We Shouda Seen This...

On balance, we humans have a mixed record on spotting the obvious. Many if not most of you can usually pick it out of a "police"-style lineup. Then there are people like me. You could have The Obvious in a room by itself, put sparklers in each of its mitts, rent those huge spotlights they use at movie openings, and I wouldn't have a clue! (My friends who are willing to venture an opinion on the subject believe it's a lack of "common sense". If you ask me, "common sense" is pretty damn uncommon these days. But I digress...)

Still, there are cases when even I get it on the first, or at worst the second, try. Take this observation on the link between neighborhood styles and diabetes worked out by a team of US researchers and published this week. Makes sense: I mean, fresh fruits and vegetables, incentives for regular walking [public transportation, stores and other amenities within walking distance], plenty of fresh air and parkland to enjoy it in; increase the potential for healthy lifestyle choices, and you increase the likelihood that people will behave in a more healthy manner. Of course, I think the researchers are a bit naive when they assume that rebuilding developed areas of the US to reflect their findings is going to happen. Yes, we are in a diabetes epidemic [here and in most of the developed world]. Yes, it's likely [but don't quote me on this] that retooling our cities and towns for better health would reduce health care costs [not only for diabetes, but for heart disease, high blood pressure, and a whole list of illnesses] by a greater amount than the cost of renovation. I can't speak for other countries, but the idea of governmental "control" of our lives [even if the "control" is limited to making healthy lifestyle choices easier] usually doesn't sit well with Americans [Prohibition is the classic story of Government paternalism gone bad; there are others, including "sin taxes" (taxes on alcohol and tobacco), and mandates/recommendations (reducing speed limits to keep Federal road money, Government - recommended vaccines, etc)].

Yeah, propaganda is always a possibility to encourage more healthy behavior [that said, I think the poster on the right had more influence than the one on the left]. But propaganda's track record has been spotty at best in America; probably of limited use. So what's a diabetic

to do? Take responsibility, for one thing. Do all the little, sometimes annoying, things that help improve your health. Eat a healthy diet. Exercise. Keep up on checking your blood sugars, skin, feet. And walk a little more. If we're depending on the government to solve our problems, we're in a lot worse trouble than we think. At least that's what seems obvious to me.

-Mike Riley

Pause For The Cause...

It is with great regret that I must take a break from writing this blog. I have several personal matters to attend to, which will consume the vast majority of the time I used to spend writing it. As of now, I hope to return to blogging, in one form or another, in January of 2010.

I want to thank my readers and commentors for their friendship and insights. So that none of you will worry, please understand that my health is good. I just need to devote my full attention to these "off-stage" matters.

My intention is to leave the previously written posts up, for those who may not have yet read them.Entrecard advertisers: please be aware that I am taking no new ads. Any ads that I have already agreed to use will be presented as scheduled. I intend to leave the EC widget up, but EC may remove it because of no new posts.

Again, with regrets, I declare INTERMISSION. Smoke 'em if you got 'em...

-Mike Riley

What's Fair...

Sometimes writing a blog can be as educational as reading one. For instance, while doing research for this post, I discovered that the first recorded case of diabetes dates back to 1552 BC! Egyptian physician Hesy-Ra had no idea what was causing his patient's ailment, but was aware enough to note "frequent urination" as one of the illness's symptoms.

Of course, even knowing there was such a disease did little in the way of aiding treatment [the timeline linked to above notes that one 19th Century practitioner recommended a diet laden with sugar as therapeutic, while others suggested oatmeal, milk, rice, and even potato diets as helpful!].

Until the 20th Century, diabetes was rightly looked upon as a death sentence. Indeed, in one of the Sherlock Holmes mystery stories [written by Doctor Arthur Conan Doyle], Holmes chooses not to turn a murderer over to the police because, among other reasons, he was a diabetic, and likely to die soon.

The modern era of diabetes treatment began in 1921, when a team at the University of Toronto, led by Dr. F. G. Banting, first isolated insulin. Around 30 years later, oral medications were added to the arsenal of treatment. Research has continued on new treatments and, although diabetes is still incurable, it can be controlled by a combination of diet, exercise and, as needed, medication.

And yet...

