Guest guest Posted April 11, 1999 Report Share Posted April 11, 1999 You won't be able to maintain an erection; you will gain weight, and the more weight you gain, the worse your diabetes will get; you will go blind; your digestive system will quit working (gastroparesis), which will make your diabetes control worse, and you will end up eating basically bland baby food; your body parts will get amputated, a little bit at a time (surgeons call it " slice and dice " ). It will start with your toes, then your feet, then your lower legs. But first you will go through numerous procedures because of sores that won't heal, etc. And you will be numb from your waist down. And you will have trouble walking. And you will get cracks on your heels and other sores on your feet and lower limbs that absolutely will not heal. And you will take many different pills, and be hospitalized numerous times. And you will be denied insurance. And you won't be able to find work. And you will apply for welfare, but you will be turned down because they will tell you you can still work. But none of the jobs that offer medical insurance will hire you because you are such a high risk. And you will be poor. And you will be depressed. And you will get gangrene. And you will go blind. And your blood pressure will skyrocket (more pills). And you will have a heart attack or two. And then you will die. HAVE A NICE DAY! -In The Rapid Exchange of Information, Grammar, Spelling & Proper Sentence Structure Are Low On My Priority List.- PK PAUL KOSSART Peru, IL USA NMRA, LDSIG, OPSIG, BRHS, TP & W-HS LaSalle & Bureau County Model R.R. Club Chicago, Burlington & Quincy Model R.R. (HO-1969) " Serving Agriculture & Industry In The Illiniwek River Valley " Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 11, 1999 Report Share Posted April 11, 1999 Ahhh... Pleasant dreams everyone! G'nite! /Celine Kossart wrote: > > > You won't be able to maintain an erection; you will gain weight, and the > more weight you gain, the worse your diabetes will get; you will go blind; > your digestive system will quit working (gastroparesis), which will make > your diabetes control worse, and you will end up eating basically bland > baby food; your body parts will get amputated, a little bit at a time > (surgeons call it " slice and dice " ). It will start with your toes, then > your feet, then your lower legs. But first you will go through numerous > procedures because of sores that won't heal, etc. And you will be numb from > your waist down. And you will have trouble walking. And you will get cracks > on your heels and other sores on your feet and lower limbs that absolutely > will not heal. And you will take many different pills, and be hospitalized > numerous times. And you will be denied insurance. And you won't be able to > find work. And you will apply for welfare, but you will be turned down > because they will tell you you can still work. But none of the jobs that > offer medical insurance will hire you because you are such a high risk. And > you will be poor. And you will be depressed. > > And you will get gangrene. And you will go blind. And your blood pressure > will skyrocket (more pills). And you will have a heart attack or two. And > then you will die. > > HAVE A NICE DAY! > > -In The Rapid Exchange of Information, Grammar, Spelling & Proper Sentence > Structure Are Low On My Priority List.- PK > > PAUL KOSSART Peru, IL USA > NMRA, LDSIG, OPSIG, BRHS, TP & W-HS > LaSalle & Bureau County Model R.R. Club > Chicago, Burlington & Quincy Model R.R. (HO-1969) > " Serving Agriculture & Industry In The Illiniwek River Valley " > > ------------------------------------------------------------------------ > Did you know that ONElist hosts some of the largest lists on the Internet? > http://www.ONElist.com > Our scaleable system is the most reliable free e-mail service on the Internet! