The CafePharma message boards are for pharmaceutical sales professionals and those interested in the pharmaceutical industry. A former Lilly sales rep started a thread about Eli Lilly and the lies they've told over the years. Pro Lilly responses flooded in, as did the anti-Lilly responses. Yesterday, however, two comments seemed to hit the message board with a vengeance.

Comments #23 and #24 epitomize the anatomy of a good old fashioned debate. Comment #23 is an Eli Lilly sales rep who claims to have helped with the successful launch of rDNA insulin, and the conversion of patients on pig and cow insulin to Humulin. He remarked from the perspective of a salesman that it was a successful venture resulting in unilateral domination. In response to his yesteryear achievement - commenter #24 raised some wonderful counter-points for modern day consideration. The following paragraph summarizes the results 25 years after the market saturation of Humulin and genetically modified human insulin.

The adverse events include: (1) Complications of diabetes are increasing. (2) Dead-in-bed syndrome is up over 300%. (3) Traffic accidents caused by people using rDNA insulins are increasing (especially in Type 2). (4) rDNA insulins are producing immunogenic responses in the same manner and numbers in the diabetic population as did pig and cow insulins. (5) No long-term studies have ever been conducted to define the dangers of the synthetic insulin hormones relative to cancer and other diseases.

Of course my favorite point is the fact that recent studies have shown that the culprit in many Type 1 diabetics may actually be the human insulin antibody produced by the diabetic. This may be self-serving beyond Type 1 diabetics needing insulin - it's giving Type 2s the very same problem.

In recognition of Foot Health Awareness Month, LifeMasters encourages diabetics to prevent foot complications by following a few simple steps to maintain healthy feet.

As you know, diabetics are more prone to foot complications. These complications include fungal infections, calluses, ulcers, foot deformities, and gangrene -- which may include infection and may in some cases, lead to amputation.

The underlying diabetic cause for these complications is the nerve damage, also called neuropathy and a decrease of blood flow to the foot. Neuropathy causes loss of feeling in the feet, decreasing feeling, affecting balance and leading to a foot injury. Diabetes also causes damage to blood vessels in all parts of the body, including the legs and feet, and can lead to poor circulation. Courtesy of LifeMasters, they are offering some tips protect your diabetic feet:

Control your blood sugar levels! Maintaining normal or near-normal blood sugar levels can reduce blood vessel and nerve damage that often lead to diabetic foot complications. If a wound or foot ulcer does occur, blood sugar control reduces the risk of an amputation. (For fair and balanced review: see Yesterdays Blog)

Wash your feet daily. This goes without say. Who wants dirty feet around? If you are grossed out by feet - pay somebody to do it for you. Get a pedicure or visit a podiatrist.

Check your feet daily for skin breaks, sores, cuts, bruises, and changes to the toenails (ingrown, coloring, etc.). If you cannot see under your feet, trick a loved one into doing it for you. Promise them you'll be their best friend and I'm sure they'll take you up on it. Who doesn't love a person with Happy Feet?

Have an annual foot check with your doctor or podiatrist. Your doctor will examine your feet, and probably perform a monofilament test (a single strand plastic thread stroked on your feet) to see if you are developing nerve damage.

Wear appropriate shoes: Make sure to wear shoes that fit well, and are not too tight. Tight shoes can cause pressure ulcers to develop. Avoid going barefoot, even in your own home, as it may increase your risk of injury to the foot. Wear clean cotton socks and change them daily. I guess this last step requires you to shop. And is that really such a bad thing?

"A few times I've been around that track so it's not just gonna happen like that because I ain't no hollaback girl", like Gwen Stefani says in her motivational chant - I want answers.

This is not an attack in any way. This is an attempt to get answers as to why human synthetic insulin was manufactured without C-peptide. Yesterday Eli Lilly called me back. Admittedly, J Scott Macgregor told me he doesn't receive many questions about human synthetic insulin development. He asked me to email. No problem. My email said:

Why did Eli Lilly manufacture human synthetic insulin without c-peptide?

