Ever wonder how Eli Lilly was able to get away with the Zyprexa scandal? A former member of the Lilly neuroscience team put it simply: statistics are like prisoners -- torture them long enough and they'll tell you what you want to hear. This YouTube video gives 6 jaw-dropping minutes of priceless pharmaceutical rep training on how to overcome sales resistance.

Quite remarkable is the coaching Lilly provided their pharmaceutical reps in dismissing the feedback they were receiving from doctors. Lilly told reps to ask doctors (in no uncertain terms) do you want a thin psychotic patient or a healthy fat patient? I think the operative word here is healthy. Does Lilly believe that excessive weight gain, insatiable hunger and Type 2 diabetes are healthy?

In Type 2 diabetes - the blood sugar rises, and spills into the urine, because the body resists insulin and resists its transfer of glucose out of the blood and into the cells of the body. The most important organ in the body – the brain – is protected by this insulin resistance. This is a protective reaction to prevent too sudden a fall in blood glucose, which can cause the brain to swell up with water! If too much glucose suddenly leaves the bloodstream the other sugars in the brain (sorbitol and fructose which are relatively unaffected by insulin) cause water to flow into the brain to correct the osmotic imbalance -- so the brain runs the risk of sustaining injury = too much sugar + too much insulin causes too much water.

Those of us who know what it's like to correct a high sugar with insulin know what it's like to feel bloated as our sugar comes down too quickly. The body is designed to protect its brain by only slowly reducing glucose in the blood and for any excess glucose to be flushed out in the urine. This is a temporary fix for a temporary carbohydrate overload. My billion dollar question is this: Have Lilly pharmaceutical reps been trained to dismiss the side effects of GM insulin (genetically modified to overcome insulin resistance) since it was first introduced in 1983? I'm curious how Lilly justifies diabetic complications.

Shhh. Big Pharma scientists hard at work. On what, you ask? Why, on Novo's new "baby" - a drug designed to treat type 2 diabetes. Liraglutide, a hormone analogue, is supposed to improve blood sugar control. It's also supposed to get you that coveted magic bullet (a la Byetta): weight loss. Ooh, baby. Now that's medication!

Novo Nordisk has been working on Liraglutide for a while now. Here's the latest: Novo announced Monday that two Phase III studies were successful in demonstrating the aforementioned blood sugar control and weight reduction. Novo is riding high on the news: its shares rose six percent on the announcement. According to a pharmaceutical industry analyst quoted by Reuters, the shares surged so healthily because the positive news was expected.

The powers-that-be at the drug giant say they hope Liraglutide can be submitted for regulatory approval by mid-2008. They hope it will become another blockbuster, with estimated annual sales topping one billion. Stay tuned.

No, no elephants here. Sorry. This is about human trunks - that is, your upper torso. "Upper trunk fat" refers to fatty deposits that form on the chest and upper back area. According to the latest research, upper trunk fat is associated with increased risk for insulin resistance. And insulin resistance, in case ya didn't know, is an early symptom of type 2 diabetes.

It was already known that visceral fat, the fatty deposits that form around and between the internal organs, contributes to insulin resistance.

This study, linking upper trunk fat to insulin resistance, was conducted by researchers based at the San Francisco VA Medical Center. The connection was actually established in the course of a study of fat redistribution and metabolic change in HIV-infected patients. Both HIV-positive patients on antiretroviral therapy and non-HIV-infected control participants were involved in the study.

A surprise finding was this fact that upper trunk fat contributes to insulin resistance just as much as does visceral fat. Also of note: this occurs regardless of whether or not the other type of fat is present. The researchers also note that all study participants were equally at risk. Says lead researcher Dr. Carl Grunfeld, "Strikingly, there was very little difference between HIV-infected people and controls. If you have fat up top, it's bad for you."

A full report has been published in the online version of the Journal of Acquired Immune Deficiency Syndromes.

Menopause means the end of estrogen production in women. One of the changes resulting from that loss is a rise in blood sugar. Other undesirable side-effects include a tendency to overweight and high blood pressure (hypertension). That news comes courtesy of a new study conducted on female rats.

The lead researcher for the study was Dr. Lourdes A. Fortepiani of the University of Texas Health Science Center at San Antonio. According to Dr. Fortepiani, simulating menopause in rats caused a thirty-five percent rise in blood sugar levels. Other changes included significantly higher blood pressure and weight gain at double the normal rate.

