Chances are if you or a love one take Avandia, you have heard this news. It seems that many of my patients heard this news before I did and called in a panic wanting to stop their medication. It reminded me  of when the Women’s Health Initiative came out saying that Estrogens were dangerous. Women around the country immediately stopped their HRT (and had all sorts of side effects from the abrupt cessation of estrogen).

While no medication is free from potential side effects, let’s stop for a moment and breathe. Let’s look at what we have.

1. Researchers did a meta-analysis of several other studies looking at Avandia. For those of you who don’t know, a meta-analysis just means they looked at other studies and brought the data together into one document (more or less a simplified description).
2. In all cases, those studies (I believe) were looking at the effects of Avandia on blood sugar…not cardiovascular complications.
3. People with diabetes already have a high risk of having a heart attack or other cardiovascular events. To determine if a medication is at the route of increased heart attacks, one must design the study to be able to filter out the heart disease due to diabetes vs medication.
4. None of the studies that were looked at, included Avandia’s close relative, Actos.
5. Depending on how the numbers are “crunched”, apparently different people were coming up with different data. (One of the things I find fascinating about studies…the way you ask the question, can determine it’s outcome).

The American Diabetic Association and the American Heart Association, issued statements stating that these are questions that certainly need to be asked (effects of Avandia and Actos on cardiovascular risk), but at the present time, urge individuals taking these medications to discuss this with their providers and not just stop the medication.

Currently, already in the works, is a study (RECORD) that is looking at cardiovascular risk in those taking Avandia. That study is expected to be complete with results available by 2009.

In the meantime, if you are looking for the “magic bullet” for diabetes care, I highly recommend taking a good long look at your diet and how you can increase your activity. In most cases, taking action on diet and exercise provide maximum benefits with almost no side effects. And often, it reduces the needs for the various medications that most people with diabetes have to be in, including medication for blood pressure and cholesterol.

(c)2007 Barbara C Phillips, NP

There is more evidence that the American love affair with coffee is helping to reduce the risk of diabetes.Drinking caffeinated coffee was found to reduce the risk of developing type 2 diabetes by as much as 60% in a newly published study that included people at high risk for the disease.

Even those who used to drink coffee but quit were less likely to develop diabetes than those who never drank it.

The new study was published in the November issue of the journal Diabetes Care.

Source: Medscape

Your Cholesterol Numbers – What do they mean?
Barbara C. Phillips, NP

Today, many people understand that heart disease is the number one cause of death in the United States for both men and women.

The good news is that we have a good amount of control over this. Why? Because several of the factors that contribute to heart disease can be modified by you and me. For example…diabetes, our cholesterol levels, exercise, obesity, dietary intake and smoking.

When you visit your health care provider and they get a donation of blood from you to test your cholesterol or lipid panel, do you understand those numbers? Many people don’t, and I’ll admit it took me a while to remember which numbers were good and bad. So, here is a break down of what they mean (with hints to help you remember) and what your “ideal” numbers should be.

Total cholesterol is the number you hear most of all and often just referred to as the “cholesterol level”. It includes the good and bad kinds of cholesterol. Ideally this number will be less than 200.

The LDL or low density lipoprotein, is what is known as your bad cholesterol. This is the one that basically causes your vessels to plug up – ie, plaque build up. Ideally this number will be below 100. A good way to remember that this is the “bad” cholesterol is to think of the LDL as being the “lousy” cholesterol and the number should be low.

The HDL or the high density lipoprotein is your good cholesterol. This is the one that is protective of your heart. In women, this number should be above 50, in men, above 40. Think of the HDL as the “healthy” or “happy” lipoprotein and know that this number should be high.

The final number that you will often see is the triglyceride level. This is a different kind of lipid or fat that is often elevated in response to high fat and carbohydrate diets as well as in those who drink alcohol excessively. It is frequently elevated in those with insulin resistance and diabetes.

Treatment recommendations for numbers that are out of whack will depend on your own risk factors for heart disease, your individual results, and other health conditions that may be affecting you.

