Normal Blood Sugar Levels and Diabetes

Vitamin D Research and Higher Intake Levels

The more I read and learn about vitamin D the more it seems that those like me who have diabetes, and those who have the related condition called prediabetes, may be missing out on a possible inexpensive supplement that could help us in our efforts to control the higher than normal blood sugar levels that characterize our disease and make us diabetics.

Whenever vitamin D research findings are referred to, and that’s frequently these days, it is so often accompanied by mention of its potential benefits in lowering or treating the risks in cancer, cardiovascular disease, and diabetes, among others. It is important to note that the research involves significantly increased intake levels of vitamin D than are currently recommended as being adequate. With exposure of bare skin to sunlight it is possible to obtain those higher levels but to do so in that way is not advisable because such exposure increases skin damage and risks of skin cancer.

Important in the case of diabetes
There is evidence suggesting that vitamin D may increase sensitivity to insulin. Insulin is the hormone that is essential to assist the entry of blood sugars into the cells of the body. Also, evidence indicates that the vitamin helps the body to secrete more insulin, a major plus for anyone with type-2 diabetes or prediabetes. If that is so, then it combats the dual conditions that causes higher than normal blood sugar levels, those being either insulin resistance or lack of insulin production by the body, and sometimes a combination of both of those causes.

Maybe because of the very fact of having the disease it is too easy to get excited when vitamin D is again mentioned as perhaps playing a role in the development of diabetes and can lower the risks of complications, something not widely recognized previously. But who can blame us when we are so conscious of our blood sugar levels that most of us test for every morning and sometimes during the day, when we see the blood sugars begin to rise to high levels. Preoccupation with blood sugars can become excessive..

But it should not be overlooked that there are 50 million or more Americans who have prediabetes according the Center for Disease Control. Prediabetes is a condition that will lead to full diabetes for many, just consider how they could benefit if their prediabetes could be prevented from worsening with the aid of vitamin D.

Diabetes associations not yet advocating changes
I realize that it may be premature to think of vitamin D in this way, the merits of increased vitamin D intake are still a matter of debate. The American and the Canadian Diabetes Associations are taking a more cautious view and not advocating any change in vitamin D intake above the current recommended levels.

In a Research Summary, the American Diabetes Association, states that more studies are needed in order to know whether taking more calcium and vitamin D is effective in preventing diabetes and its complications. Elsewhere, in a lengthy position statement, without specifically mentioning vitamin D, they say in a section headed Recommendations: “There is no clear evidence of benefit from vitamin or mineral supplementation in people with diabetes (compared with the general population) who do not have underlying deficiencies.”

But some researchers and scientists are critical of the slow action in the review process to assess the evidence pointing to increased intakes being beneficial. In the United States, the advisory board for vitamin D is expected to conclude studies in the summer of this year that can determine such possibilities. However, many scientists remain skeptical that any recommendations to increase intake levels will fall short of the amounts they should be.

Additional Information:

http://www.vitamindcouncil.org/

http://forecast.diabetes.org/magazine/your-ada/vitamin-d-and-diabetes

http://www.vitamindcouncil.org/health/deficiency/am-i-vitamin-d-deficient.shtml

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February 25, 2010
Avandia, a well-known drug used in the treatment of type-2 diabetes in the battle to control blood sugar levels, is again the subject of controversy after the release this week of a report on an investigation carried out over the last two years by the U.S. Senate Finance Committee.

Among other criticisms, the report claimed that the drug manufacturer had not kept the public informed of risks that the company knew to be associated with the drug.

The chairman of the investigation committee, Senator Max Baucus, said “Americans have a right to know there are serious risks associated with Avandia and GlaxoSmithKline, the manufacture, had a responsibility to tell them.”

The committee is also critical of the Federal Drug Agency (FDA) for allowing continued marketing of the drug in spite of warnings of the risks. Some of the FDA’s own health safety experts have raised alarms about its safety, saying it should not be on the market.

GlaxoSmithKline, the manufacturer, vigorously disagrees with the conclusions stated in the report regarding the risks and dangers to health and continues to defend the efficacy and safety of the drug as it has done on several occasions since the approval of Avandia by the FDA in 1999.

Cardiovascular deaths and severe adverse events
Safety issues about the drug were raised soon after its approval. In March of 2000, for instance, Dr. John Buse, Chief of Endocrinology at the University of North Carolina wrote to the FDA expressing concerns and warning of the risks to those using Avandia, saying there is a “worrisome trend in increased cardiovascular deaths and severe adverse events” occurring among those using the drug. Dr. Buse was also critical of the marketing of Avandia and the actions taken to understate the risks associated with the drug.

FDA Alert issued May, 2007
Warnings from other sources continued to be voiced and in 2007 much publicity was given to the FDA’s official Alert issued to healthcare professionals.

The New England Journal of Medicine, early in 2007, had published results of a meta-analysis by cardiologist Steve Nissan of the Cleveland Clinic showing a 43 percent increase in heart attacks in patients using Avandia. Although the conclusions of the study were contested by the manufacturer, the FDA issued an official Alert, noting that the analysis had shown a “significant increase in the risk of heart attack and heart related deaths in patients taking Avandia.” In their view however, other data provided contradictory evidence and it was stated that the “FDA’s review of available data is ongoing.”