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 12, 1999 Report Share Posted April 12, 1999 I wrote to Roy Dahl: << ... And you will get gangrene. And you will go blind. And your blood pressure will skyrocket (more pills). And you will have a heart attack or two. And then you will die. >> And Kossart replied: << HAVE A NICE DAY! >> " Other than *that*, Mrs. Lincoln, did you enjoy the play? " Susie ;D Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 12, 1999 Report Share Posted April 12, 1999 Did I miss something? Why was this posted? I know I have been quite for awhile but have had alot to do. This just surprised me. Stormy Re: Digest Number 112 > > > >You won't be able to maintain an erection; you will gain weight, and the >more weight you gain, the worse your diabetes will get; you will go blind; >your digestive system will quit working (gastroparesis), which will make >your diabetes control worse, and you will end up eating basically bland >baby food; your body parts will get amputated, a little bit at a time >(surgeons call it " slice and dice " ). It will start with your toes, then >your feet, then your lower legs. But first you will go through numerous >procedures because of sores that won't heal, etc. And you will be numb from >your waist down. And you will have trouble walking. And you will get cracks >on your heels and other sores on your feet and lower limbs that absolutely >will not heal. And you will take many different pills, and be hospitalized >numerous times. And you will be denied insurance. And you won't be able to >find work. And you will apply for welfare, but you will be turned down >because they will tell you you can still work. But none of the jobs that >offer medical insurance will hire you because you are such a high risk. And >you will be poor. And you will be depressed. > >And you will get gangrene. And you will go blind. And your blood pressure >will skyrocket (more pills). And you will have a heart attack or two. And >then you will die. > > >HAVE A NICE DAY! > > > >-In The Rapid Exchange of Information, Grammar, Spelling & Proper Sentence >Structure Are Low On My Priority List.- PK > >PAUL KOSSART Peru, IL USA >NMRA, LDSIG, OPSIG, BRHS, TP & W-HS >LaSalle & Bureau County Model R.R. Club >Chicago, Burlington & Quincy Model R.R. (HO-1969) > " Serving Agriculture & Industry In The Illiniwek River Valley " > >------------------------------------------------------------------------ >Did you know that ONElist hosts some of the largest lists on the Internet? >http://www.ONElist.com >Our scaleable system is the most reliable free e-mail service on the Internet! > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 12, 1999 Report Share Posted April 12, 1999 Stormy writes: << Did I miss something? Why was this posted? I know I have been quite for awhile but have had alot to do. This just surprised me. >> Our new member Roy Dahl wrote in ... Here, I'll let him tell you ... << ... In August, 1996 I suffered from the same symptoms and again saw the family doctor who again, indicated I was certainly diabetic. Since then, I have made some adjustments, but consider myself a " bad diabetic " , in that I don't follow the rules very well. Most days, my blood sugar drifts between 10.0 - 22.0 (normal is supposed to be between 4 - 8). I still indulge in a dessert at supper, and every now and then, will enjoy a coke or a chocolate bar. I know, I know - I'm not supposed to be doing these things! How do I stop? ... >> I was presenting a dire scenario to Roy, hoping it would help motivate him. Susie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 12, 1999 Report Share Posted April 12, 1999 oh ok. I was just surprised by the post. It does make you think though. My new ALT came back 125. I don't know what is wrong I have to go every week to get these done. From what I understand they are suppose to be between 5-40 whatever. I don't know how this works. Getting frustrated. I still feel pretty good. I have been spending time with the kids. They don't know what to do with me. They are use to me being so sick that I didn't really PLAY with them. I went outside yesterday with my youngest that has this water balloon ball that is on two strings and you both have to pull on the 2 strings to get it to the other person and hope the balloon pops on the other. She thought it was great. I haven't been able to do stuff like that for sooooooooo long. BTW I got wet. She really loved that one. Take care all. Stormy Re: Digest Number 112 >From: OtterCritter@... > >Stormy writes: > ><< Did I miss something? Why was this posted? I know I have been quite for >awhile but have had alot to do. This just surprised me. >> > >Our new member Roy Dahl wrote in ... Here, I'll let him tell you ... > ><< ... In August, 1996 I suffered from the same symptoms and again saw the >family doctor who again, indicated I was certainly diabetic. Since then, I >have made some adjustments, but consider myself a " bad diabetic " , in that I >don't follow the rules very well. Most days, my blood sugar drifts between >10.0 - 22.0 (normal is supposed to be between 4 - 8). I still indulge in a >dessert at supper, and every now and then, will enjoy a coke or