best prices at Costco through their price-checker website, but one item that was always expensive was insulin….but lo-and-behold my buddy, Dr. Howard Baum, the endocrinologist from Vanderbilt, showed me that Wal-Mart has inexpensive diabetes products, including inexpensive insulin manufactured by Novo-Nordisk.  The insulin is called RELION.

They do not carry Lantus or Levimir, the once daily insulins, but they carry other fine versions of insulins including N, 70/30, and Regular.  These can be used if you need a lot of insulin and need to save $$$s.

If you are paying cash for your diabetic supplies, we’ll talk about trying the Relion products.  They are about 10% of the current insulin prices.  (Thank you Wal-Mart!!! ….this is a feather in their cap)


grapesCertain Whole Fruits Linked to Lower Diabetes Risk

By Amy Orciari Herman (www.jwatch.org website)

Adults who frequently consume certain whole fruits, including apples, grapes, and blueberries, have a significantly lower risk for type 2 diabetes than those who eat little fruit, according to a BMJ study.

Three cohorts of U.S. healthcare professionals, comprising nearly 190,000 adults without diabetes at baseline, regularly completed food-frequency questionnaires. During some 3.5 million person-years of follow-up, over 12,000 developed type 2 diabetes.

The risk for diabetes was significantly reduced with every three servings per week of blueberries (hazard ratio, 0.74), grapes and raisins (0.88), apples and pears (0.93), bananas (0.95), and grapefruit (0.95). Consumption of fruit juice, on the other hand, was associated with increased risk (hazard ratio for one or more servings/day: 1.21).

“These results support recommendations on increasing consumption of a variety of whole fruits, especially blueberries, grapes, and apples, as a measure for diabetes prevention,” the researchers conclude.



Peripheral Vascular Disease, also called PAD (peripheral arterial disease), is characterized primarily by issues with bloodflow to the legs, leading to claudication (pain with walking distances that ameliorates with resting), but there are other aspects of this condition which include carotid artery disease and aortic aneurysm.

To determine who is at risk we generally look to risk factors the predispose to these issues and a new study in the JAMA (Journal of the American Medical Association) confirms the four major risk factors.  They are:  smoking, high blood pressure, high cholesterol, and diabetes.  A combination of these conditions markedly increases risk for developing PAD.   The hope is that agressive risk factor modification will reduce this risk with time.

Read more:



Type 2 diabetes is due to a relative lack of insulin effect, which is often connected to an individuals weight. We all know that being overweight is a risk for developing diabetes and that losing weight, therefore, should prevent the development of diabetes.
In a large study from Sweden, recently published in the New England Journal of Medicine, patients who were markedly overweight (BMI=40 or greater) had a reduced risk of diabetes when they had surgery for weight loss.
The 45 pounds of weight lost by the average surgical patient (either banding procedure or full gastric bypass) resulted in a 90% reduction of diabetes compared to ‘standard care’ for obese patients.
This result is touted as a major ‘advance’ in our understanding of diabetes, but really it just confirms what we already presume to know…..increased obesity is linked with diabetes and weight loss is linked with it’s prevention.


ACTOS (Pioglitizone) is a medication for Type 2 Diabetes that works by making your own insulin work more effectively in muscle, fat, and liver tissues.   It is a very effective and tolerable medication, but there are some controversies.

It has been available for over a decade and is now going generic.  Since this medication is very pricey, a generic alternative is a great savings.

Recently, a patient told me that his pharmacist said ACTOS would be taken off the market due to dangerous side effects…..but this is not the case.  There have been some issues with this class of medication and with ACTOS in particular, but none have been severe enough to warrant removal of this medication from use.  The controversies and issues are:
1.  Liver inflammation–This has rarely been a concern.  Simple blood test monitoring when you begin the medication can monitor this issue.

2.  Heart Failure–Another medication in this class, AVANDIA, has been known to cause issues with fluid retention in patients with congestive heart failure and is not to be used in such patients.  ACTOS has not been criticized as much as AVANDIA, for this issue, but it is still a consideration with ACTOS and if you have heart failure, ACTOS is not advisable.

3.  Bladder Cancer–Recent studies show a potential increased risk of bladder cancer in patients specifically on ACTOS.  In fact, I have seen advertisements on TV, from lawyer groups, looking for patients who want to sue the drug manufacturer if they have bladder cancer and are on ACTOS.  Whether this association is enough to warrant more caution in the future, it is unknown and the issue is under further investigation.  At this time, ACTOS has a warning noted on it’s package warnings about this potential, but the severity of the association will need further data.

Controlling blood sugar is critical for the health of diabetic patients and ACTOS can be an effective medication in assisting in treatment.  There are consequences of poor sugar control, just as there are side effects from medications.   The balance of pro’s and con’s need to be considered for each individual patient in deciding on the need and use of ACTOS….but for now, as Mark Twain said about his premature obituary:  “The reports of my death are greatly exagerated!”

Read more at:





Recent reports have confirmed that statin medications, like Zocor and Lipitor, do increased a person’s risk for developing diabetes over their lifetime.  This is an important issue and any negatives from the medication need to be weighed against their positives.

For cholesterol medications, in most instances, the benefits ‘do’ outweigh the negatives.  A recent study from Taiwan shows the risk-benefit profile remains favorable for these medications.


So……rather than stopping your statin or worrying, next time you are in the office we can address this concern with a simple blood test looking at diabetes issues.  Of course, keeping the diet ideal and weight best is the key to preventing diabetes in the first place.   For more information on the foods to avoid….read this list on Pre-Diabetes, by Debbie Landau-West, our favorite dietitian.



Metformin (Glucophage) is a medication used in treating diabetes for the past 50 years. It has a great track record of safety and is very inexpensive.
It has always been recognized as a ‘first line’ therapy, as it reduces the body’s insulin levels and helps in losing weight.
If that weren’t enough, recent studies have suggested that it also reduces the risk of various cancers, again, by reducing insulin levels.
This cancer reduction was recently confirmed in a large study from Holland, which included 85,000 diabetic patients.
This is great news and makes me even more of a supporter of the use of Metformin in a majority of diabetic patients, as opposed to using more expensive, and newer medications such as ACTOS or JANUVIA.
Often, Metformin needs to be used in combination with other diabetic treatments, but I will continue to focus on Metformin as the lynphin in oral treatment for Type 2 Diabetes.