Why is diabetes an imperfect science? The last 22 years of my life with diabetes have disproved as much (or more) than it has confirmed in conventional diabetes wisdom. The facts were in the studies - but researchers didn't know what to do with them, at the time. Here's where the mysteries will unfold..

The last year blogging with The Diabetes Blog has been an in your face demonstration of the imperfect science of diabetes. Many undisclosed details of studies from days gone by have proven to be a reason why diabetes has been an imperfect science. Since when has science been imperfect? When you don't complete your homework. Don't get wrong - science has done the homework, but you - the diabetic - have not been privy to every fact found in these studies. Nowadays, there's no excuse. The dog doesn't eat my homework.

It's time these facts made it to the light of day. I am taking my investigative curiosity and hanging a shingle over LoveDiabetes.com - because that's who I am: Allison Love Beatty! Let's buddy-up with the researchers and their homework. It's about time we solved the universal mysteries of diabetes. The facts are available. With combined knowledge, existential and pathological, we can make more of these studies from yesteryear and the days to come.

Someday soon we will see the trend of diabetes reverse - less diagnosis, less complications, and reduced costs. I've got Internet access, unlimited long-distance, and plenty of time. The fun is just getting started! This is my invitation to you - what's your diabetes mystery? Leave me a comment on LoveDiabetes.com so I know what's on your mind. Together we will prove there is no such a thing as an imperfect science.

Love always,
Allie B

A type 1 diabetic mystery is why do some Type 1s get complications and others seem to never get them? A massive Japanese study of Type 1 diabetics found that those with fulminant diabetes developed complications much faster and more severely than those with non-fulminant diabetes.

The difference between fulminant and non-fulminant is the speed and intensity at which the disease develops. Fulminant Type 1 diabetes typically develops suddenly with near total loss of beta cell function. This type of diabetes is confirmed with testing c-peptide levels. Non-fulminant type 1 diabetes has residual c-peptide levels that eventually taper to undetectable. Sometimes this is seen through many years of the Honeymoon Period.

This study may be the antithesis of conventional wisdom for preventing complications. Staking all hopes on blood sugar control is heavily optimistic. Yes controlling blood sugar does lessen the workload for existing beta cells, and thus extends the lifespan of each beta cell. Research suggests that c-peptide offers protection to beta cells, both from apoptosis (cell death) and encourages new cell growth. This new cell growth applies to beta cells and other cells of the body that endure long-term Type 1 diabetes complications.

Diabetics are instructed that maintaining normal blood sugars is the Holy Grail of preventing long-term complications. Yes and no. The truth is controlling your blood sugar will not allow complications of Type 1 diabetes to develop as quickly, presuming you still had some level of beta cell function upon diagnosis (i.e., c-peptide). That doesn't sound like a reward as much as it does a delayed punishment. I'd like c-peptide with my insulin, please. It's off the à la carte menu? That's fine - serve it up! I want to thank Klausen for bringing this study to my attention.

Dr. Bernstein, a world leading authority in diabetes, is hosting a live internet broadcasts to answer your questions on diabetes. Diabetes 911 is setup to stop the complications of diabetes before it's an emergency. Here's a link to the page where you can submit your questions, to be answered on his next broadcast -- September 19, 2007.

Just a heads-up for The Diabetes Blog reading community - AOL has announced they will be retiring The Diabetes Blog on September 14, 2007. So this is a preemptive blog to get your calendar out, send yourself a reminder email titled: OPEN ON SEPTEMBER 19th!!!!

This will not be my last blog shared with you, all mighty readers of the blogosphere. I'm working to get my proverbial welcome mat in place to continue unfolding the mysteries of diabetes on LoveDiabetes.com. More to come...

UCLA researchers report Nevada County, California residents have the lowest rate of diabetes in the state -- 2.6 percent. That's about one-third the state-wide average (6.8 percent), and slightly less than one-quarter the prevalence of diabetes in Imperial County (11.2 percent).

Take a few guesses why Nevada County's rate of diabetes is so much lower than Imperial County, and well under the national average of 7 percent. Do families eat less processed food around the dinner table? More jogging trails? Better health insurance coverage? Researcher Theresa Hastert states, "There is no one thing, but higher income is associated with better foods and exercise."