a chocolate >bar. I know, I know - I'm not supposed to be doing these things! How do I >stop? ... >> > >I was presenting a dire scenario to Roy, hoping it would help motivate him. > >Susie > > >------------------------------------------------------------------------ >New hobbies? New curiosities? New enthusiasms? >http://www.ONElist.com >Sign up for a new e-mail list today! > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 12, 1999 Report Share Posted April 12, 1999 Stormy reports still having elevated ALT numbers on her most recent liver test. Here is a message from a professor to his students, taken from the web: << From: Dr Velan -- Date: 5/22/97 To simplify matters, there are only three true tests of hepatocyte function, and one of them doesn't even come under the banner of " liver function tests " ! The best test of medium to long-term hepatic function is serum albumin (although liver disease is not the only cause of hypoalbuminaemia - e.g. nephrotic syndrome and protein malnutrition). Albumin is synthesised at a rate of 12 g/day, making up half of all hepatic protein synthesis. The half-life of albumin in the circulation is 17 to 20 days, hence impaired synthesis may take months to become apparent. The best test of short-term hepatic function is the prothrombin time (not usually included in " LFTs " ), which tests the integrity of the extrinsic coagulation cascade - clotting factors II, VII, IX & X are produced in the liver and have short half-lives. Acute liver dysfunction typically induces a prolonged prothrombin time which is not corrected by administration of Vitamin K. Bleeding from the GIT is a common cause of death in patients with fulminant hepatic failure. Serum bilirubin is a much less sensitive test of hepatic function, and may be normal in compensated cirrhosis or early in the course of fulminant hepatic failure. The serum bilirubin is more sensitive to cholestasis than to hepatocyte dysfunction. The other " liver function tests " (ALP, GGT, ALT, AST) measure enzyme levels which reflect ongoing hepatic inflammation, necrosis and/or cholestasis, rather than hepatocyte function. >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 12, 1999 Report Share Posted April 12, 1999 Someone needs to say it every once in a while to keep us all motivated, Stormy. Nothing to take exception to. Winston Re: Digest Number 112 > > >> >> >> >>You won't be able to maintain an erection; you will gain weight, and the >>more weight you gain, the worse your diabetes will get; you will go blind; >>your digestive system will quit working (gastroparesis), which will make >>your diabetes control worse, and you will end up eating basically bland >>baby food; your body parts will get amputated, a little bit at a time >>(surgeons call it " slice and dice " ). It will start with your toes, then >>your feet, then your lower legs. But first you will go through numerous >>procedures because of sores that won't heal, etc. And you will be numb from >>your waist down. And you will have trouble walking. And you will get cracks >>on your heels and other sores on your feet and lower limbs that absolutely >>will not heal. And you will take many different pills, and be hospitalized >>numerous times. And you will be denied insurance. And you won't be able to >>find work. And you will apply for welfare, but you will be turned down >>because they will tell you you can still work. But none of the jobs that >>offer medical insurance will hire you because you are such a high risk. And >>you will be poor. And you will be depressed. >> >>And you will get gangrene. And you will go blind. And your blood pressure >>will skyrocket (more pills). And you will have a heart attack or two. And >>then you will die. >> >> >>HAVE A NICE DAY! >> >> >> >>-In The Rapid Exchange of Information, Grammar, Spelling & Proper Sentence >>Structure Are Low On My Priority List.- PK >> >>PAUL KOSSART Peru, IL USA >>NMRA, LDSIG, OPSIG, BRHS, TP & W-HS >>LaSalle & Bureau County Model R.R. Club >>Chicago, Burlington & Quincy Model R.R. (HO-1969) >> " Serving Agriculture & Industry In The Illiniwek River Valley " >> >>------------------------------------------------------------------------ >>Did you know that ONElist hosts some of the largest lists on the Internet? >>http://www.ONElist.com >>Our scaleable system is the most reliable free e-mail service on the >Internet! >> > > >------------------------------------------------------------------------ >Looking for the perfect gift for a friend? >http://www.ONElist.com >Tell them about ONElist's 115,000 free e-mail communities! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 12, 1999 Report Share Posted April 12, 1999 Dear Stormy, what does Alt mean....still learning here.....Merry Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 12, 1999 Report Share Posted April 12, 1999 Thank you for the information. I printed it up and I am going to take it with me this week when I go back to the DR. Like I said I feel ok and have more energy than I have had in years. So I am not letting it get me down. I am having too much fun. Hugs Stormy Re: Digest Number 112 >From: OtterCritter@... > >Stormy reports still having elevated ALT numbers on her most recent liver >test. Here is a message from a professor to his students, taken from the >web: > ><< From: Dr Velan -- Date: 5/22/97 > >To simplify matters, there are only three true tests of hepatocyte function, >and one of them doesn't even come under the banner of " liver function >tests " ! > >The best test of medium to long-term hepatic function is serum albumin >(although liver disease is not the only cause of hypoalbuminaemia - e.g. >nephrotic syndrome and protein malnutrition). Albumin is synthesised at a >rate of 12 g/day, making up half of all hepatic protein synthesis. The >half-life of albumin in the circulation is 17 to 20 days, hence impaired >synthesis may take months to become apparent. > >The best test of short-term hepatic function is the prothrombin time (not >usually included in " LFTs " ), which tests the integrity of the extrinsic >coagulation cascade - clotting factors II, VII, IX & X are produced in the >liver and have short half-lives. Acute liver dysfunction typically induces a >prolonged prothrombin time which is not corrected by administration of >Vitamin K. Bleeding from the GIT is a common cause of death in patients with >fulminant hepatic failure. > >Serum bilirubin is a much less sensitive test of hepatic function, and may >be normal in compensated cirrhosis or early in the course of fulminant >hepatic failure. The serum bilirubin is more sensitive to cholestasis than >to hepatocyte dysfunction. > >The other " liver function tests " (ALP, GGT, ALT, AST) measure enzyme levels >which reflect ongoing hepatic inflammation, necrosis and/or cholestasis, >rather than hepatocyte function. >> > > > >------------------------------------------------------------------------ >Have you visited the new ONElist home page lately? >http://www.ONElist.com >ONElist: The Leading e-mail list and community service on the Internet! > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 12, 1999 Report Share Posted April 12, 1999 , Thanks for this posting. I sometimes get depressed and say, " The hell with it. " I have printed your post and will use it to remind myself of the consequences of such an attitude. Thanks again. Mr. Edd None of us is as smart as all of us. Re: Digest Number 112 >> >> >>> >>> >>> >>>You won't be able to maintain an erection; you will gain weight, and the >>>more weight you gain, the worse your diabetes will get; you will go blind; >>>your digestive system will quit working (gastroparesis), which will make >>>your diabetes control worse, and you will end up eating basically bland >>>baby food; your body parts will get amputated, a little bit at a time >>>(surgeons call it " slice and dice " ). It will start with your toes, then >>>your feet, then your lower legs. But first you will go through numerous >>>procedures because of sores that won't heal, etc. And you will be numb >from >>>your waist down. And you will have trouble walking. And you will get >cracks >>>on your heels and other sores on your feet and lower limbs that absolutely >>>will not heal. And you will take many different pills, and be hospitalized >>>numerous times. And you will be denied insurance. And you won't be able to >>>find work. And you will apply for welfare, but you will be turned down >>>because they will tell you you can still work. But none of the jobs that >>>offer medical insurance will hire you because you are such a high risk. >And >>>you will be poor. And you will be depressed. >>> >>>And you will get gangrene. And you will go blind. And your blood pressure >>>will skyrocket (more pills). And you will have a heart attack or two. And >>>then you will die. >>> >>> >>>HAVE A NICE DAY! >>> >>> >>> >>>-In The Rapid Exchange of Information, Grammar, Spelling & Proper Sentence >>>Structure Are Low On My Priority List.