As Scott Strumello points out in his blog, I've tried to contact Eli Lilly before about this issue. And I guess it look a little while for the resonating curiosity of the blogosphere to provoke a response. Again - no problem. The content of my email is an open opportunity for every diabetic injecting insulin to ask away. I think we've got Eli Lilly's attention and we're on the right path to getting answers. Now where's that turn for C-peptide?

As a diabetic with the esteemed honor of pouring my heart and soul out for an audience as well-informed as you - I feel it is OUR job to inform our doctor's of the important discoveries being made in diabetes. The discovery I am most concerned with these days is raising awareness of C-peptide.

When I learned that all forms of synthetic human insulin these days DO NOT have C-peptide (like natural human insulin does) I asked my doctor what C-peptide does. My doctor explained, "C-peptide is nothing more than a biomarker to tell us [doctors] how much insulin your body is naturally producing."

When Chrissie in Belgium asked her doctor he told her that [C-peptide] has absolutely no importance. Uh oh...

Doctor's are convinced that C-peptide is useless for type 1 diabetics. Give the next paragraph consideration and you and your doctor might have a new perspective on the importance of C-peptide.

In a healthy, nondiabetic individual -- islets produce insulin. Insulin is made of 51 amino acids in 2 chains, with a tail of something called C-peptide (connecting peptide). Insulin grabs sugar from the blood and transports it into the cells where it becomes energy. It gets into and out of the cells through cellular pathways that are monitored by a delicate balance of sodium (Na) and potassium (K). This balance is regulated by C-peptide. The movement of insulin and glucose through these cellular membranes without C-peptide is dangerous and causes diabetic complications that develop in small vessesls of the eyes, kidneys and nerves.

Tight control of diabetes results in complications over time. If you find 500 mg of protein in a 24 hour urine collection - it's a complication (nephropathy). If your nerve conduction velocity reaction time is measured at 5.0 seconds - it's a complication (neuropathy). You take your insulin -- these complications should not occur, right? The reason for diabetic complications may not be your insulin at all. It may be the thing that your insulin is lacking.

So here's a little community service we ALL can do to enlighten our doctor's. Ask your doctor about C-peptide. Chances are you will get the same answer Chrissie in Belgium and I did. When this happens - smile, and politely hand your doctor a printout of this blog.

After all, if the Creator put receptors in our cellular membranes - He must've done it for a reason. The path to enlightenment is paved with gold.

Now that the US market is suspiciously saturated with human insulin - and many of us diagnosed within the last 10 years did not have a shot at trying porcine insulin - I'd like to set the record straight. When the pharmaceutical companies cherry pick the studies they wish to use for their gain, and not so much for your enhanced quality of life - they must've lost this study.

Please read the entire study (if you have access to it in a local library) but what grabbed my undivided attention was the sentence that says: it was observed that the action of porcine insulin was associated with... a striking increase of prolactinaemia, in relation to semisynthetic human insulin.

Okay -- so as I look deeper into the function of prolactin -- aside from some definite dopamine enhancing activities (if you know what I mean) :::wink wink::: -- it is responsible for the formation of myelin coatings on axons in the central nervous system. This is a certifiable problem that results in diabetic neuropathy and the related side effects (numbness, nerve dysfunction, i.e, ED).

Ex-queeze me? Does this say that human synthetic insulin may be a cock blocking drug?

Sorry for the blunt delivery -- but this is the truth. Why doesn't human synthetic insulin have this listed as a side effect? My guess is: if you had a choice of human synthetic insulin versus highly purified porcine insulin -- and you knew the side effects of human synthetic might take a toll on the health of your sex life -- you might be praying to the porcine gods.

Shame on the companies who knew about this study and kept it undercover so you couldn't...