Yikes! Is that what we ladies have to look forward to?? This is certainly something to keep in mind if you have diabetes. But wait. There is a silver lining. Estrogen replacement therapy erases all these nasty hormonal and metabolic side effects, says Dr. F. Could this mean that hormone replacement therapy, which has lately fallen really, really out of favor, might be making a comeback?

Type 2 diabetes, mate? By crikey. Australia's diabetes epidemic continues to be a problem. News this week indicates the spread of obesity, and with it associated conditions like Type 2 diabetes, in rural areas is far worse than previously realized. A survey of 806 randomly selected adults (okay, not the biggest sample, admittedly) found that a great many are affected by the disease.

Based on their findings from that survey, researchers calculate that almost three-quarters of Aussie men living in rural areas are overweight. They think women in rural areas may be slightly better-off - around two-thirds may be overweight. This puts rural Australians at a very high risk for T2DM. The conclusion, stated in the Medical Journal of Australia: "urgent population-wide action is required to tackle the problem."

As is the case in the US, a big concern is how to treat all those people as they age and their overall health worses. Specifically, what will become of Australia's public healthcare system? "We might get a whole generation, now in their 40s, 50s and 60s, who will do markedly worse than their parents," predicts lead researcher for the study, Professor Edward Janus of Melbourne's Western Hospital.

Hot on the heels of my previous cat-related post comes yet more kitty news from the UK. This time it's about the extent to which diabetes is affecting British cats, and the news isn't good. A study conducted at Edinburgh University reports that one in 230 pet cats in the UK is diabetic. Neutered, overweight male cats are most at risk, apparently. Hmm, at least our hefty male friends don't have to contend with the one of those risk factors! Like humans, however, the more sedentary the cat, the greater the risk.

Overall, being overweight ups the risk of diabetes in felines by three times. There are now around five times more diabetic cats in the UK than there were back in the 1970s. Says Professor Danielle Gunn-Moore of the veterinary program at Edinburgh University, "The lifestyle of cats, just like their owners, is changing. Unfortunately, just like people, cats will overeat if they are offered too much tasty food, particularly if they are bored. While cats would naturally exercise outside, many cats are now housebound, so they have little to do all day but eat, sleep, and gain weight."

Yikes, this describes our own chunky kitty Kato to a T. He is getting older, is sedentary, and weighs in at around 19 pounds last time I checked. Like many people, I'm reluctant to let my cats out in case they get lost, hit by a car, stolen, trapped and impounded...the list goes on and on. Then there's the killing of backyard birds to consider. So: what's a cat lover to do?

Pet enthusiasts may know that diabetes is rife amongst domestic cats these days. Why? Same reasons type 2 diabetes is such a problem for people - overeating and a sedentary lifestyle puts us at risk for the disease. But here's a cute story from the UK about some diabetic felines who just got lucky in life...or not, depending on your view.

The Lincolnshire Echo reports that an animal rescue organization called Lincoln Cat Care is trying to place rescued diabetic kitties with diabetic owners. Representatives with the group have appealed to diabetics in the community to come forward and help out one of the formerly-homeless cats. Their rationale is simple: people who have diabetes - or perhaps a family member with the condition - can better care for diabetic cats. They know the signs and symptoms of diabetes, they understand the whys, whens and hows of giving insulin.

Now, I'm involved in animal rescue and I have met tons of devoted pet owners over the years. I just don't buy that diabetics are more likely to make better owners. Nope. Sorry. People who really love their pets make the best owners for diabetic cats and dogs. I've met many wonderful owners of diabetic cats. None of those people are diabetic, but they've gone out, asked questions, read up in books and on the Web, and they are pretty darn knowledgeable. And who's to say a diabetic person would provide that level of care just because they have the disease themselves? Many diabetics out there don't even manage their own blood sugar very well! In short, it's dedication that matters here, not your diagnosis.

Fat. Never a good thing, right? At least not in the US, where food is super-abundant. Instead of being rightly grateful for all that food, we blame it for our weight woes. Yes, there's a growing sense that food is the enemy. Food leads to weight gain, which leads to obesity, which leads to heart disease, type 2 diabetes, and on and on. (Read Michael Pollan's The Omnivore's Dilemma for more on what he terms "our national eating disorder.")