- PK >>> >>>PAUL KOSSART Peru, IL USA >>>NMRA, LDSIG, OPSIG, BRHS, TP & W-HS >>>LaSalle & Bureau County Model R.R. Club >>>Chicago, Burlington & Quincy Model R.R. (HO-1969) >>> " Serving Agriculture & Industry In The Illiniwek River Valley " >>> >>>------------------------------------------------------------------------ >>>Did you know that ONElist hosts some of the largest lists on the Internet? >>>http://www.ONElist.com >>>Our scaleable system is the most reliable free e-mail service on the >>Internet! >>> >> >> >>------------------------------------------------------------------------ >>Looking for the perfect gift for a friend? >>http://www.ONElist.com >>Tell them about ONElist's 115,000 free e-mail communities! > > >------------------------------------------------------------------------ >Did you know that knowledge is power? >http://www.ONElist.com >Join a new ONElist e-mail community and strengthen your mind! > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 13, 1999 Report Share Posted April 13, 1999 In a message dated 99-04-12 00:19:08 EDT, you write: << And then you will die. >> PAUL: YOU SAID IT LIKE IT IS! ONE HAS TO GET CONTROL OF HIS BLOOD SUGAR LEVELS! AND God's Speed. ***Robin*** Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 13, 1999 Report Share Posted April 13, 1999 ALT is one of the liver function test. I can't really explain it because I am still learning myself. I think one of the other people could probably explain it better. Stormy Re: Digest Number 112 >From: Om8421@... > >Dear Stormy, > what does Alt mean....still learning here.....Merry > >------------------------------------------------------------------------ >Share the wealth! >http://www.ONElist.com >Tell a friend about ONElist's 115,000 free e-mail communities! > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 13, 1999 Report Share Posted April 13, 1999 http://www.mtio.com/mclfa/lfalt1.htm http://www.hepplace.com/alt.html Re: Digest Number 112 > > >>From: Om8421@... >> >>Dear Stormy, >> what does Alt mean....still learning here.....Merry >> >>------------------------------------------------------------------------ >>Share the wealth! >>http://www.ONElist.com >>Tell a friend about ONElist's 115,000 free e-mail communities! >> > > >------------------------------------------------------------------------ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 14, 1999 Report Share Posted April 14, 1999 In a message dated 99-04-14 22:53:09 EDT, you write: << Hi everyone I have been taking Rezulen for about a year now it has really helped with my blood sugars. I just had the liver tests my Dr. said I should keep taking it for now. I take 400mg a day. I would like to hear from you all >> KATHIE: I have been on 400mg of Rezulin since September of 98. My blood sugars have really dropped (from over 200mg/dl to under 120mg/dl). I take monthly liver test and so far no damage to my liver. I pray that it continues to help my blood sugar levels and not damage the liver. AND God's Speed. ***Robin*** Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 14, 1999 Report Share Posted April 14, 1999 Hi everyone I have been taking Rezulen for about a year now it has really helped with my blood sugars. I just had the liver tests my Dr. said I should keep taking it for now. I take 400mg a day. I would like to hear from you all.kathie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 14, 1999 Report Share Posted April 14, 1999 Hi Kathie, My doctor started me out on 400 mg. daily of Rezulin, then increased to 300 mg. twice daily and later decreased to 300 mg. once daily. Reduction was because I have a problem with water retention and that is a side effect of Rezulin. Do you also take insulin? I take a small amount twice daily and it really boosts the effects of the insulin. Only once my liver enzymes were elevated and he repeated them in two weeks and considered taking me off the medicine but didn't as the second set of liver tests were normal. Rezulin is in the news quite a lot and sometimes I am a little scared to take it. I took Redux and it worked wonderfully well for me and I was really sad they took it off the market. I know someone who took Duract for pain and almost died and has unreversible liver damage. She is a single Mom with 3 kids, the youngest in 1st grade and I really feel for her. Sorry to be so long winded but am glad you brought up the subject of Rezulin. If you wish, you can e-mail me privately so we won't bore the others on the list to death! Kay To: diabetes_intonelist Subject: Re: Digest Number 112 Date: Wednesday, April 14, 1999 9:00 PM Hi everyone I have been taking Rezulen for about a year now it has really helped with my blood sugars. I just had the liver tests my Dr. said I should keep taking it for now. I take 400mg a day. I would like to hear from you all.kathie ------------------------------------------------------------------------ Did you know that ONElist hosts some of the largest lists on the Internet? http://www.ONElist.com Our scaleable system is the most reliable free e-mail service on the Internet! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 15, 1999 Report Share Posted April 15, 1999 Believe me it MOTIVATED me. I wasn't upset about the post. I thought maybe someone had something really terrible happen to them. Stormy Re: Digest Number 112 >> >> >>> >>> >>> >>>You won't be able to maintain an erection; you will gain weight, and the >>>more weight you gain, the worse your diabetes will get; you will go blind; >>>your digestive system will quit working (gastroparesis), which will make >>>your diabetes control worse, and you will end up eating basically bland >>>baby food; your body parts will get amputated, a little bit at a time >>>(surgeons call it " slice and dice " ). It will start with your toes, then >>>your feet, then your lower legs. But first you will go through numerous >>>procedures because of sores that won't heal, etc. And you will be numb >from >>>your waist down. And you will have trouble walking. And you will get >cracks >>>on your heels and other sores on your feet and lower limbs that absolutely >>>will not heal. And you will take many different pills, and be hospitalized >>>numerous times. And you will be denied insurance. And you won't be able to >>>find work. And you will apply for welfare, but you will be turned down >>>because they will tell you you can still work. But none of the jobs that >>>offer medical insurance will hire you because you are such a high risk. >And >>>you will be poor. And you will be depressed. >>> >>>And you will get gangrene. And you will go blind. And your blood pressure >>>will skyrocket (more pills). And you will have a heart attack or two. And >>>then you will die. >>> >>> >>>HAVE A NICE DAY! >>> >>> >>> >>>-In The Rapid Exchange of Information, Grammar, Spelling & Proper Sentence >>>Structure Are Low On My Priority List.- PK >>> >>>PAUL KOSSART Peru, IL USA >>>NMRA, LDSIG, OPSIG, BRHS, TP & W-HS >>>LaSalle & Bureau County Model R.R. Club >>>Chicago, Burlington & Quincy Model R.R. (HO-1969) >>> " Serving Agriculture & Industry In The Illiniwek River Valley " >>> >>>------------------------------------------------------------------------ >>>Did you know that ONElist hosts some of the largest lists on the Internet? >>>http://www.ONElist.com >>>Our scaleable system is the most reliable free e-mail service on the >>Internet! >>> >> >> >>------------------------------------------------------------------------ >>Looking for the perfect gift for a friend? >>http://www.ONElist.com >>Tell them about ONElist's 115,000 free e-mail communities! > > >------------------------------------------------------------------------ >Did you know that knowledge is power? >http://www.ONElist.com >Join a new ONElist e-mail community and strengthen your mind! > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 17, 1999 Report Share Posted April 17, 1999 I just don't understand why T2 goes faster than the speed of light at times. Now that they took me off the Rezulin my blood sugars are going up real high then down real low again. That does not do well with me. I feel like I am a rollercoaster from you know where. I know that I am whining but I am just frustrated right now. Sorry I will try to get in a better mood. Thanks. Stormy Re: Digest Number 112 > > >> <<< The ADA has issued guidelines to doctors that all adults 45 and older >> should receive annual testing for fasting blood glucose levels. This should >> go a long way toward locating the undiagnosed ones.