Hastert explained Nevada County is mostly white, affluent, educated and insured. Imperial County has a large population of Latinos and migrant farm workers. Nevada County's numbers support general findings that minorities without affordable, continuous health care are more prone to the disease. Who's got time for the dinner table -- Hastert openly speculates eating more junk food may be a consequence of dodging between three jobs just to get by. Also, Nevada County is a beautiful area -- she wonders if environmental factors play a role.

Is diabetes a socio-economic disease? If so, we're in trouble. The gap is widening between our nation's haves and have nots, and large concentrations of poor minorities may explain the disproportionate rates of diabetes from county to county. Read more in The Union.

Diabetic foot complications are responsible for many lower extremity amputations. But this last drastic step can be prevented up to 85 percent of the time with early diagnosis and proper care.

Now Thai researchers and physicians have shown using a patient's own stem cells can effectively heal chronic foot wounds. Diabetes patients with chronic foot wounds, aged 50-72, were injected with stem cells obtained from their own blood. Most excitedly, the wounds healed nicely within three to four months. The stem cell treatment also makes fiscal sense. According to this article, stem cell treatment for wounds in a patient with diabetes costs about $6,000, one-fifth the cost of conventional treatment for a leg wound.

Studies have shown primary care physicians often fail to examine the feet of patients with diabetes. It's a shame, as this step is the least costly and most effective way to prevent foot wounds and potential amputations. But at the same time, it is nice to know there is a promising, cheaper treatment utilizing patient-donated stem cells.

Creator of Diabetes Health Magazine, Scott King, has been a type 1 diabetic for over 34 years. Needless to say, he knows diabetes, and he is doing a remarkable job of introducing cutting-edge treatments for diabetics. In the first Diabetes Health TV broadcast, he shared interviews from the recent AADE Conference. A really exciting product he featured is called Neuragen - a topical treatment for diabetes neuropathy.

With diabetes neuropathy, people experience pain due to damage to the peripheral nerves. Neuropathic pain is often characterized by burning sensations or shooting pain, or may occur as numbness or chronic itching. Clinical trials have shown Neuragen to be effective in 70% of patients for the pain associated with diabetes. The ingredients are pretty kosher, too. Neuragen is made of a proprietary blend of essential oils from special species of geranium, lavender, bergamot, eucalyptus, and tea tree.

The Neuragen rep was blunt when he described the effective nature of this all natural product - using more does not make it any more effective! You have to admire his refreshing honesty. But like I said upfront - if Scott King is willing to spend the time getting the scoop on this product - it's probably worth your time using it. For more interviews, checkot the full coverage of the AADE Conference on Diabetes Health TV!

Recently I posted on the California Department of Education's recent lawsuit settlement with the American Diabetes Association. CDE promised students would have access to legally-required diabetes care on campus. With a shortage of school nurses, CDE agreed caregivers could include trained volunteers. I came away from the agreement thinking, "Good! It may have taken a lawsuit, but problem solved." But this settlement is hardly a neatly wrapped package.

Liability drives many decisions. Now the California School Nurses Organization has advised school nurses to seek guidance from district lawyers before training volunteers. Nurses are concerned they could lose their licenses if they train non-medical staff. Executive Director Nancy Spradling stated insulin injections should be monitored by licensed personnel -- incorrect calculations can be fatal or trigger a coma. They've got a point.

Student diabetes care varies widely in California. With a student population of 22,000, Lake Elsinore Unified School District is doing a good job. They have eight nurses taking care of 70 students with diabetes. Last year, Palm Springs Unified School District had only 3 nurses for 24,000 students, requiring parents to visit district schools daily to inject children too young to handle the task themselves.

Arlene Mayerson, directing attorney with the Disability Rights Education and Defense Fund (they represented the ADA in the lawsuit), stated California has one of the lowest nurse-to-student ratios. Perhaps a new certification for a 'School Diabetes Specialist' is on the horizon. Regardless, I hope the CDE figures out a solution to honor the settlement. I bet school districts across the country are watching -- the health of students with diabetes is at stake. Don't forget the nurses' concern. Beyond losing their licenses, no one wants to see a student with diabetes hurt or killed due to an improperly trained, unlicensed adult volunteer. Read the full story in The Press Enterprise.

