Monthly Archives: June 2016

Honeymoon


So why do some patients go into honeymoon and some do not? It is a great mystery to me that I am hoping will also help us unravel the mystery of type 1 diabetes.

So type 1 diabetes is when your pancreas is NOT able to produce insulin. Is this problem, well yes. Every cell in the body requires glucose and the key molecule to take glucose into the cell is insulin. So without insulin cells literally die of starvation. The cell metabolism tries to use a desperate way to stay alive that is not sustainable and the eventual outcome is cell death.

What is it that causes one person to have a “honeymoon” period – i.e. easy to control diabetes either with diet or a combination of medication and diet and then all of a sudden the honeymoon is over?

Are we able to extend the honeymoon?

Are we able to figure out why some patients are diagnosed and never have a honeymoon?

These are answers I am after.

Type 1 diabetes is a real bugger of a disease. One you can never have a holiday from. One only a patient or a parent understands the devastation of.

WE have made leaps and bounds in type 2 diabetes, it is now time to make leaps and bounds in type 1.

Please contact me if you have any info/answers to my questions.

Statins are NOT satan, indeed the contrary!


satan2statins2Ok, so I am not Tim Noakes, neither am I a professor of medicine – though I have listened over the past 20 years to many of them and do on an ongoing basis. They as a whole (generalisation) tend to speak from journals and science. Science these days has to be proven quite well.

There is honestly so much rubbish on the internet from the absolute hogwash about statins to the dribble about vaccines.

LEt’s talks science and let’s talk LIFE quality and quantity.

No I am not a professor but I aim to give my patients the absolute best I can.

What do we know? We know that the diabetes/cardiovascular (another way of saying heart attacks) epidemic is growing on a log curve (if that does not shock you look up what a log curve is). It is not stopping, on the contrary it is snowballing. Why?

Multi-factorial.

What do we know from science and trials like Jupiter – these are big (100 000s) patients across continents. The long and the short is that if your number – LDL is at target (2.8 mmol/l) you will NOT have a heart attack and you will NOT have a stroke.

Now think about this for a minute, would you rather have a heart attack/stroke or would you rather have a bit of muscle ache? Not so bad if the heart attack takes you – although bad for the family. But a trainsmash if you are “maimed” by it, especially when we KNOW it is preventable.

WE have so many statin trials that it is unethical to have one arm on a statin and one arm off a statin – that’s how strong the evidence is as we KNOW the non-statin arm will have “events”.(Secondary prevention).

I am also not a huge fan of big pharma and whilst various conspiracy theories exist in this regard. This is not a conspiracy. This is indeed science.

“Statin therapy is effective at reducing cardiovascular event rates among those with prior myocardial infraction, stroke, diabetes, or overt hyperlipidemia, and current guidelines strongly recommend lipid-lowering therapy among these patient groups as an adjunct to aggressive lifestyle interventions. However, of the nearly 1.7 million heart attacks and strokes that occur annually in the United States, more than half occur among apparently healthy men and women with average or low levels of cholesterol. Thus, novel screening and treatment strategies for cardiovascular prevention are needed that can detect high vascular risk in the absence of hyperlipidemia, that are inexpensive and simple to implement in the primary care setting, and that can provide comparable or superior effectiveness compared to currently accepted approaches”. This is the opening paragraph of Jupiter. What jupiter was trying to ascertain is whether primary prevention is worth doing.

The results ? “Finally, in terms of net clinical benefit, when a composite end point of a first cardiovascular event, venous thromboembolism, or death from any cause is considered, the 5-year NNT in JUPITER was 18.13“”Current guidelines for statin therapy emphasize the need to achieve specific LDLC goals to maximize benefit. However, statins reduce hsCRP in a largely LDLC independent manner, and in the CARE,10 PROVE IT – TIMI 22,9 A to Z,11 and REVERSAL21 trials, best clinical outcomes in terms of event reduction or atherosclerotic regression were observed among those who not only reduced LDLC, but who also reduced hsCRP. Specifically, in these studies, the lowest clinical event rates were consistently seen among those who not only achieved LDLC levels <70 mg/dL, but who also achieved hsCRP levels <2 mg/L. Although these findings are consistent with laboratory evidence indicating antiinflammatory properties of statin therapy as well as current pathophysiologic understanding that atherothrombosis is a disorder of inflammation as well as hyperlipidemia, the concept “dual targets” for statin therapy remains controversial.22

“JUPITER not only confirms that men and women with elevated hsCRP and low LDLC are at substantial vascular risk, it demonstrates that statin therapy can cut that risk by half. Simplified guidelines that advocate combined lifestyle and pharmacological therapy in those groups where trial evidence clearly supports a net benefit have the potential to greatly improve patient care and public health.”