>>> > >Hi Stormy, > >My doctor checked me about 6 weeks before I was diagnosed and I had a fasting BG >of 146 so he wanted to check it again in 3 months... Unfortunately my T-2 was >catching up with me faster than that. > > > > >------------------------------------------------------------------------ >Has ONElist changed your life? >http://www.ONElist.com >Visit our homepage and share with us your experiences at ONElist of the Week! > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 17, 1999 Report Share Posted April 17, 1999 Stormy writes: << ... Now that they took me off the Rezulin my blood sugars are going up real high then down real low again. That does not do well with me. I feel like I am a rollercoaster from you know where ... >> Stormy and others, Rick Mendosa is a writer with diabetes expertise whose web sites contain a wealth of information. His home page is http://www.mendosa.com/ Here is an article he wrote regarding diabetes medications (http://www.mendosa.com/newdrugs.htm): Beyond Sulfonylureas -- The New Drugs for Blood Glucose Control By Rick Mendosa Life is getting more complicated for people with type 2 diabetes and the doctors who treat them. But that's good. If you think you and your doctor have a lot of glucose-lowering drugs to choose from now, hang onto your hat as we look at what the biotech companies are developing. Until 1995, the sulfonylurea class of drugs was the only choice other than insulin for treating type 2 diabetes. Certainly you had a choice of brand, but they all work the same way, by squeezing more insulin out of your beta cells and improving insulin's ability to get glucose into the rest of your body. Sulfonylurea drugs include Glucotrol (glipizide) and DiaBeta, Glynase, and Micronase (glyburide). The explosion of drugs available for controlling blood glucose began when Glucophage (metformin) became available in 1995, quickly followed by Precose (acarbose). Bristol-Myers Squibb's Glucophage works differently from the sulfonylureas by keeping the liver from making too much sugar. Bayer Corporation's Precose, a third class of drugs, slows carbohydrate digestion. The fourth choice hit the market a year ago. Parke-'s Rezulin (troglitazone) makes the body more sensitive to its insulin. In spite of reports of liver damage in some people, the drug continues to be available here with warnings that people who use it need very frequent liver tests. Rezulin remains on the market here because it works well for most folks. In one study, average levels of HbA1c dropped 1.4 percent. For example, if you have an HbA1c level of 8, you might expect it to come down to 6.4. Rezulin works even better in combination with a sulfonylurea. In fact, " Any one of these drugs can be used in combination with any other, " says Dr. W. Quick, a board-certified endocrinologist practicing near Kansas City. " The research studies are a bit stronger for some of the combinations than they are for others, but out here in clinical practice we use all the combinations. " " Vegetable soup " is what Dr. Quick calls the choices open to him and his type 2 patients. " We can add any of several different ingredients and come up with a slightly a slightly different flavor for individualized therapy with the drugs that are available now. I am very impressed that we are doing a heck of a lot better than we did in the past when we had just one flavor to our soup. " PRANDIN Now, a fifth class of drugs hit the market in April, when Novo Nordisk and Schering-Plough jointly launched Prandin (regaglinide). It works by stimulating insulin secretion from the beta cells and differs from earlier drugs both in its structure and how it is eliminated. It needs to be taken just before each meal because it is so fast-acting. Prandin may be even more effective than Rezulin. It reduced HbA1c levels by 2.1 percent in one study reported in the package insert that will come with the drug. Beyond Prandin, there is an explosion of research on glucose control drugs. " As someone who has had diabetes for 48 years, I don't think that I have ever seen a more exciting time, " says Dr. , associate dean and professor of pharmacy practice at Washington State University College of Pharmacy and a Certified Diabetes Educator. ERGOSET The glucose control drug probably closest to market after Prandin is Ergoset. The FDA is considering its approval after receiving a New Drug Application from its manufacturer, Ergo Science Corporation, in October. " We are probably looking at an early 1999 launch, " says Donna LaVoie, Ergo Science's executive director, corporate communications and investor relations. & will market Ergoset under the terms of a multimillion dollar deal the two companies signed this February. Ergoset is a low-dose and fast-acting formulation of bromocriptine, which doctors have prescribed for years in a different form to treat Parkinson's disease. Unlike other diabetes control drugs that work at the gut level, Ergoset's action is through the brain, resetting the body's clock that regulates daily metabolic activity. Studies of Ergoset show an average drop in HbA1c of 1.04 percent. But unlike other studies, that's a measure only of the