Previous studies have examined visual impairments of Caucasians with type 1 diabetes, but this is the first study analyzing vision loss for African Americans with type 1.

The vision and associated risk factors of approximately 500 African Americans with type 1 were studied over a 6-year period. At follow-up, 4.3 percent of patients realized vision loss in their better eye (visual acuity of 20/40 or worse) and 0.6 percent became blind in their better eye (visual acuity of 20/200 or worse). Nearly 10 percent lost 15 or more letters on the eye chart due to a doubling of the visual angle in their better eye. Another 13.5 percent had this doubling in either eye, which the researchers stated was "particularly high".

Independent predictors of vision loss over the six years were identified as poor blood sugar control, older age, high protein levels in the urine (symptomatic of kidney disease) and diabetic retinopathy, a common degeneration of the retina seen in people with diabetes.

Dr. Monique S. Roy, of the University of Medicine and Dentistry of New Jersey in Newark, stated African Americans with diabetes as a whole have poor blood sugar control. Beyond efforts to improve glucose control, monitoring retinopathy in this population can identify those requiring treatments to prevent severe vision loss. The study is published in the Archives of Ophthamology.

This story in Reuters does not mention why African Americans with type 1 might have poorer control leading to vision problems. One factor is likely a lack of health insurance. I did a little digging. According to the Commonwealth Fund Biennial Health Insurance Survey, 33 percent of working age African American adults were medically uninsured or experienced a gap in insurance in 2005. The numbers are even worse for Hispanics. Most troubling, African Americans have higher rates of health problems among lower and higher income groups compared to both Caucasians and Hispanics.

Do not miss this recent NY Times article by Gina Kolata, Looking Past Blood Sugar to Survive With Diabetes. It is a must read for anyone associated with type 2 diabetes, including patients, family caregivers and doctors. I am very encouraged to see a feature on type 2 diabetes in such a well-read newspaper. Many doctors are uninformed on the best ways to treat a person with type 2 diabetes, they spend much more time with type 1 patients. Furthermore, type 1 and type 2 are very different diseases, but since they both end in 'diabetes' there is deep confusion -- see Diane's previous post on this topic. Undoubtedly, we need Big Media to provide greater coverage on the differences and unique treatments for both type 1 and type 2 diabetes.

First off, type 2 diabetes is a form of the disease that usually appears in adulthood where the body does not produce enough insulin or the cells are resistant to insulin. Kolata's article focuses on one man's battle with type 2 diabetes, as well as the importance of other treatments beyond blood sugar control that can markedly prevent heart disease -- the number one threat to a person with type 2. Dave Smith, a pastor from Fairmont, Minnesota, has dealt with type 2 diabetes for nine years. From the start, his doctor advised him to control his blood sugar, so he was a faithful carbohydrate counter, finger pricker, type 2 pill taker. Nothing worked, so he added insulin.

Unfortunately, his fixation on controlling blood sugar ignored the most crucial treatment of all -- lowering cholesterol. According to Kolata's article, heart disease kills nearly everyone with diabetes. The second treatment Smith did not consider was the importance of controlling blood pressure. The third treatment is taking aspirin to control blood clots. Last October, Smith had a major heart attack and nearly died. He had never thought about heart disease, and his doctor never advised him to take a cholesterol-lowering statin or a blood pressure drug. The American Diabetes Association reports only 18 percent of people with diabetes know their increased risk for cardiovascular disease. Grrrr! This lack of awareness among patients and doctors must change for lives to be saved. It took a near-fatal heart attack for Smith to receive the combination of drugs he should have been prescribed at diagnosis: a statin, two drugs to lower blood pressure, aspirin, insulin and two drugs to reduce his blood sugar level.

The article also points out the myth of obesity and type 2 diabetes. While obesity does increase the risk for type 2, only 5 to 10 percent of obese people have the disease, and many people with type 2 are not obese. Genetics is a big determiner. Losing weight can definitely improve type 2 control, but most are not cured. Smith lost 40 pounds and still has type 2.