Benfotiamine can help diabetics protect delicate microvessels. Much of the damage of diabetes is caused when glucose-derived compounds, called triosephosphates, accumulate in small vessels. Transketolase, turns these toxic compounds into harmless chemicals that can be removed from the body. benfotiamine increases transketolase activity, thus reducing or eliminating the complications associated with diabetes.

Administration of benfotiamine helped to prevent retinopathy in test subjects with diabetes. Study subjects who received benfotiamine for 36 weeks demonstrated completely normalized levels of damaging toxins in the retina, preventing or delaying the onset of diabetic retinopathy.

In a 24-week study, benfotiamine was shown to improve kidney function. This was shown by a 50% reduction of toxin levels in the kidneys, and a reduction in oxidative stress associated with diabetes. Subjects exhibited a 70-80% inhibition in the development of microalbuminuria, protein in the urine that serves as an early sign of kidney dysfunction.

Benfotiamine mitigates oxidative stress in the eyes, the kidneys, the heart, and even the brain that typically occur with diabetes. Researchers conclude that benfotiamine may offer critical protection for the delicate nerves of the eyes, the kidneys, the peripheral limbs, the heart and the brain by shielding them from damage caused by diabetes.

When treating diabetes, today's doctors focus on establishing blood glucose control, but often overlook the need to protect against common diabetic complications such as blindness, kidney damage, and nerve damage. The DCCT, even with a comprehensive treatment program, had a complication rate of approximately 40% of participants.

People who do not have diabetes make insulin with C-peptide. Those of us diabetics who inject synthetic insulin do not get the C-peptide. When scientists began developing insulin - they weeded out the pieces of the amino acid chain they felt were insignificant in lowering blood glucose. Synthetic insulin was designed to reduce the dangerous buildup of excess sugar in the bloodstream. Uh oh - hindsight is surprisingly clear! The long-term complications were initially thought to be caused by lack of insulin - not lack of something that should've been in it. It would make sense if insulin came equipped with this critically important element, wouldn't it?

Tada! C-peptide is the connecting peptide found on the amino acid chain of naturally produced insulin, but left on the cutting room floor in the lab. Studies have shown that C-peptide prevents the development and progression of many diabetic complications and was shown to improve glucose metabolism up to 66%.

Regardless of the potential profit decay C-peptide might cause the production of insulin - the bottom line is the salvation it will provide every man, woman, and child injecting insulin. If you're taking insulin injections, chances are you won't stop taking insulin because you're adding C-peptide to your daily lineup. Chances are - you'll be around a lot longer, and a lot healthier because you do not have the complications most often associated with long-term diabetes.

Wouldn't that be reason enough for you to celebrate the company that brings C-peptide to the drugstore nearest you? Consumer loyalty goes a long way. For those companies who knew a long time ago how beneficial C-peptide would be but didn't do a thing about it - is it really the 33% loss in insulin sales you didn't want to encounter? C'mon. We can handle the truth.

Tai Chi for Diabetes is easy to learn, effective and safe. It is designed to prevent and improve control of diabetes. The program will help to improve muscle strength, increase heart and lung activity, as well as improve balance and harmonize mind and body.

Gentle exercise helps people with diabetes by improving the control of blood glucose level. Tai chi is a gentle exercise with strong emphasis on mental relaxation, it is reasonable to assume tai chi can help to control diabetes by improving cellular uptake and glucose metabolism. Tai chi can also help mitigate the effects of stress, which is shown to make the control of diabetes worse. Tai chi reduces stress and improves relaxation.

The major problems of diabetes are complications such as hypertension, heart disease, visual impairment and vascular problem. Diabetes causes peripheral neuropathy, a condition that the nerves of feet are damaged thus affects balance and walking. Tai chi has been proven to be effective in improving balance and mobility.

The immense power of the mind has not been fully estimated. As one of the most effective mind-body exercise, Tai Chi teaches the student to be mindful of the intrinsic energy from which he or she can perceive greater self-control and empowerment. The mental training in Tai Chi will enhance clarity of the mind, improve relaxation and uplift mood.