patients who responded well to it, excluding the 36 percent who didn't. The drug also has a lipid-lowering effect and is in Phase II trials for obesity. And that's another problem in understanding its effectiveness. Since patients on Ergoset lose weight, there's a question whether it lowers HbA1c directly or because of weight loss, says Dr. Dan Baker, director of drug information at Washington State University in Spokane. " It is an interesting product, and it will be useful, " he believes. He notes that two other weight-control drugs close to market may also help people with diabetes reduce their blood glucose, Meridia and Xenical (see following table). TARGRETIN Like Ergoset, Targretin's original target was another disease. And like Ergo Science, Targretin's developer has a powerful corporate alliance that is some indication of the likelihood the drug will actually come to market. Ligand Pharmaceuticals developed Targretin to fight certain cancers, but serendipitously discovered that it is also an insulin sensitizer. Ligand has licensed marketing rights to Eli Lilly and Company for $99 million. " Targretin is a Vitamin A derivative, " says Henry Niman, an associate professor in the University of Pittsburgh's epidemiology department and the scientific founder of Ligand's parent company. The drug is in phase II trials for diabetes and probably won't be on the market until three to four years from now, he says. " In animals it worked great. It was as effective as one of the second generation compounds in Rezulin's class, which are even more effective than Rezulin itself. " It also reduced triglyceride levels. BRL 49653 The second generation compound Dr. Niman is talking about is BRL 49653. Kline Beecham, which developed the drug says that it is an insulin sensitizer and is in Phase III trials. Beyond that, the company releases little additional information. " It's frustrating to us in pharmacy and in medicine to project what is going to happen in the future with drug therapy, " Dr. says. " For almost every new drug that comes out there is almost nothing in the scientific literature until about the time the FDA recommends it for approval. " SP-134101 Among all the other drugs now in clinical and preclinical trials to reduce blood glucose levels perhaps the most interesting is SP-134101, which Shaman Pharmaceuticals is developing. The drug just started Phase I trials and probably won't hit the market until about 2003, according to Vice President J. D. Haldeman. What makes SP-134101 exciting is that it is the first of 21 compounds the company found in tropical plants that lower blood glucose levels in animal models. " SP-134101 comes from a plant that grows in the southeastern part of the U.S. and Mexico, " she says. " We will be isolating it directly from the plant. " DRUG PROBLEMS Even if all of these drugs prove effective in reducing blood glucose, that's not the end of the story. " I consider effectiveness as only a minor factor in my decision-making, " Dr. Quick says. " Other factors to consider include cost, side effects, rules about time of administration, taste and other eccentricities of the pill, and contraindications. " He emphasizes that these issues affect how well patients use these drugs. And as Dr. points out, little of this information will be available until just before they come on the market. Stay tuned. An edited version of this article appeared as " Beyond Sulfonylureas " in Diabetes Wellness Letter, May 1998, pages 1-4. 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Guest guest Posted July 3, 2001 Report Share Posted July 3, 2001 Hi Debbie, My name is Sharon and I went to Curlin in Sept of 99. Bad mistake ! I am now getting ready to go to Dr.L. Out of all of the doctors I have talked to I believe for him to be the very best choice.(MY OPINION)I live in Raleigh 30 mins from Dr Berger but have chose to go to Dr L. I love the fact that he does'nt think twice about answering my phone calls or emails. And he has always been very honest with me. With Curlin I know that you are out of $500.00 but it could be worst. I am out of the whole thing and now I am going to pay another$5,500.00 but I believe tit to be wirth it this time. Stick with your gut feelings. If I would have went with mine when I went to Curlin's office I would have gotten up walked out and came right back to NC without him touching me. Again my opinion. Sharon Digest Number 112 Quote Link to comment Share on other sites More sharing options...
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