Dr. Irl B. Hirsch, a professor of medicine and director of the diabetes clinic at the University of Washington, stated it plainly. The first priority for a typical middle-age person with type 2 diabetes is to take a statin and lower the LDL cholesterol level. FYI, a person with diabetes should keep LDL cholesterol below 100 milligrams per deciliter, ideally 70 to 80. Keep in mind, this is even lower than the recommended LDL levels of 100 to 139 for a healthy person. Dr. Michael Brownlee, director of the JDRF International Center for Diabetic Complications Research at the Albert Einstein College of Medicine in New York, stated beyond a statin, blood pressure control and taking an aspirin to prevent blood clots are two other important measures.

Diabetic ulcers are the most common foot injury leading to amputation in the lower extremities. Encouragingly, early detection and proper treatment of a foot ulcer can prevent up to 85 percent of amputations. It is important for physicians to perform regular, thorough foot exams, however people with diabetes can also rely on a foot thermometer for early detection of inflammation and potential ulceration.

Xilas Medical Inc. manufacturers the TempTouch (R), an infrared temperature measurement device for at-home use. In previous clinical trials, TempTouch (R) successfully detected inflammation before an ulceration perforated the surface skin. Patients compared temperatures of each foot in like positions. Spikes in skin temperature signal foot ulcers -- this early warning allowed patients to purposely reduce activity levels or off-load to prevent ulceration.

Approved by the Food and Drug Administration in 2005, the TempTouch (R) requires a doctor's prescription, costs around $150 and is 16" long for easy reach. Unfortunately, the device is not covered by insurance. Health insurance companies prefer to pay for costly ulcer treatments and possible amputation versus a preventive device? The product is intended for daily use -- perhaps daily compliance is a challenge. At the very least, the device should be covered for people at high risk for foot ulcerations. Read more at WKRG News.

The renowned author of The Diabetes Solution, Dr. Richard Bernstein is now ready and waiting to answer your questions on The Bernstein Connection.

In 1946, at the age of 12, Richard Bernstein developed Type 1 Diabetes, and for more than two decades, he was what he calls, "an ordinary diabetic"-one who dutifully followed doctor's orders. Despite his diligence with maintaining the disease, the complications from his diabetes worsened over the years, and like many diabetics in similar circumstances, he faced death at a very early age. Though he was indeed still alive, the quality of his life wasn't good, and by the time he reached his twenties and thirties, many of his body's systems began to deteriorate. Now, beyond his best selling books, Dr. Bernstein is opening up the airwaves to those who wish to learn from his real world experiences and conquer the daily hurdles of diabetes. He's doing so through The Bernstein Solution, offering direct access to Dr. Bernstein's methods, latest advice on diabetes, best selling books, and regular live broadcasts where Dr. Bernstein answers your questions.

I was fortunate enough to listen to his last broadcast, from August 8th. I do own The Diabetes Solution but I'm strongly considering joining The Bernstein Connection. The broadcast I listened to was as informative, if not more so, than the book! For $80 a year - if it can help a diabetic reverse damage to their eyes and kidneys, I don't think it's unreasonable at all!

Many people with type 1 and type 2 diabetes have to deal with vascular problems. Just ask my brother. A type 1 for over 30 years, he has diabetic retinopathy and had a stroke in his late 30s. Microvascular complications can cause kidney disease, vision disorders and neuropathy, while macrovascular complications can cause heart disease, stroke and peripheral vascular disease.

Researchers at the University of Warwick have definitively shown diabetics are deficient in thiamine (vitamin B1), and the deficiency is connected to vascular complications associated with the disease. The research team found thiamine concentration in blood plasma was decreased 76 percent in type 1s and 75 percent in type 2s. Why is this only being discovered now? Previously, conventional assessment of thiamine levels involved measuring the activity of an enzyme (transketolase) in red blood cells. Past research observed normal enzyme activity, thus, thiamine levels were assumed normal. However, the 'normal' activity was actually due to increased levels of two proteins that aid in thiamine transport into red blood cells. Turns out increased levels of the proteins were triggered by a deficiency of thiamine. Who knew?