But apparently there's a silver lining in all that fat. Says journalist Natalie Angier for The New York Times, "to castigate fat for getting too big and to blame it for high blood pressure or a wheezing heart is like a heavy drinker blaming the liver for turning cirrhotic." That is, if the body couldn't convert energy to fat cells in an efficient manner we'd really be up the proverbial creek. In fact, evolutionary biologists have even speculated that humans' ability to store good-sized quantities of fat has aided the survival of the species and made it possible for our big brains to grow so big and, um, brainy. The fat, you see, helps us through hard times. Food for thought, huh?

I really don't get this, but here goes: according to a report summarized on the website DiabetesHealth, weight gain reduces the severity of heart disease in type 1 diabetics. Huh? How can that be possible, I'm wondering? After all, we live in a world where weight gain is considered a great evil, a threat to individual health, a drain on our healthcare resources etc. etc. And now this!?

The findings come from the Pittsburgh Epidemiology of Diabetes Complications Study, which was conducted over a period of sixteen years and involved the participation of 225 type 1 diabetes patients. The Pittsburgh people agree more fat on the bones adds up to one heck of a big risk factor for heart disease. However, they also say that if you're type 1 and do get heart disease, carrying extra weight makes the heart disease less severe. They also report that this effect is especially true for women. So, the big question: why? The researchers think it's because heavier people may have better insulin control. But don't run for the local Burger Barn; weight gain is not desirable as it does more harm than good in the long run.

Ever noticed that people tend to be around the same weight as spouses and friends? Well, it's not your imagination. A study just out in the New England Journal of Medicine reports that obesity, a major risk factor for type 2 diabetes, acts somewhat like a contagious disease - so when one person puts on weight, others around them follow suit. This, the researchers say, helps explain why Americans have gotten so fat in recent decades.

The study, a summary and discussion of which is featured in The New York Times, involved the analysis of a social network of 12,067 people over a period of thirty-two years (from 1971 to 2003). Researchers tracked not only the health and weight loss/gain of these people, but also who knew whom, who was friends with whom, and who was related to whom. Over time, it became clear that those whose friends became obese were much more likely to grow obese themselves. The likelihood, in fact, tripled in the case of close friends. Interestingly, friendship mattered more as a determining factor than did being related or being neighbors with someone.

It works like this: people tend to share the lifestyle habits of their family and friends. Folks who consider salads delightful and who enjoy frequent jogs around the park generally surround themselves with similarly-minded folks, and it shows in their trim physiques. Likewise, fast-food munchers who enjoy lots of TV tend to hang out with a similar crowd...and their thighs - not to mention waistlines, hearts, blood sugar levels etc. - suffer the consequences. Another factor, says researcher Nicholas Christakis, is the perception of the self in relation to others: "You change your idea of what is an acceptable body type by looking at the people around you."

It's often said that serving food on smaller plates makes a diner inclined to eat less. Well, a Canadian researcher decided to put that theory to the test. Sue Pedersen, who is an endocrinologist at the University of Calgary, conducted a study designed to evaluate the efficacy of a specially designed "portion-control plate." The plates, designed by Diet Plate Limited of England, are marked with lines indicating how much of the day's main meal should be divided amongst the various food groups.

For six months, sixty-five study participants ate their food from regular dishes, while sixty-five others ate their food from the portion-control plates. All of the participants were type 2 diabetics and clinically obese. End result? The plates worked quite well at getting subjects to curb their appetites. After six months, those using the plates lost an average of 1.8 percent of their body weight, whereas the control group lost an average of only 0.1 percent. Interestingly, those on insulin regimens did the best of all, with an average of 2.5 percent weight loss.

The fatal flaw? What happens when the white lab coat crew aren't charting your intake any more? Call me a naysayer, but I'm predicting some major snacking in the future of those study subjects. Because special plate or not, you have to have the will to cut portion intake, and it's hard to maintain that will long-term.

The results of Pedersen's study have been published in the Archives of Internal Medicine (June 2007). Check out the Diet Plate website too.

Did you hear about renowned Harvard scientist Barbara Kahn's latest published research? I blogged about it recently. Kahn and colleagues state, in a report published in Cell Metabolism (July 2007), that it's possible to use a simple blood test to detect the presence of a specific protein called RBP4. Kahn et al say the presence of RBP4 can be used to measure accumulations of deep belly fat. Underpinning this research is a belief that such accumulations of belly fat increase risk for metabolic syndrome, leading to various maladies including heart disease and diabetes.

