FW: Low-Carb Diets Take a Punch

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Welcome to Diabetes E-News Now!

July 8, 2004

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You are receiving this newsletter by request.

It is sent to you free from the American Diabetes Association.

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Check out the new Cholesterol section on diabetes.org.

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THIS WEEK'S ISSUE INCLUDES:

IN THE NEWS...

1. J. Tibbetts Elected President, Health Care and Education, American

Diabetes Association

2. Low-Carb Diets Take a Punch

3. Diabetes Increases Cancer Risks

ONLINE SHOPPING...

4. Charting a Course to Wellness ***New***

E-NEWS NOW! FEATURE ARTICLE...

5. Medication to Improve Your Lipid Levels

TOOLS...

6. Diabetes Forecast

7. " Ask the Pharmacist "

8. Get Local - Augusta, Maine

9. From the ADA Message Board

10. Additional FREE E-Newsletters!

SUPPORT THE SEARCH FOR THE CURE...

11. Honor a Loved One with a Gift to the American Diabetes Association

12. Gift of Hope Clearance Sale

13. Join America's Walk for Diabetes!

14. Get an ADA Credit Card

RECIPE HIGHLIGHT...

15. Cooking Tips

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IN THE NEWS...

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1. J. Tibbetts Elected President, Health Care and Education, American

Diabetes Association

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The American Diabetes Association (ADA), the nation's largest and leading

voluntary health organization in the fight against diabetes, has announced that

J. Tibbetts, RN, MPH, CDE of Arlington, VA, was elected President,

Health Care and Education, of its Executive Committee at the organization's 64th

Annual Meeting and Scientific Sessions, held recently in Orlando, Florida.

Ms. Tibbetts is a Diabetes Nurse Educator and Center Manager at the INOVA

Diabetes Center of Fair Oaks Hospital in Fairfax, Virginia, where she provides

both basic and advanced diabetes self-management training and support. Her

practice includes children as well as adult patients. In addition to basic

diabetes education she works with patients initiating insulin pump therapy,

others with gestational diabetes, and transplant patients. To learn more, click

here:

http://americandiabetesassn.org/GoForwardNow/a16366a106397a33312a2

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2. Low-Carb Diets Take a Punch

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While the South Beach Diet and the Atkins Diet continue to tally book sales --

an estimated 30 million to date -- 11 health organizations have teamed up to

dispel what they call popular misconceptions about the low-carbohydrate approach

and to warn about the risk of its long-term use.

The Partnership for Essential Nutrition, led by former U.S. Surgeon General C.

Everett Koop's Shape Up America! group, cautions that studies show the low-carb

approach can starve the brain of carbohydrates, produce constipation and other

gastrointestinal problems, reduce energy levels and cause difficulty

concentrating.

In the long run, the groups warn, the regimens can stress the kidneys and

increase the risk of liver disorders, gout, coronary heart disease, diabetes,

stroke and several types of cancer.

" Low-carbohydrate diets conflict with decades of solid scientific research that

clearly encourages us to reduce saturated fat and boost fruit, vegetable and

fiber intake, " said Barbara , president and CEO of Shape Up America!

To learn more, click here:

http://americandiabetesassn.org/GoForwardNow/a16366a106397a33312a0

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3. Diabetes Increases Cancer Risks

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Diabetes appears to increase the risk of death from a number of types of cancer,

new research suggests. Moreover, this holds true even after accounting for

obesity, which is common among diabetics and is a well-known risk factor for

cancer.

Dr. S Coughlin, from the Centers for Disease Control and Prevention in

Atlanta, Georgia, says, " Several studies have suggested that diabetes mellitus

may alter the risk of developing a variety of cancers, and the associations are

biologically plausible. "

To investigate further, the researchers examined the relationship between

diabetes and death from cancer in a group of 467,922 men and 588,321 women who

were cancer-free when the study began in 1982. The findings are published in the

" American Journal of Epidemiology. " After 16 years of follow-up, the authors

uncovered a link between diabetes and death from colon and pancreatic cancers.

