Higher Level of Vitamin D Associated with Lower Risk of Developing Type 1 Diabetes

March 30th, 2013 by DoctorZaidi

A recent case-control study analyzed the data from healthy military service members between 2002-2008. Blood samples for 25 OH Vitamin D level of 1000 cases who later developed Type 1 diabetes, showed a clear inverse relationship between the level of vitamin D and risk of developing Type 1 diabetes. A serum 25(OH) D concentration ≥60 nmol/l was associated with a 3.5-fold lower risk of developing Type 1 Diabetes.

http://www.ncbi.nlm.nih.gov/pubmed/22955995

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Traditional Diet and Exercise Failed to Reduce Heart Attacks , Stroke and Mortality in Type 2 Diabetics: Unexpected Results of a Landmark Trial, Known as Look AHEAD.

October 21st, 2012 by DoctorZaidi

The Action for Health Diabetes (Look AHEAD) study, a trial comparing an intensive lifestyle-intervention program versus the standard diabetes support and education had to be stopped, as it failed to show any improvement in cardiovascular events or death rate. It is interesting to note that previously, the investigators were all excited that the trial would show a reduction in cardiovascular events, as it had shown improvement in cardiovascular risk factors. http://www.ncbi.nlm.nih.gov/pubmed/17363746

The study began in 2001 and was funded by the NIH (National Institute of Health). It enrolled 5145 Type 2 diabetic patients, who were roughly, equally divided into two groups: The intensive lifestyle-intervention arm, which included individual sessions with a nutritionist and/or personal trainer, as well as group sessions and refresher courses versus the control group that received standard diabetes support and education.

Intensive lifestyle-intervention did show an improvement in cardiovascular risk factors, but it did not translate into reduction in cardiovascular morbidity or mortality. In other words, intensive diet and exercise conducted with the help of dietitians and exercise trainers did not make any difference, as far as cardiovascular events are concerned.

It is an excellent study that brings out several points: Current diet and exercise recommendations can improve cardiovascular risk factors, but do not prevent heart attacks, strokes and deaths. Isn’t it time, we reevaluate our so called cardiovascular risk factors? Perhaps we are missing something. One such major factor is stress, which is well known to cause heart attacks and stroke. We don’t even mention stress management when we talk of lifestyle intervention. Interesting, isn’t it? Perhaps our recommendations about diet and exercise are also flawed.

I came to these conclusions about fifteen years ago and developed my own treatment strategy for my Type 2 diabetic patients. It consists of five steps: My own recommendations about diet, exercise, stress management, vitamins/herbs and medications, in that order. The results have been astounding. Heart attack or stroke is a rare event in my Type 2 diabetic patients. When some of my Type 2 diabetic patients get hospitalized for elective surgery, usually some orthopedic surgery, they are shocked to see the kind of food on their tray (like cake, cereal, juice and pancakes) at the hospital. They refuse to eat half of those food items. Sadly, they also see the high charges of the dietitian’s consultation fee on their discharge bill.

I Have discussed my revolutionary, comprehensive and scientific treatment strategy in my book, “Take Charge of Your Diabetes.”

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How often should I check my blood glucose?

October 12th, 2011 by DoctorZaidi

If you are Type 2 diabetic, Ideally, you should test your blood glucose first thing in the morning and then about two hours after each meal. For many patients, this becomes cumbersome. Pricking your fingers several times a day is no fun. I tell my patients to rotate the timing of testing each day. For example, one day check it in the morning, the next day check it two hours after lunch and the third day, do it two hours after dinner.

The two hours post- meal blood glucose value is particularly important for the following reasons: 

  • It has been shown to be closely linked to the risk for heart attack in several excellent medical studies.
  • It shows the impact of your food on your blood glucose. The two hours post-meal blood glucose value should be less than 140 mg/dl, preferably less than 120 mg/dl. A value more than 140 mg/dl indicates that you either ate too much or you ate the wrong food or a combination of these two factors. You should write down what you ate. Soon you will know what to eat and what to avoid. Share this diary with your doctor on each visit.

Excerpt from “Take Charge of Your Diabetes.”

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FDA warns: Victoza (Liraglutide) may cause Acute Pancreatitis and Medullary Thyroid Cancer.

June 21st, 2011 by DoctorZaidi

Victoza (Liraglutide) is an antidiabetic drug which was approved by the the US Food and Drug Administration (FDA) in January 2010. Finally on June 13, 2011 FDA decided to warn healthcare professionals to closely monitor patients receiving this anti-diabetic drug for thyroid C-cell tumors and acute pancreatitis.

What is Thyroid C-cell tumor?

