How Estrogen Influences Glucose Control

estrogenWhen you realize the power estrogen has in the balance of glucose, you may have a new respect for the hormone. An expert in estrogen and beta cells, Dr. Franck Mauvais-Jarvis speaks with me about his work. Our conversation may teach you things about your body you never thought applied to you.

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Exercise to Slow T1D Onset

delay_T1DonsetgIf only we knew of an effective way to slow the onset of Type 1 diabetes. Starting with this premise, Clinical Senior Lecturer and Consultant at University of Birmingham, Dr. Parth Narendran speaks with me about how exercise may prove to be the free panacea to this unfair force of nature. The origins of this work was published as a debate article in Diabetolica.

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The Abusive Relationship with my Doctor

ozuredexTrustworthiness is the most valuable tool when it comes to a doctor-patient relationship. It’s been nearly six years since I encountered the most abusive relationship I’ve known in my life. Before I delve further into my explanation of this “abusive relationship”, I have to explain how I feel about choosing a medical team.

When it comes to a chronic disease, the doctors you choose to make up your medical team should be nothing less than excellent. These healthcare providers are going to be a part of your life. Not too different from friendships, you want somebody who is reliable, responsible, and trustworthy. When you’re looking for a guardian of your health, whether or not they can make you laugh and get your sense of humor is irrelevant. Remember, were interviewing for your health like your life depends on it.

In 2008, I had to choose a new retinal specialist because I started a new health insurance. The retinal specialist that I had been seeing since 1996 did not take my new health insurance. This turn of events led me to her office. This new retinal specialist wrote all her notes by hand. However she did all her treatments by injection.

My first appointment with her was in March 2008. At the time, I had just experienced my first vitreous hemorrhage. Without blinking an eye, no pun intended, she recommended an ocular injection of Avastin. She just met me and knew nothing about my medical history. Three days later, I blacked out when I was driving.

My next appointment with her was in June 2008. Curiously, she offered another injection. This time it was for diabetic macular edema. The vitreous hemorrhage did not clear from the Avastin injection. As she was aware of my blackout from the first shot, this time she injected me with Lucentis. A few days later I had a stroke and spent a week in the hospital.

She came to the hospital after my internist and neurologist called her. She did not mention to them that this injection could have caused a stroke. No worries. As my neurologist was still concerned, he performed a spinal tap. The results from my cerebrospinal fluid came back pristine. My neurologist recommended that I get a second opinion from a doctor who was the director of optometry at a local university.

The next time I saw her was September 2008. I advised her that the neurologist recommended I get a second opinion from the director of optometry. She asked who he had recommended I see for a second opinion. I told her the name. She responded,” I know him. I wouldn’t waste your time. You won’t get to see him but you’ll probably be seen by one of his students.”

I didn’t think much of her reaction at the time. But I never forgot it. Without fail, I still had diabetic macular edema.  So her decision was to treat with another injection. This time, she said,”Macugen is much better than Lucentis.”  Following my blind faith, I went with her recommendation.

Avastin and Lucentis belong to a class of drugs known as anti-VEGF which are used to treat cancer. Essentially they are chemotherapy. Chemotherapy is a cumulative treatment. This means that the more you get it, the more concentrated it becomes in your body. In hindsight, it makes perfect sense that I blacked out after the first injection and had a stroke after the second. But at this time, I was still unaware of the side effects of these drugs. I was just under the impression that she was doing the best she could for my eye health. I feel so stupid now.

After the stroke, I had gone to physical therapy for a few months. Part of the brain that regulates balance was affected from the stroke. My ability to track items with my eyes was affected, as well. Having gone through extensive testing, CAT scans, MRIs, and dozens of blood tests the only thing that was clearly failing in my body were my kidneys. Under the delusion that my doctor would never make a poor decision for my health, I just believed this stroke happened because of my kidneys failing.

This is where the story gets very interesting to me. My next appointment was in December 2008. From what I can remember, I hadn’t noticed an improvement in my vision. In fact, it continued to get worse since I began seeing this doctor. The interesting thing on this appointment is that she was going to give me an injection of Macugen but learned that they didn’t have one in the fridge. So she said everything looks good. So my “Christmas present” was to go home and enjoy the holiday. There’s a reason I didn’t get the injection and it wasn’t because of the medical necessity.