In addition, in men, diabetes seemed to increase the death risk from liver and

bladder cancers, whereas in women an association with death from breast cancer

was seen. The researchers note that study had a number of limitations, but

conclude that the findings " may help to clarify cancer risks for men and women

with a history of diabetes mellitus. "

To learn more, click here:

http://americandiabetesassn.org/GoForwardNow/a16366a106397a33312a1

ONLINE SHOPPING...

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4. Charting a Course to Wellness ***New***

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If we did it, so can you! " New from the kitchen whiz and former Galloping

Gourmet, Graham Kerr comes an all-NEW tastes sensation for people with diabetes.

Inside Charting a Course to Wellness you'll find more than 400 recipes that

satisfy every taste bud! Every one is lower in carbs and lower in fat, so not

only are they good for keeping your blood sugar balanced, they're super heart

healthy!

For a limited time we're offering a copy of the Flavorful Seasons Cookbook FREE

with all orders over $35. Hurry! This offer is good only while supplies last.

http://americandiabetesassn.org/GoForwardNow/a16366a106397a33312a10

The American Diabetes Association bookstore offers a variety of books

and other educational materials to assist you in managing diabetes.

Discover new cookbooks, meal planners, self-care guides, and more.

To learn more, click here:

http://americandiabetesassn.org/GoForwardNow/a16366a106397a33312a22

E-NEWS NOW! FEATURE ARTICLE...

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5. Medication to Improve Your Lipid Levels

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By: a F. Kruger, Marjorie Cypress, Melinda niuk, Belinda P. Childs, and

Jody Tieking

Your cholesterol level was high, and your doctor referred you to a dietitian,

who helped you revamp your diet: less saturated fat, less trans fat, less

cholesterol, and more fiber. You’re using one of those special margarines that

lower cholesterol. You've been more physically active. All to get to the goals

for adults with diabetes:

* LDL ( " bad " ) cholesterol: under 100 mg/dl

* HDL ( " good " ) cholesterol: over 40 mg/dl in men, over 50 mg/dl in women

* Triglycerides: under 150 mg/dl

Three months later, your " lipid profile " says that your cholesterol levels still

aren't in the healthy ranges. Now what? Now, medication. Statins and fibrates

are the top choices.

Statins

If your biggest problem is high LDL, taking a " statin " may be your best bet.

Statins lower LDL, and they also lower total cholesterol and triglycerides. Even

if your lipid levels are near-normal, your doctor may prescribe a statin to

further lower your risk of a heart attack.

Cautions:

- Before you start taking a statin, you need a liver function test, which should

be repeated after you've been taking the statin for 12 weeks.

- Don't drink grapefruit juice or eat grapefruit while you’re on a statin.

Grapefruit juice will keep the statin from being cleared from your bloodstream,

and the level of statin will get too high.

- If you take a statin, your doctor might avoid prescribing cyclosporine,

fluvoxamine, indinavir, nefazodone, nelfinavir, or ritonavir. The only statins

that are safe with those medications are pravastatin and fluvastatin. Whenever

you’re prescribed a new medication, show your pharmacist a list of all the

medications you take so he or she can check for potential problems.

- A possible, serious side effect is a condition called rhabdomyolysis. Symptoms

include muscle tenderness and dark-colored urine. Report these to your doctor

right away.

Fibrates

If your biggest problem is high triglycerides, the first choice of medication is

a fibric acid derivative (fibrate). Fibrates lower triglyceride levels and raise

HDL levels. Studies have shown that fibrates slow the progression of hardening

of the arteries and reduce the risk of heart attacks in patients with type 2

diabetes. Gemfibrozil and fenofibrate are the two fibrates currently on the

market. Gemfibrozil is available as a generic, and that may save you some money.

Fenofibrate also lowers LDL, so it's a good choice in people who have high LDL

cholesterol along with high triglycerides and low HDL cholesterol.

