A Roche Diagnostics survey found eight out of ten adults are willing to self-manage a future chronic condition such as diabetes or cardiovascular disease, but self-management in practice is not always a success story. Unfortunately, poor blood glucose management is reality for two out of five adults with diabetes, and this can lead to serious complications. Roche Diagnostics is leading a campaign for greater awareness of various tools to help patients self-manage chronic disease.

In 2005, only six percent of Diabetes UK patient members took the self-management training available to them. Six measly percent. Diabetes is a responsibility-laden disease. Annually, people with diabetes spend 8,757 hours managing their disease, and a mere three hours with their doctor. I never really thought about managing diabetes in terms of hours -- it can be one lonely disease, even with the love and support of family and friends. Roche Diagnostics does offer several innovative tools to manage the disease, but an insulin delivery system does not give you a hug or hold your hand on the difficult days.

Diabetes Nurse Consultant Debbie Hicks stated it is good news self-management is embraced by the public, but clearly many people with diabetes struggle as they fail to self-manage. Hicks pointed out successful self-management is a combination of correct treatment, reliance on monitoring systems, professional education and support. Don't forget those free hugs.

House Calls, a popular newsletter written by the prestigious Dr. Inglis, highlights a very important question in light of the Avandia mishap: how many other potential whistle-blowers are out there who have been silenced into submission before the Big Pharma vultures?

A medical expert testified that he agreed to sign a statement that was meant to appease the company's investors. This is not the type of behavior anyone should expect or dismiss of a doctor, entrusted with a patient's life. In his defense, he did forward a letter with his concerns to the FDA, which means they also were aware of the same threat. This same doctor is the President-elect for none other than the American Diabetes Association. Isn't that special? The ADA -- my friend, my confidant, my utter supporter of the C-peptide crusade ... sense the sarcasm? So much for advocacy, when the president-elect of this organization so willingly swept those safety concerns under the table, when he should have been throwing a tantrum on top of it! And all over the threat of litigation from a drug company more concerned about its investors than patients.

The closing comments in Dr. Inglis' newsletter say it all: There are so many vultures out there waiting to pick the bones of the American public, it disgusts me. This example goes to show why I always recommend to you -- and to all of my patients -- that you always question everything when it comes to your health. I don't care if it's your doctor you've had for 50 years or one of these nonprofit organizations -- give them all hell.

Governer Ed Rendell is worried. An estimated eight percent of Pennsylvanians have diabetes. Nearly 800,000 people. We all know money talks, and what has caught the attention of state politicians is the tremendous cost to manage chronic diseases.

Governor Rendell recently shared that about 78 percent of the state's health care costs are linked to 20 percent of chronic diseased patients. The Governor has announced The Pennsylvania Diabetes Action Plan to improve how Pennsylvanians with chronic disease benefit from future health care.

In an effort to prepare Pennsylvania to educate the public about diabetes and diabetes prevention, and improve management of the disease to reduce complications, the Plan focuses on four key areas: surveillance, standards of care, health policy, and evaluation.

Truly a collaborative of care, more than 200 stakeholders, agencies, organizations and individuals contributed to the Pennsylvania Diabetes Action Plan. The plan was funded by the Centers for Disease Control and Prevention (CDC) and a state appropriation.

In 2005, potentially avoidable hospitalizations for diabetics in Pennsylvania cost nearly $730 million. Now that is a number even the Governor cannot ignore.

After living with diabetes for over 50 years, and witnessing few changes in the treatment of the disease, Brent Hoadley has written Too Profitable to Cure.

Distressed that the cure is no closer now than when he was diagnosed, at the age of 14 -- Hoadley took it upon himself to find answers. He notes the current state of healthcare for those who suffer from chronic diseases, and contends that profit, not humanitarianism, is driving American healthcare. As an entrepreneur and an investor, he is aware, and appreciates the profit motive that drives capitalism. However, he feels the bottom line should not interfere with the pursuit of a cure. With pragmatic drive, he identifies culprits and urges activism as a countermeasure.

Diabetes is only one shining example of the pharmaceutical industry's criminal pursuit of profits. Patients' health, patients' lives, patients' freedom-all are fair game in the quest for limitless wealth and unbridled power.

The question of evening news and print advertisement for pharmaceuticals is posed. Is this marketing speaking to doctor's in lieu of doctor's reading unbiased research? Or does this research derive from the very company making the pill? Hoadley reveals pharmaceutical sales reps now supply more education to physicians than they obtained in medical school. In other words, Big Pharma has climbed to the top of the totem pole; medical professionals stubbornly cling to their subordinate position; and the poor patient (pun intended) supports the entire structure. Do I need to tell you that the support is vulnerable and under attack? Whether it can remain viable is, or should be, a question of great concern.