The Macugen injections she gave me were based on a patient assistance program called the Macugen Access Program. Every time she gives me an injection, she can order another dose of Macugen to issue. Whether it’s for me or somebody else is irrelevant. Every appointment, she’d ask her office manager “do we have one in there for Allison?” Thank goodness that she didn’t have one for me. This had nothing to do with the spirit of Christmas. It was green but didn’t smell like a Christmas tree.

My next appointment was in March 2009. Sure enough, she gave me a shot of Macugen. Remember what I said about the cumulative effects of chemotherapy? The last injection of Macugen I had received was in September 2008.

My next appointment was in June 2009. This was the straw that broke the camel’s back. On this appointment, she gave me an injection of Macugen. Sure enough, days later I was in the hospital having suffered another stroke almost a year after the first one. This hospital stay was not one week. This hospital stay was one month, followed by years of physical therapy, speech therapy, and occupational therapy.

So as my kidneys and vision were failing, I couldn’t help but revisit the details of each and every appointment with her. As soon as I got out of the hospital, I requested a copy of my records from her office. Something seemed off to me when months later I hadn’t received my records from her office. So I took the next step and contacted the OPMC or Office of Professional Medical Conduct.

Within a few weeks, I’d received all my records from her office. Strangely enough, they were not handwritten like they were when she saw me. They were all electronic medical records. Also, there were several informed consent signatures in my file. I had never seen any of these informed consent forms. The package that the OPMC received contains sanitized records and forged signatures.

Furthermore, the medical records provided to the OPMC indicated falsified appointments where supposedly I had received injections that never happened. There are so many details to this story that are falsified in her office records that it makes me feel violated. My visual health in the 15 months I saw her declined consistently. I dismissed it as my kidneys failing but now I know better.

The important thing is that today I’m alive and well. I know what I can do to make the most of my experiences in life. I’ll always be sad for trusting the doctor who hurt me, over and over again. The bright side is my health, my loved ones, and my unwavering hope to keep learning and sharing every day to improve life for others. Even when there are dark clouds in the sky, the sun will shine again.

I hope my YouTube video explains why I’m happy about my bloody eye. With good reason, my new retinal specialist heard me out and made the decision to treat me with Ozuredex. Thank you for letting me share this story.

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When Good Cholesterol Turns Bad

cholesterolDid you know sugar substitutes can kill good HDL cholesterol? There’s more explaining to it and the lead investigator of this study speaks with me to help us understand what this means. Lead researcher Dr. N Rabbani, of the Warwick Medical School, tells us about Glo1, MG, and how this effects people with diabetes. The work was published in Nutrition & Diabetes.

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Diabetes Distress vs. Depression

distress-familyWhen it comes to the question of mental health, where is the line drawn between normal diabetes distress and meaningful depression? Dr. Lawrence Fisher speaks with me about diabetes distress and how it can affect the family. Dr. Lawrence Fisher presented the findings at the 2014 American Diabetes Association Scientific Sessions

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VBLOC for Diabetes Weight Loss

vblocThe name of this device to trigger the brain of fullness is the VBLOC system. The VBLOC works by transmitting signals of fullness to the brain from the stomach through the Vagus nerve. The VBLOC system is made by EnteroMedics (NASDAQ: ETRM).

The VBLOC system is implanted by a bariatric surgeon. It’s a minimally invasive procedure done with a few incisions, leads placed on the Vagus nerve, and a device the size of your palm nestled beneath the rib cage.

The surgery takes about 60 to 90 minutes. After the initial surgery, the device is set by your doctor to help it work efficiently. It operates on a lithium ion battery that is recharged about every day or so. The battery lasts for up to 8 years. If at any time, the patient wishes to have the VBLOC system removed, it’s an option.

There’s nothing out of the ordinary about the VBLOC system because the Vagus nerve is supposed to relay a two way signal between the brain and the digestive system.  However, in people with Type 2 diabetes it seems this message is unclear and the brain needs an amplifier.

The results for obese diabetic people were compelling. However, the results for morbidly obese non-diabetic people were not as exciting as the obese diabetic people. People with Type 2 diabetes had improvements across the board: insulin sensitivity, weight loss, blood pressure, and overall blood lipids.

The only downside of the VBLOC system is that the results for people who are morbidly obese are not as impressive as the results for people who have Type 2 diabetes. It’s curious how morbid obesity disregards the brain and nervous system and the action of eating is no longer instinctual. If something we do isn’t instinctual — what is it?