Both gemfibrozil and fenofibrate are generally well tolerated but may cause

stomach upset and stomach pain. Fibrates have also been shown to cause

gallstones and symptoms of myopathy (muscle soreness) in some patients.

Gemfibrozil is less well tolerated when combined with a statin.

Cautions:

- You'll need to have liver function tests periodically.

- If you take warfarin, you may need a dose change.

- Small studies have shown an increased risk of hypoglycemia (low blood sugar)

when gemfibrozil is used with repaglinide (Prandin) or rosiglitazone (Avandia).

It's probably the same for pioglitazone (Actos). Monitor your blood sugars more

often for the first month you take gemfibrozil, and ask your diabetes educator

about the symptoms and treatment of hypoglycemia.

If you have high LDL and high triglycerides, your doctor may want to try a high-

dose statin. The second choice is a fibrate plus a statin.

- Any combination treatment involving statins puts you at an increased risk for

rhabdomyolysis, especially with gemfibrizole. Be alert for symptoms and report

these to your doctor.

Next week, we'll cover medications that are used for those who can't use the

first-choice medications or who need to use two or more medications. Many people

with diabetes require at least two medications plus diet and exercise to reach

their lipid goals.

a F. Kruger, MSN, APRN-BC, BC-ADM, is a certified nurse practitioner in

diabetes at Henry Ford Health System in Detroit, Mich. Marjorie Cypress, MS, C-

ANP, CDE, is a certified nurse practitioner and a doctoral student in nursing at

the University of New Mexico in Albuquerque. Melinda niuk, MEd, RD, CDE, is

Program Manager, Special Services at the Joslin Diabetes Center in Boston, Mass.

Belinda P. Childs, ARNP, MN, BC-ADM, CDE, is a clinical nurse specialist at

MidAmerica Diabetes Associates in Wichita, Kans. Jody Tieking is a student in

the School of Pharmacy at the University of Kansas.

TOOLS...

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6. Diabetes Forecast

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Diabetes Forecast is the health and wellness magazine of the American

Diabetes Association. Each month, a selection of Diabetes Forecast

articles is available online for viewing.

http://americandiabetesassn.org/GoForwardNow/a16366a106397a33312a20

New this month, read about:

Tips For Site Rotation

By Terry Lumber, RN, CNS, CDE, BC-ADM

When it comes to insulin, where you inject is just as important as how much and

when. For years, people who inject insulin have been advised to " rotate " or

change their injection sites regularly. That advice still stands, even though

times have changed and some of the original reasons for doing so no longer hold.

Read the article.

http://americandiabetesassn.org/GoForwardNow/a16366a106397a33312a18

To view all of the articles, including tips to help you lead a healthy

life, become a member of the American Diabetes Association today and

receive Diabetes Forecast every month. Sign up for a free month trial

membership.

http://americandiabetesassn.org/GoForwardNow/a16366a106397a33312a21

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7. " Ask the Pharmacist "

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The American Diabetes Association and Rite Aid present a new section of

diabetes.org called " Ask the Pharmacist " . This new interactive feature

allows visitors to submit questions online about diabetes management

and receive guidance from a Rite Aid pharmacist. All pharmacists are

specially trained in diabetes management, and are happy to answer any

questions or concerns you may have. Visit the " Ask the Pharmacist " area

of the new diabetes.org today.

To learn more, click here:

http://americandiabetesassn.org/GoForwardNow/a16366a106397a33312a19

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8. Get Local - San Francisco, California

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Circus Chimera

August 10th - August 16th

The circus is coming to town! A portion of every ticket sold will benefit your

American Diabetes Association. Circus Chimera will perform under its Big Top at

Marina Middle School, located at the corner of Chestnut and Fillmore Streets in

San Francisco's Marina District from August 10th - August 16th.