The Tai Chi for Diabetes DVD costs $25. It includes 90 minutes of a general introduction of Tai Chi and diabetes, warm up and cooling down exercises, Qigong for Diabetes, 11 basic movements and 8 advanced movements. Viewers can learn different part at their own pace using the easy-to-learn and step-by-step instructions. If you prefer a less expensive option, you can order the Tai Chi for Diabetes Handbook for $10 or you can subscribe to the newsletter for free. Your budget, your decision.

Below I've included some feedback from people who have firsthand knowledge of Tai Chi for Diabetes. Here's what they have to say:

"I use your video a lot to perfect my technique, to check accuracy of movements, listen to instructions and recall various Tai Chi principles." Jana Solovka, Vic. Australia

"I have been practicing Tai Chi for over 20 years, and I have found no one that compares with Dr Lam - your presentation and expertise are what make the difference." Ted Stark, OR, USA

"The other day I was at the library and saw your video on the shelf... I was impressed with your presentation and the ease of following along. It is clearly one of the best Tai Chi instructional videos I have seen." Allan J. Glazer, DPM USA

Knocking out the gene for a peptide associated with insulin was shown to protect mice against the harmful effects of a high-fat diet. Urocortin 3 plays a role in the increased production of insulin in response to high caloric intake in animals.

Scientists found that by removing the urocortin 3 gene from mice, they did not develop the age-related insulin resistance and high blood sugar observed in the normal control mice. The metabolisms of normal mice were compared to the metabolisms of those without the urocortin 3 gene. When placed on a high caloric diet for three months, the mice without the urocortin 3 gene packed on the same amount of weight but had lower insulin levels. But these mice also had lower blood sugar, improved glucose tolerance curves and they did not develop the fatty livers the control mice experienced.

Scientists hypothesize that by curtailing the abnormally high insulin levels, they were able to manipulate insulin sensitivity and avoid some of the untoward consequences of the high food intake and weight gain. Like many of us diabetics already know too well - while insulin is effective at lowering blood sugar it also promotes fat storage. This is a natural protective response to prepare for times when food may not be available. When insulin is produced at too high a level for too long, the body becomes insulin resistant and blood sugar and certain blood lipids gradually creep up, which can cause progressive damage to multiple organs.

Urocortin 2 and urocortin 3 are part of the system that governs the body's response to insulin. Scientists already know that mice on a high-fat diet do better if either urocortin 2 or urocortin 3 is removed. Now they want to know if the mice will respond even better if both are missing. Such results may instruct us how best to develop therapeutic means to exploit these powerful effects.

Allow me to explain my choice of photographs. I choose to spot the picturesque sunset over the Ventura Beach horizon, where I will NOT be attending the upcoming Gordon Research Conference on Oxidative Stress and Disease. For those who will be there, do me a favor and drop me a line on Section 3: Oxidative Stress and Diabetes. Here's what I've got so far...

Alpha-lipoic acid is approved in Germany as a drug for the treatment of diabetic polyneuropathies. Alpha lipoic acid shows evidence of being effective in the treatment of diabetic neuropathy and may be useful in treating some other aspects of diabetes. It may help prevent the oxidation of LDL cholesterol and may be protective against oxidative stress. As much as I wish I could jump forward in time, I'll make a forward-looking statement about an upcoming event and come back to update it, after March 11th. Here's my forecast: the Gordon Research Conferences is holding a conference on Oxidative Stress and Disease and it just so happens that section 3 of the Monday night speakers will address topics such as: A radical explanation for diabetic complications, A role for ROS in the etiopathogenesis of insulin resistance, and Mitochondrial dysfunction and type 2 Diabetes. If you need me to drop names to lift your scientific credence in this convention - the speakers come from Harvard Medical Scool, Yale University School of Medicine and Albert Einstein College of Medicine.