And yet, diabetics can still face bias in their careers and everyday lives. Take Sonia Sotomayor, US President Barack Obama's candidate for the Supreme Court. Among other firsts, Sotamayor would, if confirmed by the Senate, become not only the first person of Hispanic ethnicity to serve on the High Court, but the first diabetic [given the age and health histories of some of the previous Justices, I have my doubts on that last point. But she would definitely be the first openly diabetic member]. While her selection has been welcomed in the diabetic community, some concerns have been raised. The argument says that, while Sotomayor seems to be in good health right now, complications arising from diabetes, as well as the on-going progression of diabetes itself, could leave her unable to serve an extended term on the Court [in the US, Supreme Court justices are appointed for life: in practice, however, the Court's members can and do resign when their health makes it impossible to serve]. Politics, of course, enters into the discussion [when doesn't it?]: Sotomayor is perceived as a moderate-to-liberal-leaning judge, based on her previous rulings, and those who agree with her decisions want to ensure that a Justice with that mindset serves as long as possible. Those who disagree with her previous rulings hope that, if she is turned down for the Court, the next candidate offered may be closer to their beliefs.

I am not an expert in law, or politics, or a lot of other things, for that matter. But I do see what goes on in the world, and I believe I can make observations based on what I've seen. I do not believe that anyone can predict the future. You can report statistics, make "educated guesses", or even just throw an idea out for consideration [the Criswell Predicts method]. Yes, Ms. Sotamayor may live a shorter life than other Hispanic women in similar health, but not diabetic. Then again, it is an unarguable fact, based on statistics, that women live, on average, five years longer than men. If another person became the Court nominee, that person could live a longer life than Sotomayor. Or they could be run over by a bus three months into their term. The point is, no one can predict the future. If opponents of Sotomayor base their arguments on opposition to her previous rulings, I respect their opinions, as I hope they would respect mine. But opposing her because of her state of health, or worse, using a health issue to cover other points of disagreement, is nothing more than a bias-laden ploy that should be naturally abhorrent to any fair-minded person. I hope things don't end up coming down to this.

-Mike Riley

Okay, What ELSE Can It DO?

The inquisitiveness of human nature may be one of our most-useful, as well as most-dangerous, character traits. YOU probably can think of "most-dangerous" examples without much help from me. But, for a moment, let's think about the "most-useful" trait of curiosity. For instance, who was that first brave person to get past the forbidding outer surface and enjoy a pineapple? What could have made him or her realize the sweetness that awaited beneath the skin? Or, picking a real hero, why did someone think that the inside parts of the artichoke plant would be good to eat [then again, as sometimes happens in bars at closing time with shots of hot sauce, could it have been a dare]? It's one of those questions that we'll never get a final answer to, but it does show the versatility we humans bring to the table.

Of course, this adaptability is not limited to our table habits. A tire iron is clearly designed for aiding in the removal or attaching of tires, but, in a pinch, it makes a fine weapon, suited for crashing across a rival figure skater's knee cap. What about the cottage industry that's sprung up around unintended uses for WD-40 [the company's official web site admits to over two thousand, and seems to demur only in cases of alleged medical uses]? Balding persons may recall that minoxidil, better known as Rogaine, was originally a high-blood pressure medication, that just happened to grow hair. Who knew?

This all came to me with word that Xoma Ltd, a medical company best known for its work in anti-inflammatory treatment, will report positive results this weekend for its Xoma 052 medication's Phase II testing on diabetics. Xoma 052, an anti-inflammatory, was reported as showing positive results in a presentation last weekend in Rome. Phase I testing was reported as successful last September, and the next report is expected at the American Diabetes Association 's 69th Scientific Sessions, being held in New Orleans. A couple of questions come out of all this:

-Did anyone realize that diabetes could be related to other illnesses caused by inflammation? Don't feel badly if you didn't; I didn't either, until I read a Xoma release that noted the inflammation angle has been under research for the last decade or so.

Xoma has high hopes for 052, believing it can aid sufferers of everything from rheumatoid arthritis, to heart disease, to, of course, diabetes.