I have specifically quoted Jupiter verbatim as I am so tired of unsubstantiated claims in this regard and I would urge all the statin haters to read the science and chat to the professori of our times. The professori at large.

Statins are not the devil indeed if you are a loved one they may be the saviour. The saviour in terms of preventing a death or a person that now has to be “cared” for. The saviour of our failing medical system that does not need the added burden of cost of multiple patients with stroke and heart attack. Look up how much the average cost to medical aid (or patient if not on one) a heart attack/stroke costs in money terms. Then think about that cost in emotional/psychological terms. Then just have a little think about the vast body of science for a longer while than it takes to read some pathetic unsubstantiated claim on the vast body of internet rubbish. The choice really is yours, the answers are there if you look for them properly.

Circulation: Cardiovascular Quality and Outcomes.2009; 2: 279-285doi: 10.1161/CIRCOUTCOMES.109.868299statinsstatins2

 

 

 

Arborisation – broccoli brain – a good thing


The brain is amazing – we all know this. However it is indeed more and more amazing the further we actually delve into it so to speak.

Our brains have endless connections we know this, but the extent is far greater than we ever thought. And the more you create connections – arborisation – lots of little broccoli chains – the better it functions, the more “healthy” it is and the easier it is to maintain ” brain health”.

Without a brain we are not human. Rice and mice etc have far fewer connections they also have far fewer glial cells. Now what are those? Glial cells are the “support” cells to the neurons. Before we thought that depression happened due to low transmitter levels and whilst this is true there is a lot more to the story. The glial or helper, support cells all play a role – a critical role in the homeostasis – healthy brain – this is brand new information.

Why is this important?? Well because we can now see that “inflammation” damages these glial cells and contributes to depression and other mental unwellness.

Why is this at all important. Well because the diabetes epidemic seems to be running along fairly parallel with the increase in depression that we see and perhaps the path towards both is similar. And also it means that preaching against fast food, rubbish, coke – the devil etc, becomes even more paramount.

It also means that exercise is a viable and excellent co-treatment modality. Yes I said exercise. It works even for depression.

This is actually super exciting because it means we have a means to tackle things like diabetes and depression right through from prevention to cure!

And we can all exercise and eat well. NO excuse! There are endless options on both fronts, unleash your creativity today and start to eat well and exercise.

Exercise – an under-utilised drug – unlock your pent up “non deep breath”


One of the most efficacious keys to unlock insulin resistance, weight loss, fatigue and a plethora of diseases. We all (even me) seem to fright for exercise (when you are not into it). When you get into it you wonder how you “breathed” without it.

And it is indeed about breathing, “hema” “pephamula”.

Oxygen is a vital ingredient to the cell soup and without it you become : tired, unstable, overweight and insulin resistant to put it very plainly.

Even mild exercise like stretching and very beginner pilates classes engage your breathing muscles and get way more oxygen into the system so to speak.

Do it! Just do it. I am not saying do comrades to start. Start slow and get moving, even it if is just your ribcage to get more oxygen in.

Unlock the process and shake a leg.excersisebreathe

Does “knowing your number” matter?


Oh yes definitely ! There is indeed a HUGE difference between a 10 on its way up and a 10 on its way down. For 10 on its way up depending on where you are meal time wise you need more insulin. For a 10 on its way down you would approach “fixing” it quite differently.

The same goes for a 3 on its way up and a 3 on its way down!

Continous monitoring affords one the “luxury” of “learning” your diabetes and understanding your individual response to certain situations and conditions without over or under correcting (once you learn to do this properly).

Anyone with type 1 themselves or a type 1 child will know the absolute helplessness you feel when you/your little one goes low or runs high.

In my personal opinion 4-6 injections with 4-6 finger sticks is such a “patchy” way of dealing with diabetes.

It’s 2016 and we have options !!

WE have pump therapy with and without continuous monitoring, we have continuous monitoring ! this has revolutionised care and quality of life of patients.

And now (drum roll) we have on the horizon non-invasive (i.e. not sore no prick) continuous monitoring !!! arriving sometime later this year – this is truly revolutionary.

Yes knowing your number is important. It not only adds quality to your life but gives loved ones the peace of mind they need.sugarbeat2sugarbeat