These people don't mess around! I close with a big thank you to the creator of Miracle Muffins, for taking an interest in his mother and sharing it with the rest of us battling frustrating complications of diabetes. I'll be actively checking to see how the experts diagnostically address the role of oxidative stress and what they perceive as the best resolution. Until we hear better in days to come, let's keep betting on the benefits of a little ALA in our day.

It is well known that people with type 2 diabetes are at increased risk of pancreatic cancer, and now it seems that the risk extends to those with type 1 diabetes.

The risk was assed as small, but nonetheless - increased compared to those without diabetes. The research found that the likelihood of developing pancreatic cancer was twice as high in subjects with type 1 or young-onset diabetes as in people without diabetes. This increased risk is similar in magnitude to that seen with type 2 diabetes. There are many theories about the link between diabetes and pancreatic cancer. A cancer-inducing role of the insulin-producing beta-cells in the pancreas, is ruled-out because in type 1 diabetes these cells have largely or entirely been destroyed. The researchers want to stress that people with type 1 diabetes should not be overly concerned. The leading scientist issued a statement, "pancreatic cancer is an extremely rare disease, and twice a tiny risk is still a tiny risk."

In light of the study results, the researchers encourage diabetics to stay the course and focus on preventing the common complications of diabetes such as heart disease, eye disease and kidney disease. Good plan, good doctor. Thank you for the reassuring news – phew!

Remember the A-Game suggestions I dangled for Eli Lilly to tap for performance enhancement? Well here it comes. I called Eli Lilly headquarters to speak with the Chairman and CEO, Mr. Sidney Taurel but I was directed to their idea submission form (which consequently didn't work). Oh boy, Sid. I'm a little disappointed. So here goes - my idea is going free for all when you could've had it, first. Let's call this new and improved product Beta Juice. It delivers the essential functions of a fully operational beta cell. It produces: insulin, amylin and c-peptide. Here's why insulin should always come equipped with the other two...

Insulin brings sugar to the cells to keep our energy levels sufficient for life, homeostasis and (if we're lucky) some energy for the gym. Amylin is a controlling agent for appetite, gastric emptying and tells the liver to dispatch glucose. It is also shown to have an impact on lipolysis --- the metabolism of stored fat. Until recently C-peptide was nothing more than a number used to decipher if you were a type 1 or a type 2 diabetic. However, recent scientific studies have shown C-peptide protects small vessels from the complications associated with diabetes. The Reuters Health article is titled C-Peptide Replacement Improves Early Diabetic Neuropathy.

The American Diabetes Association promotes the ABC's of Diabetes Care in an effort to educate diabetics on controlling their disease. The ABC's of diabetes care refer to a patient's Hemoglobin A1c, blood pressure, and cholesterol. A diabetic must maintain a hemoglobin A1c less than 7%, their blood pressure must remain below 130/80 and their good and bad cholesterol must be kept in range. The ABCs of Diabetes Care were established in order to reduces the chances of developing diabetic complications like neuropathy (nerve damage), nephropathy (kidney damage) and retinopathy (eye damage).

Here comes the perfect Insulin (code name Beta Juice) -a laboratory engineered balance of insulin, amylin, and C-peptide. Insulin to balance the blood sugar level, amylin to regulate fat and cholesterol levels and C-peptide to control the damage inflicted upon the micro vessels throughout the body. This is a GREAT IDEA!! Not just because it is MY idea, but because this is a huge opportunity to mitigate the complications that insulin by itself can impose, without the checks and balances of the other beta cell hormones. What do you say, Eli Lilly? You're halfway there!! You've already partnered with Amylin Pharmaceuticals. They have one third of this patent pie. Now hop on the horn and join forces with the C-peptide patent holder and ride your stock price to the moon. The diabetic girl has spoken. I know you care, Eli Lilly. Now put your money where your mouth is and make this new and improved insulin a light at the end of the diabetes tunnel.