Researchers also found thiamine deficiency in vascular cells is linked to a marker of those serious microvascular and macrovascular complications in people with diabetes. Most discouragingly, ingesting a thiamine supplement with your eggs and toast is of no help. Decreased plasma thiamine concentration in clinical diabetes has nothing to do with diet, it is due to a marked increase of thiamine removal from the blood into the urine.

On the bright side, at least we know diabetics are deficient in thiamine, and it is related to vascular problems. I'm sure a cascade of new research is on the way.

Most school cafeterias and vending programs feed our kids junk, but even worse, students with diabetes are not provided legally required care to manage the disease during school hours. Children with insulin dependent diabetes are heading to school without the assurance of regular blood glucose testing, the administration of insulin or other diabetes care tasks.

In 2005, four California families and the American Diabetes Association (ADA) filed a suit in San Francisco, alleging some California school districts were not providing adequate diabetes care. In some cases, parents were called to give aid before summoning a school nurse. Michelle Ferry was one such parent. When her son was in first grade, this widowed mother of four had to hire a babysitter so she could head to school to give her son an insulin shot. Risky business for her son, let alone expensive for the Ferry family. What if she could not secure a babysitter and her son ran high blood sugars? This is outrageous and unacceptable. This is just one example, many schools across the country are not adequately serving students with diabetes.

The lawsuit has been settled, and per the agreement, the California Department of Education will now require districts to ensure all children with diabetes have access to proper diabetes care during the school day. What took so long? Students with type 1 diabetes have been in public schools for years! Now a volunter school employee can be trained to assist a student with diabetes. San Ramon Valley school district claimed they wanted this ability, but they were following state regulations that care be provided by a health practitioner. State law outlines seven different categories of caregivers -- which includes a self-administering student, a school nurse or other health professional and family/friends. Now the agreement states if a licensed health professional is unavailable, a trained, unlicensed school employee may provide insulin shots per individual physician order. Hallelujah -- may California trigger a domino effect nationwide.

Jack O'Donnell, State Superintendent of Public Instruction, explained a lack of resources, uncertainty of how to best deliver services, and lack of clarity about state and federal requirements combined to cause hardship to some parents of children with diabetes. He said no parent should have to risk their job to care for their child. What his statement truly lacks is concern for the student with diabetes -- O'Donnell misses the point when he disregards the cumulative, tragic complications of poor blood glucose control.

A big legal team contributed to this win. Hats off to the ADA, attorneys with the Disability Rights Education and Defense Fund and the generous law firm of Reed Smith LLP (donor of $2.6 million in pro bono legal services). Here is the announcement of this landmark agreement and a story from Inside Bay Area.

Avandia-maker GlaxoSmithKline might have breathed a sigh of relief after the U.S. Food and Drug Administration's (FDA) panel voted to keep Avandia on the market. But trust me, it is a very heavy sigh This vote was followed by the panel's official acknowledgment (20-3) the drug increases risk of heart attack in patients with type 2 diabetes.

What are the healthcare professionals saying? In a recent MedPage Today poll, only a trickle of respondents (9 percent) stated they would continue prescribing Avandia with no worries. One in four said the drug should be swept off the shelves. Per the FDA panel's recommendation, 36 percent stated they would continue treating certain patients with Avandia. But a whopping 55 percent will not write any more Avandia prescriptions. MedPage Today pointed out the current doctor strike against Avandia could crumble a bit over time. When a late May meta-analysis showed a 43 percent higher risk of heart attack for Avandia takers, a MedPage Today poll initiated shortly thereafter revealed 75 percent would not write any new prescriptions. Today, this 'no new prescriptions' number stands at a lower 55 percent.

The sages say 'time heals all wounds', but Avandia will likely be tattooed with the FDA's strictest black box warning. GlaxoSmithKline can knock on doctor doors and perform a public relations tap dance, but I doubt the Shim Sham will ever return this drug to previous sales levels. At the moment, healthcare professionals do not think so either. They see that tattoo.