C-cells are special cells in the thyroid gland, which produce a special hormone called calcitonin. Cancer of these cells is called medullary thyroid cancer, a rare but one of the most malignant thyroid cancer.

What is Acute Pancreatitis?

A potentially life-threatening condition which causes acute upper abdominal pain, often accompanied with nausea and vomiting and usually radiates to the back.

Comments by Dr. Zaidi

When Victoza (liraglutide) was first approved and I saw the drug package insert warning about the potential for medullary thyroid cancer, I decided not to prescribe it to any of my patients. My guess is any endocrinologist who have dealt with medullary thyroid cancer patients would have decided along the same line.

I am glad finally FDA is warning physicians especially primary care physicians about these potential but very serious side-effects of this drugs.

It also reminds me of a very wise statement: There is not a problem till there is a problem-solver.

Actos (Pioglitazone) may increase risk of Urinary Bladder Cancer.

June 15th, 2011 by DoctorZaidi

 

FDA issued a public safety information today ( June 15, 2011) that pioglitazone ( sold under the brand name of Actos) may increase the risk of urinary bladder cancer if drug is taken more than one year and in high doses. These finding are based on the interim 5-year review of an ongoing 10-year epidemiological safety study on pioglitazone. Earlier this week, pioglitazone was taken off the market in France. And In Germany, physicians are advised not to start any new patients on pioglitazone.

In the US, the drug is on the market. Physicians are advised to be more careful about signs and symptoms of potential urinary bladder cancer such as blood in the urine, urgency of urination, low abdominal pain and pain in the low back. The continuation of the use of pioglitazone (Actos) is a decision between patients and their physicians.

Comments by Dr. Zaidi:

I think, France and Germany have over-reacted. To put things in perspective, patients with type 2 diabetes are at increased risk of any type of cancer, including urinary bladder cancer, which is a rare cancer. Why? primarily because these patients have underlying insulin resistance with compensatory high insulin level, which causes growth of tissues, benign as well as malignant.

Insulin resistance is the consequence of a number of factors including genetics, aging, obesity, sedentary lifestyle, stress and vitamin D deficiency. Therefore, my treatment approach consists of diet, exercise, atress mangement, vitamins and medications.  As far as medications are concerned, I use metformin and pioglitazone, as these are the only two drugs that treat insulin resistance: metformin treats insulin resistance at the level of liver and pioglitazone at the level of muscle and fat.

With this comprehensive approach, I have seen some amazing results in my patients: an excellent control of diabetes, with very few complications and almost no one  requiring insulin therapy.

In the last 12 years, I have treated thousands of type 2 diabetics with my above mentioned approach. Fortunately, I have not encountered a single case of urinary bladder cancer.

However, we should be careful with any drug and I agree with FDA patient safety information about pioglitazone. 

To view FDA report, please visit www.DiabetesSpecialist.com

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Stress and Diabetes Connection

March 12th, 2011 by DoctorZaidi

 

Stress Causes Diabetes

While there are several factors that contribute to the development of diabetes, stress is an important one.

 This is how:

Type 2 Diabetes:

           About 95% of diabetics suffer from Type 2 diabetes, which occurs due to a process in the body called insulin resistance.  Stress is a major cause for insulin resistance. Obesity is another important culprit for insulin resistance. Stress through Stress Eating plays the main underlying cause for obesity. In this way, stress significantly contributes to a person’s obesity and risk for developing diabetes. 

Insulin resistance is a process in the body which causes insulin, a chemical in your body, to be less effective in keeping your blood sugar normal. Consequently, your body produces more insulin in order to keep your blood sugar normal. This compensatory increase in the amount of insulin may control your blood sugar for a while, but it’s harmful for the rest of the body. Large amounts of insulin can raise your blood pressure and increase your risk for cancer. Insulin resistance also increases your risk for heart attacks and strokes

After many years of escalating insulin resistance, eventually your insulin producing cells in the pancreas get exhausted and cannot churn out the huge amounts of insulin needed to keep your blood sugar normal. At this point, your blood sugar starts to rise and you end up being diagnosed with Type 2 diabetes. 

Type 1 Diabetes:

Type I diabetes is the other type of diabetes. It is much less common, accounting for about 5% of diabetics. Type 1 diabetes is an autoimmune disease in which your dysfunctional immune system starts to attack and kill your own insulin producing cells. Eventually, your pancreas is unable to produce any insulin and you become diabetic. As I mentioned earlier, stress is a major reason for the dysfunction of your immune system. To learn more about diabetes, please refer to my book, “Take Charge of Your Diabetes.” 

Stress Worsens Diabetes.

