Diabetes Research

We all read the newspaper and magazine articles about the newest miracle supplement. Bonnie can remember when friends sneaked chromium tablets to each other at a spa to help with weight loss, headaches, and to cure other nonspecific ailments. Like aroma therapy from the year before, the pill bottles now sit in dressing room cabinets with the oils when the results proved too little or too slow.

We all wish for the “magic pill”. In doing research for this question, we found, as we frequently do, that research just brings up more questions as to what we know for sure and how to interpret information for ourselves.

What appears to be most universal in the books and articles published on vitamin and mineral supplements, is that many doctors prescribe a vitamin/mineral supplement to diabetics because they are concerned that poor glucose control which leads to frequent urination, causes loss of nutriments.

From this point, the research on vitamin and mineral replacement becomes more complicated. The most striking fact is that suggested government daily requirements are based on research done on healthy subjects.

Since people with diabetes may have other medical disorders, merely following these guidelines or complying to a new regime touted by researchers may not be beneficial to you. Also, the amounts of vitamins and minerals required for good health are small, and can be acquired, for the most part, by eating a diet rich in complex carbohydrates, vegetables, and fruits. If you are spending as much on supplements as on your medication, stop and think!

Vitamins

Vitamins function as co-enzymes and attach to specific protein substances in cells. Each cell has a maximum capacity to combine the vitamin and protein so it is biochemically impossible for excess vitamins you ingest to function as vitamins. In fact, with vitamins and minerals it is wrong to think that “more is better,” as megadoses of some can be dangerous.

There are 13 known vitamins for humans. These are organic substances which can be divided into two categories related to the way they are absorbed by the body. Vitamin A, D, E, and K are fat soluble, which means they are absorbed with the help of fats or bile and are stored in fat.

The eight B vitamins and vitamin C are water-soluble. These vitamins are stored in the body in amounts to last from a few weeks to months. The liver is the main storehouse and it releases stored vitamins which the body needs, but which are not available from the diet.

One B vitamin we read a lot about if Folic Acid or Folate. Women of child bearing age take this vitamin to prevent spina bifida and other birth defects, but recent research correlates folic acid with reduced death rates from heart disease. More studies are necessary to replicate these findings, but this is worth a conversation with your physician.

Minerals

Minerals are inorganic substances. In the body, the amount of minerals is larger than that of vitamins. Those minerals which are needed in the largest amounts are called major and include calcium, phosphorus, and magnesium. Trace minerals are needed in much smaller amounts and include iodine, copper, manganese, fluoride, zinc, iron, chromium, selenium, molybdenum, arsenic, boron, nickel, and silicon.

Minerals are important in almost every body function including oxygen transport and maintaining proper chemical and fluid balance. When combined with vitamins, minerals produce enzyme activity or become components of enzymes or hormones.

The two minerals of most importance to the majority of us are calcium, especially for bone growth in young children, lactating females, and post menopausal women; and iron. Research has shown the necessity of retaining appropriate levels of these two minerals, although for many people, daily diets diabetes provide the amounts needed for good health.

Women with osteoporosis or who have a family history of this disease may wish to talk to their physicians about testing bone density and look into a program of exercise, diet, and supplements. A less important mineral, but one about which much as been written, is zinc.

During the summer, claims were made about the positive effect that zinc lozenges had on colds. Although the zinc did not control fever or sneezing, it did seem to shorten the time people reported suffering from other cold symptoms.

However, many of the people in the study reported nausea and dislike for the taste of the lozenge. The American Diabetes Association suggests that you should know that the lozenges are not “clinically proven” as the package suggests, and that you should not take them for more than a few days because too much zinc can lead to other medical problems.

Antioxidants

Two vitamins to examine are the antioxidants C and E because they are most frequently in the news with claims of their powers to fight diseases, and keep us younger, longer. Of course you can get these antioxidants from vegetables and fruits. Think dark green and orange! Lists of foods high in specific vitamins and minerals are available from your health team and in nutrition books.