However, not everyone accepts this point of view. A Yale research team says that deep belly fat may not be so evil after all. The researchers, who are based at Yale University School of Medicine in Chevy Chase, Maryland, assert that metabolic syndrome is caused not by belly fat but by insulin resistance in skeletal muscle. This resistance, they state, makes it tough for the body to manufacture glycogen, so - in people who are insulin resistant - energy that cannot be stored as glycogen gets diverted into fatty acid production, which then contributes to metabolic syndrome.

The team compared abdominal fat levels in young and healthy individuals, some of whom were insulin sensitive and some of whom were insulin resistant. The result? "There is absolutely no difference in the volume of abdominal fat," states Yale's Gerald I. Shulman, who was lead author of the study. Abdominal fat, says Dr. Shulman, "may come later in the course of the disease [metabolic syndrome], but it's not a primary, underlying factor."

A major study of patients with rheumatoid arthritis (RA) is just out. It found that those treated with hydroxychloroquine (HCQ) - brand name: Plaquenil - an antimalarial drug also prescribed for RA, are much less likely to develop Type 2 diabetes. The study was conducted over a period of more than twenty years and analyzed the treatment of 4,905 adult patients with RA. Bottom line: relative risk for T2 diabetes declined by up to seventy-seven percent in patients who took HCQ for four years. Wow.

But that's not all. The researchers also say the RA patient who did develop diabetes were less likely to need medications for blood sugar control. Moreover, according to Mary Chester M. Wasko, a rheumatologist and professor of medicine at the University of Pittsburgh School of Medicine, the greatest potential application could come in using HCQ as a preventive for people with pre-diabetic symptoms, "much in the same way as a daily baby aspirin is suggested for people at high risk for heart disease."

This is significant because having RA is a condition that usually leads to reduced activity levels and also to weight gain (as a consequence of taking corticosteroids), and these two factors put them at risk for Type 2 diabetes. So this is good news indeed.

The study was directed by scientists at Stanford University, however, researchers from multiple institutions were involved. Funding was provided by the National Institutes of Health. The report has been published in the latest issue of the Journal of the American Medical Association. Click here or here to read more.

In light of Novo's Meet the Face of Change campaign, I figured I'd address an idea worthy of mention coming out of the Novo product pipeline. This treatment is for Type 2 diabetics but it is not insulin - it's called liraglutide. Liraglutide is a once-daily human analog of the natural hormone Glucagon-Like Peptide-1 (GLP-1). It causes neither excessive hypoglycemia nor weight gain.

Liraglutide works by stimulating the release of insulin only when glucose levels become too high. Unlike many other diabetes drugs - liraglutide also leads to weight loss instead of weight gain. Now we're getting somewhere, Novo!! Patients with Type 2 diabetes treated with liraglutide had a greater reduction in average blood sugar than those patients treated with placebo or insulin glargine (Lantus). As expected, the combination of a GLP-1 analog with a sulfonylurea caused some of the patients to experience hypoglycemia. Okay, point taken. So why impose a glucose lowering drug while mitigating the problem causing elevated sugar in the first place? One drug at a time, folks.

So this is a step in the right direction and I like where it is going. Treating Type 2 diabetes with insulin is counter-intuitive. Looking at another hormone that might interfere with the use of insulin might be the culprit. So here lies a very good idea and I like it. Gold star, Novo! Now when can we meet the face of liraglutide?

The FDA has approved a new over-the-counter weight loss drug called alli (orlistat) that is designed to absorb 25% of the fat from your meal. However, nutrition and fitness expert Dr. Len Lopez, author of "To Burn or Not to Burn, Fat is the Question" shares his reasons why the new approved weight loss drug may not be beneficial to your health.

New research is showing that medications don't make us healthier. Research is showing that losing weight with medications doesn't decrease the rate of heart attacks, strokes or diabetes. Add that to the fact that your body loses nutrients with these medications and you can easily see how these new weight loss drugs can hamper your health. Dr. Lopez discusses practical steps to losing weight which includes diet and exercise, but also covers how stress and adrenal fatigue can disrupt our hormones, such as cortisol and adrenaline. These hormonal imbalances can throw off our metabolism and take us out of our fat burning mode.

Both of Dr.Lopez's books cover a good deal of information to understand how we can correct our imbalances in piecing together the weight loss puzzle. His knowledge explores the roles of insulin and cortisol in weight gain, cravings, fatigue and more. He also explains how stress can take you out of your fat burning zone and helps you regain your blood sugar balance, as well as implementing the "Five and Two" dieting plan.

Say NO to the weight loss drugs and say YES to the empowering knowledge Dr. Lopez has to share.