In many cases lifestyle choices can have a huge impact on keeping your cholesterol under control without medication – but it does take consistent effort. Make sure you are getting exercise on a daily basis, eat low fat, moderate carbohydrates, keep your weight healthy, include more fruits, vegetables and whole grains in your diet. Make sure your daily intake of fiber is 35 grams or more, and of course, drink water.

(c)2006 Barbara C. Phillips, NP
OlderWiserWomen | Healthy Aging For Women

How do I reach my blood sugar goals?

This question comes up at least a few times a day in practice. I orginally wrote this checklist for my patients to help them troubleshoot their blood sugar results. If you asked these questions of your provider…here are some questions you can ask yourself. I hope you find this helpful!

Are you reaching your blood sugar goals?

Having diabetes means you need to monitor several things – what you are eating, your glucose levels at various times of day, your weight, your exercise level, etc.

These are only a few of the items that need to be monitored to keep you healthy. Your health care provider should be recommending that the following screening be done on a regular basis.

Every visit with your provider:

• Review blood pressure. Your goal is to keep your reading less than 130/80 mmHg
• Review your glucose log. Depending on which guidelines your provider is monitoring they will look for your glucose goal to be 90-130 before meals and 140-180 2-hours after meals.

Every 3-6 months (depending on your level of control)

• A1C reading which is an average glucose over 24 hours a day over 3 months. You should be less than 6.5-7% (again depending on the guidelines being followed).

Annual Screening

• Cholesterol panel
• Triglycerides should be less than 150
• HDL should be greater than 50 in women and 40 in men
• LDL less than 100
• Microalbumin urine test (check fro urine protein)
• Get a dialated eye exam to check for retinopathy and glaucoma
• Foot Exam, specifically looking for numbness, changes in sensitivity to touch, coldness and sores.

Make sure you are keeping up with your screening. It will help detect any early problems so you can make changes to prevent long term complications.

LONDON (Reuters) – The world’s top two diabetes organizations have questioned the existence of a medical condition widely cited by drug firms, in a move that could hamper prospects for Sanofi-Aventis’s (SASY.PA: Quote, Profile, Research) new drug Acomplia.

The American Diabetes Association and European Association for the Study of Diabetes said in a joint statement on Thursday that “metabolic syndrome” — which has come to be seen as a predictor of cardiovascular disease — was poorly defined, inconsistently used and in need of further research.

Doctors should not diagnose people with the “syndrome” or treat it as a separate condition until the science behind it is clear, according to a paper to be published in the September issue of Diabetes Care and Diabetologia.

“There is no combination of risk factors that boosts a person’s cardiovascular risk beyond the sum of the parts, or constitutes a separate disease,” said Dr Ele Ferrannini, president of the European diabetes association.

Read more here:National, World and Business News | Reuters.com

I hear this question more often these days, and it’s a good question to ask.

Often people do not know they have diabetes, because the signs and symptoms can be nonexistence or do mild that they don’t know it’s there. More importantly, you may be in a “pre-diabetic” state, and not yet know it – this is why is so important to see your health care provider for screening.

A person with diabetes may notice the following signs and symptoms: increased thirst and/or hunger, fatigue, increased urination (especially nighttime), weight loss (especially type 1), blurred vision, and sores that do not heal. In women, something that is often overlooked is frequent and even continuous vaginal yeast infections. All of these things warrant a check up.

Do you have any of these risk factors?

• Family history. This means a parent, sister or brother has diabetes.
• You are a person whose heritage is African-American, American Indian, Asian American, Pacific Islander or Hispanic.
• You have a history of gestational diabetes. This means you had diabetes when you were pregnant.
• You have high blood pressure.
• You have an abnormal cholesterol panel
• Your lifestyle can be described as inactive
• You are overweight or obese.

You can assess your risk further with this tool. Make sure you go over these factors with your health care provider so the proper tests can be made.

Diabetes does not have to ruin your life. With treatment you can avoid many of the complications. And if you have pre-diabetes, you can even prevent or delay the onset of diabetes.

Make sure you take care of the most important woman in your life…you!

Barbara C. Phillips, NP
OlderWiserWomenâ„¢