You may wish to talk to your physician about studies which indicate the presence of increased oxidation and glycosylation in diabetics, and the concomitant earlier aging of the body. Glucose itself can create free radicals that can damage protein structures in the body. It makes sense then to look to antioxidants for help. There are studies to show that vitamin E has a inverse relationship to angina.

Both vitamins have been researched for their implications in lowering death rates of heart disease and cancer. There is also evidence that antioxidants may have a protective effect in the body. For example, there is a high level of vitamin E in healthy retinas suggesting its importance is protecting the eyes.

It should be noted, however, that the relationship between lowered levels of antioxidants in diabetics along with a higher rate or free radical production and long term effect of the disease has not been proven. Taking vitamins and supplements on your own is frowned upon and can interfere with your care. For example, a recently reported study shows that taking a high dose of vitamin E may lower sensitivity to insulin.

Your Best Bet

Remember, there are no magic pills, and for every miracle cure there are follow-up scientific research projects that must be done. Your best bet is to keep reading and look for scientific results that can be replicated.

Make sure you have a good relationship with you health-care-team so that they become a reliable clearing house for news headlines. Once again, look to how much you spend on supplements and what you really know about how the vitamins and minerals work. Be a wise consumer and do your homework, but never close your mind to new ideas prematurely.

This morning’s newspaper about Rezulin, the medication that was taken out of the type 2 diabetes prevention study because it was implicated in the death of a subject. The article, dated July 28, 1998, with a Washington, D.C. byline, states that seven months after being banned in Great Britain because of its liver risks, consumer advocates here, citing at least 26 world-wide deaths, have asked for the same ban in the United States.

The Food and Drug Administration (FDA) responded that the drug offers an important benefit to type 2 diabetics who are not helped by other drugs. They indicated that physicians were not following repeated warnings to test patients on Rezulin to monitor any developing liver disease so that it can be stopped before permanent damage occurs.

Deaths, according to the FDA were caused by improper monitoring. Parke-Davis, the manufacturer, will send letters to 800,000 U.S. Doctors saying that the FDA has upgraded its warning for Rezulin. Doctors should test patients on Rezulin monthly for liver toxicity for the first eight months of therapy. If you are currently on this medication, talk to your physician if you have not had these monthly tests, or if you are concerned about side effects or liver disease.

Monitor Recall

A warning from the U.S. government and a recall of the Sure Step blood glucose monitor by LifeScan. The monitor may flash ERROR rather than register very high glucose levels. If you have one of these machines, contact the manufacturer or the place where you purchased it. LifeScan phone numbers are available later in this article after the announcement of a new monitor by this company.

Noninvasive Blood Glucose Monitoring Studies

July 22, 1998 Journal of the American Medical Association has a review article on the Development of Noninvasive methods to Monitor Blood Glucose Levels in People with Diabetes. The article reviews information from the Juvenile Diabetes Foundation sponsored meeting of the National Aeronautics and Space Administration, National Institute of Diabetes and Digestive and Kidney Diseases, and the National Center for Research Resources.

Infrared and axon spectroscopy, polarized light rotation, and minimally invasive devices that analyze the interstitial fluid secretions harvested from the skin are some of the methods being tested. Ultimately, the goal is to link these procedures to a device that will automatically deliver the correct amount of insulin, effectively creating an artificial pancreas.

The article goes on to say that although much progress has been made, truly noninvasive glucose monitoring is not a reality. There is, however, much research and manufacturing interest in the concept.

The glucose module reacts as it is exposed to various wavelengths of electromagnetic energy. Different methods using differing wavelengths have been developed to solve the problem on noninvasively measuring these reactions and so determining glucose concentration.

Each method has its proponents, each holds promise, each has it difficulties. They all face the same problem: how to magnify small perturbations of the glucose molecule as it responds to a beam of electromagnetic radiation sufficiently to obtain a totally useful reading. Recent electronic technical developments may enable measurement of the very tiny increments of energy involved.