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BPA Bad News for Diabetes

BPA.We love our plastic and it’s found in almost everything we use in life. Studies have looked at the potential harm an additive in plastic called BPA can cause. BPA has been shown to cause a disruption in hormonal balance which leads to obesity and diabetes. I speak with Priya Mirmira, the first author who worked under Dr. Carmella Evans-Molina studying the effects of BPA. Our discussion may help reshape the way you make decisions like paper or plastic.

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The OTF Water Bottle Review

OTFNalgene was kind enough to send us the OTF water bottle.  OTF stands for on-the-fly.  When I first saw it my initial response was they should have named it WTF.  When looking directly at the bottle the latch release imprinting was just very weird to me.   The way it flipped open in an arc was also very foreign, but I took the bottle and decided to keep an open mind.

Before we get into the nitty-gritty of the review let’s get some practical basic facts out of the way. Forget about what the manufacturer says these are actual facts about the bottle weights, capacities and observations as tested by us.

So now that we’ve gotten that out of the way let’s jump into the review.  This review consists of daily use of the OTF bottle for three weeks.  The bottle was utilized as a car beverage holder, gym bottle, day hike bottle, multi-day camping bottle, and everything in between.

The bottle portion is fairly slender and is slightly tapered towards the top, making for a very comfortable grip even for someone with smaller hands.  Applying a lot of pressure will cause the bottle to slightly flex.  The bottle body is manufactured in the United States.

The cap is a standard Nalgene wide mouth.  This is pretty exciting as it will interchange with any other wide mouth Nalgene bottle and since a lot of the industry utilizes a standard wide mouth it even fit our Klean Kanteen stainless steel bottle in wide mouth.  There is no gasket on the inside of the cap.

Since it is a wide mouth design it will accommodate certain water filters such as the MSR MiniWorks EX Water Purifier Pump, which screws on directly to the body of the water bottle and allows you to pump directly into it, making for a very convenient and well thought out water system.  The cap is manufactured in China.

The mouth piece on the cap is sealed off with the rubber gasket that is forced over the opening and then latched closed. The main locking mechanism is operated by depressing a button which arks the top of the bottle back exposing a nice sized opening for chugging your desired liquid.   It also has a safety latch that will prevent the cap from opening should the button be pressed on accident.  If the safety latch is utilized one-handed operation becomes more cumbersome, but doable.

The real treat is the actual spout that you drink from. It is utter perfection. The sizes ample enough to be able to chug liquids quickly without any kind of dribble that some bottles are notorious for.  Probably one of the best designed spouts we’ve ever come across.

As a daily driver commuter bottle it is absolutely perfect. It fits into cup holders. Handles hot beverages such as coffee. Easily operated with one hand. Leak-proof.

As a gym bottle functioned well. Withstood several knocks without opening or spilling. Handled protein drinks and energy drinks without leaving a residue taste.

As a day hiking/camping bottle in our opinion it’s great as long as you have sources to refill the bottle. 25 ounces of water on its own in our opinion is simply not enough. However coupled with a larger bottle it excels as a hiking/camping bottle.  There are several advantages to utilizing the smaller bottle while coupling with other water storage/sources. This probably hits home for anyone who’s ever tried to bring up 64 ounces or better of beverage to their mouth. Also if you are in environments where you need to conserve water due to limited availability, it is much easier to do so with a smaller bottle, since it allows you greater control over rationing one’s water.  It also has the advantage that if you drop or lose a bottle less water will be lost, which can be critical in certain situations.

Because a standard climbing carabiner can be attached securely to this bottle it is a great choice for someone to clip on their harness should one wish to do so.  A better alternative than a regular water bottle with zip ties if you ask us.

Overall this is one of the best water bottles we ever had the pleasure of using.  Cannot say enough good things about this bottle, especially for regular daily use where the 25 ounce water limit is not an issue.  However like every other piece of gear it will not fill every need, but when coupled with other gear it can create a system that is synergistic in nature.

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American Diabetes Association T1D Position Statement – 2014

ADAT1D-PSIn June 2014, the American Diabetes Association issued a new position statement for Type 1 diabetes care. Dr. Jane Chiang speaks with me about the new position statement and what it means for the promising prognosis of Type 1 diabetes management throughout the lifespan of a person. The position statement is available on Diabetes Care.

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The Fast Way to Slow T2D Risk

fastingDr. James Brown is a lecturer in aging metabolism at the Aston Research Centre for Healthy Ageing, Ashton University. Dr. Brown spoke with me about how intermittent fasting may be a dietary intervention for the prevention of diabetes and cardiovascular disease.  Dr. Brown’s work has been featured in the Medscape article on Intermittent Fasting and Diabetes.

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