Too Profitable to Cure is available online through Hoadley's site. Scott Strumello had turned me on to Brent Hoadley after he posted an Open Letter to Eli Lilly and one of the comments left was from Mr. Hoadley, himself. Definitely worth checking out! Thank you to Scott for the great find and to Brent Hoadley for putting it into words for us!

Ketone bodies are produced from liver cells when carbohydrates are scarce and energy must be obtained from breaking down fatty acids.

When excess ketone bodies accumulate, this abnormal (but not necessarily harmful) state is called ketosis. When large amounts of ketone bodies accumulate such that the body's pH is lowered to dangerously acidic levels, this state is called ketoacidosis. Ketone bodies are transported from the liver to other tissues, where they are reconverted to produce energy. The heart gets much of its energy from ketone bodies, although it also uses a lot of fatty acids. The brain gets its energy from ketone bodies when insufficient glucose is available (during a fast). In the event of low blood glucose, most other tissues have additional energy sources besides ketone bodies (such as fatty acids) but the brain does not. The brain retains some need for glucose, because ketone bodies can be broken down for energy only in the mitochondria, and brain cells' long thin axons are too far from mitochondria. If levels of ketone bodies are too high, the pH of the blood drops, resulting in ketoacidosis. This happens if diabetes is left untreated. A telltale sign of ketoacidosis is a fruity smell on the breath, like an apple.

Certain carbohydrate-restrictive diets induce ketosis for weight loss. Ketosis, again, is not necessarily harmful. However, when enough ketones enter the blood to lower the pH – this condition is ketoacidosis, and it is harmful. It can impair mental sharpness and inflict damaging effects on the body. Sadly and not so uncommon, the phenomenon hits type 1 adolescent girls on a dangerous level. A study found that young women with type 1 diabetes have manipulated their insulin to lose weight through ketoacidosis. In a chronic disease where every number of every reading and every calorie of everything you eat defines the control of your health -- how can diabetes NOT inherently fracture the self-image of young girls and mankind alike?

It hasn't gone unnoticed - the cost of healthcare is rising, diabetes diagnoses are rising, the pharmaceutical industry has dramatically increased its investment in research and development -- but that has not translated into more new treatments.

Between 1993 and 2004, funding for new drug applications submitted to the FDA increased almost a 150%. However, the number of new drug applications increased only 38%. Of those applications, only 7% were for innovative drugs with new ingredients. The Government Accountability Office (yes there is such a thing) says the reason for unimpressive returns on medical research funding dollars is due to the difficulty of developing new treatments, combined with marketplace pressure to produce blockbuster new drugs.

The phenomenon known as "me too" drugs (where companies produce drugs similar to drugs already on the market) has also become much more common. These drugs offer little in the way of innovation. However, despite the economic challenges of bringing new and innovative drugs to market, the pace of scientific discovery has increased substantially in the past 10 years - 56 diabetes drugs in development, alone. As the cost of discovering new medicines rises, it becomes more difficult for drug companies to recover these costs. It seems the research dollars are plentiful but ideas for new drugs can't compete with all the profit-decaying hurdles along the way. It's not a problem of interest until it's your own. I wouldn't wish diabetes on anybody-- even those who care more about the profit margin versus the quality of life of the person taking the pill.

A popular article from The New York Times is worth a look. It's all about how people are so much more robust and healthy than were previous generations, particularly comparing today's Americans with those from the mid-1800s or the early 1900s. One of the topics discussed at length in the feature is disease, specifically chronic diseases that used to be commonplace and affected people from relatively early ages.

The article discusses various studies that link health and longevity to health in early childhood (and, specifically, the availability of good food, vaccinations and antibiotics). These studies have also identified a link between individuals' health and longevity and the state of their mothers' health during pregnancy.

One example: researchers studied the health of babies born to women who were pregnant during the Dutch famine, which occurred during World War II, between November 1944 and May 1945. These babies seemed no worse for their mothers' terrible suffering - their birth weights were normal, for example. However, it was found that now, as age catches up with those people, they are developing chronic diseases, including diabetes, at unusually high rates.

Similarly, a study of children born to mothers who were pregnant during the influenza epidemic of 1918-19 found that they were also more likely to suffer from chronic illnesses than were children born to women pregnant before or after the epidemic. Again, the incidence of diabetes was higher than for other people - in this case, twenty percent higher by the age of sixty-one.

The conclusion? When a mother is ill or starved during pregnancy, the danger is not just the health of the baby, but for that child as he or she grows, and even for the rest of his/her adult life. That is, the experience of the mother may predispose the child to illnesses that typically do not develop until later in life (middle age or later).