Electromagnetic Radiation has four different types:

Near-infrared spectroscopy uses an external light source whose wavelength is just above the visible spectrum. The light passes through or is reflected by a part of the body, and glucose and other parts of the blood absorb a small amount of the light at each wavelength. The reflected light is analyzed to determine the blood glucose level.

Mid-infrared radiation spectroscopy measures natural thermal emissions. When radiation in the mid-infrared passes out of the body, glucose in the blood absorbs some of it. The absorption can be stectroscopically determined by comparing measured and predicted amounts of thermal energy at the skin surface and the difference can be converted into a measure of the blood glucose concentration.

Radio wave impedance works when waves pass through the blood with glucose present. The glucose interacts with the beam to attenuate the amplitude and shift its phase. Using a conversion factor, the glucose concentration can be calculated from measuring the impedance of the radio wave as it passes across a finger.

A fourth method is to measure the optical rotation of polarized light which rotates in proportion to the concentration of glucose in the blood. A beam can be passed through a body component such as the ocular aqueous humor, and the amount of rotation then used to calculate the glucose concentration.

Interstitial Fluid Measures:

These are minimally invasive methods of harvesting interstitial fluids from the skin. They all rely on recent research that dermal interstitial fluid glucose is directly proportional to blood glucose concentrations. Because it is easier to get this information, minimally invasive methods are closer to clinical application than are noninvasive devices.

Methods described at the meeting:

Using reverse iontophoresis, one method extracts fluid from the skin by the application of an electric current. This fluid contains salt, water, and glucose. The glucose concentration is then measured. The GocoWatch, made by Cygnus Inc. of Redwood City, CA. who demonstrated this watch which can read glucose levels up to three times an hour and can sound an alarm if glucose levels fall too low or rise too high. The manufacturer states that the device has been tested clinically and is as accurate as current glucose monitors.

Another device described as a transdermal patch is called the TD Glucose patch. It is made by Technical Chemicals and Products of Fort Lauderdale, FL. The patch is placed on the skin to 5 minutes. It draws the interstitial fluid using a combination of skin enhances and a medium for transporting the glucose in the fluid. When a small amount of fluid reaches the patch, the glucose undergoes a biochemical reaction resulting in a color formation that is directly measured by a meter directly correlated to the blood glucose levels.

Currently this device is undergoing comparison testing at three university-affiliated diabetes clinics in the U.S. The owner of the company expects these studies to be completed later this year at which point he expects to be able to file with the FDA for marketing approval of the device.

New Glucose Monitor: FastTake

LifeScan, a division of Johnson and Johnson, has come out with a new glucose monitor, the FastTake which they claim has an all-new contoured styling. It is slender and lightweight in design with large, easy-to-read display. The meter has a fast 15 second test time and yet is described as compact in a sporty carrying case.

It requires a very small amount of blood and a touch-anywhere test strip. The meter comes with a 150 test memory with date and time, automatic 14-day averaging, and it can interface with a computer for in-depth test results. This meter comes with a 5-year warranty and 24-hour toll-free customer assistance. LifeScan also has an excellent video tape for showing to groups. Information about products is available in both English and Spanish.

Laser Irradiation Improves Skin Circulation in Diabetics

Diabetes Care: Volume 21, No.4 has an article on Low-Intensity Laser Irradiation Improves Skin Circulation in Patients with Diabetic Mocroangiopathy by Schmidl, Andreas, M.D. et al. The researchers knowing that food problems due to angiopathy and neuropathy account for 50% of all nontraumatic amputations and that low-intensity laser irradiation has been shown to reduce wound healing in conditions of reduced microcirculation, investigated the influence of low-intensity laser radiation by means of infrared thermography on skin blood circulation in diabetic patients with Mocroangiopathy.

Thirty patients with diabetic ulcers or gangrene and elevated levels of glycosylated hemoglobin were treated randomly. The results indicated that after a single transcutaneous low-intensity laser irradiation a statistically significant rise in skin temperature was noted and demonstrated an increase in skin micocirculation due to athermic laser radiation in these diabetic patients.