-How effective is 052? I'm not a scientific expert, but some of the testing indicates fewer doses may be required than under current treatments. In fact, some research is indicating that as little as one dosage in 90 days, may cause a significant reduction in A1C levels. Anything that reduces the number of treatments will likely reduce the cost of treatment overall. Anything that can do that can help the millions of diabetics around the world that struggle to pay for treatment.

-Where can I get it? Nowhere yet. It's wrapping up Phase II testing in the US, and is on similar tracks in other countries. If the US FDA works at its usual pace, it'll probably be a year or two before Xoma 052 is generally available. This is not necessarily a bad thing. Considering the disaster that followed, for instance, the release of the diet drug fen-phen, a little caution is probably in order.

Is this a breakthrough? Maybe. Keep an eye out for more details as the research into anti-inflammatory and diabetes continues. This site will try to keep up.

-Mike Riley

Some Addicts Get Their Fix At McDonald's

One of my favorite TV shows when I was a kid was The Addams Family. I'm not sure why. Yeah, the action was frequently designed for the youngsters in the audience [lots of slapstick, things blowing up, etc]. Then there was Carolyn Jones, as "Morticia". She looked so good in that slinky long black dress, it might have single-handedly kick-started puberty in me! (Hang with me, Dear Friends; there is a point to all this...)

Years later [sometime in the 1970's, to be exact as I can], she was a guest on a radio interview show hosted by, of all people, Howard Cosell. During the broadcast, she referred to her husband at the time, who had a weight problem. She used the then-new term "food addict" to describe his eating style, then observed that food addicts are the only addicts who, by definition, have to use the addictive substance in everyday life. I've always thought it was an apt way to summarise the basic difficulty in weight loss for many people. (Of course, this isn't a weight-loss blog. And many diabetics, especially type I's, don't really have weight issues. But, as an obese type II, I think the topic is still valid for a diabetic blog.)

To start our examination, this article, part of a collaboration between ABC News and USA Today on health issues. It gives a good overview of the problem, and notes the difficulties in determining whether an eating disorder is food addiction or not [indeed, the article notes that there is no hard-and-fast definition of food addiction]. WebMD notes characteristics and signs of food addiction in this article, which connects food addiction with mental health. The website Springboard4Health.com [NB: the site sells nutritional supplements and other items as its principal reason for being, so its degree of unbiasedness may be questionable; however, the viewpoint its article on the subject takes is far from unique, and the article is well- and clearly-written] speculates that food allergies may be responsible for some so-called "food addictions". Finally, About.com notes the on-going controversy within the medical community about "food addiction" here.

Is there such a thing as "food addiction"? And, if so, what causes it [and, more

to the point, how can it be treated?]? Treatment will depend on the cause, and,

either way, the potential doesn't seem spectacular. If food addiction is a mental-health-related issue, most treatments seem to fall within the realm of "12-step" programs; many people find themselves unable or unwilling to complete such systems. If food addiction is caused by an allergy, the tedious, frequently drawn-out, and sometimes unsuccessful process of discovering what food is causing the allergy begins.

Is there such a thing as food addiction? Well, one of the finalists on the current edition of TV's The Biggest Loser has said he would formerly visit three or four fast food places during a relatively short drive. At each, he'd order a large amount of food, pull over, then consume his purchase by himself, in about five minutes. Compulsion, [perhaps] a specific food "trigger", shame [as an overeater, I certainly get this one]; it sure looks like food addiction, one way or another.

Is there hope for the food addict? Well, the person mentioned above is one of the finalists, so there is hope. But, like any addiction, there is also lots of hard work [physically and mentally] for anyone trying to get the Burger King off their back. The first challenge is finding a doctor willing to pursue the possibility; then, both doctor and patient must cautiously pursue whichever course of diagnosis and treatment seems most helpful.

-Mike Riley

Strength In Numbers

Whether it's building a barn or bringing your A1C number down, a few helping hands make the job easier. Depending on where you live, help may be close at hand. For instance, many communities have diabetic support groups. These groups usually hold open meetings on a regular basis, and are always looking for new members. Many times, these sessions pass along information on new diabetes treatment, new medications and advancements in technology [glucose monitors, pumps, etc]. They are also places to ask questions, share concerns, pass along experiences.