A 12 year study examined three separate definitions of the Metabolic Syndrome and how it can be used to predict major outcomes of diabetes (MOD). In case you were wondering, MOD is the easy way to explain complications like coronary artery disease, renal failure, diabetes-related death, or an aggregate of all of the above.

The study involved 514 type 1 diabetics. The three definitions of Metabolic Syndrome used for the study were taken from: NCEP ATP III (AHA Modified), International Diabetes Federation (IDF), and the World Health Organization (WHO). The prevalence of Metabolic Syndrome ranged from 8% (IDF) to 21% (WHO) at the conclusion of the 12-year follow-up. All definitions showed reasonable specificity (83%) for each outcome, while the WHO definition had the highest sensitivity for all outcomes except Renal Failure, for which eGDR was most sensitive. However, the individual assessment of each complication, rather than an aggregate estimate, was most accurate. Microalbuminuria was clearly the strongest predictor of all individual outcomes.

What an acronym! MOD stands for major outcomes of diabetes, which is far less posh than the vernacular predecessor, mod, which means vanguard in style. But I digress -- praise be microalbuminuria for being crowned the best single predictor of MOD. If you happen to linger with curiosity to learn more about microalbuminuria, indulge in the deep ocean of Wikipedia.

A report published in Diabetes Care says C-peptide improves sensory nerve function in type 1 diabetic patients with early-stage diabetic neuropathy. Thanks to Scott Strumello's comment, earlier today, I couldn't help but query the world wide web for more information on this C-peptide revelation. If I forget to mention it - thanks a million, Scott!

C-peptide was shown to be a significant factor in the maintenance of microvascular function. In a 6 month study of type 1 diabetes patients receiving replacement C-peptide, their nerve functions improved remarkably. A randomized study of 139 patients received one of 3 daily treatments: 1.5 mg of C-peptide, 4.5 mg of C-peptide, or placebo. At the beginning of the study, the sensory and motor nerve conduction velocities were significantly reduced compared with normal. After 6 months of treatment, peak sensory nerve conduction velocities improved in the groups treated with low-dose or high-dose C-peptide, but not significantly compared with the control group. The study showed a significant advantage in nerve functions for those treated with C-peptide (37%) verses those in the control group (19%). Overall, there were no adverse drug reactions reported from treatment of C-peptide.

At this time, there is strong evidence supporting the belief that C-peptide may be beneficial not only for nerve function, but also for the treatment and prevention of other long-term complications caused by type 1 diabetes such as nephropathy and perhaps retinopathy. Phase II clinical studies are ongoing at this time to demonstrate the safety and efficacy of C-peptide replacement therapy for the treatment of diabetic peripheral neuropathy. I can hear the trumpets playing already. I'll be right there with pen-in-hand ready to sign the dotted line for such a study. Thank you, Scott and thank you, Creative Peptides.

Bariatric surgery is the term for operations to help promote weight loss by making it difficult for the patient to consume a lot (or even a normal amount) of food. It offers a viable solution of mitigating type 2 diabetes, if not curing it entirely. In 2004, a major study showed that after 10 years, diabetes disappeared in 36% of patients who had the surgery, compared with 13% who did not.

Bariatric surgery is an increasingly popular option for people who can't lose enough weight by diet and exercise. The number of such surgeries has quadrupled since 2000, reaching 177,600 this year. For morbidly obese patients with type 2 diabetes, bariatric surgery results in a cure rate of 80-98%. About 90% of type 2 diabetics are overweight. In terms of just diabetes alone, the cure rate of serious illness after surgery is greater than 80%.

Bariatric surgery is nothing to take lightly. Although it is a serious procedure, it gives type 2 diabetics a token of hope they may never have to rue the day of diabetic complication like blindness, amputations, neuropathy, stroke, heart attack, and life itself. Is the risk worth the reward?