The FDA Alert also said that it was providing the emerging information to the doctors so that they and their patients could make individualized decisions on its use. My own decision as a patient after discussing with my doctor was to immediately stop taking Avandia.

Now, many years later, we appear to be in the same place, criticism continues and GlaxoSmithKline rejects any claims that the drug is unsafe. Company spokeswoman Nancy Pekarek, appearing on CNN a few days ago said “We disagree with the conclusions in the report. The FDA has reviewed the data and concluded that the drug should be on the market.”

Meanwhile, there are hundreds of thousands of our fellow diabetics who still take the drug. And the complications of diabetes continue to take their toll, for whatever reason whether hastened by a drug or otherwise, there are more people dying of diabetes complications than are being killed in Afghanistan, we need help and prompt decisions,

The FDA commissioner is reviewing the report issued by the Senate Investigation Committee, while awaiting recommendations of the agency’s own group of advisors. I assume those would include the beliefs of some of the FDA’s health safety experts who say the drug should be withdrawn. The advisory committee’s report is expected in July and at the present time the opinion of the FDA is that patients should not stop taking Avandia.

In our struggle to achieve normal blood sugar levels, perhaps Avandia really is effective and beneficial, in spite of the apparent risks. Let us hope that after ten years of controversy, a final decision is near on whether Avandia is safe or not.

Link for 342 page  Senate Finance Committee report.

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For type-1 diabetics, can this pump improvement make it reality?

The development of what is being called an “artificial pancreas”, was reported in the pages of the February 2010 issue of Great Britain’s leading medical journal, The Lancet, bringing new hope to type-1 diabetics who depend on insulin injections every day to manage their disease.

Reference: “Closed-loop insulin delivery in children and adolescents with type 1 diabetes”. Roman Hovorka et al. The Lancet, February 5, 2010

With the aid of 17 type-1 diabetic children and teenagers, spending 54 over-nights in hospital during which they experienced varying conditions to simulate real life situations, researchers at England’s Cambridge University have successfully tested a device described in The Lancet as “a milestone in the quest for the holy grail of artificial insulin delivery that started almost 50 years ago”. The results were compared with those of their regular subcutaneous infusion pumps.

With the aid of 17 young type-1 diabetics confined to a hospital setting but in varying conditions to simulate real life situations, researchers at England’s Cambridge University have successfully tested a device described in The Lancet as “a milestone in the quest for the holy grail of artificial insulin delivery that started almost 50 years ago”.

The importance of this development cannot be over-estimated although, apparently, it will still take some years to perfect and for it to pass through the necessary series of trials yet to be carried out.

If it can be brought into production it would fulfill the promise of a close to normal life with normal blood sugar levels for all insulin-dependent diabetics who choose to use it, most of whom are of the Type-1 form, also called juvenile diabetes.

Insulin and Type-1 diabetes
Insulin is needed to help the absorption of glucose into the cells of the body where it provides the energy required in the metabolic processes to sustain life.

Type-1 diabetes, a very serious disease usually diagnosed in childhood, is a disorder of the body’s immune system in which an organ called the pancreas becomes impaired and ceases to produce the hormone insulin. The result is that it becomes essential to administer artificial insulin by daily injections with a special insulin primed needle or by an insulin pump usually attached to the body. This also first involves a series of finger-pricks to obtain a blood droplet for testing to determine the amount of insulin actually required, if any.

To the non-diabetic person I would say:
If you could just imagine that you are a type-1 diabetic. The blood tests and the injection of insulin has to be done multiple times every day of your life in order to stay alive. You would then realize how wonderful the “artificial pancreas” would be for you. There are also many other diabetics, suffering from a different form of diabetes called Type-2, many of whom also have to inject insulin.

Depending on the types and amounts of food being consumed, blood sugar levels vary throughout the day and insulin is needed to maintain them within a safe range. Electronic subcutaneous insulin pumps have been in use for many years, able to deliver insulin at a slow and steady fixed rate throughout the day, adjustable as required by the diabetic after taking finger-prick test readings.

Providing a more accurate response to changing blood sugar levels
But the development of the new insulin pump device provides a better and more accurate response to changing glucose levels as they occur, signaled by a glucose sensor that monitors the fluctuating blood sugar levels, enabling the delivery of insulin doses that are matched to the glucose level detected.

The test results showed that the system maintained blood glucose levels within the normal range for 60 percent of the time compared to the usual 40 percent provided by the regular insulin pumps. Also the new device is able to prevent glucose falling to dangerously low levels while keeping overall blood glucose levels stable all the time. This is very significant for the reassurance of parents whose fear is that their child may fall into a coma because of a drop from normal blood sugar levels to dangerously low blood sugars at night while sleeping.

In the United States there are also several ongoing projects to develop and perfect an artificial pancreas able to provide a variable insulin delivery system in response to sensors that monitor changing blood glucose levels.

So let us hope that we are on the threshold of a new era for the insulin dependent diabetic. It cannot come too soon.

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