Many diabetics know that their blood glucose gets elevated when they are under stress, even though their eating habits didn’t change at all.  They also know that with the release of stress, their elevated blood glucose comes down. 

Over the years, I have seen many such examples. I vividly remember one particular case. 

The gentleman was a highly successful businessman who was struggling to keep his blood glucose levels down. Then he went on a vacation to his native homeland in a rural setting. When he came back from vacation, he came to see me. “Doc, you’ve been telling me about the effects of stress on diabetes. You are absolutely right. During my vacation, my blood glucose readings were perfect for the first time. Now that I’m back at work, my blood glucose levels are going up again.” He was genuinely excited to see for himself the strong relationship between stress and high blood glucose levels.  

Even subtle stress can elevate your blood glucose levels. For example, some diabetics get so preoccupied by their blood glucose readings that they stress themselves out. As a result, their blood glucose reading starts to escalate. Then, they get more stressed out and a vicious cycle sets in. 

I remember one lady who was always preoccupied with her blood glucose readings. During one visit, I told her to stop checking her blood glucose. Two months later, her diabetes was under better control, as evidenced by her blood test report from the laboratory. She was completely amazed.

 These examples clearly demonstrate the negative impact of stress on diabetes.

Tingling in a Diabetic

November 8th, 2010 by DoctorZaidi

Tingling in a diabetic is usually due to a complication of diabetes known as peripheral neuropathy. It usually starts in the toes and in time, can progress to involve the entire foot, bilaterally. Sometimes, it can even extend into the legs below the knees. At times, it can also involve fingers and hands. Hence, the description in medical books as “stockings and gloves” neuropathy.

Tingling due to peripheral neuropathy in diabetics typically starts to occur at night. In more advanced cases, it is present through the day as well, but is worse at night.

Tingling can also be due to other factors such as Vitamin B12 deficiency which is quite common in diabetics who take Metformin to control their diabetes. Some drugs such as Niacin can also give rise toa  tingling sensation.

A good control of diabetes and Vitamin B12 supplements via sublingual route or by subcutaneous injection can make a big difference.

Please refer to my book ” Take Charge of Your Diabetes” for an indepth discussion about the treatment of diabetic peripheral neuropathy.  

 

Written by Sarfraz Zaidi, MD, FACE.

All Rights Reserved.

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No insulin shots for diabetics

May 13th, 2010 by DoctorZaidi

The majority of diabetics have Type 2 diabetes. In these individuals, the root cause of diabetes is insulin resistance. Therefore, treatment should aim at reducing insulin resistance. When you treat insulin resistance, you not only control blood glucose levels, but also prevent heart attacks and strokes, which are other manifestations of insulin resistance. I have developed a strategy to treat insulin resistance that has worked well in thousands of my diabetic patients over the last 15 years. I have discussed this strategy in detail in my book, “Take Charge of Your Diabetes.”

Written by Sarfraz Zaidi, MD.

 www.Doctorzaidi.com

All Rights Reserved.

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Avandia and Heart Disease

March 31st, 2010 by DoctorZaidi

Avandia (rosiglitazone) is back in the news!

According to the New York Times, an internal F.D.A. reports say “that if every diabetic now taking Avandia were instead given a similar pill named Actos, about 500 heart attacks and 300 cases of heart failure would be averted every month because Avandia can hurt the heart.”

Since late 2007, there has been controversy about the safety of Avandia, but the F.D.A. has decided to keep the drug on the market.

Back in 1999, when Avandia and Actos were released to treat Type 2 Diabetes, like some other endocrinologists, I picked Actos over Avandia. Why? Because although the two drugs belong to the same class of drugs, TZD  (Thiazolidinediones), they are different from each other as far as their effect on Triglycerides (lipids) is concerned.

In Type 2 diabetics, there is an increase in the blood level of triglycerides, which is due to insulin resistance at the level of the fat cell. In the vast majority of Type 2 diabetics, insulin resistance is the root cause.

While Actos consistently decreases the level of triglycerides, Avandia has variable effects and can sometimes increase the blood level of triglycerides. For this reason, I decided to choose Actos over Avandia and was not swayed by the intense marketing done by Avandia’s manufacturer, GlaxoSmithKline.

As it turns out, this was a good decision. My patients have benefitted from the great effects of Actos and did not suffer from the potential bad side-effects of Avandia.

Over the last ten years of using Actos in thousands of my diabetic patients, I find this drug to be safe and an extraordinary drug in treating Type 2 diabetics.

Written by Sarfraz Zaidi, MD.

 www.Doctorzaidi.com

All Rights Reserved.

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