ADA Standards of Medical Care in Diabetes 2012

The ADA has just released their 2012 Position statements on several issues. A clickable set of pdf files can be found in the latest Diabetes Care Table of Contents page.

The most important document is probably the overall position paper: Standards of Medical Care in Diabetes 2012

I am posting the links immediately for those who wish to read the ADA documents for themselves in detail. I will post more detailed comments later after I have had time to analyse the full document.

A quick skim found that there are some significant changes, especially in acceptance of low-carbohydrate diets in the Medical Nutrition Therapy section. Unfortunately, they tend to still qualify that with statements like:

• For weight loss, either low-carbohydrate, low-fat calorie-restricted, or Mediterranean diets may be effective in the short term (up to 2 years). (A)

• c For patients on low-carbohydrate diets, monitor lipid profiles, renal function, and protein intake (in those with nephropathy), and adjust hypoglycemic therapy as needed. (E)

With no direct acceptance that low-carb may be better for blood glucose levels, not just weight. There is some oblique acceptance:

115). A meta-analysis showed that at 6 months, low-carbohydrate diets were associated with greater improvements in triglyceride and HDL cholesterol concentrations than low-fat diets; however, LDL cholesterol was significantly higher on the low-carbohydrate diets (116).

 and earlier in the paper:

Macronutrients in diabetes management

•  The mix of carbohydrate, protein, and fat may be adjusted to meet the metabolic goals and individual preferences of the person with diabetes. (C)

• Monitoring carbohydrate, whether by carbohydrate counting, choices, or experience-based estimation, remains a key strategy in achieving glycemic control. (B)

• Saturated fat intake should be <7% of total calories. (B)

Of course, that final comment can make low-carbing difficult for some. Not for me; I simply ignore that :)

There are also some other significant changes in non-dietary areas, such as very qualified acceptance of the value of post-prandial home testing.

One of the changes that may be of concern to those who believe that diet and exercise should be tried first and medication should only be added if d&e is inadequate is this:

2. Therapy for type 2 diabetes

Recommendations

•  At the time of type 2 diabetes diagnosis, initiate metformin therapy along with lifestyle interventions, unless metformin is contraindicated. (A)

There is a lot more; take a little time to read the papers in depth.

Cheers, Alan, T2, Australia

Everything in Moderation - Except laughter

What on Earth Can I Eat? Now out as an eBook!

When I reached my '50s I mistakenly thought that my learning years were long behind me. 

How mistaken I was. My double diagnosis in 2002 led to a whole new world where I was a naïve ignorant student learning about a host of mysterious things neglected from my education in my various earlier stages of life. Things like carbohydrates, insulin, blood glucose, lymphocytes and all that.

Some of those subjects were vital to my continued health. In many of those fields I will be a student for the rest of my life.

Other things I had to learn were less directly important but still necessary to assist my search for knowledge; thus I became net-savvy and learned how to use the web and usenet to get the information I needed. Later, further learning was needed to allow me to find ways to pass on to others the knowledge I had gained. As a consequence I spent a lot of time in 2010 researching self-publishing;. That led to me eventually publishing What on Earth Can I Eat? late last year.

Originally that was going to be the only form of the book, but after publication I received many requests from people to produce an ebook. That involved another learning curve, as I tried to re-work the manuscript for the various e-reading options. I floundered around until I was directed to Smashwords. That made it so much easier.

So now, responding to popular demand, the ebook is out there on the web!

I have to admit I'm still an old fogey and tend to prefer printed books, but for those modern people who prefer to download and read on their Kindle (or any other ebook reader) please click here: What on Earth Can I Eat? Food, Type 2 Diabetes and You. As a service to my blog readers, a $1.00 discount is available if you  include coupon number JP52U when you get to the checkout.

The Discovery of Insulin

A couple of years after I was diagnosed I spent a fascinating few hours reading a Canadian web-site titled “The Discovery of Insulin”. Recently I went looking for it again and was sorry to see it was no longer directly available on the web.

However, all is not lost! The marvellous way-back machine was able to find it again for me. I don't know how long such archives are kept, so I suggest you don't delay if you are interested in reading this wonderful story.

Begin here: The Discovery of Insulin

Use the site as you would any other, clicking on icons as appropriate. The way-back bar at the top is not too intrusive. I suggest you start by clicking “Enter” then click on “Introduction” before reading the rest. Click on the “Home” button at the top or your “back” button if “Home” is missing to return to the index page after you finish each section.

The dLife web-site also has a three-part video series on the discovery of insulin. I was unable to find the code to show them directly here so you will need to click on the links. The "non-intrusive" ads for Novo-Nordisk are worth wading through for the story.

The Story Of Insulin, Part 1

The Story Of Insulin, Part 2

The Story Of Insulin, Part 3

For those in the Tampa area tomorrow or in the Tyler, Tx, region next month, this exhibition may also be worth attending: Breakthrough: The Dramatic Story of the Discovery of Insulin

After reading and watching all of that information I was reminded again how remarkable this achievement was and how close it came to not occurring. There are millions of diabetics alive today as a direct consequence of the discovery; the story of Dr Lois Jovanovic's grandmother gives the perspective of those living under a death sentence back in the 1920s. As a lateral thought, one has to wonder whether it would have ever been discovered if there had been the same strict rules for using animals like dogs in lab experiments then as there are now.

At the moment I do not need insulin, but I am very grateful that it is available for that possible day in the future when I may need to.

Cheers, Alan, T2, Australia

Everything in Moderation - Except laughter