People joining groups sometimes find they are a bit shy; first of all, there is no shame in not knowing something. There is only shame if fear keeps you ignorant. People in support groups are almost always happy to share their knowledge, experiences and, yes, support [why do you think they're called "support" groups?]. Yeah, I know the image at right is about condom use [and, by the bye, if you're sexually active with multiple partners, condom use is a pretty darn good idea!], but the message works here too; "Dare to speak up, or shyness will kill you" [an interesting, if disturbing factoid from the International Diabetes Federation: nearly 7 % of the world's deaths each year are related in some way to diabetes. That's about the same rate of deaths worldwide attributed to HIV/AIDS. This is not a game...]

So, how do you find a support group? A good way to start is by asking your doctor or diabetic educator [you do have a doctor and diabetic educator as part of your treatment team, right? If not, go back a few posts and read this entry about who should be a part of that team]; they're probably aware of support groups in your area. If you live in a country with a strong diabetes association, it may have an office in your area. Give them a call. Look through the "events" section of your local newspaper, support groups usually publicize their meetings as well as they can. Many hospitals sponsor, or at least host, support group meetings. Give them a call [ask for the hospital's diabetic educator, if they have one]. If all these fail, why not start a group yourself? Now, that's brave! But it is doable. Contact one of the people you spoke to before, and ask for their help.

Of course, some areas just don't have support groups. Perhaps starting such a group is just not possible for you. Maybe you can't get to support group meetings. Or maybe you see yourself as a "lone wolf" [some people do]. There are [surprise!surprise!] online support groups. One I stumbled on just recently, and one I think you should at least look at, is TuDiabetes.com, an offshoot of the Diabetes Hands Foundation. A quick look at the discussion groups with in TuDiabetes reveals on-going entries on subjects as diverse as:

-pros and cons of glucose monitors

-users of one or more types of insulin

-questions and concerns of diabetics like you.

It's free to join, and, even if you find a good support group, it can serve as a source of information between group meetings [or give you something to talk about at that next meeting]. (Remember, any changes in your treatment should always be discussed with your doctor first.)

Don't let fear keep you out of the loop. Find a support group, check out TuDiabetes, stay informed! Knowledge is more than power; it's the first step in improving your health.

-Mike Riley

A=>B=>?

Sometimes what you plan is not what you get. For instance, this was supposed to be an entry about how pale your fingernails are can be an indicator of diabetes, based on this item from WebMD. But, before I could write it, my reality changed.

For some time now, I have had swelling in my legs; it's believed to be a result of my heart attack in 1995. Before you ask, no, it's not painful, and, except for leaving me less than attractive in a pair of shorts, causes me no particular difficulties. But for the last few weeks, my left leg ballooned to a disturbing size. Walking became very difficult, and I was in great discomfort. Like most people, I was stalling seeing a doctor about it [I have an appointment with my regular physician early next month, and I thought it could wait]. A visit to my podiatrist last Friday changed my mind. He reminded me that I had had a blood clot in the leg two or three years ago, and that I should have it checked. So off to the Emergency Room I went [my doctor, for various reasons, is unavailable several times during the week], TheWomanILove dragging me, kicking and screaming a little [me, not her].

After several hours in ER, the physician on-duty decided it would be best to admit me. I spent the rest of the weekend, plus all of Monday and most of Tuesday in a hospital bed, waiting while the medical staff resolved the issue. Turns out I had an infection in the leg [source unknown as of this writing]; a regimen of antibiotics, along with a little rest, seems to be doing the trick.

Interesting, you're probably saying. But what has this to do with diabetes? A few things:

-diabetics are more prone to infections - it's very important for diabetics to keep up on any infections they do have, and vigilant about infections they may get [since, in addition to being easy targets for illness, we don't recover from them as easily as our non-diabetic friends].

-diabetes can lead to other serious complications - of course, it's difficult to prove that my diabetes led to my heart disease, which led to the heart attack, which led to the swelling, which might have contributed to my infection. But it's not an unlikely chain.

-diabetics need to stay on top of anything that's wrong with them - I don't know if this could have turned into something worse than it was. Fortunately, I'm not going to find out. But I'm stubborn. Don't you be stubborn.

-Mike Riley