Circus Chimera bills itself as the " circus of the future. " If it is, there are

no lion tamers in the future, as there are no animals in this circus. Just

acrobats, trapeze artists, clowns, contortionists and more. This helps to make

the show an upbeat family show and an experience that sends audiences out

smiling. For more info or to reserve tickets by telephone, call: 1-888-DIABETES

ext.7525.

To learn more, click here:

http://americandiabetesassn.org/GoForwardNow/a16366a106397a33312a5

Find out what's happening in your area. It's an easy way to get

involved and it's in your community.

http://americandiabetesassn.org/GoForwardNow/a16366a106397a33312a27

Every week we feature an event or promotion from one of the

American Diabetes Association's local areas.

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9. From the ADA Message Board

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The American Diabetes Association Message Board is your space to

share ideas and opinions with people affected by diabetes. We would be

happy to have you join us and look forward to sharing with you.

To learn more, click here:

http://americandiabetesassn.org/GoForwardNow/a16366a106397a33312a25

In a recent post, hiho60 wrote:

" Although my doctor says that I have diabetes, I disagree with him. Hemoglobin

A1C says 7. My sugar level runs about 135 which he does not have me check except

when he does blood work. Have none of the classic symptoms that one would expect

with diabetes. So why is he subjecting me to taking another pill and claiming

that I have something that he has no basis for? "

Do you have any advice for her? Click here, sign in, and join us today!

http://americandiabetesassn.org/GoForwardNow/a16366a106397a33312a9

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10. Additional FREE E-Newsletters!

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Did you know that the American Diabetes Association offers additional

free e-newsletters? Topics include:

*Book News

*Parents' E-Newsletter

*Volunteers in Action (VIA)

Signing up is easy so learn more about them today.

http://americandiabetesassn.org/GoForwardNow/a16366a106397a33312a16

SUPPORT THE SEARCH FOR THE CURE...

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11. Honor a Loved One with a Gift to the American Diabetes Association

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Your tax-deductible donation to the American Diabetes Association shows your

thoughtfulness while helping us fund critical research and education the public

about diabetes. We'll send a card personalized with your feelings to whomever

you designate or you can send an electronic message to announce your caring

support.

Help fund critical research that is bringing us closer to a cure for diabetes

with your gift to the American Diabetes Association.

To learn more, click here:

http://americandiabetesassn.org/GoForwardNow/a16366a106397a33312a12

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12. Gift of Hope Sale

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Shop the ADA's discounted Gift of Hope catalog! Our Clearance Sale offers you 50

to 70% savings on most items, so take a look! Every penny of profits from your

purchases (about 32 cents per dollar) and 100% of

donations go directly to support diabetes research.

To learn more, click here:

http://americandiabetesassn.org/GoForwardNow/a16366a106397a33312a14

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13. Join America's Walk for Diabetes!

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This spring join thousands of people in cities across the country who

also want to find a cure for diabetes. One in 17 Americans has diabetes

today - and a third of them don't even know it. Walking can help

prevent diabetes. Stay fit, raise money in the fight against diabetes,

and reduce your risk to develop type 2 by joining us in America's Walk

for Diabetes.

To learn more, click here:

http://americandiabetesassn.org/GoForwardNow/a16366a106397a33312a32

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14. Get an ADA Credit Card

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Every time you make a purchase with the American Diabetes Association

Platinum Plus Credit Card, the ADA receives a contribution to help

support Diabetes research - at no additional cost to you! Request yours

today!

http://americandiabetesassn.org/GoForwardNow/a16366a106397a33312a3

RECIPE HIGHLIGHT...

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15. Cooking Tips

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Did you know that our newly revised Virtual Grocery Store (VGS) includes a

section on Cooking Tips for people with diabetes? Get tips on how to decrease

your total fat and calories, how to increase the flavor, and more.

To learn more, click here:

http://americandiabetesassn.org/GoForwardNow/a16366a106397a33312a24

Virtual Grocery Store:

http://americandiabetesassn.org/GoForwardNow/a16366a106397a33312a29

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